Nov 032012

Call it a Spade:

This article is one that will raise your eyebrow. And that is the intention:-) A lot of things/procedures around pregnancy and birth have followed a ‘hush hush, don’t think or talk about it” kind of approach. So we call it a spade, and tell you what it entails, hoping that you can now think and talk about it:-)

Disclaimer: evesmama is a midwifery service provider meaning we follow the midwife’s model of care. It has a different approach from the Medical Model of care and this is how…


Midwife vs. Medical model of care:

The practices around these two models has been a debate for a long time. Both models do work, have statistics to back the practice and outcomes, but are governed very differently. It is therefore important as a parent, to know and understand what each model entails and make a decision or choice on which model suits you best.

Here are a few major differences that will explain the rest of this article.

The Midwife’s model believes that birth is a normal event in a woman’s life and her reproductive body system can handle it. It is a life-transforming family event that can happen at an informal set up like the home. Pregnancy and birth need a holistic approach with longer time spent during the prenatal visits. The woman and her family are at the center of the process making familiar language and information very key to her decision making and involvement in the process.

The midwife actually midwife’s the process by being constantly available at all stages, to give support to the family and her family. This model believes in the empowering effect of birth to the woman and integrity during the process helps achieve this. It uses minimal and only appropriate technology and interventions.

The medical model views Childbirth as a potentially pathological process. The work of birth is done by the experts, the woman is a patient and the family has a very small role to play. The event must happen in the health care facility and a hierarchical system of delegating care is in place. It views a natural birth as an outcome and not a possibility.

The model values technology, and professionals who dominate the relationship and share very little or no information. Care is ‘on a script” and rarely personalized and only focuses on the clinical aspect of pregnancy and birth.


The Estimated Date of Delivery (EDD):

When German Dr. Naegele published the rule that is today used to calculate EDD in 1806, he was trying to help obstetricians and midwives determine the length of stay of a baby in the womb.

The theory was first by Harmanni Boerhaave, a botanist. In 1744 he came up with a method of calculating the EDD based upon evidence from the Bible that human gestation lasts approximately 10 lunar months.

This calculation has caused a lot of conflicts as the lunar period is by other philosophers said to be longer than the 28 days that Naegele’s theory used too calculate the due date. Different women have different cycle lengths and assuming that they all have 28 days predisposes babies born to women with long cycles to be born before full term. Numerous studies have been done since and majority report that only 5% of women world over get their babies on the due date while 50-80% will get their babies after the due date.

The use of technology to estimate due date is also not as accurate. It has been found that pregnancies grow at the same pace only till 13 weeks making scans done before this time a little more accurate as after this time the size of baby is not determined by the time they have been in the womb. The scans can generally be off by a week or more depending on the stage of pregnancy, size of baby, the machine and technologist operating it.

A research done to calculate the average length of an uncomplicated human pregnancy done by Mittendorf et Al in 1990 found that for first time mothers pregnancy lasted an average of 288 days (41 weeks 1 day). The average for mothers who had a child/children before was 283 days which is 40 weeks 3 days.

The due date however may be a useful guide when calculating the age of the pregnancy when there are complications to the mother or baby’s health. It should be calculated with the knowledge that pregnancy is often longer than 280days to determine the best time to administer interventions.

Remember, it is an estimated date, and not the birth date. Only the creator and the baby know the birth day. And when the time is right, the body and the baby work in unison to facilitate birth. Wait it out.


Vaginal Examinations:

I was taught to do vaginal exams in Midwifery school. Later in practice I learnt that this is the one procedure most women detest. It is uncomfortable, especially when one is not relaxed or when the care provider does it too fast as the vagina during late pregnancy and labor becomes very sensitive.

In theory: The first one is done at week 36 to determine whether the size of baby equals the size of the pelvis.
In Practice: This is not always an accurate measure as with the hlp of the hormone relaxin, the pelvic bones stretch and open just before and during labor to allow effective passing of the baby…

In theory: During labor a vaginal exam done every 4 hours gives information on how open the cervix is.
In Practice: Checking the cervix too often may predispose a mother to infection. If birth is going to follow the natural path, the state of the cervix is not necessary as the body ensures that the cervix is ready before active labor. How far the cervix is dilated may not necessarily determine how long or short the labor will be. Women have moved from 4cm to 10 in half an hour and from 3cm to 10cm in 7 hours.

Practice sometimes beats theory; the best theory comes from the mother’s body.


breech2Breech Birth:

My “Text Book of Midwifery” put Breech Birth under birth that can occur naturally. Breech Presentation means that baby has their bottom area (buttocks, knees or foot near the cervix). The book went ahead to describe how to actually conduct the birth with keen attention to the cord and baby’s spine as the way they come out is different.

World over, 4-6% of babies at term will be breech and often, they present as a surprise. It is assumed that breech babies have preexisting malformations that cause them not to assume the head down position but they are often born healthy. If picked early, babies can be turned manually, by positions such as Knee to chest, lifting mum’s bottoms when she is lying down or exercise such as swimming. To prevent the Breech position, keep an upright position and avoid sleeping on your back.

Babies in breech can be born normally but as always a confident mum, dad and provider make the best team as baby is already confident that they can be born that way (seeing as they did not turn…). The risk though is at the birth of the head, the mother will need to help bare down fast to exit the baby so their head is not in for long.


Vaginal Birth After Caesarian (VBAC):

“The doctor said that since I had a CS last time, I will automatically have another CS”.
This is a statement I have heard very many times. The assumption has been that letting a woman with a scar go through labor will burst the scar and uterus. This assumption probably doubts the ability of the body to heal.

Numerous studies around VBAC have been done and evidence exists that it is not as risky as it is made to sound. Vaginal birth will always be simpler and easier for the body.

What mums opting for a VBAC need is the will power to do it, believe you can and have a supportive team that believes you can. The focus at each VBAC is it is a birth as opposed to it being a VBAC.

In my survey in rural Kenya, I was amazed to meet women who had a CS and with their subsequent births decided to have a home birth also called HBAC-Home birth after Caeserian or a UBAC – Unassisted birth after caesarian. These women made this decision because they “feared the knife” and opted out of hospital. I met a woman who had a HBAC after 15 months and one who had a UBAC after 18 months, so time too is a debatable factor.

The success of a VBAC is determined by the individual woman and the confidence (or lack of it) of the care provider to support her through it.

A VBAC can be successful or unsuccessful; the essence is to give the body a chance as that is the only way to determine the success.


We always window shop every time we want to purchase a valuable thing like furniture, electrical equipment, or phone. Window shopping for the person who will care for you during pregnancy and birth is as important.

Lucy Muchiri

  One Response to “Conflicts in Pregnancy and Birth Care:”

  1. Lucy, yet again you’ve hit the nail on the head. I’d go for the midwives and TBAs any day. I detested vaginal examination during labor of my first child because the male nurse that did it was very rough and forced me to lie flat on my back and did it when I have having . contractions, It was very painful and uncomfortable. I prefer and recommend checking while standing and in between contraction rather than during one especially when on is at advanced labor.

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