Prior to the 1930s, when hospitals became the common place to give birth in the United States, most women would choose a set of funeral clothes for the child while they were preparing to give birth. While modern medical technology takes credit for saving the lives of infants with advanced neo-natal intensive care units and a surgical alternative to vaginal birth, simpler advances such as cleaner drinking water and better nutrition have also played a role in healthier pregnancies and deliveries.
But the dramatic and -- many believe -- unnecessary cost has been losing touch with the natural process of giving birth, according to Paula Morelli, a certified nurse-midwife with Greater Cincinnati Nurse-Midwives (universityhospitalcincinnati.com/nurse_midwifery.html).
"A core belief and in our training is that pregnancy and childbirth are natural processes," she says, "and we're there to support, to help women understand what is going on with their bodies, what's involved in the labor process ... to learn how and why and to deal with normalcy. We're looking at normalcy and accessing for the abnormal. Generally speaking, the medical model tends to be more disease-oriented: Where are the problems and how do we correct them?"
As one of 11 practitioners in Greater Cincinnati Nurse-Midwives with a bachelor's degree in nursing and a master's degree in midwifery, Morelli says nurse-midwives combine the best of modern medicine and nature because their practice is housed in the University Hospital.
"We're more experienced in un-medicated childbirth," she says. "It's not that the doctors can't or don't support that. We are trained. We're more experienced. If something ensues that is high-risk, then we have our back-up doctors and the resources for anything that turns abnormal."
The profession is governed by state and national certifications and educational standards established by the American College of Nurse-Midwives (acnm.org). A core tenet of the organization, Morelli's practice and most literature on the subject is the need to support women throughout their pregnancies, not treat them like a disease waiting to happen.
"Midwives are more patient when it comes to the baby coming out the way Mother Nature intended," says Erika Johns, a mother of two, who delivered her second child with a nurse-midwife. "I almost gave up. ... I thought that I wasn't strong enough, but there was a lot of encouragement. Eventually I delivered him, and we were surprised to learn he weighed 11 pounds, 12 ounces. I wasn't weak at all!"
Morelli was the midwife who provided much of that encouragement to Johns before and during the birth Feb. 14.
"It's scary having a baby," Johns says. "You don't know what the outcome is going to be. It's obviously very painful, and it's emotionally draining as well as physically draining. It's good to have that support of women there to be there and keep you optimistic. I think Paula hit the nail on the head when she said it's important to make educated choices."
In addition to making sure an expectant mother has all the medical care she needs, a midwife also helps a pregnant woman understand what's normal during pregnancy and make the necessary preparations for the kind of birth she wants to have.
"It's being present," Morelli says. "It's listening, giving information: 'Here's why you're nauseated in early pregnancy or what we understand about it and ways you can correct it or try to prevent it.'
"It's what the woman wants. It doesn't mean if somebody wants to have an epidural, we're going to look down on (her). It's about educating women so that they are informed, so they can make choices -- and then empowering them to do that. Those are big concepts for us: education and collaboration with the woman and then empowering her to make decisions about her health care."
After having to wait 11 weeks just to get in to see a physician -- the docs in the group were busy taking vacations -- Johns says the man she saw made her "feel like a number." When she found out her health insurance would pay for a midwife, she made the switch.
The midwives in her group schedule long appointments, are available 24 hours a day seven days a week and can administer an epidural or write prescriptions for almost any medication that might be needed.
In addition to her expertise, attention is one of the greatest assets a midwife has to offer, according to Dr. Jeff Livingston, one of the physicians who supports the group at University Hospital.
"Midwives have a lot more time to spend with their patients," he says. "During the labor process, they tend to be in the room more often. If you're looking for time with a health-care provider, you're going to get more time with a midwife than you are with a physician."
Referring to midwives a "physician extenders," Livingston says he appreciates the work done by midwives.
"I think most physicians have respect for physician extenders," he says. "You're going to have people who are very pro-physician extender and people who are very anti-physician extender. A lot of has to do with how many gray hairs you have, when you trained and where you trained."
While the term "extenders" makes doctors appear superior, a review of national statistics reveals that their medical-risk approach to "low risk" pregnancy can actually create problems. Midwife-attended births result in fewer C-sections (11.6 percent vs. the overall average of 23.3 percent) and lower infant mortality rates (4.1 per 1,000 vs. the overall average of 8.6). Studies show midwife-attended home births reduce the risk of infection, risks from hospital errors and interference in bonding and breastfeeding because of facility policies.
"I think the literature is very clear that outcomes in women who are at low risk for having complications are better in women who are cared for by midwives than who are cared for by physicians," Livingston says. " For people who are at low risk, it is a very reasonable thing to consider doing." ©