My first baby was born in a hospital birthing center. We went home less than 24 hours later, with instructions to bring the baby back in 3 days to have blood drawn for the newborn screening. We did get a phone call the next day asking how things were going — a follow-up we would not have received had we been discharged from the regular maternity ward rather than the birthing center.

When I had my second baby at home, I was amazed at the difference in the post-partum care. My midwife came for the first post-partum visit the day after the birth and again two days later. She checked on us again at 2 weeks and 6 weeks postpartum. Each visit lasted about an hour.

Postpartum support is an important component of the Midwives Model of Care. But for women who give birth in the hospital, there is often little or no follow-up care in the early days at home with their new baby.

Though most new mothers need little more than encouragement and reassurance as they learn to care for their new baby, early discharge without in-home follow-up can be dangerous when problems develop.  The Chicago Daily Herald reports on a group of CNMs in Colorado who have a post-partum home care practice that attempts to fill the gap.

Lillian Craze, 38, felt fine for the first few weeks after the home birth of her son Cooper, but then one morning she began to feel feverish and extremely fatigued. After a conversation with her physician, she was connected with Beyond Birth Midwifery, and within 30 minutes Chandler was at her door. She diagnosed her with mastitis (a breast infection), called in a prescription for antibiotics, and gently encouraged Craze’s family members to help her to get more rest.

“It was huge to me to have her come to my home, rather than having me sit in the doctor’s office with a 103-degree fever,” she says, noting that Chandler was better able to assess her situation and offer advice by seeing her at home. “It reminded me of the good old days of the family doctor who made house calls.”

At a party yesterday, a co-worker of my husband’s admired my new baby, who was peacefully sleeping in a sling. “I became a great-aunt this morning,” my acquaintance informed me. “My niece had her first baby.”

She continued, “It was very ironic — a few weeks ago she was in the hospital to keep the baby from coming early. But when he was allowed to come, she didn’t go into labor, so she had to be induced. And then he didn’t come in 24 hours, so she needed a Cesarean.” She added, “Of course, she was very happy to be done!”

Stories like this are as common as baby announcements. This article looks at studies and statistics from the U.S. and Europe and comes to some troubling conclusions. In most developed nations, the combined total of cesarean deliveries and induced labors ending in vaginal birth outnumber vaginal births after spontaneous labor.

With less than half of all babies “coming in their own good time”, births drop dramatically on weekends and holidays, and fewer births happen at night — even though, as the article notes, “many studies have shown that women’s natural hormonal cycles tend toward labor starting at night.”

Despite the risks of inductions and cesareans, the article finds a way to put a positive spin on obstetric convenience. Having babies during “banker’s hours”, the article tells us, is actually safer. According to a recent Texas study, “Particularly among hospitals that delivered about 4,000 to 7,700 babies [in a 3-year-period], there was a 51 percent greater risk of death for a baby born on a weekend than on a weekday.”

Sounds alarming, doesn’t it? The Texas study article advises parents to be to “shop” for their hospital, choosing one that delivers more babies and has a better-staffed neonatal nursery just in case their baby needs special care.

At least parents weren’t advised to schedule their birth during the week to avoid weekend staff shortages. Induction increases the already high risk of Cesarean section, and non-emergency Cesareans increase neonatal mortality by 70 - 90%.

The issue of increased neonatal mortality on weekends has been debated for years, with conflicting findings in different studies. Reduced staffing on weekends is generally blamed for the “weekend effect”. However, some of these studies have noted that pre-term and low-birth weight births are over-represented in weekend births — probably because preterm births are least likely to be affected by obstetric practices which lead to the higher rate of births on weekdays. A 2003 study found that after adjusting for birth weight, the weekend increase in neonatal mortality was no longer statistically significant.

Expectant parents need more options than shopping for the best neonatal intensive care nursery and scheduling their induction for the most convenient weekday. In the hospital setting, the Midwives Model of Care has been shown to reduce inductions, cesareans, and preterm and low-birth-weight babies. As for me, I’ll stick with a CPM who makes house calls — even on weekends and holidays.

According to survey of maternity experiences by Statistics Canada, just over half of Canadian women found their birth experience to be “very positive” — but this number increased significantly if they were attended by a midwife.

“Women whose primary caregiver at birth was a midwife rated their labour and birth experiences as “very positive” more often (71%) than those cared for by obstetrician/gynaecologists, family doctors or nurses and nurse practitioners (53%).”

Midwives are legally regulated and integrated into the health care system in all of the most populous Canadian provinces, while most other provinces have midwifery legislation pending. Canadian midwives provide care for both hospital and out-of-hospital births.

Midwives practicing in out-of-hospital settings are a dedicated bunch. Anecdotal reports abound of inductions scheduled, pitocin administered, and cesareans performed in greater numbers just before a holiday. Midwives joke about how many events they’ve missed because of babies. I called my midwife away from her family Christmas gathering to attend my fifth birth two years ago. Somewhere, yesterday, a midwife (likely, more than one) missed Thanksgiving dinner to go to a birth.

As guardians of natural birth, midwives can’t schedule, speed up or surgically end labors for their own convenience. Their phones ring at all hours of the night. When a labor lasts two days, they don’t go off shift and let someone else take over. They learn to catch their sleep when and where they can. Their families get used to having them unexpectedly called away and not knowing when they’ll be back.

Midwifery is not a financially lucrative or widely respected profession.  Health insurance may refuse coverage for a home birth. Midwives who invest many years of their life into creating a freestanding birth center are frequently forced out of business by rising malpractice insurance costs or difficulty finding physicians willing to work with them.

In states like Ohio, where direct-entry midwifery is not legally recognized, midwives who have spent years training and passed rigorous national certification exams may also risk criminal investigation and prosecution should they accompany a client who needs to transfer to the hospital.

Midwives remain on the “front lines”of the battle for birthing women’s autonomy in  choice of birth place and management of labor, because they passionately believe in the value of their work for women, babies, and families. If you have benefited from the sacrifice and dedication of a midwife, take some time this Thanksgiving weekend to show your appreciation with a note, a call, or a quick email. And then, consider what you can do to help make midwifery care an option for everyone who wants it.