by Risa Klein, CNM, OB/GYN NP, M.S.
The Yoga minded pregnant person will find a natural and spontaneous connection to midwifery care, as yoga and the midwifery model of healthcare share similar values and disciplines. If you reflect on your own unique life story, which has inspired you to become a member of the Love Child Yoga Community as your pathway to pregnancy wellness, you will find parallels between your Yoga mindset and practice, and midwifery care.
Parallels between Yoga and Midwifery
“Feel your shoulders release. Gently open your hips. Take a breath. Let your jaw soften. Feel your baby as your center.” Sound familiar? This kind of instruction given in your prenatal yoga class, is also the language of midwifery. As a nurse midwife, I am always excited to meet clients who practice prenatal yoga, as they understand how to cultivate awareness which helps to move their bodies and breath. In my many years of midwifery practice, I believe students of yoga have an easier time while in labor and are better able to hear and implement changes suggested. Women are flexible, open-minded, calmer, and better connected to their babies, when they have awareness of how to let go. It comes more naturally for women who practice yoga - to attempt a recommended posture or position I present as her midwife. After all, if I want to move the baby - I need to move the mother! Working with a midwife will feel second nature because there is a similar mindset in midwifery as yoga practice.
Just as yoga gives you opportunity to connect with and align with your body, midwives are inclined to take this concept to another profound level and help you focus inward and align yourself with your baby. When I was five months pregnant I took my first prenatal yoga class, and had never felt closer or more in touch with my growing babying body. Accomplishing a challenging yoga asana is something I never anticipated doing in my lifetime, never mind starting the practice during my pregnancy – and yet my instructor patiently guided me through what I called my pregnancy yoga orientation. I was grateful to her for preparing and aligning me for my birth. Looking back, it was as if she was midwifing me, however I didn’t realize it at the time. If only my own back up obstetrician in the day applied such awareness and warmth during my delivery, perhaps I would have felt better taken care of. My birth propelled me to become a midwife.
Students of yoga know the benefits they feel over time as they become more in tune with their bodies, movement, rhythm, and their breathing. Same level of progression occurs while under a midwife’s care. Pregnant people get in tune with their bodies and babies and each prenatal visit is like a childbirth class of inspiration, education, as you integrate pearls of midwifery wisdom, into your vision for birth.
So who will guide you during your gynecological care, pregnancy, labor, birth and postpartum? A midwife, or an obstetrician? To determine which provider is best suited to you, it is important to have a good understanding of your own health history, philosophical viewpoint, and the differences between the midwifery and the medical models of care. Regardless of who you decide will be the best healthcare provider for you - an OB/GYN or midwife, this information can help you decide who is best suited to carefully tend to yours and your baby’s health.
CNM’s (Certified Nurse Midwife) work with healthy women. They do not take care of women who have high risk medical conditions such as Diabetes, Heart or Liver Disease, or some auto immune disorders. Rather, obstetricians do because they are trained surgeons – experts in their specialty field when a woman or fetus encounters a high risk medical problem and needs procedures requiring initiation and adjustments of medications, surgical procedures including Cesarean sections. Midwives do not perform cesarean sections, although some are certified to first assist. While obstetricians are trained in medicine, disease, and abnormality – midwives are trained to recognize variations in pregnancies, using screening and diagnostic tests to uncover potential health challenges that may require an obstetrician, maternal fetal medicine specialist, genetic counselor, or other medical provider, thus risking them out of midwifery care. When medically indicated, midwives refer their clients to the appropriate physician, and consult, collaborate and co-manage with these practitioners on an individual basis. Midwives co-manage women who desire a VBAC (vaginal birth after cesarean section), or twin pregnancy.
Midwives do not see birth as an illness and have a more holistic approach to pregnancy, labor and birth, than the traditional obstetrical medical model.
Midwives are independent health care providers with expertise in annual gynecologic well woman care, pregnancy, childbirth, the postpartum period, care of the newborn, common primary care issues, and family planning. Midwives graduate from accredited midwifery schools and receive their master’s degree, while some go on for their PhDs. A CNM is educated in two disciplines of nursing and midwifery. Midwives practice in accord with the Standards for the Practice of Midwifery, as defined by the American College of Nurse-Midwives. They are licensed by their individual states, and have prescription privileges. You can give birth with a midwife at home, in a free standing birthing center, an in an in hospital birthing center, or on a hospital labor and delivery floor. Midwifery care is reimbursed by most health insurance companies. You can reap many benefits by working with a midwife if you are not a high-risk patient:
1. Nutrition and Education. You will become educated in how to stay healthy and low risk during the course of your pregnancy. Midwives take a significant amount of time throughout your pregnancy to address how optimal and balanced healthy nutrition serves as the foundation for achieving better outcomes. You will learn about and be validated for the naturally occurring changes that are happening in your body as your baby gestates in inside you. This orientation continues during labor and birth, with a mindful understanding of your body’s innate potential. Midwives teach clients to become mindful of their body, breathing, postures, balance, timing, and rhythm as important assets.
2. Emotional Support. Prenatal visits are the time when your midwife will take the time to get to know you, your medical and reproductive health, job, family history, lifestyle, and how each facet of your life may impact your pregnancy and birth outcome. From the first day you meet your midwife, she or he will impart confidence in your natural abilities to give birth by virtue of your own innate capacities, rather than looking outside of yourself. Fears, concerns, and feelings are explored and women are encouraged to share them as their bodies change and their babies grow.
3. Patience. “I didn’t feel rushed,” is what my clients often share after their labor and birth experience. (I do not wear a watch during labor so women do not feel rushed). Midwives honor birth as a process and give time for labor to unfold, guiding their clients patiently with specific postures and positions to promote optimal movement and fetal heart rate for baby. If you are in a small practice, midwives are apt to devote and maintain continuity of care before, during and after your birth.
4. Epidural. Yes, you can have one if you birth in a hospital, not at home.
5. C section. If medially needed your midwife is with you during the procedure. The attending or collaborating obstetrician will perform the procedure. If you need to work with an obstetrician for medical reasons, and have a planned c section, you can still apply your yoga awareness to help you during your delivery. Your midwife will support you on breastfeeding and teach you a proper latch on right from birth in the O.R.
6. When Your Health Requires Transfer to an Obstetrician: If you or your baby’s medical situation in utero become high risk, your midwife can help make referrals to a compassionate, skilled physician.
To learn more about midwifery, check out The American College of Midwives website, www.mymidwife.org.
Risa Klein, CNM, is a highly experienced private practice senior CNM. She brings her home birth approach to her midwifery practice with privileges at Mt. Sinai West. She promotes peaceful pregnancy, empowered birth, and individualized care. She is a graduate of the Columbia University School of Nursing Midwifery Program. Check out her website at www.manhattanmidwife.com.