By Gustavo Arellano
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By Charles Lam
Even though she'd known she wanted to have a natural birth during her first and now second pregnancy, she wasn't familiar with midwives. Parker's doula introduced her to the idea, but Parker was hesitant. "I was pretty naive about the whole thing," she says. "When she brought it up, there was a concern. The whole idea of midwives to me at that point was, well, what does that mean? Are they some hick from the backroads? Are they educated?"
At the beginning of the 20th century, midwives were delivering about half of all babies born in the United States. A majority of these midwives were immigrants or African-Americans and had been apprentice-trained; no formal schooling for midwives existed. During the same period, the burgeoning, male-dominated medical-obstetrics specialization was having difficulty establishing itself among the elite medical sciences; it was viewed as not much different from midwifery. This concern, along with a spike in infant-mortality rates in the U.S., led to a well-documented public and legislative campaign waged over two decades by doctors and nurses on what was then referred to as "the midwife problem."
Midwives were blamed for the country's high infant-mortality rates despite evidence to the contrary. Britain and Germany had lower mortality rates than the United States; in those countries at the time, midwifery had been formalized, and midwives were delivering 75 percent to 80 percent of all babies. By 1935, traditional midwives were only delivering about 12 percent of U.S. babies. During the same decades, nurses who had an interest in formalizing midwifery began establishing the country's first midwifery schools and training programs. Although midwifery gradually regained ground and exists today as a nationally certified profession with thousands of practicing nurse midwives, the stigma of the early campaign created barriers that persist today.
Midwifery is not nearly as widely accepted in Orange County as in other parts of California. In San Diego County, half of all hospitals grant delivery privileges to nurse midwives. In Los Angeles, about a third do, including UCLA; USC did before it closed its nursing division. The closure of South Coast's ward left only two county hospitals—Orange Coast Memorial Medical Center in Fountain Valley and Kaiser Permanente in Anaheim—where patients can deliver with a midwife. Kaiser employs 23 full-time nurse midwives who handle 90 percent of all vaginal births there.
The reasons for the county's limited offerings are varied. Some point to the ongoing misconception that midwives operate as unlicensed, backroom doctors who only do home births.
In reality, certified nurse midwives—who become nurses before they begin specialized midwifery training and are one of four midwifery designations in the U.S.—deliver primarily in hospitals or birth centers affiliated with hospitals. Midwives deliver about 10 percent of the babies born vaginally in this country annually; almost 97 percent of those deliveries are attended by nurse midwives in hospitals. Home births account for fewer than 1 percent of total births. Certified midwives, certified professional midwives and direct-entry midwives are the other midwifery designations; all involve varying degrees of professional training. Certified nurse midwives are the only group that can practice legally in every state.
Although the recent film The Business of Being Born has done much to debunk the backroom-midwifery myth, the documentary's focus is not hospital-based midwifery. The account of Ricki Lake's and other women's blissful midwife-attended home births also offers a biting critique of the current industry surrounding traditional hospital births. The film prompted the American College of Obstetricians and Gynecologists (ACOG) to reiterate its opposition to home births. Just two weeks ago, the American Medical Association joined ACOG, stating that it would support legislation banning home births in the U.S., a move that prompted an outcry from women's-rights supporters nationally and reignited the century-old debate over midwifery.
Another reason for Orange County's limited midwifery offerings, some say, may be tied to the county's obstetricians, who are steadily growing in number and who could be viewed as having an interest in keeping midwives at bay and out of hospitals, since they're often seen as direct competitors. When midwives seek privileges at hospitals, that hospital's physicians, not its administrators, must vote on whether to write the midwifery category into their bylaws and approve the applications.
By all accounts, delivering at South Coast Medical Center, a community hospital perched on the lip of the shimmering Pacific Ocean, was a kind of idyll. When patients chose to deliver with midwives Snell or Sherwood, the event was a seamless blending of multiple disciplines. Nurses worked with midwives who worked with doctors in a collaboration of streamlined care driven by what mothers wanted—and an overall trust in the labor supervision done by midwives. "We were like one big family there," Dr. Ken James says. "Really."
James was Snell's and Sherwood's "supporting physician" at South Coast, meaning he would intervene if any complications arose with their deliveries. He also shares an office with Snell next door to the hospital.
When a woman chose to deliver with one of the two midwives who had privileges at South Coast, she knew she was signing up for a particular kind of care. Prenatal visits would last no less than half an hour. Phone calls would be answered and returned promptly by Sherwood or Snell. On the day of delivery, a patient could wear her favorite pair of pajamas or nothing at all. She could sit, squat, shower, eat, drink, laugh, roll around on a giant yoga ball, get on all fours, pace down the hall—whatever her body craved, she could do, so long as her baby was progressing normally. Snell and Sherwood would spend the bulk of their patients' tumultuous labor with them.