Mothers-to-Be and HMOs Help Deliver Resurgence of Midwives

Stacy Seitzinger was in huge pain.

For the past five hours she had paced her house, watched television, played cards, stood in her shower and tried to relax as her labor progressed.

But as her delivery peaked, she took to her bed and focused on the tender voice of her midwife, Ramona Ludwig: “This is the hard part and it doesn’t last forever. You can do this.”

They breathed together, working intensely, and then an amazing, wonderful, natural thing happened--8-pound Ian was born.

For Seitzinger, 30, the birth of her second son recently in Santa Fe, N.M., brought her new confidence. Her first child had been delivered by a doctor at a “cold and scary” hospital. This time she opted for a midwife.

“Now I wish I’d had enough guts to do it the first time,” she says.

These days, more pregnant women are choosing midwives--with their empowering and attentive approach--to deliver their babies.

“I didn’t want to be in a hospital and have anything happen that I didn’t want happening,” says Julie Bellamy, 40, of Boulder Creek, Calif., whose 9-pound girl, Leilani, was delivered by a midwife earlier this year.

Leilani and Ian are among more than 220,000 babies expected to be delivered by midwives this year in the United States. Most will be born in hospitals, but more than 10,000 will be delivered at home.

New Mexico has the highest rate of midwife deliveries in the nation--more than 20% last year. Reasons include a state government that encourages the practice, remote communities hard for doctors to reach quickly, and community members--from doctors and lawyers to indigent transients--interested in working with midwives.

“New Mexico is really unique. We’re a model for other states about how to make good use of midwives,” says Peggy O’Mara, editor of Mothering magazine in Santa Fe.

Albuquerque midwife Barbara Pepper has delivered more than 1,000 babies during the last 15 years.

“In New Mexico, there’s an accepted attitude that birth can be a very special moment,” she says. “It doesn’t have to be a clinical, technical experience. It’s an animal act.”

Midwifery declined in the United States in the 1920s when doctors took over delivering babies. Midwives returned to the medical scene about 50 years later with training and licenses that allowed them to work in hospital delivery rooms.

In the mid-’70s, one of every 100 babies in the United States was delivered by midwives. By the mid-’90s, about five out of 100 were delivered by midwives and the number is rising, said the National Center for Health Statistics.

James Unland, president of Health Capital Group of Chicago, says the increased use of midwives is “one of the most interesting convergences of trends in health care today.”

Unland says more women are choosing midwives over obstetricians so they can have more one-on-one care and have their babies at home or in birthing centers instead of hospitals. In addition, health maintenance organizations are assigning midwives instead of obstetricians to patients to save money.

“The medical doctor is the most expensive person in the loop,” says Unland, who negotiates managed-care contracts.

A Kaiser Family Foundation study in 1995 found 39% of HMOs and 46% of independent provider associations allowed patients to choose a nurse midwife as a primary caregiver during pregnancy and birth.

Lovelace Health Systems, an Albuquerque-based HMO, is a leader in using certified nurse midwives, doubling their numbers in 1993 to 18. Since then, the HMO has had higher birth-weight babies and fewer Caesarean sections.

“We certainly seem to be doing something right,” says Lovelace midwife Tercia West.

She lets women decide while in labor if they want a home or hospital birth. She said those options draw mothers to midwives and away from traditional obstetricians.

Laura Migliaccio, who is studying to be a midwife at the University of New Mexico, says she decided to become a midwife instead of an obstetrician because she “didn’t want to enter a more strictly medical model of practice.”

“I wanted to work with women and children, I wanted to do a hands-on skill but also develop interpersonal relationships,” says Migliaccio, 30.

“This is really the golden age of midwifery,” says Ruth Walsh, who chairs the North American Registry of Midwives in Linn, W.Va.

“One hundred years ago women did die because they couldn’t have a C-section. Now they can have the superior care of a midwife with a normal pregnancy, supported by an obstetrician if there are complications.”

With the swift revival of the practice comes several types of midwives with different levels of training, including:

* Certified nurse midwives, who have completed nursing education and two years of midwifery training and are allowed to practice in hospitals in many states.

* Lay or home-birth midwives, who have different levels of training, education and experience, and who deliver babies at homes or in private birthing centers.

The American College of Obstetricians and Gynecologists in Washington does not support lay or home-birth midwives, but encourages joint practice with certified nurse midwives.

Jennifer West, a home-birth midwife in Albuquerque, says doctors and health organizations who rule out practices like hers are missing out.

For $2,000, West provides prenatal care complete with herbs, vitamins, classes and home visits. Many insurance plans or Medicaid will pay between $800 and $1,000 of that.

On birth day West shows up at the home with a portable Jacuzzi. After the baby is born, she visits the mother at least four times.

“Women have been doing this for ages without a doctor or a hospital,” she says. “Our bodies were made to do this.”

If the birth gets complicated, West doesn’t hesitate to take clients to a hospital. But if the birth is normal, she works through labor to keep the mother comfortable at home.

“If you want to have your baby hanging from a chandelier,” she says, “we’ll figure out how to get you up there.”

Dr. Norman Gant, a professor of obstetrics and gynecology at the University of Texas Southwestern Medical School in Dallas, says he supports certified nurse midwives but is “scared to death” about the resurgence of home births.

“If you’re willing to write off the occasional baby and mother, fine, that’s nature’s way,” he says. “Otherwise, get to the hospital to deliver that baby.”

Labor is the most risky medical process most women in the United States will go through in their lives, he says.

“And birth is the riskiest thing for most babies until they start driving and turn sullen and rude,” he says.

Gant stressed, however, that certified nurse midwives are valuable colleagues in hospitals.

“We need to have good people who deliver babies and take the load off the rest of us,” he says.