Delivered with care Mothers find midwives offer labors of love

September 08, 1992|By Sandra Crockett | Sandra Crockett,American College of Nurse-MidwivesStaff Writer

Apple pie, motherhood and . . . midwives?

To Tamara Thiel, midwifery indeed falls into place right next to the things that many of us hold dear.

"I have two kids and both of them were born with the assistance of nurse-midwives," she says. "It was a wonderful, beautiful, warm experience. I wanted personal attention and personal care. They treated me like a smart, intelligent woman able to make my own choices."

She is far from being the only woman who feels that way.

An increasing number of women are opting to have midwives deliver their babies rather than choosing an obstetrician's care. In part, their decisions may be influenced both by the decreasing number of doctors who deliver babies because of rising malpractice insurance costs and a growing interest in more personalized women's health care, says Pat Paluzzi, president of the Maryland chapter of the American College of Nurse-Midwives, a professional association. "Midwifery has been having a big resurgence in the past several years," she says.

In the United States, there now are 4,500 practicing, certified nurse-midwives (about 2 percent are men), according to the American College of Nurse-Midwives. There are about 145 in Maryland, says Lara Slattery, spokeswoman for the association.

Nurse-midwives are registered nurses who take additional training at colleges and universities, then pass national exams for certification. Most work in hospitals, clinics or birth centers where they see both women who are pregnant and those who come in for general health care. Nurse-midwives work in affiliation with physicians who are available for consultation or referral if needed.

Generally, nurse-midwives, who are not trained in surgery, work with low-risk women and don't perform cesarean sections or forceps deliveries. In Maryland, they can prescribe medication although each state sets its own guidelines.

Before the 1900s, it was common practice for midwives to coach women through labor at home because pregnancy was not seen as an illness to be treated by a doctor. But with the medical profession becoming increasingly high-tech and organized, eventually pregnancy became viewed as a condition needing a doctor's treatment for a successful outcome. Now doctors and nurse-midwives are working together in hospitals and clinics.

"Nurse midwives provide a different kind of service from physicians. They are known for their emotional and educational help for low-risk women," says Kit McDaniels, director of nursing at Mercy Medical Center.

Dr. Scott Taylor, acting chief of Obstetrics and Gynecology at Sinai Hospital where nurse-midwives have worked for a few years, says the relationship between physicians and midwives has improved.

"Midwifery traditionally has been a practice popular and prevalent in areas that have been poorly staffed with physicians," Dr. Taylor says. "But in the last several years, more midwives have been surging up in metropolitan sections."

And more have been given privileges for seeing patients at hospitals, he says.

Indeed, in the Baltimore area, nurse-midwives have practicing privileges at Johns Hopkins, Sinai, Frances Scott Key, Mercy Medical Center and other hospitals.

The American College of Obstetricians and Gynecologists, a Washington-based professional organization with more than 30,000 members, is opposed to home deliveries -- but not to midwifery. "Our position is that we are opposed to the practice of midwifery without the back-up of a medical team," says spokeswoman Kate Ruddon.

It was at Hopkins that Ms. Thiel's healthy baby girl was delivered with the assistance of a nurse-midwife Aug. 7

Ms. Thiel -- who lives in Annapolis with her husband David Kao and their two children -- chose a nurse-midwife because she felt she would get more personal attention.

"The attention you get from nurse-midwives is incredible," Ms. Thiel says. "When you go into labor, they are with you the whole time. They never leave you."

And these days women who use nurse-midwives are just as likely to be middle-class, city dwellers whose interest in women's health issues grew out of college experiences, as women in more remote or poor areas in which there are no physicians.

Lynn Fux is a Baltimore wife and mother who learned about midwifery in college when she took a women's studies class.

Still, the first of her four children was delivered by a physician. She turned to midwifery when her obstetrician/gynecologist stopped delivering babies because of increased malpractice insurance costs. After being referred to another physician "who was horrid," Mrs. Fux found a midwife through the Baltimore Birth Center.

Now she speaks in glowing terms of her experience. "It was such an overwhelming difference," she says comparing her last three labor and delivery experiences with the first one.

"There's no getting around it. Childbirth hurts! But it was still a warm, loving experience. If it weren't for midwives, we wouldn't have had any more kids in this family!" Ms. Fux jokes.

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