Florida Nurturing Midwives’ Practices : Childbirth: State wants half of all its babies delivered by midwives by year 2000. Proponents say such births are cheaper, statistically safer and often more pleasant.

Midwife births are cheaper, statistically safer and often more pleasant than doctor-assisted hospital births, Florida officials say. That’s why they would like to see half the state’s babies delivered by midwives in the year 2000.

Necessity largely explains the push for midwives; the number of obstetricians in Florida has fallen from more than 2,000 in 1985 to about 1,000 today.

“If we are to make real progress in providing primary and preventive care and in reducing infant mortality rates, we must broaden our provider base by encouraging the growth of midwifery,” said Dr. Charles Mahan, Florida’s deputy secretary for health.

An advisory committee to Florida’s Healthy Start program--aimed at helping every pregnant mother and young child--has recommended that half of the state’s normal pregnancies be cared for by midwives by the end of the decade.

In 1992, Florida’s 350 midwives delivered more than 21,000 babies, or 11.2% of the state’s births.

The financial incentive to move toward midwifery is strong. Training a midwife costs only a fifth of what it costs to educate a doctor, a factor that translates into lower costs for patients.

Cynthia Feinberg, a licensed midwife practicing in Miami for a decade, said her average charge for prenatal care and delivery is $2,500, contrasted with $8,000 for a doctor-assisted hospital birth.

“Poor women don’t get prenatal care because they can’t afford it,” she said. And inadequate prenatal care means more infant deaths and health problems that can translate into even more expense.

Many nations with lower infant mortality rates than the United States--including the Scandinavian countries, the Netherlands, Ireland and Japan--rely primarily on midwives, she said.

Anne Richter, deputy director of the Florida Midwifery Resource Center, said once-skeptical physicians have satisfied themselves that the use of midwives is safe.

Sixty percent of obstetricians and family physicians, according to a University of Florida study, say they are willing to help train certified nurse midwives. Twenty-two percent plan to employ or develop a partnership with them.

In addition, more than half the hospitals surveyed by the University of Florida either have midwives on staff or expect to hire them eventually.

Years of studies show that midwives have better infant mortality statistics than obstetricians, although physicians caution that in the United States, midwifery patients tend to be healthier and better-educated than average.

“There have been many very well done studies showing the infant mortality rate is equally as good, if not better, when you introduce midwifery,” Richter said. “And by getting care to women earlier, you can reduce human suffering as well.”

One key advantage of midwives is their willingness to work in rural areas where obstetrical care has all but vanished, she said.

Feinberg sits down with her clients for an hour or more, hands out books for their older children to read and often spends the entire day with a woman about to give birth. In addition, midwives tend to take fewer cases and are unlikely to hand the delivery off to a different practitioner because of a time conflict.

Richter calls the midwifery experience empowering, compared to the often depersonalized care at hospitals and clinics.

“Women want to have a health care practitioner who will sit down with them, talk to them, take care of them,” Richter said. “ . . . They really help the women understand it’s her birth, and her baby.”