Midwives Making a Comeback

Picture the movie scene: a pregnant women about to go into labor screams like a hormonal creature as she’s rushed down a hospital’s long, brightly-lit hallway to the delivery room, where she gasps for drugs and relies on the doctor to call the shots.

But fewer and fewer pregnancies play out like this. According to the 1999 book Midwifery and Childbirth in America, written by Judith Pence, more than 10 percent of American babies are delivered by a midwife.

Midwife-assisted births appeal to women who are seeking a more natural birthing experience, with minimal drugs and medical interference. This represents a paradigm shift from the days when women took for granted the use of pain-killing drugs and anesthetics such as epidurals.

“Doctors treat women as patients with a condition, whereas a midwife guides you through the labor and is compassionate about this amazing experience,” said Kara Kinsey, a Brooklyn resident who recently gave birth to her first child with the help of a midwife.  

For centuries, women of all countries and cultures have used midwives to successfully deliver babies. But a cultural shift toward professional doctors, along with the development of other methods of medication and hospitalization, pushed midwives into the background.Now, this once-universal birthing method is coming back into style.

Research shows that in countries with the best pregnancy outcomes, midwives are the primary providers of care to women. In fact, the United States has the second-worst newborn death rate in the developed world, according to statistics compiled by Dr. Marsden Wagner, a former director of Women’s and Children’s Health at the World Health Organization. This fact is especially surprising given that the U.S.has the most technologically advanced equipment.

The midwife Adrian Feldhusen has created a timeline to trace the history of American midwifery. The first hospital in colonial America was founded in the mid-1700s. As time went on, doctors began pushing midwives out of the birthing industry. By the early 1900s, physicians were attending about half the nation’s births, including nearly all births of middle- and upper-class women, while midwives took care of women who could not afford a doctor. By 1939, a majority of American women delivered in hospitals.

However, the tide is turning. In2005, nurse-midwives attended 11.2% of vaginal births in the U.S., and this percentage continues to rise according to Feldhusen’s research.

Georgia Rose has been a midwife for more then 20 years. She has delivered over 1,600 babies in her career and taught a later generation of midwives at Columbia University.Rose makes it abundantly clear that her career isn’t about the money. “It’s a wonderful profession,” she said in a phone interview.

She said that her clients appreciate the “close and personal relationship” they develop with a midwife,especially those parents who delivered their first babies in a more-sterile, traditional hospital setting. “I emphasize each detail of the experience to make it as memorable and enjoyable as possible so that the family leaves with optimal memories of that day,” she said.   

Not all women have the option of midwife-attended childbirth. Midwives recommend that only those with low-risk pregnancies, who are unlikely to experience complications during labor should engage the services of a midwife.

Midwife-assisted births are also appealing because they are less costly than hospital births. The average cost of a midwife-attended vaginal birth in the U.S. is $1,200, whereas the average cost of physician-attended vaginal birth is approximately $4,200, according to Dr. Wagner. In the 2007 documentary The Business of Being Born, Patricia Burkhart, a professor in the New York University Midwifery program said, “Hospitals are businesses- they want those beds filled and emptied. They don’t want women hanging around in the labor room.” Doctors pop in every so often while the woman times her contractions, as opposed to a m
idwife who is by the woman’s side every second. “For a physician to charge more when they have less of an appearance is beyond me,” Burkhart said.

             Roosevelt Hospital—one of the few in New York City with an in-hospital Birthing Center—offers three private rooms for $850 a night, much more affordable than the standard price of a night’s stay in a hospital room. The other rooms in the birthing center are covered by insurance and fit two women per night. At a birthing center, the experience is shorter, with women usually going home within 24 hours of arrival and 15 to 18 hours of delivery. In a birthing center, babies are allowed to room with their mothers. Visiting hours run all day and patients are allowed to have as many visitors as they please, including allowing one to sleep overnight with them in a private room.

At Roosevelt Hospital,the birthing center rooms can be easily mistaken for a 4-star hotel, aside from the bassinet and changing table sitting next to the queen-sized bed. The room is decorated with homey floral bedding, curtains and tablecloth. There is enough room to fit ten people, and there is a small round dinner table, a rocking chair, exercise ball, night stand and in the far left corner a large Jacuzzi bathtub, built for two. 

Elizabeth Boyce maintains a private midwifery practice with a partner and has delivered many babies at the Roosevelt Birthing Center. At monthly meeting, the two midwives invite expecting mothers to stop in at their downtown office to discuss what to expect throughout the pregnancy, along with the services the midwives offer, ensuring that all her patients are fully educated and are able to participate in creating the birth plan. She describes in detail the process of the birth from the first pregnancy appointment to the 6-week post-birth check up, and everything in between. Elizabeth stays with her patient through every moment of the labor, being at the service of her client in whichever way she requests. However, her practice does not offer the option of insurance or Medicaid because the program reimburses midwives at a low rate. “In order to keep giving quality of care, we had to either increase the number of patients or keep numbers low and not take insurance,” she said.

Kara Kinsey, the Brooklynite who gave birth with the assistance of a midwife, stayed for two nights at the in-hospital birthing center at Beth Israel after a long labor during which her midwife checked in every hour. “Pregnancy is a wonderful thing and my midwife embraced that. I wanted a natural childbirth and I was able to stick to my birth plan all thanks to my midwife.”

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