A friend alerted me to an article on midwives from the May 20, 2009 Orlando Sentinel.  It's about a recently-developed program of the Orange County Health Department that provides hospital-based midwife services for low-income women in the Orlando area, and told me some things I didn't know about midwives and Florida law.

Knowing from experience that links to Sentinel articles break after a while, I'll provide a few relevant excerpts below.

The program came about after health officials took notice of the positive birth outcomes of women who were working with local lay midwives. Florida is one of only four states in the country where women with little medical training can be state certified as midwives....Legal practice of [lay] midwifery in Florida—one of 25 states that regulate midwifery—is done by Certified Professional Midwives, who must complete training and meet clinical requirements.

"We were seeing low cesarean rates and very low percentage of low birth weight babies," said Dr. Kevin Sherin, Orange County Health Department director. "It was sort of a natural to bring together their successful practice and our resources."

For those of you following the trial of Judy Wilson, Judy is a Certified Professional Midwife.  According to this state-by-state chart from the Midwives' Alliance of North America, the statement that Florida is one of only four states to license lay midwives is incomplete; many other states have licensing procedures in a different form.

But instead of lay midwives, the county hired five certified nurse midwives to work with women at the Lila Mitchell Health Center in west Orlando, where about half the patients are uninsured and the other half are on Medicaid. The clinic also serves a largely black and Hispanic clientele....Certified nurse midwives, like doctors, can use some medical intervention including electronic fetal monitoring, labor-inducing drugs, pain medications and episiotomies.

I'm all in favor of Certified Nurse Midwives—especially the one that delivered Faith Smile—though it should be clear from all the medical interventions listed that they're operating from a different model of care from the midwife in Amish country who delivered Jonathan and Noah.  "Electronic fetal monitoring, labor-inducing drugs, pain medications and episiotomies" are, in my experience, what people who employ the services of midwives are seeking to escape.  This route is not for everyone, however, and Orange County's hospital-based choice appeals to many of the women they hope to reach.

Like a lot of women, Tiana Marrero thought having a midwife meant giving birth at home.  "I was kind of scared," said the west Orlando resident. "Once they broke it down for me, I learned it was a good program that gave you a lot of good information about having a healthy baby.....They give you personalized service. They make you feel comfortable."

"In Hispanic countries, women know all about midwifery. When we tell them about it, they say, ‘Oh, yeah, partera," said Alyn McGee, a certified nurse midwife, referring to the Spanish word for midwife. McGee said women from the Caribbean islands are also well-versed in the practice. Other women, like Marerro, get on board once stereotypes about midwives are debunked.

"There's a lot of education that goes on," said Stacey Gruka, a certified nurse midwife. "When they find out a midwife isn't someone wearing hoop skirts and lighting candles, they feel better about participating." 

I don't remember any hoop skirts, nor can I imagine a midwife wearing one—it would get in the way, horribly.  I don't remember candles, either, but they may have been an option.   I wonder how wide-spread that stereotype is.

It seems to me that hospital-based midwifery is providing the care that obstetricians gave in the 70s and 80s, back when our children were being born.  The practice of obstetrics has changed radically since then, as I wrote in Options in Childbirth.  All women should have legal access to home birth, free-standing birth centers, and midwives for whom medical intervention is a last resort rather than a first response, but Orange County's program is a good middle ground.

So far, the program, under way since last October, has had a cesarean rate of less than 10 percent and low percentage of low birth weight babies. The average cesarean rate is 30 percent for pregnant women who don't have pre-existing conditions such as high blood pressure or HIV infection.

Posted by sursumcorda on Thursday, May 28, 2009 at 8:13 am | Edit
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