On New Year's Eve, Gloria Forgash was not celebrating like most holiday revelers.
Instead, the veteran nurse midwife was helping deliver a baby boy during the last exhausting stint of a prolonged labor.
Hours later, nurse midwife Ellen M. Ray arrived at the hospital for another marathon labor, resulting in the birth of a baby girl ninehours later.
For Howard County's nurse midwives, it was out with the old and in with the new -- nurse midwives here delivered the lastbaby of 1990 and the first of 1991.
Although Forgash missed out on champagne toasts and noise-makers, she couldn't think of a better way to end 1990.
"I love to deliver babies," she said.
Forgash and her partner, Beth Rodgers, are part of the obstetrics-gynecology department of the Columbia-Freestate Health System, a health maintenance organization in Columbia. Ray and her partner, Jackie Notes, practice with a group of six physicians in the Medical Arts Building next to the hospital.
Both practices, focusing on low-risk pregnancies,have grown in popularity since opening about three years ago. From about five deliveries a month in 1987, she and her partner now handle around 20 deliveries a month, Ray said. Her patients come from as faraway as the Eastern Shore and northern Virginia for their service.
Ray, the first nurse midwife to receive delivery privileges at Howard County General in 1987, was followed by the three others. The hospital may add two more nurse midwives, one from Columbia-Freestate andanother from a private practice in Columbia, in the next few months.
Nurse midwives here say Howard County General has been progressive in its attitude toward midwives and supportive of their efforts. Last year, midwives delivered about 20 percent of the 2,600 babies bornin the county's only hospital, whereas statewide, midwives deliveredonly 2.5 percent of all babies born in 1987, the most recent year for which statistics were available.
Only 10 of Maryland's 55 acute-care hospitals, including Howard General, have given nurse midwives delivery privileges, although others, such as St. Agnes Hospital in Catonsville, are considering it.
A certified nurse midwife is a registered nurse with an additional one to two years of training at an accredited school of nurse midwifery.
Many patients said they chose midwives because they offered more "personalized" attention than conventional obstetric care.
Kim A. Barnes, 37, of Columbia, chose a midwife to deliver her second child, born two months ago, because she believes midwives focus more on the individual, are more compassionate, and spend more time working with and educating the patient.
"Doctors ask all the same questions, but I got the impression the midwives really cared about the answers," said Barnes, who is a nurse at Howard County General.
Several patients said midwives also were more open-minded about their preferences and more flexible during the delivery. And they liked having a midwife attend to them throughout the entire delivery, rather than the periodic attention they would get from most obstetricians.
Katherine G. Gibbs, 32, of Columbia, the mother of Howard County's first baby born this year, chose Ray to deliver her third child because the nurse midwife practice was small and feltcomfortable to her.
Gibbs, who delivered her first two children with physicians, said many of the obstetrics practices have grown so large that it is difficult, if not impossible, for mothers to get to know the doctor who will ultimately deliver their child.
"I thoughtit would be more intimate with a midwife," she said. "I really got to know both of them well."
Ray said she believes midwifery is an idea whose time has come -- again.
Although lay midwives delivered most babies in this country for centuries, their status and popularity deteriorated in the late 1800s and early 1900s. These old-fashionedmidwives, sometimes called "grannies," often had little or no training and were virtually exempt from government regulation.
Mortalityrates for both mothers and infants were extremely high at the turn of the century and midwives took most of the blame, said Karen S. Fennell, governmental affairs specialist for the American College of Nurse-Midwives in Washington, D.C.
However, after male doctors took over obstetrics, mortality rates did not decrease, at least not initially, she said. Most pregnancy-related deaths were due simply to the lack of medical advances at the time, she said, and could not be attributed to midwives.
But by the 1920s, the practice of lay midwifery was illegal in most states, and physicians alone oversaw women's health care and the delivery of babies. The belief that babies should be delivered only by doctors in hospitals lingered for decades.