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Midwifery Care And Risk Factors

When planning for the birth of a new baby, there are many options and decisions that soon-to-be new moms need to make. One of the most important decisions is choosing a healthcare provider during your pregnancy. One type of provider is a midwife.

Midwives are healthcare providers who deal with pregnancy, childbirth, newborn care, and postpartum health. Some midwives provide routine reproductive care like pelvic exams, Pap tests, or counseling on birth control. Midwives tend to be more holistic and supportive of natural approaches to pregnancy and birth. Midwives are normally used by those who choose to have a planned home birth. 

Are There Risks Associated With Using A Midwife?

While midwives provide the majority of care in countries like the U.K. and the Netherlands, midwife-led home births account for only about 10% of births in the United States.  (https://www.forbes.com/health/family/what-is-a-midwife/)

While in recent years, more families have sought out a more holistic, non-hospital location for giving birth and for the care provider, such as a home birth using a midwife, the complications of giving birth outside of a hospital have their own risk factors and cause concern.

Midwives consult with OBGYNs, maternal-fetal medicine specialists, and other healthcare providers to mitigate risk in your care. Working with a midwife who attends births in a hospital setting is usually recommended if you are worried about delivery. This can give you the safety net you’re looking for if a complication arises.

CASE STUDY: Recent Midwifery Medical Malpractice Case At Zarzaur Law

In a recent medical malpractice case, the firm handled an expecting mother who enrolled the services of midwives for an out-of-hospital birth.  The risks of this pregnancy and labor included:

  • Advanced maternal age
  • Absent collaboration with a physician with admitting privileges at a hospital in the immediate area
  • Incomplete emergency backup plan
  • Pregnancy extending to late-term and post-term (41-42 weeks)
  • Meconium stained amniotic fluid
  • Arrest of cervical dilation, with the ultimate outcome resulting in severe medical complications for the laboring mother and intrauterine fetal demise.

If you would like more information on the particular case or have had a similar, complicated experience, please reach out to the firm at zarzaurlaw.com or call us at 855hirejoe.

Why Would You Use A Midwife Instead Of A Doctor?

Many women choose a midwife over a doctor because they want additional emotional support before, during, and after delivery. A midwife will get to know you, your family, and your preferences over the course of your pregnancy. Midwives also allow for a planned home birth in Florida.

What Are The Possible Risks Of A Planned Home Birth?

midwifery care and risk factorsMost pregnant people who choose to have planned home births deliver without problems. But research suggests that planned home births are associated with a higher risk of infant death, seizures, and nervous system disorders than planned hospital births.

There are several factors that might reduce the risks of these problems, including having:

  • Assistance from a certified nurse-midwife
  • Access to a doctor who specializes in obstetrics
  • A plan for transportation to a nearby hospital, if needed

It’s important to talk to your health care provider before you make a decision about a planned home birth. For some people with certain health conditions, as well as those who have never given birth before, the risks of a planned home birth may be higher than they are for others.

What Is A Midwife?

Midwives are healthcare providers who deal with pregnancy, childbirth, newborn care, and postpartum health. Some midwives provide routine reproductive care like pelvic exams, Pap tests, or counseling on birth control. Midwives tend to be more holistic and supportive of natural approaches to pregnancy and birth. People often choose a midwife when they know they want a nonmedicated birth or want to give birth at home.

Midwives are usually not physicians. They often work alongside obstetricians and gynecologists (Ob/Gyns) in a hospital to ensure you have access to any care you need. A midwife is recommended when your pregnancy is low-risk or if you have only mild complications.

Pregnancy and labor are very personal experiences. You have a choice about the kind of care you’d prefer. That’s why it may help to know the differences between midwives and Ob/Gyns.

What Does A Midwife Do?

It depends on their credentials, certifications, schooling, and where they practice. Certified midwives and certified nurse midwives can offer the most services. Midwives who aren’t certified offer fewer services.

Some of the health services a midwife may provide include:

A certified nurse midwife can practice at hospitals, clinics, birth centers, or your home. Midwives who are not certified are limited in where they can practice. It’s best to ask your midwife what credentials they have and ask your hospital or birth center what the regulations are for midwife care.

What Are The Different Types Of Midwives?

There are a few different types of midwives:

  • Certified nurse midwives (CNMs): CNMs have completed nursing school and have a graduate degree in midwifery. In addition to pregnancy care and delivery, they can provide general reproductive care, prescribe medication, order lab tests and diagnose conditions. They’re qualified to work in hospitals, homes, and birth centers. CNMs are certified by the American Midwifery Certification Board. They work in all 50 states and the District of Columbia.
  • Certified midwives (CMs): CMs have a master’s degree in midwifery, but they haven’t completed nursing school. CMs have an undergraduate degree in something other than nursing. They’re certified by the American Midwifery Certification Board and can prescribe medications. CMs are only licensed to practice in a few (nine) states.
  • CPMs (certified professional midwives): CPMs work in birth centers or at home.They have completed coursework and are certified by the North American Registry of Midwives. CPMs aren’t licensed to practice in all states and can’t prescribe medications.
  • Unlicensed or lay midwives: These midwives don’t have certification or a license to practice. They are either self-taught or have received some other type of training, which could include an apprenticeship. Unlicensed midwives work almost exclusively in homes.

Are Midwives Doctors?

Most midwives aren’t doctors. Some earn doctorates in nursing practice.

The Differences Between A Midwife And An OB-GYN

OB-GYNs and midwives both provide great pregnancy care and safely deliver babies. But there are some fundamental differences.

OB-GYNs and midwives have different credentials and educational backgrounds.

While OB-GYNs and midwives are part of the same specialty area, the training, education requirements, and credentials they hold are different.

OB-GYNs are medical doctors

An OB-GYN (which is short for obstetrician-gynecologist) is a medical doctor who specializes in women’s reproductive health, as well as pregnancy care and delivering babies. They’re also surgically trained and can perform cesarean sections (C-sections) when necessary. You may already have visited an OB-GYN for your annual well-woman’s visit.

When it comes to training and education, OB-GYNs complete four years of medical school, a four-year residency program, and a three-year fellowship.

Board-eligible vs. Board-certified OB-GYNs

OB-GYNs – like other medical doctors – can also pursue certification from the American Board of Obstetrics and Gynecology (ABOG) after they’ve completed their residency and gotten their license to practice. Board-certification is optional but a mark of distinction, implying that a doctor has gone above and beyond the minimum standard of education in their field.

The path to certification requires passing a qualifying exam, preparing an extensive case list demonstrating expertise in multiple categories, and then passing a certification exam. At HealthPartners, all our OB-GYNs are board-certified.

Is A Midwife Better Than An OB/Gyn?

It’s a personal preference. Some people prefer midwives, and others prefer OB/Gyns. A midwife is typically only recommended for low-risk pregnancies. Most pregnancies in the United States are low-risk. Some advantages of using a midwife are:

  • There is less chance of induction or assisted delivery.
  • Cesarean delivery is less likely.
  • Reduced use of epidurals or other medications.
  • There is less risk of third and fourth-degree perineal tears.
  • More flexibility for home births.
  • You have greater control over your care.

Midwives are typically not trained to perform surgeries. Midwives will refer people to OB/Gyns if their pregnancy or birthing experience becomes complicated or high-risk.

Should You Have A Midwife?

A midwife might be for you IF you have a low-risk, routine pregnancy and if you desire a more personalized relationship with your provider. If you have a health condition that could complicate your pregnancy or delivery, close collaboration between your midwife and obstetrician is ideal. Some of these conditions include:

If you decide to use a midwife, we recommend finding one who’s licensed and certified to practice in your state.

The links below provide information on midwifery practices and licensed midwives in the state of Florida.

 

Florida Rule 64B24-7 Midwifery Practice >

Florida Statute Chapter 467 Midwifery >

FL DOH Licensed Midwifery >

Do Midwives Do C-sections?

Midwives can’t perform c-sections, but they can assist in them. If you require a c-section, a collaborating physician will be called on to assume care.

Do Midwives Give Epidurals?

Some midwives can prescribe epidurals, but midwives can’t give epidurals. They consult with an anesthesiologist or a certified registered nurse anesthetist (CRNA). Anesthesia providers are typically available in hospital settings only.

What Questions Should You Ask Before Choosing A Midwife?

A lot of people interview potential midwives to make sure they feel comfortable with them prior to beginning services. Some questions you should consider before choosing a midwife are:

  • Where will I deliver my baby?
  • What kind of training do you have?
  • How long have you been a midwife?
  • How many births have you attended?
  • What are your philosophies or values when it comes to childbirth?
  • What kinds of tests or screenings do you perform during pregnancy?
  • Does insurance cover any of the cost?
  • Do you work with any local Ob/Gyns?

If Necessary, Prepare To Go To A Hospital

Make the following preparations for a smooth transition to a hospital, if you need it:

  • Discuss with your health care provider the symptoms that might mean you’ll have to go to a hospital. Talk about how that fits into your birth plan.
  • Make sure you have access to transportation. Ideally, your home or other birth location is within 15 minutes of a hospital with 24-hour maternity care.
  • Ask your health care provider to make arrangements with a nearby hospital to ensure that you can be promptly moved to the hospital and treated, if necessary.

The links below provide important information with regards to emergency backup plans and agreements for midwives in the state of Florida.

 

Florida Department of Health Emergency Plan for Licensed Midwifery >

Florida Department of Health Collaborative Management Agreement >

Hospitals or certified birth centers are the safest settings for delivery. However, you have the right to make an informed decision about where you prefer to deliver your baby. Keep in mind that life-threatening problems can occur during labor and delivery. In those cases, the need to take you and your baby to a hospital could delay care. That could put your lives at risk. Understand the risks and benefits of a home birth before you make a decision about where to deliver.

Watch Our YouTube Video On This Subject 

Joe Zarzaur is a Board Certified Civil Trial Attorney whose firm is dedicated to promoting community safety since 2007. ZARZAUR LAW’S AREAS OF PRACTICE: Serious Personal Injury, Product Defect, Auto Accidents, Cycling Accidents, Motor Vehicle Accidents, Products Liability, Wrongful Death, Community Safety, Boat and Jet Ski Accidents, Slip and Fall Injuries, and more. Licensed in Alabama and Florida.

If your newborn child has been injured or have experienced a birth injury, while in the care of a midwife, it’s important that you don’t make any rash decisions. Put yourself in the best possible position to receive the justice you deserve. It is also important to consult with a Board-Certified Trial Lawyer who has the knowledge and experience to help you. We know accidents can be stressful and want to make the process as easy as possible for you. Call Zarzaur Law, P.A. today at (855) Hire-Joe, or by requesting a free case review through our website.

Sources:

https://my.clevelandclinic.org/health/articles/22648-midwife

https://www.healthpartners.com/blog/midwife-vs-obgyn-whats-the-difference/

https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/home-birth/art-20046878

Florida Rule 64B24-7 Midwifery Practice

https://www.flrules.org/gateway/ChapterHome.asp?Chapter=64B24-7

Florida Statute Chapter 467 Midwifery

http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0467/0467.html

FL DOH Licensed Midwifery

https://www.floridahealth.gov/licensing-and-regulation/midwifery/index.html

FL DOH Emergency Backup Plan For Licensed Midwifery

https://www.floridahealth.gov/licensing-and-regulation/midwifery/resources/_documents/emergency-backup-plan.pdf

FL DOH Collaborative Management Agreement

https://www.floridahealth.gov/licensing-and-regulation/midwifery/resources/_documents/collaborative-management-agreement.pdf

Good Riddance 2020 – What’s on the Horizon for 2021?

 

Zarzaur law Get rid of Coronavirus

Dumpster fire or you can call it what you will – some people just call it “2020.”

I don’t think I need to explain to anyone how horrible this year has been from a productivity standpoint, not to mention the fact that we all have been basically fighting for our lives and well-being trying to avoid contracting the coronavirus.

Unfortunately, many people in our country don’t have access to healthcare and some have been left without necessary treatment to beat the virus. We should all be mindful of this fact which has been brought to the forefront because of this pandemic.

We have faced challenges that prior to this year we didn’t even realize existed. For example, how many of us knew what a ZOOM call was prior to January 2020? What did our bosses say about working remotely prior to this year?

The challenges brought about in 2020, in large part by the pandemic, have also made us persevere. We have had to figure out how to work together and not infect each other, how to be productive at home, and how we can relate to our friends and family without infecting them. We have done all of this and still have been able to survive and thrive.

At Zarzaur Law we were able to do this in large part by the guidance of our in-house physician Dr. Evan Malone. Dr. Malone has since the very beginning of the year shepherded us through the various stages of this pandemic, providing us information based on scientific studies. Dr. Malone has also connected us with a local testing company which has provided a level of security in our office each week by knowing that at least, for that week, the people around us at work were not infected. This sense of wellness has not only allowed us to be personally more secure with her own health but has also allowed us to more effectively serve the clients of the law firm in a near-normal manner.

We have not been able to have as many social gatherings or our charity events this year. Whether it be the legal graffiti events, various races that we sponsor, our gavel triathlon team, or competitions that we usually have a chair – when you’re faced with a pandemic like this the priorities become clear.

We knew our priorities were to our own family’s health and well-being followed very closely by the well-being of our client’s cases.

So, our focus this year has been on two main things:

  1. Keeping ourselves healthy
  2. Keeping our client’s cases moving

The news of the vaccine is certainly encouraging, or I should say various vaccines. Zarzaur Law will continue being diligent in protecting our staff from infection until we have all been rid of this disease for good. That will include aggressive masking, distancing, and testing and we will continue to encourage our community to do the same.

At the same time, we will remain focused on our client’s cases. We will make certain that nothing other than aggressive representation is exhibited in the pursuit of their day in court. We will also continue to be available 24 hours/7 days a week (safely) by phone or virtual meetings.

I don’t remember ever being this excited about ending a year. I completely understand the idea of shooting fireworks and perhaps blowing up the past year while looking towards the new one. All of us at Zarzaur Law look forward to serving our community in 2021, as we leave this virus behind and hopefully this time next year be able to serve not only our clients but also our community again in Zarzaur Law fashion.

Happy New Year, Pensacola