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Peer review needed on the vital roles midwives play in today's society

This is a rough draft of the final paper, excluding the conclusion. Any feedback is welcome, but I would like specific feedback on my thesis and transitions/content. Thank you!

Midwives play a pivotal role in the overall care of women

The staggering rate of maternal and newborn mortality and new mothers who did not have the birth experience that they dreamed of needs to be brought to attention. With an increasing push for midwifery care for expectant mothers, there would be a huge improvement in both overall health and experiences gained during the prenatal process, as well as with postnatal health improvements. Midwifery care places second best behind obstetricians, but with more research, women would find that midwifery care is a far safer alternative to the use of ob/gyn's. In order for the country to see an effect of midwifery, there must be a change in the policies that health insurance companies have put in place. Only then will we be able to see a decrease in maternal and newborn mortality, decrease in medical interventions, and an increase in the health of the new mother and infant.

Evidence implies that there is a link between a decrease in maternal and fetal death, with the attendance of a midwife, during prenatal and postnatal care. While midwives have been around a very long time, over the years these birth attendants were pushed further to the side with the rise of obstetricians. The staggering numbers of fetal or maternal death at the hands of obstetricians should be evidence enough to look into a second route, such as midwifery. Evidence shows that midwifery can prevent 80% of maternal and newborn deaths, including stillbirths. (Horton 1075). "Midwifery, therefore, has a pivotal, yet widely neglected, part to play in accelerating progress to end preventable mortality of women and children." (Horton 1075).

Midwives play a pivotal role in the overall care of women that most ob/gyn's cannot even attempt to compare too. While obstetricians are educated and knowledgeable, they have lost the core founding of maternity care and the care for their patients. Midwives understand that each woman is different and the process of her delivery is unique for her. A large part of the high mortality rates is due to unnecessary medical interventions, which will be discussed in more detail later. These interventions are what lead to complications after birth with both mother and baby. In the early 1900's an obstetrician by the name of Dr. Joseph DeLee wrote a book about the "evil of natural labor" and created interventions to ease through labor, such as sedatives, esther, episiotomies, and forceps. This man was very influential in the course of change from naturally laboring mothers, to mothers who had medical interventions applied even if unnecessary. Dr. DeLee argued, "that midwives were untrained and incompetent, that pregnancy is a dangerous condition requiring care available only from highly trained medical specialists, and that midwives' clients-mainly poor women-were needed to provide the clinical experience for training doctors in obstetrics." (Rooks) If obstetricians took a step back and let the natural process of labor occur, as they were intended by the female body, there would be a drastic decrease in complications arising after the fact. Many new mothers-to-be are leaning hard on their trusted physicians for advice and guidance through their pregnancy. What these mothers don't know is how horrendous the current maternal-fetal healthcare climate is with obstetrician attended births. "The current maternal-infant healthcare climate in the US is widely acknowledged to be in great need of modification with midwives being seen as key in returning birth care to a more normal, physiologic state that is woman-centered." (Walker 9). By increasing the accessibility to midwives, a pregnant woman can have a healthy, natural, and positive birth experience with little to no complications.

Medical interventions appear to be the leading cause of pregnancy and postnatal complications. Low-risk expectant mothers are receiving unnecessary medical interventions every day, but with the implementation of midwife-attended births, we would see that decrease as well as the overall cost for the patient. Midwives believe in the physiological ability of a woman's body to be able to go through labor in a natural and "hands off" way. This allows women to be able to listen to their bodies and do what suits them best at the time. A midwife understanding the physiological aspect of labor means that midwives understand the natural function that the female body goes through to birth a child. This brings into question why a woman is birthing laying flat on her back in a hospital, versus a woman who can birth on her hands and knees and let gravity help progression along. Not only do midwives play huge roles in the natural progression of labor for a mother, they also end up bring a lower out-of-pocket cost to the patient with these methods. "Midwifery care results in lower costs due to fewer unnecessary, invasive and expensive interventions and is associated with lower rates of cesarean birth, labor induction, and augmentation; less use of regional anesthesia; significant reduction in the incidence of third and fourth degree perineal tears; and higher rates of breastfeeding." (Walker 9). Women who chose an obstetrician are more likely to be offered a scheduled cesarean, scheduled induction, piton during active labor, episiotomies, and epidurals. These are just a few of the unnecessary, expensive, medical interventions that doctors all across the nation are offering daily to a pregnant or laboring woman. With the increased push for scheduled deliveries via piton induction, we also have an increase in emergency cesarean sections. "Rising cesarean birth rates have been an ongoing challenge with 1 in 3 women giving birth by cesarean section in 2011 for a rate of 32.4%." (Walker 9). These statistics alone should be enough to ask the question, "Why?" Cesareans were created for very specific medical emergencies during labor. The reasons these have become much more prevalent is that mothers are allowing obstetricians to schedule their delivery via induction, which leads to many other medical complications, but the most common is a failed progression of labor, resulting in an emergency cesarean. This can be prevented by implementing a nationwide policy to prevent medical professionals from scheduling unnecessary interventions for low-risk, healthy, pregnant mothers to be. "More midwife-attended births may be correlated with fewer obstetric procedures, which could lower costs without lowering the quality of care. This raises the possibility of improving value in maternity care through greater access to midwifery care for childbearing women in the United States." (Managed Care 21) As stated before, these medical interventions add up, and before a woman knows it, her medical bills are outrageous.

By increasing the availability of midwives in healthcare, the cost of prenatal care will decrease, and the risk of adverse events will decrease. In a research study done at the University of Massachusetts, they found that "Women who gave birth at hospitals with more midwife-attended births had lower odds of delivering by cesarean and lower odds of episiotomy." (Managed Care 21). Midwives have a unique service to bring in natural and holistic approaches that are patient based, not wallet based. On average, cesarean deliveries cost around $4,500 versus a natural, uncomplicated, vaginal birth around $2,600. This is after insurance has paid a portion of the cost. Without insurance, and uncomplicated vaginal birth is around $9,600 and a cesarean is closer to $16,000! These numbers are steep in both scenarios, but if a midwife were to be in attendance the rate of cesarean births with decrease and the overall cost for a natural vaginal birth could decrease as much as $2,000. This doesn't seem like much, but a bulk of the costs for vaginal births are for the use of the facility as well as the doctors pay. "In the U.S. health-care industry, the more care that is provided, frequently more money is made by the doctors and the hospitals, so there is less incentive to not use these methods." (Rooks) Midwives are universal, they can be employed by a hospital or physician, or they can be employed by themselves. Many licensed midwives own their own birthing center and offer home births as well. Unfortunately, most insurances will not reimburse for a birth center or home birth, so the cost that is paid toward a midwife is the patients to pay before labor occurs. This is not the case for all insurances, however. Some have paid back the patients up to 90% of the out of pocket cost. Many women are willing to pay upfront for the services rendered by a midwife for the benefits that they have for healthy pregnant women.

Studies show that women expect a high quality of care when they seek medical professionals during pregnancy. Increasing the overall health, mentally, emotionally, and physically, of a new mother should be a health cares number one priority. Midwives have been proven time and time again that they are exactly what a new mother needs to go through the journey of pregnancy and birth with. Woman seek out a midwife for their well-known knowledge in what works best for most woman and how they are prepared for change at any moment. "They (women) value good communication, high-quality information, having a sense of control, and the ability to participate in their care and make choices." (Sakala e40). When a mother enters into an obstetrician office, she enters into a group of cattle that are being herded one by one into triage, then the patient room, and then before they know if they are walking out with their heads spinning and more questions than they had before. This is not the case when you enter into a midwives practice, or she enters into the mothers home for home birth patients. "Women placed greater value on the emotional, cultural and spiritual aspects of care to make them feel safe." (Rigg 99). That is just what a midwife specializes in, they make expectant mothers feel safe, heard, and understood. During midwifery attended births, the mother is allowed to labor how she sees fit while the midwife is coaching, in necessary, on breathing or positioning through contractions. During delivery, midwives implement the mother's support system, whether that be a spouse, parent, or sibling, the midwife will likely have that support system involved in the successful delivery of the newborn. They also follow the mothers birth plan, which can be very different for every mother. What feels natural for one woman, can feel foreign to another woman. The support that is offered by a midwife is vast and their competencies for labor support, emotional nurturing, and comfort, makes midwives the superior choice for pregnant mothers.

Comparing women who had obstetrician attended births versus midwife-attended births, there is an overall higher rating score for the experience that women had with a midwife. Midwives wear many hats and their responsibility is "care that promotes, supports, and protects innate, hormonally driven, physiological processes optimizes labor, birth, breastfeeding, and attachment, assisting women and newborn infants during these immense perinatal life transitions, whereas medical interventions often disrupt these processes." (Sakala e40). The support of a midwife during labor an delivery is extensive, they are there from the start to well past delivery and switch over into post-partum care. Midwives believe in delayed cord clamping, which is when the umbilical cord is not clamped until it is done pumping blood. The advantages of delayed cord clamping are that for both pre-term and full-term births, the transfusion of red blood cells from the placenta into the baby increase by 60% and approximately 30% of total blood volume increase. The benefits of delayed cord clamping are vital and can help newborns transition from life inside the womb, to like outside of the womb. Breastfeeding and skin to skin contact are a couple of other huge factors that midwives suggest for the benefit of both mom and baby. Skin to skin is the act of placing the newborn immediately onto its mother's bare chest were the baby's temperature, breathing, and heart rate stabilizes. This easily transitions into a successful breastfeeding experience where the infant feels safe and secure in its mother's arm. Midwives also support and encourage breastfeeding. This benefits the baby in many ways, including antibodies through the milk that help fight off viruses and bacteria, lowers risk of asthma and allergies in later life, greater bond with mom, and lower risk of SIDS, those are just a few. The benefits to mom are equally as great with the ultimate being that a mother has the ability to not only create a child in her womb, birth that child, and then has a custom-made supply to sustain that child for the first year or two of life. That alone gives a new mother a sense of empowerment that can't be matched. Both breastfeeding and skin to skin are highly suggested and promoted by midwives in and out of hospitals.

Apr 15, 2018   #2
Lauren, this is a pretty good draft. I would have liked to have read more discussion on a comparative point between the treatment of mothers in labor under midwives and those under the care of an OB/GYN. I believe that the comparison is necessary in order to prove your point. Making your claims stronger and more influential in the process of reading it. Without the comparison points, the discussion and research becomes lopsided, not really offering complete information by which the reader can make an informed decision. While your discussion in support of midwife birthing is based on facts, there may be questions arising from these facts presented. The research paper should anticipate such questions and provide responses beforehand. That is why the comparison is important in some aspects of the presentation.

With regards to the transitions, you need to work on it. The transitions are not clear at the end of the essay paragraphs. The transitions should connect the preceding paragraph discussion to the upcoming paragraph. Now, you may have done that but it is not as effective as you thought it was. I found myself wondering about the transitions throughout the essay.

By the way, try to limit your quotes to one paragraph each. Remember, you can't just stick the quote in there and move on. You always have to explain your understanding of the quote and its relationship to the topic sentence of the paragraph. You sometimes close the paragraphs with quotes, which makes the reader wonder about why you moved on from the discussion so quickly.

Your essay is overwhelmed with information. You may want to lessen some of it so that the essay can better focus on a specific discussion for the overall topic. Right now, you are taking on too much with the discussion so it becomes unfocused and difficult to present in a manner that will continuously retain the interest of the reader. Not bad work for a draft. You can definitely improve some presentations though.

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