Oh how the times have changed. During the last decade there has been a significant increase in the number of licensed midwives and birth centers in the United States. As midwifery in the United States becomes a greater part of the mainstream health care system, the scope of midwifery practice is changing and midwives are now required to follow mandated health care regulations. What does this all mean for the practice of midwifery?
Traditionally, the majority of a midwife’s interactions with her clients have focused on the health and well-being of the mother, which leads to positive birth outcomes and of course a healthy baby. Midwives screen mothers to detect any pre-existing conditions – such as high blood pressure, gestational diabetes and Strep B infections – and they provide nutritional information, childbirth education and tips for good health; all while offering emotional support. Midwives have been thoroughly trained in maternal assessment and have both the skills and tools necessary to ensure healthy mothers and babies. With limited legislation regarding the care of pregnant women in the past, it was easy for midwives to continue with their traditional ways, while still ensuring optimal care.
When it comes to newborn assessment, the scope of midwifery practice has changed over the years. Thirty years ago midwives would do a basic assessment, weigh and measure the baby, and monitor for a few hours. It was routine to then have parents take their baby to see a doctor within a few days after birth. Gradually midwives have started providing legally required eye care, Vitamin K, newborn blood screening and developed further skills for assessing newborn health. However, overtime more newborn testing has been mandated leaving midwives wondering how best to serve their clients.
With increased legalization, midwives are entering a new era of compliance with government mandated screenings - especially when it comes to the newborn. Midwives have also gradually expanded their scope of practice and now provide longer postpartum care for both mom and the baby. In addition to increased newborn screening, midwifery practices are growing to include postpartum follow-ups for infants as they grow. This additional area of care is great for parents who value the holistic approach of a midwife more than that of a medically-focused pediatrician. This expansion of practice is also a positive indicator that midwifery is becoming more widely embraced by families as a preferred approach to care.
Yet with the desire to provide midwifery-based care while also meeting newborn assessment requirements, midwives are faced with some tough decisions. Do they invest in expensive but necessary equipment so they can test newborns in the family’s home? Or do they send mothers and their babies off to a medical facility where the necessary newborn screening can be done within the required 24 hours? The cost of purchasing the equipment required for newborn assessments is at times difficult to justify based on the number of births a midwife attends. There is a statistically low probability of a home-birth baby’s screening results showing a problem. So is it worth the investment to increase the comfort of mother and baby by offering at home testing after birth, or is it more feasible for midwives to delegate the necessary screening process to a medical facility?
The decision to invest in the equipment that allows a midwife to test for CCHD (Critical Congenital Heart Defects) or Hearing Loss is one each midwife either has or will soon face. Even if the majority of births a midwife attends are uncomplicated and result in healthy babies, the cost of vital testing equipment, like a Neonatal Pulse Oximeter or a Newborn Hearing Screening Device, may be worth the investment. Why? Because it only takes one time to catch a baby’s low blood oxygen level or signs of hearing loss to realize that having the right instruments plays a vital role in the quality of that baby’s life.
With the midwife’s foray into longer postpartum care comes an additional need to be savvy when choosing equipment that will not only serve at birth, but also as infants grow. A great example is the steady move from traditional hanging scales to more reliable digital scales that are functional at birth and throughout early infancy. Being able to monitor accurate weight gain and loss in newborns is part of the expanding role midwives play through postpartum care.
So is this all a welcomed change? The sentiments are mixed. Midwifery has always been founded on a holistic approach to pregnancy and birth, where a mother’s informed consent is revered above all else. With increased regulations now encompassing out-of-hospital births, there is concern that what is most paramount to the practice of midwifery will be jeopardized: the ability to empower women to make their own informed decisions for their bodies and their babies. Midwifery has been a welcomed alternative for maintaining dignity during birth and ensuring the best of care for both mother and her baby. Increased regulations raise concerns that mothers will have less say during and after birth, especially when it comes to newborn assessments.
At Cascade, supporting midwives during this time of change and ensuring you have what you need for whatever choice suits your practice best, is paramount to us. That is why we work hard to make sure we not only meet the regular day-to-day needs of our midwives, but also the expanding needs of your practice. You can trust that we will do the research for you to ensure we offer the best equipment required to meet mandated testing standards. We are also always focused on making sure our prices are reasonable, because if you decide to expand your practice we don’t want it to be overshadowed by the expense.
If you enjoyed this post, the topics covered in the following blog posts may also be of interest to you: 'Why Do We Use Fetoscopes?', 'How to Choose the Right Doppler', and 'Why Do We Use Plastic Cord Clamps?'. Click the post title to view the full article, or scroll through our complete archive of posts by clicking here.
Written By: Samantha Darling for Cascade HealthCare Products
Neonatal Pulse Oximeters: www.1cascade.com/pulse-oximeters
CDC, 'Facts About Critical Congenital Heart Defects': www.cdc.gov/ncbddd/heartdefects/cchd-facts.html
Newborn Hearing Screening: www.1cascade.com/newborn-hearing-screening-devices
HealthyChildren.Org, 'Purpose of Newborn Hearing Screening': www.healthychildren.org/English/ages-stages/baby/Pages/Purpose-of-Newborn-Hearing-Screening.aspx
Newborn and Infant Digital Scales: www.1cascade.com/medical-infant-scales