Birth Choices (from Dragonfly Doulas)
f you are delivering your child in Oregon, you are in luck! We are considered the best state in the nation for maternal choices, in fact according to a Fit Pregnancy.com January 2008 survey found Portland, Oregon to be the #1 best place to have a child.
Oregon has very few laws regarding birth, which means that most families are able to find a birth option that works well for them.
Midwifery and home birth are both 100% legal here, as is unassisted birth. There are several freestanding birth centers, and many of the local hospitals have “in hospital birth centers” which are geared to normal, low intervention deliveries.
So, who do you choose to care for you and your baby? For your professional prenatal and birth care providers, you can choose from Midwives, Naturopaths and Physicians.
Licensed or Certified Professional Midwives
Certified Nurse Midwives
In Oregon, direct entry midwives are free to attend “normal deliveries,” which can vary widely among care providers. Be sure you discuss what situations you would “risk out” with any midwife or birth center you are considering.
Direct Entry Midwives (DEMs): operate under the assumption that birth is not a medical event, but a life event and as such follow the Midwifery Model of Care, which assumes healthy women do not need the assistance of doctors or a hospital setting to deliver a child safely. DEMs attend home and birth center births. Most DEMs are trained to handle most normal birth and pregnancy situations. There are no legal requirements in Oregon for the practice of direct entry midwifery, although a DEM may choose to become licensed through the state at this time. There are many competent midwives who have chosen not to become licensed or certified. Please note that direct entry midwives are not permitted to give pain medication, epidurals or perform cesarean sections.
Licensed Professional Midwives, Certified Professional Midwives, Licensed Direct Entry Midwives (LPMs, CPMs & LDMs): A LDM is a direct entry midwife who has completed the requirements for licensure through the State of Oregon. LDMs follow the Midwifery Model of Care and attend home and birth center births. To read about the legal requirements for licensure of Direct Entry Midwives in Oregon, click here. A CPM is a direct entry midwife who has requirements for certification from the National Association of Registered Midwives, or NARM Like DEMs, CPMs follow the Midwifery Model of Care and attend home and birth center births. For information on the requirements for CPM certification, click here.
Certified Nurse Midwives (CNMs): A CNM is a midwife who holds a Master’s Degree in Nurse Midwifery and has passed the requisite boards, which are administered nationally. Oregon CNMs are governed by the Oregon Chapter of the National Association of Nurse Midwives. CNMs follow the Midwifery Model of Care although most do so in a hospital setting and can prescribe IV drugs such a pitocin. CNMs frequently work in a practice with OB/GYNs, and have hospital privileges. If you choose a CNM as your care provider, find out what the hospital regulations are regarding monitoring, and at what point the CNM will recommend a cesarean section. Make sure your views are in line with theirs regarding your birth choices.
Naturopaths (NDs): Naturopaths are Naturopathic Physician who holds a Doctorate degree of Naturopathic Medicine and are allowed to attend births in Oregon if they have obtained a certificate of Special Competency In Natural Childbirth from the Oregon Board of Naturopathic Examiners, per ORS. 685.135. Naturopaths follow the Naturopathic Medicine model of care. Naturopaths typically are in private practice unaffiliated with a hospital and may have a birthing suite in their offices. Naturopaths may attend homebirths, but it is not very common.
Family Practice Doctor (MDs): These are Medical Doctors who hold a Doctorate degree in medicine. MDs follow a pathology based approach which is typical in Western Medicine. A family doctor will have training in typical deliveries and may be very knowledgeable about birth, especially if they have been in practice for 10 years or more. However, MDs are no longer trained to handle certain natural childbirth anomalies such as breech birth or gestation longer than 42 weeks in any way other than by cesarean section. If you choose a MD as your care provider, make sure your views are in line with theirs regarding your birth choices, particularly regarding breech birth and gestation time. Most MDs have hospital privileges.
Obstetrician/Gynecologist (OBGYNs): These are Medical Doctors who hold a Doctorate degree in medicine, and have additional surgical expertise in the field of obstetrics and gynecology. OBGYNs follow a pathology based approach which is typical in Western Medicine. An OBGYN will be knowledgeable in the diseases surrounding pregnancy and childbirth and will have a set standard of care regarding each issue. If a mother has compounding medical issues, she may be referred to a perinatologist who specializes in high risk pregnancies. The current standard of care for most OBGYNs is geared towards an induction and/or elective cesarean section for the following conditions: preeclampsia, macrosomia, breech position, or gestation longer than 42 weeks. If you choose an OBGYN as your care provider, make sure your views are in line with theirs regarding breech birth and gestation time. Most OBGYNs have hospital privileges.
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©Willow Birth Association, 2008