- The Washington Times - Sunday, May 27, 2001

When Gayle Friedman and Niel Rosen were preparing for the birth of their son nearly a decade ago, they wanted an experience focused on the healthy miracle of birth, not on a medical procedure.

The couple decided to use a certified nurse-midwife and deliver in a birth center. There, Ms. Friedman could labor among green plants in a queen-size bed or in a whirlpool. A midwife could motivate her to ease her labor pain without medication.

"We wanted an event that was ours," Mr. Rosen says. "We wanted a birth experience that was considered natural and beautiful rather than medical."

The Northwest Washington couple was looking for the same kind of intimate experience when they returned to the Maternity Center in Bethesda earlier this month for the birth of their second child.

The couple´s new baby is among the nearly 300,000 babies born in the United States this year with the assistance of certified nurse-midwives. That number makes up 9 percent of vaginal births, but it is a total that has grown each year for the past 25 years, says Marion McCartney, director of professional services for the American College of Nurse-Midwifes (ACNM).

A certified nurse-midwife must have a bachelor´s degree in a field such as public health or nursing and also must complete a two-year master´s degree or one-year certification program in one of 47 accredited nurse-midwife programs. Local schools offering advanced training include Georgetown University and the University of Maryland.

Certified nurse-midwives are authorized to write prescriptions, deliver babies vaginally, supervise prenatal care and perform well-woman exams and birth-control consultations. They do not perform Caesarean sections.

Certified nurse-midwives are different from lay midwives, unlicensed midwives who primarily help women give birth at home. Lay midwifery is illegal in many states, including Maryland and Virginia.

"Women should have a choice when it comes to labor and delivery," Ms. McCartney says. "The most common reason women go to the hospital is to have a baby. Having a baby is a healthy event, yet in our culture, we act like they are going to have brain surgery. The most important thing we must do is to educate women, encourage them to ask questions and have ongoing discussions."

Working together

Even though they view birth as a healthy event, certified nurse-midwives understand the need for communication and consultation with physicians, Ms. McCartney says.

Ninety-six percent of certified nurse-midwife births take place in a hospital, Ms. McCartney says. Less than 3 percent occur in free-standing birth centers. About 1 percent take place at home.

The majority of certified nurse-midwives either work in a medical practice alongside obstetrician-gynecologists or have a working relationship with an obstetrical-gynecological practice.

"We work together in our practice," says Dr. Leonard Rosen, a Fairfax obstetrician-gynecologist whose practice includes three certified nurse-midwives and four physicians. "Midwives are very well-trained. They are much more hands-on than a physician. They are able to handle the normal, run-of-the-mill patient, while we are available for the high-risk patient."

Extra attention

Dr. Rosen says the biggest benefit for his patients who see a midwife is the greater amount of time a midwife is able to spend on a routine office visit.

"I would say I spend about five or 10 minutes with a normal OB patient," Dr. Rosen says. "A midwife is able to spend a half-hour."

When it comes time to give birth, midwives are ready to give extra attention, too, says Beth Goodiel, a certified nurse-midwife who works in Dr. Rosen´s practice, Fairfax OB/Gyn Associates.

"A midwife considers the total patient," Ms. Goodiel says. "We have a noninterventionist approach. We like to let the patient do whatever they want in labor, within reason. We know how to let women go without medicine in labor."

Indeed, statistics from several sources, including medical journals and the National Center for Health Statistics, show rates of epidurals, episiotomies and Caesarean sections are lower for women using certified nurse-midwives than for those using physicians.

That is not to say women who use midwives lose the option of choosing those medical procedures, Ms. McCartney says.

"Using a midwife does not mean you cannot get medication," she says. "If you are delivering in a hospital, you can get an epidural. Most of what midwives do has to do with support during pregnancy and labor. Midwives are a lot more reassuring and hands-on. Instead of saying to the patient, 'Do you want your epidural now?´ we are a lot more focused on what the woman needs to be successful without it."

Certified nurse-midwives also are taught to know their limits, Ms. McCartney says. In higher-risk cases, such as when the mother has diabetes or high blood pressure, the midwife and doctor will work more closely together.

"Sometimes if a woman is having problems, she needs support even more," Ms. McCartney says. The criteria for working solely with a midwife is a bit stricter at a free-standing birth center such as the Maternity Center. The Maternity Center´s six certified nurse-midwives work in conjunction with doctors at Shady Grove Adventist Hospital. Patients having anything more complicated than a normal, low-risk pregnancy still can deliver with a midwife, but they must do so at the hospital.

The Maternity Center also is able to transport mothers in labor to the hospital quickly if a complication arises during labor and delivery, says Julie Bosak, a certified nurse-midwife at the Maternity Center.

"We are trained to know when we need a hospital," Ms.Bosak says. "Some indications for the hospital would be toxemia, twins, breech position, placenta problems or a previous C-section."

Darcy Perl trusts that her midwives know when to call for a doctor´s assistance. The Olney woman has had three completely different birth experiences.

In 1995, when her son, Jonathan, was born at Georgetown University Medical Center, Mrs. Perl was in labor for 21 hours. The baby spent a week in the Neonatal Intensive Care Unit.

"It was the worst possible experience," she says.

When she was preparing for the birth of her first daughter, Juliana, in 1996, Mrs. Perl heard about a friend´s good experience with a midwife. She and her husband, Sol, were skeptical, but they took a class at the Maternity Center and decided to give it a try.

"I got at 4 p.m.," Mrs. Perl says about Juliana´s birth. "She was born at 5. We went home at 11. Things went very smoothly. Even though the cord was wrapped around her and I hemorrhaged, they were able to deal with that there."

This spring, another daughter, Elizabeth, was born. Because of her complications in the second pregnancy and the risk of hemorrhaging again, Mrs. Perl´s labor was induced at Shady Grove.

Mrs. Perl still delivered with a midwife and went home a few hours later.

"I think I called my midwives more on the weekend during this pregnancy than anyone they have ever had," says Mrs. Perl, cradling her healthy newborn. "But they dealt with everything. I still don´t feel birth should be a medical situation. I just want a happy, healthy baby."

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