Nurse-Midwives Provide Another Kind Of Birthing Experience

To have a hospital birth or a home birth? On the one side, a fear of unnecessary interventions and on the other a nervousness about “what if?” When Santa Cruz pediatrician Raelene Walker found out she was pregnant, she chose a third option of working with a midwife in a hospital setting.

“I think midwives can safely deliver the majority of babies,” explains Dr. Walker, “because, for the most part, birth is a normal life-event, not a medical one.” When people think of working with a midwife, their perception is of a home birth. While home birth is a wonderful option for many women, the reality is that ninety-six percent of all midwife attended births take place in a hospital with Certified Nurse-Midwives (CNMs). Dr. Walker’s experience with her first pregnancy made her choices for her second delivery clear, “With my first child I lived in a town where all normal pregnancies were delivered by CNMs, and so when I was pregnant with my second child, midwife care just felt like the obvious choice.”

Local mom, Amy Wimmer, had both her girls, now ages two and four with a CNM. Her father is a doctor, and he encouraged her to find a good OB-GYN to care for her during her pregnancy, emphasizing the potential medical complications. “I really wanted to find someone who I felt I could trust to keep the experience as natural as possible. I wanted a birth without all of the pathological interventions; with someone who would take the time to explain what was happening and who valued my opinions.” When Amy talked with friends in the community about their birth experiences, she found the idea of midwifery care appealing, as she would have an advocate for normal birth within the hospital setting.

In Santa Cruz, the overall average for primary cesarean sections is twenty percent; using a CNM cuts that number in half. CNMs are licensed health care practitioners educated in the two disciplines of nursing and midwifery and are certified by the American Midwifery Certification Board. Approximately eighty percent of them also have a Master’s Degree. By taking an active role in quality control and hospital protocol meetings, local CNMs work to keep normal birthing standards a priority.

California leads the nation in midwife assisted births, with almost double the number of any other state. In Santa Cruz, approximately twenty percent of births are by hospital-based midwives, while CNMs delivered close to ten percent of all vaginal births in hospitals nationwide. The availability of midwifery care in the United States has been rapidly growing, supported by published research which demonstrates that CNMs provide high quality outcomes, high levels of patient satisfaction and lower overall costs due to not performing unnecessary, invasive and expensive technological interventions. Midwives are becoming more widely available primarily due to their popularity among patients.

When Amy began researching her options, she found that both Dominican Hospital and Sutter Maternity Center offered midwife care. There are currently five CNMs working in Santa Cruz County providing prenatal care and in-hospital deliveries as well as gynecologic care for both well-women and problem visits. When she went to meet with her midwife for her first prenatal visit, Amy was reassured to learn that she offered all of the same comprehensive options for care that an OB-GYN would, including all the latest testing and ultrasound technology. However, in addition to these medical choices, her prenatal care visits were longer and more personal. She felt like her midwife really took the time to listen to her concerns and offer support. She was also reassured to learn that her CNM planned to arrive at the hospital when she was in active labor and stay with her all the way through her delivery.

The CNMs from left to right: Margann Mentor, Timmi Pereira, Leora Fromm, Kris Ayer and Meredith Hammig.

When she first decided to choose a CNM for care, Amy believed that she would be supported in her desire for a non-medicated birth. Her midwife assured her that she would recommend many non-medical pain coping techniques such as walking, position changes, and laboring in a tub, but she also clarified that if Amy should change her mind, an epidural was an option. While CNMs are trained in techniques for supporting women in labor without medical pain relief, they are equally comfortable working with the hospital anesthesiologist to provide medication in labor as well. The goal of midwifery care is to assist patients in making whatever choices are right for their particular birth experience, so that women feel supported and empowered.

When the day came for Amy to have her first baby, she arrived at the hospital in very early labor. Her family shared their concerns and emphasized her medical options, but her midwife reassured her about her prospects for a normal delivery. She went on to have a quick and easy delivery with her midwife by her side. When she got pregnant for the second time, she knew that the in-hospital midwife option was the perfect choice for her. In discussing her overall experiences Amy emphasized her personalized care explaining, “A lot of people assume that choosing to deliver in the hospital means that you give up all control. Before my labor I made a list of preferences: low-lighting; quiet environment; no medication; the freedom to birth in the position of my choice. I felt like for both of my deliveries, all of these preferences were honored.”



Leora Fromm is a CNM who has been delivering babies in Santa Cruz hospitals for the past ten years. She is currently working at OBGYN Associates of Santa Cruz. Her two children, ages six and nine, were born at home. She received her nursing degree from Columbia University, and her master’s degree at UCSF.



Photos by Gayle Mitchell
 

Nurse-Midwives Provide Another Kind Of Birthing Experience
By Leora Fromm