Are you expecting a baby but can’t give birth at home? Are you planning to give birth in the hospital and want natural childbirth? If so, Advanced Labor Support/Monitrice Support is just what you need. A Monitrice is an advanced labor support professional with skills to monitor you and your baby’s well-being, allowing you to stay home longer before going to the hospital.
Seannie Gibson, LM, CPM
Licensed Midwife Providing Monitrice Services
Labor of Love Advanced Labor Support
Labor of Love Advanced Labor Support offers expertise and compassionate care for your birth by a Certified Professional Midwife who is licensed as a midwife by the state of California and has many years experience offering hospital labor support and midwifery care.
A Licensed Midwife or Nurse-Midwife who offers support to women planning hospital birth who want skilled support to labor at home is a Monitrice, or an Advanced Labor Assistant. She provides skilled care during labor and postpartum.
Midwives or nurses with labor and delivery experience and training as a doula, who provide Advanced Labor Support/Monitrice Services for women who plan to give birth in the hospital are called “Montirices”. In this capacity, The Midwife is not acting as the woman’s primary care provider. Instead, she works collaboratively with the pregnant woman and her doctor to help her achieve her birthing goals by providing expertise and skilled labor assistance. She does not make any medical decisions and encourages the woman to follow the instructions of her doctor.
Basic Doula Support provides emotional support and physical comfort to women during labor. The Doula may also provide consultation for creating a birth plan before the birth and breastfeeding support afterward. She does not conduct physical assessments of mother or baby such as fetal heartrate monitoring, assessing cervical dilation, or taking maternal blood pressure.
The Advanced Labor Assistant/Monitrice—or Licensed Midwife, labor and delivery nurse, or Nurse-Midwife providing labor support–offers the customary services that Basic Doula Support provides, but with something extra. The Monitrice will monitor the mother and fetus’ well-being. She can help the woman know when it is time to go to the hospital by evaluating labor progress. A Monitrice offers skilled support during labor and postpartum including:
- Monitoring the woman’s vital signs (blood pressure, temperature and pulse
- Checking the laboring woman’s cervical dilation (opening of the mothers cervix) and assessing the baby’s descent.
- Listening to baby’s heartbeat during labor to ensure that he/she is tolerating labor well.
- After the birth, she will make home visits to assess mother and baby: providing physical examination of the newborn, weighing and measuring the baby, monitoring mother’s postpartum recovery, giving breastfeeding instruction and emotional support.
The Monitrice has been trained to recognize danger signs. If anything is abnormal during labor or postpartum, she can help the family access medical help in a timely manner. She can also help communicate with the woman’s doctor, and will work collaboratively as part of the birth team.
Childbirth Connection’s Cochrane Review of studies on continuous labor support* (2003, 2007) summarized outcomes reported in at least 4 studies involving at least 1,000 women. Women who received continuous support were less likely than women who did not to:
- Have regional analgesia
- Have any analgesia/anesthesia
- Give birth with vacuum extraction or forceps
- Give birth by cesarean
- Report dissatisfaction or a negative rating of their experience.
*Research by Kennel and Klaus of Continuous Labor Support
“Outcomes include, but are not limited to, lower rates of analgesia and anesthesia use, lower operative birth [cesarean section] rates, shorter labors, fewer newborns with 5-minute Apgar scores less than 7, increased maternal satisfaction with the birthing process, and much more.” (from the abstract of Journal of Obstetric, Gynecologic, & Neonatal Nursing, Volume 31 Issue 6, Pages 733 – 741. Published Online: 9 Mar 2006).
With a Monitrice present during labor, the woman and her family can relax. She will assure them that everything is okay.
Fathers and other family members may feel uneasy at home while the mother is in labor, as labor can be quite intense for some women. Because of this, expectant parents may go to the hospital too soon. For many mothers, the early part of labor can take many hours. During this time, mothers are usually more relaxed in their own homes where they can eat and drink, walk, rest and wait for active labor. A calm environment helps labor progress. The Monitrice helps create an atmosphere of trust and tranquility, and helps boost the mother’s confidence and puts the father and/or other family members at ease.
Going to the hospital in early labor can lead to unnecessary medical procedures such as cesarean section surgery. There may be strict time limits for labor progress, restrictions on the mother’s movement, and eating or drinking in labor may not be allowed. The presence of a professional labor companion can help the woman cope with these obstacles. These restrictions of movement and imposed time limits can either slow labor down, make labor more painful and harder for the woman to tolerate, and increase the possibility of receiving pitocin to make labor stronger and go faster (“augmentation”). This can make labor more painful for the mother. As time passes, and labor becomes more intense, the woman may want pain medication. While that is always an option, there are side-effects on labor, woman and baby. The Monitrice can offer education, helping the woman and her partner make informed choices.
Results from the Listening to Mothers Survey II (2006) conducted by Childbirth Connection of 1573 mothers who gave birth in 2005 revealed that technological birth is the norm in the U.S.
The executive summary of the report states,”despite the primarily healthy population and the fact that birth is not intrinsically pathologic, technology-intensive childbirth care was the norm. Each of the following interventions was experienced by most mothers: continuous electronic fetal monitoring, one or more vaginal exams, intravenous drip, epidural or spinal analgesia and urine catheter. Half the mothers experienced one or more methods of inducing labor…and a notable minority experienced each of the following: labor that was induced with synthetic oxytocin (pitocin) during labor, artificial rupture of membranes, narcotics, cesarean section (32%), episiotomy, perineal stitches, staff directed pushing and staff member pushing on mother’s belly to help push baby out. Only 11% had Vaginal Birth After Cesarean.” One quarter of the women surveyed said they felt “weak” and “overwhelmed” and used other negative words to describe their feelings about their births.
With few exceptions, the report states, “the forms of care appropriate to low-risk women were not used”. These include use of the birth ball, immersion in a watertub or shower, monitoring baby with hand held devise, eating, drinking, ambulating and laboring in an upright positions and self-directed pushing.
Childbirth Connection states only “a very tiny minority (2%) experienced all of the care practices that promote natural birth.”
Such care practices are endorsed by Lamaze International and the Coalition for Improving Maternity Services (CIMS), which developed the Mother Friendly Childbirth Initiative, 10 evidence-based steps to improve maternity care.
Lamaze’s “Six Care Practices That Support Normal Birth” represent “evidence-based care which is the gold standard for maternity care worldwide. Evidence-based care means using the best research about the effects of specific procedures, drugs, tests, and treatments, to help guide decision-making.” (Lamaze, 2009). The practices are:
1. Labor begins on its own.
2. Freedom of movement throughout labor.
3. Continuous labor support.
4. No routine interventions.
5. Spontaneous pushing in upright or gravity-neutral positions.
6. No separation of mother and baby after birth with unlimited opportunities for breastfeeding.
The Coalition for Improving Maternity Services (CIMS), “a coalition of individuals and national organizations with concern for the care and well-being of mothers, babies, and families” developed The Mother-Friendly Childbirth Initiative (MFCI) and “The Ten Steps to Mother-Friendly Care” which are evidence-based recommendations for maternity and newborn care (CIMS, 2009). The evidence for the recommendations were published in the peer-reviewed Journal of Perinatal Education (2007). To download the document: click here
This snapshot of birth in America sounds grim indeed, but the presence of a Monitrice can help mitigate these interventions.
If you want natural childbirth and are planning a hospital birth, you need a skilled professional who can do more for you than hold your hand and wipe your brow. You need a strong advocate to help negotiate with the hospital staff, who is also a skilled birth attendant helping you remain at home until active labor thus avoiding hospital procedures which may disrupt the normal process of labor, birth, breastfeeding and mother-infant bonding.
Given all these benefits, why wouldn’t you choose to have one of these special women by your side when you give birth? If you are committed to having natural childbirth, hire a Monitrice.