Day 1: Overview, Goals, and Research

My first intensive is focused on hospital-based midwifery with the Mercy Sylvania Physicians and Midwives practice. I will be able to shadow several different Certified Nurse Midwives (CNMs), attend regular appointments, and ideally see a birth! Most of the time I will be with my primary mentor, Irma Cobian, following her into appointments and doing things such as listening to babies' movements and heartbeats, measuring mothers' bellies, and assisting in other small tasks that won't interfere with liability restrictions. Near the beginning of my Independent Study, I will be paired with a woman who agrees to have me in the room while she gives birth, which will hopefully be within the three weeks I am in my intensive.

I currently have five goals for my Independent Study, but some new goals could be formed depending on what happens throughout my experience:
1) To develop a relationship with at least one mother so that she is comfortable allowing me witness the birth of her child
2) To be present at the birth of at least one baby
3) To determine if I want to pursue midwifery as a career
4) To research, analyze, and compare statistics of infant mortality rates in other countries around the world versus the United States and understand some of the causes
5) To better understand the differences between physicians and midwives

Today was a research day, mostly focused on the the last two goals, in addition to learning the basics of what happens during pregnancy and what midwives are equipped to do.

One recurring theme that came up in many of the articles I read today was that infant deaths are consistently lower for births attended by CNMs than physicians. For example, the National Center for Health Statistics (NCHS) and Centers for Disease Control and Prevention (CDC) determined through research that in the United States, infant mortality was 19% lower for births with CNMs, neonatal mortality was 33% lower, and the risk of delivering low birthweight infants was 31% lower. This can partially be explained by differences in prenatal, labor, and delivery care practices. For example, CNMs generally spend more time with patients during prenatal visits, putting more emphasis on patient education and providing emotional support, as well as focusing on non-interventionist methods. One chart that I read showed statistics on this, highlighting the difference between home births with midwives and hospital births with physicians:

Another common theme found in the articles today was that European countries utilize midwives much more than physicians and have found great success with them, an area in which the US is still struggling. In fact, all European countries have lower perinatal mortality rates than the US, which is not surprising when considering the fact that the percent of births in the US attended by midwives is 4%, whereas the percent of births in Europe attended by midwives is 75%. This also goes along with CIA Factbook's study showing that the US is the 50th safest country for the baby in birth and the 47th safest country for the mother giving birth, which are scary facts considering the US should be at the top or at least in the top ten. However, in the countries with the best outcomes, midwives are the primary providers of care for pregnant women.

After reading these articles comparing practices within different countries, I read some excerpts from books written by Ina May Gaskin, who is a very well-respected midwife and author. I learned what the mother's body goes through during each of the four stages of labor and the different hormones involved. This will help prepare me for understanding the process while watching a birth in the upcoming weeks. I also read about basic nursing skills such as taking blood pressure.

Starting on Monday I will be in the office with my mentor! I am excited to see what the next three weeks will bring.