Should You Circumcise Your Newborn?

Circumcision has been practiced for centuries, often rooted in religious, cultural, or social traditions. In the United States, the procedure became widely normalized during the 20th century, based on claims of improved hygiene, reduced infection risk, or even just on grounds of aesthetics. For parents weighing this important decision, it's important to also consider the potential harms of circumcision before their child is born. 

Take a deep dive with Dr. Eric Tygenhof on newborn circumcision

What Does the Foreskin Do?

The foreskin is not just a redundant piece of tissue - it serves several important biological functions. It protects the glans (head of the penis) from irritants, keeps the area moist, and contains thousands of nerve endings that enhance sexual sensitivity later in life. From a purely anatomical perspective, the foreskin is a naturally occurring, functional part of the male body, and its removal permanently alters functionality.

Debunking the Health Benefits of Circumcision

Circumcision advocates often cite health benefits such as reduced risks of urinary tract infections (UTIs), sexually transmitted infections (STIs), and penile cancer. However, the data behind these claims is often overstated or context-dependent. For example:

• Urinary Tract Infections: UTIs are relatively rare in male infants, with only about 2% of boys experiencing one before they turn 5. Even though circumcision might reduce the risk slightly, infections can typically be treated effectively with antibiotics. The small risk reduction does not justify the removal of healthy tissue from all newborn males.

• Sexually Transmitted Infections: While some studies suggest a lower risk of HIV transmission among circumcised men in high-prevalence areas, such as sub-Saharan Africa, the situation is not comparable in countries like the U.S., where HIV prevention through safe sexual practices and education is far more effective.

• Penile Cancer: Penile cancer is very rare in both circumcised and intact men in the USA, making circumcision an unnecessary preventive measure for this condition. About 300,000 babies would need to be circumcised to prevent one case of penile cancer. Proper hygiene and regular medical checkups are far more relevant factors in minimizing cancer risks.

Parents may also choose to circumcise their newborns on religious grounds, for aesthetic reasons, or because it is more culturally accepted. If you are not considering circumcision based on religious reasons, we want to challenge you to explore why circumcision may not be the best choice.

An Ethical Debate: Bodily Autonomy and Consent

One of the strongest arguments against newborn circumcision is the question of consent. A newborn simply cannot provide informed consent for a permanent surgical procedure that has no immediate medical necessity. Many critics, including medical ethicists, argue that circumcision infringes on the individual’s right to bodily autonomy, as it removes a healthy, functional part of the body without the person’s consent. Waiting until adulthood, when the individual can make an informed choice, respects their autonomy and allows them to weigh the pros and cons based on personal preference or health considerations.

The Risks of Circumcision

Though often described as a routine procedure, circumcision carries more risks than people realize. These risks include bleeding, infection, and complications from anesthesia. In some cases, circumcision has led to more severe outcomes, such as damage to the penis or excessive scarring. Studies have also shown that newborns experience significant pain during and after circumcision, despite the use of local anesthetics. 

This directory of articles on the complications of circumcision show the dozens of adverse affects many people experience.

Circumcision also often affects sexual experiences later in life. Circumcision removes one of the most sensitive areas of the penis - in fact, the moveable skin creates more sexual pleasure than circumcised males are able to experience. This Danish study concluded that circumcision is responsible for sexual difficulty among many men.

Caring for an Intact Penis: Education Is Key

One common reason parents opt for circumcision is the belief that it will make hygiene easier. However, with proper education, caring for an intact penis is straightforward and requires no more effort than caring for a circumcised one. Misconceptions around intact care often stem from a lack of understanding or outdated medical advice.

• For Newborns and Infants: During the early years, the foreskin is fused to the glans, making it unnecessary (and harmful) to retract the foreskin for cleaning. Parents should simply wash with water and mild soap.

• As Boys Grow: Over time, the foreskin naturally becomes retractable. When this happens, boys should be taught to gently retract the foreskin to clean underneath during baths or showers, much like how one cleans other body parts. There is no need for aggressive cleaning or special procedures—just normal hygiene.

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The decision to circumcise a newborn is a deeply personal one, but it's important that parents make this choice with accurate, up-to-date information. 

As awareness grows and the science behind circumcision is critically re-examined, more families are recognizing that the most natural option is often the best one. By keeping their children intact, they allow them to make their own choices about their bodies when they are ready, giving them autonomy, respect, and a balanced approach to health.

Yoni Steaming for Fertility, Birth, and Postpartum Healing

Women’s health has been seeing a decline, especially in the United States. Infertility, Endometriosis, PCOS, and other health issues have skyrocketed, alongside childbirth complications. Many women are realizing that it’s time to start looking to tried and true medicinal practices that have been around for centuries to get their health back on track.

Yoni steaming, also known as vaginal steaming, is an ancient practice traditionally used in various cultures around the world. When used correctly, this is a safe therapy that involves exposing the vaginal area to steam or smoke infused with medicinal herbs. For centuries, women have used yoni steaming for help in boosting fertility, easing childbirth, and aiding postpartum recovery.

The Benefits of Yoni Steaming

• Fertility and Menstrual Health: One of the main draws to yoni steaming is to enhance fertility. The practice is believed to balance hormones, regulate menstrual cycles, and cleanse the uterus, making it an attractive option for women seeking to conceive. Herbal blends used in yoni steaming often include ingredients such as mugwort, rosemary, wormwood, and basil—plants known for their detoxifying and circulation-boosting properties.

  The steam is thought to soften and nourish the tissues of the reproductive system, increasing blood flow to the pelvic area and helping to remove any blockages that could affect fertility or other health problems such as fibroids, infections, or painful periods. 

• Pregnancy: Some use yoni steaming to prepare the body for labor, usually at 37 weeks or after (we do not recommend steaming during pregnancy at any point before 37 weeks). The warm steam relaxes the pelvic muscles and perineum, which may reduce the risk of tearing. 

• Postpartum Recovery: After delivery, the vaginal area may experience swelling, soreness, or discomfort. Yoni steaming is believed to help cleanse the uterus, promote tissue repair, and reduce inflammation.

The warm steam infused with healing herbs can soothe the perineal area, support the body in releasing lochia (postpartum discharge), and restore the reproductive organs to their pre-pregnancy state.

How to Yoni Steam

What is Used?

• Herbs (Commonly used herbs include mugwort, rosemary, lavender, oregano, basil, chamomile, and calendula)

• Large bowl or pot

• Heat source

• Towel or blanket to create a tent around your lower body, trapping the steam

• A comfortable chair or yoni steaming stool (These are specially designed with a hole in the seat to allow the steam to rise directly to the vaginal area)

How to Steam

Use about one cup of dried herbs or two cups of fresh herbs and place them in the pot or bowl. Boil 2-3 quarts of water and pour over the herbs. Allow the mixture to steep for a few minutes and so that the water slightly cools. 

In a comfortable, relaxing area, sit or squat over the pot so that the steam can rise directly to your vaginal area. Drape a large towel or blanket like a tent around your waist to trap the steam, then remain seated over the steam for 20-40 minutes.

Drink water during and after steaming to remain hydrated.

Safety Precautions

1. Temperature Control: Do not burn yourself! Always check the temperature of the steam before positioning yourself over the pot.

2. Timing: It’s generally recommended to steam 1-2 times per month, especially before and after menstruation. However, frequency may vary based on individual needs. Avoid steaming during menstruation or if you have an active infection.

3. Medical Conditions: If you have any medical conditions, such as pelvic inflammatory disease, yeast infections, or open sores, avoid yoni steaming. Women who are pregnant should hold off from steaming until after at least 37 weeks gestation, and then only under professional supervision.

4. Hygiene: Make sure all equipment used for steaming is clean and disinfected before and after each use to prevent infections. Use only high-quality, organic herbs to avoid exposure to pesticides or contaminants.

5. Listen to Your Body: If you experience any discomfort, pain, or unusual symptoms during or after steaming, stop the practice immediately and consult a healthcare provider.

This Fall, we will be offering traditional Yoni Steaming as a part of the Cincinnati Birth Center services for pre- and post-pregnancy!

Please feel free to reach out with any questions - we are happy to discuss with you!

Mayan Abdominal Massage Therapy

Services starting at the Cincinnati Birth Center this Fall

Contact us with questions!

Mayan Abdominal Massage, also known as the Arvigo Techniques of Maya Abdominal Therapy®, is rooted in the traditional medicine of the Maya civilization. The abdomen is a central hub for health, so abdominal massage focuses on balancing and aligning internal organs for full system health. 

What is Mayan Abdominal Massage?

Mayan Abdominal Massage dates back thousands of years to the Maya civilization. The Maya were renowned for their advanced understanding of medicine, astronomy, and spirituality. They understood that misalignment of the body’s internal organs (due to physical trauma, emotional stress, poor posture, or other factors) often could lead to various health issues.

Mayan healers, known as "curanderos," developed a system of massage techniques to reposition the organs, improve circulation, and enhance the flow of energy throughout the body. 

In the 20th century, Dr. Rosita Arvigo, an American herbalist and naturopath, studied under a Maya shaman in Belize named Don Elijio Panti. She later systematized and introduced these ancient techniques to a modern audience.

The main purpose of Mayan Abdominal Massage is to restore balance within the body by aligning the internal organs, particularly those in the abdomen and pelvic region. 

This alignment is believed to support the body’s natural healing processes and prevent various health problems.

Benefits of Mayan Abdominal Massage

The benefits of Mayan Abdominal Massage are for everyone, whether they are pregnant or not!

Benefits for Non-Pregnant Individuals:

• Digestive Health: Mayan Abdominal Massage can relieve chronic digestive issues such as bloating, constipation, indigestion, and irritable bowel syndrome (IBS) by improving digestion and elimination.

• Menstrual and Reproductive Health: For women, this massage can alleviate menstrual pain, irregular cycles, endometriosis, and other gynecological issues by enhancing blood flow to the uterus and ovaries and addressing uterine misalignment.

• Emotional Well-being: Massage can help release stored emotions and tension, which helps improve mental clarity and reduce anxiety or depression.

• Detoxification: By stimulating the lymphatic system and improving circulation, abdominal massage helps the body eliminate toxins.

Benefits for Pregnant Individuals:

• Pregnancy Discomfort: Abdominal massage can relieve common pregnancy discomforts such as back pain, sciatica, and digestive issues by improving circulation and relieving tension in the abdomen and lower back.

• Fetal Positioning: Massage may also help with correct fetal positioning by making sure the uterus is properly aligned and has enough space for the baby to move into the ideal position for birth.

• Labor Prep: Massage can help prepare the body for labor and delivery, which may lead to a smoother birthing experience.

• Postpartum Recovery: After birth, abdominal massage supports the uterus in returning to its pre-pregnancy position, reduces the chance of hemorrhage, and helps with breastfeeding challenges.

Conditions Addressed by Mayan Abdominal Massage

This is a list of some conditions that Mayan Abdominal Massage can help manage:

• Constipation

• Bloating

• Gas

• IBS

• Infertility

• Menstrual Irregularities

• Pelvic Pain

• Fibroids and cysts

• Incontinence

• Bladder Infections 

• Emotional Stress

• Endometriosis

• Labor and Delivery Aid

How Mayan Abdominal Massage is Performed

Mayan Abdominal Massage involves gentle, non-invasive manipulation of the abdomen and surrounding areas to reposition organs, improve circulation, and promote healing. 

Your practitioner will use their hands to apply gentle pressure and move the abdominal organs into their proper positions. This may involve massaging the lower back, hips, and pelvic area as well.

After the massage, clients are often given self-care techniques to continue at home, such as specific exercises, dietary recommendations, and lifestyle changes to support the healing process. Regular sessions are recommended for optimal results, especially for chronic conditions or during pregnancy.

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Whether used during pregnancy or to address other health concerns, Mayan Abdominal Massage offers a pathway to healing rooted in traditional medicine. 

We’re so excited to start offering Abdominal Massage services at the Cincinnati Birth Center this Fall! 

Want to find out more? Contact us with any questions!

How to Handle Postpartum Hair Loss

If you have a shedding pet, you’re probably used to vacuuming up pet hair ALL. THE. TIME. After having a baby, you might feel like your own shedding rivals that of your four-legged friends!

Postpartum hair loss happens to almost every mother, and it can actually be difficult to cope with when you lose handfuls of hair every day and it starts to lose its fullness. Why does hair loss happen, and how can you manage it?

What Causes Hair Loss?

Hair loss after birth is called “pregnancy alopecia”, and usually starts around 2-3 months postpartum. It can be startling to start losing hundreds of hairs every day and watching your hair thin out, but don’t worry! Shedding usually slows down around 6 months and new hairs start to grow back.

Postpartum hair loss happens when hormones disrupt the hair growth cycle. During pregnancy, estrogen levels spike, which causes more hair follicles to enter a “resting” phase simultaneously. Did you have thick, glossy “pregnancy hair?” This is why!

However, after giving birth, estrogen levels take a sharp drop, returning your hair to its normal cycle and shedding all the hair stored up during pregnancy at once. This can be alarming, but it’s temporary and will level out later. 

Keep in mind, other factors can contribute to hair loss as well, such as inadequate iron levels and high stress levels - both common after giving birth.

Managing Hair Loss

It can be distressing to lose so much hair at once, but rest assured there is an end in sight! In the meantime, there are ways you can manage your hair loss so that it isn’t worse than it needs to be.

1. Nutrition: Diet is everything when it comes to health! Keep eating a balanced diet rich in vitamins and minerals to support hair growth. Key nutrients include iron, zinc, vitamin D, and omega-3 fatty acids.

2. Gentle Hair Care: For the next few months, avoid harsh hair treatments, reduce heat styling, and use gentle shampoos and conditioners to minimize additional hair damage. It can be tempting to throw your hair in a tight ponytail or bun each day (especially with a baby to care for), but this can actually weaken your hair follicles. Try either wearing it down or using a thick scrunchy and keeping your hair style loose.

3. Stress Management: Stress is a huge reason for hair loss even outside of postpartum. Stress-reducing activities such as yoga and meditation, and getting enough rest can help manage physical and emotional strain.

4. Consult a Professional: If hair loss is severe or persists beyond a year, consulting a healthcare provider or dermatologist can help rule out underlying conditions such as thyroid disorders or alopecia areata.

   ***

Remember, hair loss is temporary after giving birth - this too shall pass! Keep focusing on healthy practices, enjoy this season with your new baby, and let time and regrowth take its course. 

Can New Fathers Get Postpartum Depression?

Families welcoming a new child are usually aware to watch for signs of maternal postpartum depression, with 10-15% of mothers affected worldwide [1]. But did you know that fathers can also experience PPD?

Studies show that around 10% of fathers are affected by paternal postpartum depression, often occurring between 3-6 months after birth [2]. That’s a big number! The issue isn’t talked about much in the medical field, so couples are often caught completely unaware, leading to stress and tension while trying to raise a new baby.

What Causes Paternal Postpartum Depression (PPPD)?

It’s easy to pinpoint why mothers experience PPD, but what causes fathers to struggle as well? As it turns out, many of the same factors that contribute to women’s postpartum depression also cause men’s symptoms as well.

1. Hormonal Changes: While not as pronounced as in women, fathers also experience hormonal changes during their partner's pregnancy and after childbirth. Shifts in testosterone, cortisol, and oxytocin levels can affect mood and emotions.

2. Psychological Stress: The transition to parenthood is often overwhelming for both parents. Fathers may experience stress related to financial responsibilities, changes in relationship dynamics, and the demands of caregiving.

3. Personal and Relationship History: A history of depression or anxiety, unresolved trauma, or strained relationships can cause a predisposition to PPPD. This is only exacerbated by a lack of social support or feelings of isolation. 

4. Sleep Deprivation: Usually, both parents tag-team to some degree in caring for the newborn at night. Sleep deprivation is a known risk factor for depression in both men and women.

5. Expectations vs. Reality: Unrealistic expectations about fatherhood and the perceived loss of freedom or identity can contribute to feelings of disappointment or inadequacy.

PPPD not only affects fathers but also impacts the entire family. Untreated depression can put strain on relationships, hinder bonding with the infant, and make it difficult for the father to support the mother as much as she needs.

Symptoms of paternal postpartum depression might include:

• Aggressiveness

• Irritability

• Anxiety

• Depressed mood

• Fatigue 

• Feelings of worthlessness

• GI symptoms

• Headaches

• Withdrawing from relationships

• Negative parenting behaviors 

• Low motivation

• Substance misuse

Recognition and Treatment

Despite how common it is, PPPD is often overlooked. Fathers are less likely to recognize or admit their symptoms if they feel societal pressure to be a strong support and focus solely on the mother’s well-being. Healthcare providers may also overlook PPPD symptoms during routine screenings.

Spreading awareness of PPPD will improve its recognition and support system so that fathers also can navigate birth and postpartum. Some ways to address PPPD:

Education and Awareness: Healthcare providers should be trained to recognize PPPD symptoms and offer appropriate support and referrals for treatment.

Peer Support and Counseling: Support groups and counseling can provide fathers with a safe space to discuss their feelings and learn coping strategies.

Partner Involvement: Encouraging open communication between partners and shared responsibilities in childcare can reduce stress and the risk of PPPD.

Healthy Iron Levels During Pregnancy

If you’re like 35% of the female population in the U.S., you probably don’t have enough iron in your body. Iron deficiencies come with a host of unwelcome symptoms such as dizziness, fatigue, or irritability, but when you’re pregnant, healthy iron levels suddenly become even more important.

What Is Iron and Why Is it Important?

Iron is a mineral that plays a key role in producing hemoglobin, a protein in red blood cells that carries oxygen from the lungs to the rest of the body. During pregnancy, a woman's blood volume increases significantly, leading to a higher demand for iron to deliver enough oxygen to both her own tissues and to the growing baby.

Your hemoglobin and hematocrit levels will likely get checked during prenatal blood work to check for anemia or iron deficiency. If iron levels are low, your midwife can recommend dietary adjustments or quality supplements to start taking.

Why Mama Needs Iron:

1. Preventing Anemia: Iron deficiency can lead to anemia, characterized by fatigue, weakness, and shortness of breath. Anemia during pregnancy can increase risks such as:

   Fatigue and Weakness

   Increased Risk of Infections

   Preterm Delivery

   Postpartum Depression

2. Supporting Increased Blood Volume: A pregnant woman’s blood volume increases by about 50% to support the growing baby, requiring more iron for hemoglobin production.

Why Baby Needs Iron:

1. Development: Adequate iron is essential for the baby’s growth and brain development.

2. Preventing Low Birth Weight: Insufficient iron levels in the mother can lead to low birth weight and delayed development in the baby.

3. Placenta Health: Iron keeps the placenta developing and functioning effectively.

Recommended Iron Levels

The recommended dietary allowance (RDA) for iron during pregnancy is 27 milligrams (mg) per day. This is higher than the RDA for non-pregnant women, which is 18 mg per day. The body's ability to absorb iron increases during pregnancy, but it can still be a challenge to meet the increased needs. 

A whole food diet is the best way to get iron in your body, but sometimes this is easier said than done, especially if it is hard to keep certain foods down. That’s why we recommend reputable iron supplements if you are struggling to keep your iron levels up.

Best Foods for Maintaining Healthy Iron Levels

Heme Iron Sources:

Heme iron, found in animal products, is more easily absorbed by the body than non-heme iron found in plant sources. Foods rich in heme iron include:

1. Lean Red Meat: Beef, lamb, and pork are excellent sources.

2. Poultry: Chicken and turkey.

3. Seafood: Particularly shellfish like oysters, clams, and shrimp.

Non-Heme Iron Sources:

Non-heme iron is also important and can be found in:

1. Legumes: Lentils, beans, chickpeas, and soybeans.

2. Tofu and Tempeh: Good sources for vegetarians.

3. Leafy Greens: Spinach, kale, and Swiss chard.

4. Fortified Cereals and Bread: Many grains are fortified with iron.

5. Nuts and Seeds: Pumpkin seeds, sunflower seeds, and cashews.

Nutrients such as vitamin C and animal proteins can improve the absorption of non-heme iron.

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Looking for quality iron supplements to support your pregnancy?

Check out our natural and vegetarian Gaia Herbs Liquid Iron for pregnant and breastfeeding mothers!

We also recommend grass-fed beef liver supplements from reputable sources as a way to maintain iron levels.

Pitocin: Risks and Side Effects

Pitocin has become a go-to solution of convenience for managing labor, whether used for induction or to speed up a slow progression. Hospitals across the United States use Pitocin as a regular part of the birth process - often as a time management tool - which means that longer labors will either deliver faster or may result in a C-section.

In some high-risk cases, Pitocin can be valuable when used correctly. However, our medical system is pushing Pitocin more and more when unnecessary, frequently causing complications where there were none to start with. 

Birthing Interventions in the U.S.

Maternity care in the U.S. involves a lot of interventions. According to the Listening to Mothers III report [1]:

• 89% of women had electronic fetal monitoring (66% continuously)

• 62% received IV fluids

• 79% weren't allowed to eat during labor

• 60% weren't allowed to drink during labor

• 67% of women who had vaginal births got an epidural

• 31% were given Pitocin to speed up labor

• 20% had their membranes artificially ruptured

• 17% had an episiotomy

• 31% had a C-section

Sometimes there are true birthing emergencies. But why does every birth suddenly “need” so many medical interventions? 

Such heavy use of interventions comes from a mindset of expecting problems and viewing birth as a medical emergency. However, research is showing that a routine use of interventions in the past several decades has actually caused more complications for both moms and babies.

The Paradox of Pitocin

Pitocin is a synthetic form of the naturally occurring hormone, oxytocin. It’s used for inductions: when the birth is scheduled, when the pregnancy goes beyond the due date, or when there is a high-risk medical reason such as preeclampsia or diabetes. It is also used for labor augmentation to strengthen and regulate contractions if labor is not considered to be progressing.

Did You Know? It’s actually super normal for pregnancies to go beyond their due date! The due date is just an estimation, and there’s no reason to be worried if the baby hasn’t arrived a week or two after (as long as there are no medical concerns). 

Here is where the paradox of Pitocin comes in: while it is supposed to facilitate labor, Pitocin often leads to complications that can slow the process and increase the chance of a C-section. Forcing a pregnant woman’s body to labor before it is ready can cause several issues, usually related to uterine hyperstimulation or protracted labor.

• Uterine Hyperstimulation: Pitocin can cause overly strong and frequent contractions, known as uterine hyperstimulation.

• Protracted Labor: Even though Pitocin is supposed to progress labor, it often does the complete opposite. For many women, it actually prolongs labor. The uterus can become fatigued or the cervix may not dilate as expected, leading to a slower, more painful labor process.

Other Side Effects and Risks of Pitocin

Maternal Side Effects: 

• Nausea, fever, or headaches

• Increased risk of postpartum depression and anxiety

• Breastfeeding problems

• Study shows that half of the women who received Pitocin had less optimal breastfeeding outcomes than those who did not receive Pitocin [2]

• Rare cases of uterine rupture

Fetal Side Effects: 

• Hyperstimulation can cause fetal distress, often leading to an emergency C-section

• Oxygen deprivation from hyperstimulation is a leading cause of birth injuries such as cerebral palsy [3 , 4]

• If Pitocin leads to a C-section, the baby misses out on the huge benefits of traveling through the birth canal (improved microbiome, less allergies, less risk of obesity, diabetes, or asthma)

Pitocin When Used with Other Interventions

Using Pitocin often sets off a domino effect of interventions. Pitocin usually goes hand-in-hand with electronic fetal monitoring, which can restrict the mother’s mobility and make labor more uncomfortable. This, in turn, can lead to an increased use of pain relief such as epidurals, which often slows labor down even further and increases the risk of more interventions, including C-sections.

Epidurals and Pitocin are often used together, which tends to cause a downward spiral in speed and ease of labor. 

To navigate the birth canal, the baby needs SPACE. To give the baby space in your pelvis, we recommend walking, squatting, or laboring on all fours so gravity can help. With an epidural, you are typically confined to a bed, which means you cannot walk around or get into natural positions that will help the baby engage.

At the same time, if Pitocin is administered, your body will start to experience strong contractions. If you are in a less-than-ideal position that does not give the baby enough room to move down, yet your uterus is being forced to contract, labor can easily stall, possibly putting the baby in distress and making a C-section more likely.

We recommend caution when dealing with Pitocin - there are certainly times when it works as intended and women have the births they want! Unfortunately, there are also many times when it only hinders labor and causes preventable problems. Our goal at the Cincinnati Birth Center is to help women make informed decisions for their births so they can choose what is best for them and their babies.

Midwife Model of Care - Our Philosophies

Over the centuries, midwifery has evolved into a woman-centered model of care using philosophies that align with local cultures and scientific research. 

In the United States, the Midwife Model of Care views pregnancy and birth, not as something to fear, but as a normal life process that does not always require interventions or invasive practices.

Find out how the Cincinnati Birth Center handles topics such as:

Schedule a free tour of our birthing center!

• Epidurals

• Natural Pain Management

• Breech Babies

• Hospital Transfers

The heart of midwifery lies in prioritizing the health of mother and baby while standing shoulder-to-shoulder with the mother in personalized approaches.

What Does the Midwife Model of Care Include?

The Midwife Model of Care is an approach that attends to the physical, psychological, and social well-being of the mother throughout pregnancy, childbirth, and postpartum.

This model is distinguished by several key practices:

1. Holistic Monitoring: Midwives continuously monitor the overall health of the mother, including her physical condition, emotional state, and social environment.

2. Individualized Support: Mothers receive personalized education, counseling, and prenatal care. During labor and delivery, midwives provide continuous, hands-on assistance, followed by supportive postpartum care.

3. Minimizing Interventions: Technological and medical interventions are minimized to help mothers achieve natural childbirth whenever possible while ensuring safety.

4. Timely Referrals: Midwives are trained to identify situations that require obstetrical intervention and make timely referrals when a pregnancy is no longer considered low-risk or a hospital transfer is needed.

The above key practices are shaped by the following philosophies:

• Midwives are considered the most suitable caregivers for women during childbirth, offering specialized and compassionate care.

• Midwife care promotes, protects, and supports women's health and rights, respecting ethnic and cultural diversity.

• This care model is continuous and holistic, addressing the social, emotional, cultural, spiritual, psychological, and physical experiences of women.

• Midwives build up the health and social status of women, empowering them through their ability to cope with childbirth.

• Midwives are respectful, personalized, continuous, and non-authoritarian, referring back to the philosophy of a woman-centered model of care.

• Midwife care is guided by ongoing education, scientific research, and the application of evidence, making sure that it is both ethical and competent.

History and Evolution of the Midwife Model of Care

The role of midwives in the United States has constantly evolved over the years. Historically, midwives were the primary providers of maternity care, particularly in rural and underserved areas. However, the rise of hospital-based obstetric care in the 20th century led to a decline in midwifery services. It wasn’t until the latter half of the century, amidst growing concerns over high intervention rates and a movement towards more personalized care, that midwifery began to experience a resurgence.

The establishment of professional organizations, such as the American College of Nurse-Midwives (ACNM) in 1955, played a role in professionalizing midwifery and integrating it into the broader healthcare system. Today, midwives are recognized as key providers in maternal healthcare, working in various settings including hospitals, birth centers, and home birth practices.

Midwifery Today

Today, the number of births attended by midwives in the U.S. is increasing as awareness grows and home birth myths are dispelled. Studies have proven that midwife care reduces the need for cesarean sections or medical interventions, and significantly lowers the rate of birth injury or trauma [1 , 2]. 

Despite the proven benefits, midwifery in the U.S. faces challenges such as:

• Varying state regulations

• Limited integration into some healthcare systems

• Public misconceptions concerning safety

We need to constantly advocate, educate, and address policy reforms to push our cause forward.

Looking ahead, integrating midwives into regular healthcare and increasing access will help meet the needs of diverse populations, reduce medical interventions, and lead to healthier outcomes for mothers and babies.

Midwifery Legislation in Ohio

Meghan speaking at the capitol

Midwife legislation has experienced a lot of evolution in the United States. Regulations vary across all 50 states depending on how each approaches healthcare, autonomy, and professional standards.

Ohio is currently a focal point with a bill in review which could open up midwife licensure and integration into healthcare. Our very own Meghan Nowland recently visited the state capitol and advocated for midwifery legislation, coinciding with the International Day of the Midwife on May 5, 2024!

Midwife Regulation in the US: CNMs vs CPMs

Midwifery is governed by a web of state-specific laws and regulations across the U.S. These laws typically distinguish between Certified Nurse-Midwives (CNMs) and Certified Professional Midwives (CPMs).

• CNMs generally enjoy broader practice privileges due to their nursing background and advanced education. CNMs are licensed in all 50 states and are usually authorized to practice in hospitals, birth centers, and home settings.

• CPMs, on the other hand, tend to work exclusively at home births and birth centers and face more restrictive licensing laws. Only 36 states have specific licensure pathways for CPMs, which leaves them advocating for their right to practice. 

Ohio Legislation - House Bills 496 & 545

In 2022, House Bill 496 was introduced which would allow midwives to become licensed and fully integrated into the healthcare system. 

Meghan with State Representatives Riordan McClain & Melanie Miller

As of May 2024, House Bill 545 was also introduced into the 135th General Assembly to further the cause of midwife regulation. 

The proposed legislation, backed by a coalition of midwifery advocacy groups, healthcare professionals, and lawmakers, seeks to create a regulatory framework that acknowledges the competencies of CPMs while ensuring safety and quality standards.

The bills have received substantial support from both the public and professional communities. Proponents argue that formal licensure will enhance access to midwifery services, particularly in underserved rural areas where traditional healthcare facilities are sparse. It will also integrate CPMs into the broader healthcare system, providing better collaboration and emergency care protocols.

Currently, we are facing a shortage of midwives due to restrictive regulations. The enactment of these bills will increase the number of those who can practice and will open up employment opportunities in Ohio.

To summarize, the formal licensure of CPMs would:

1. Enhance Access to Care: By providing a clear regulatory framework, the bills will likely increase the number of practicing CPMs, improving access to midwifery services, particularly in rural and underserved communities.

2. Integrate Midwifery into Healthcare: The bills will foster greater collaboration between midwives and other healthcare providers, promoting a more integrated and comprehensive approach to maternal and infant health.

3. Standardize Quality and Safety: By setting educational and practice standards, the bills aim to ensure high-quality care and enhance patient safety, addressing concerns about the variability in midwifery practices.

4. Improved Outcomes: This change could potentially improve maternal and infant outcomes by providing more birthing options and integrating midwifery more fully into prenatal and postnatal care frameworks.

When to Transfer to a Hospital During Home Birth

Most home births go smoothly without the need for any medical interventions or hospital transfers. Since a low-risk pregnancy is required to qualify for a home birth, any emergencies that occur can usually be handled by the midwife at home. 

Sometimes, despite careful planning and preparation, a hospital transfer might be necessary. The decision to transfer during labor is never taken lightly and is one your midwives will carefully consider with you, prioritizing the safety of both you and your baby. At the Cincinnati Birth Center, we average around 10% of our clients transferring during labor with a 6% cesarean section rate. Even with these low numbers, it is always best to be prepared. In the event of an emergency, what are some reasons a transfer might need to happen?

4 Reasons for a Hospital Transfer

1. Stalled / Slow Labor

Usually, slower labor isn’t something to be too concerned about, especially during the first part of labor or if you are a first-time mom. If nothing seems to be progressing or contractions are slowing down, you may want to try different ways to get things moving that don’t involve medical interventions:

• Try going for a walk to encourage the baby to descend.

• Change your surroundings if you are uncomfortable, feel closed in, or need more privacy.

• Switch up positions frequently - being stationary for too long can slow things down.

• Stimulate your nipples to produce oxytocin for contractions.

However, if labor is progressing too slowly during the second stage of labor, the mother may become exhausted and the baby could run the risk of fetal distress. Your midwife will work with you to make a judgment call if it’s time to move to a medical facility.

2. Postpartum Hemorrhage

At a home birth, midwives are equipped to handle most hemorrhages the same as a hospital doctor would, and there is very rarely any cause for concern. Most hemorrhages are mild and are easily managed. Sometimes postpartum hemorrhages happen after the first 24 hours post-birth, which is one reason why your midwife will conduct multiple postpartum visits to check on both you and baby.

In the rare event of a severe hemorrhage, an ambulance will be called while the midwife massages the uterus to stimulate a contraction, administer an oxytocic drug, and put up an IV if this does not stop the bleeding.

3. Infant Respiratory Problems

After the baby is born, his or her respiration is monitored and recorded until it has remained stable for two hours. If the baby is born in respiratory distress, the midwife will immediately perform resuscitation with her emergency equipment. However, a medical transfer will take place if the infant continues to show signs of respiratory distress or cyanosis (blue skin due to lack of oxygen).

4. Request for Epidural 

Sometimes mothers (especially first-time moms) change their minds and decide they want to transfer to a hospital for an epidural or help with accelerating labor. Before choosing a provider, it’s wise to consider whether you can commit to a birth without medical pain management. If you change your mind during labor, your midwife will respect your choice and transfer you to your chosen backup hospital.

Remember, a decision to transfer to a hospital is not a home birth “failure!” Your midwives are committed to ensuring the safety of you and your baby, and sometimes extra medical attention is needed. At the end of the day, what matters is that your baby is in your arms no matter where you are.

How Should I Plan for an Emergency Transfer?

Although most births proceed without complications, you will want to have a plan in place just in case of an emergency.

• Start by researching or asking your midwife reasons a transfer might be necessary to help you understand when and why it might need to happen. 

• If you have a written birth plan, include a “plan B” if you need to go to a hospital and make sure your preferred location is listed along with a phone number. Include a section specifically addressing the possibility of a transfer, detailing preferences for transportation, choice of hospital, and preferences for medical interventions if needed.  If you aren’t writing out a birth plan, keep the hospital’s address and contact information somewhere close by, such as hanging on the refrigerator.

• Discuss transportation options in advance and make arrangements if needed so that you have a reliable mode of transport to the hospital if needed.

• Even if you are planning on a home birth, you will still want to pack an emergency bag just in case you have an unexpected hospital stay. Include clothing, toiletries, personal documents, and any comfort items that can help make the transition smoother. Keep the bag nearby in case of a sudden transfer.

• Keep an emergency contact list close by of healthcare providers, family members, and anyone else who may need to be notified in case of a transfer.