Midwives see growth curve for birthing options

Licensing, technology join with traditional philosophy

Denise Midstokke stands in the birth center at Pend Oreille Midwifery Services. State licensing, medical technology and public awareness have changed the way midwives assist in out-of-hospital births. (Photo by DAVID GUNTER)

SANDPOINT — The sacred rite of giving birth has seen its share of changes over the centuries, most of them packed into the last half-century or so.

By the 1950s, the days of calling in the local midwife came to be seen as both arcane and dangerous. Women were rushed to the hospital to give birth while strapped to a gurney. Waiting around for baby to arrive in its own sweet time became a thing of the past, as sedation and forceps sped things along.

Most modern hospitals now offer a completely different birth experience — more gentle, more comfortable and more in tune with the needs of the woman having the baby. Bonner General Hospital would be a prime example, with its family-centered maternity unit, where babies stay with mom after birth and there’s even room for dad to spend the night.

Moving along on a separate track has been the role of midwives in the modern world. Not terribly long ago — the 1970s, to be exact — they had to provide their service in secret in places like California, where it was against the law to assist in an out-of-hospital birth.

In Bonner County, where midwifery has been a popular option for more than 30 years, there are now at least six midwives available for assisting in the birthing process. Just as hospitals have shifted, philosophically, midwives have made some moves of their own.

Denise Midstokke was one of those California midwives whose work was cloaked in secrecy before moving to North Idaho in 1985.

“At the time, midwifery was just trying to put together a process of certification,” she said, adding that education, training and testing to meet national standards all fell under the certification procedures. Two years ago, legislation was passed in Idaho — “pushed through,” as Midstokke describes it — to allow midwives to be licensed.

“We wanted to do it because there was some noise that they were going to try and make out-of-hospital births illegal in Idaho,” she said.

That would have been a decision that flew in the face of popular opinion in places like Bonner County, which last year saw a  25 percent increase in out-of-hospital births over the past year at Midstokke’s Sandpoint-based Pend Oreille Midwifery Services offices. According to the midwife, the increase is part of a national trend.

“I had been doing about 45 births a year,” she said. “Last year, I did 60.”

Much of that increase has been due to the birth center at Pend Oreille Midwifery Services, which, with its location just minutes from the hospital, offers a more conservative option to home birth. There, too, however, midwives have seen growth in the number of families who want the experience to take place in familiar surroundings.

“A lot of people come up here to get back to the land and midwifery is seen as part of that movement,” Midstokke said, pointing out that “home” can mean different things to different people. “As midwives, we do births everywhere. I’ve done them in places with dirt floors, in tipis, trailers, yurts and school buses.

“I tease that I haven’t done one in a finished house yet.”

Emily Baker, another licensed midwife serving the local area, recently returned to the practice after having a baby of her own.

Her experience also points to heightened interest, especially with the advent of birth centers as an alternative to having a baby at home.

“I think that any midwife with a birth center will tell you that she sees an increase in families choosing that option,” said Baker.

“Word of mouth is a powerful promoter and the more women who have positive out-of-hospital birth experiences, the more women we see coming to inquire about our care as midwives.”

What they find in many cases is an environment where traditional approaches to birth have linked up with modern technology. Licensing also has changed the landscape for midwives, Midstokke noted.

“There’s a real sweetness to the traditions of midwifery,” she said. “But as we license each other, we face a different set of circumstances.

“Things have changed,” she added. “Now, we’ve become so medical that the question is: Are we becoming ‘med’-wives?”

At Pend Oreille Midwifery Services, pre-natal care includes lab work and ultrasound checkups — though the latter was added to satisfy parental curiosity as much as to provide early warnings for things such as cleft palates, heart problems, spinal bifida or organ development.

“More people are interested in wanting to know the sex of the baby than in the value of a medical ultrasound,” Midstokke said.

Baker agrees that licensing has changed things, but believes the basic principles of midwifery have stayed the same.

“There are some more specific guidelines we have to follow, but, essentially, I don’t think it changes the way we provide our service at its core,” she said. “We still provide women with the opportunity to birth their babies safely and naturally in a supportive environment — and licensing doesn’t change that.”

In stark contrast to California in the 1970s, Sandpoint had at least one general practitioner who provided home deliveries during that time, often working alongside one of the local midwives.

Those days are gone, as “GPs” have stepped away from births due to the potential of malpractice suits, according to Midstokke. Obstetricians, whose qualifications make them an obvious provider for care before, during and after pregnancy, have filled the gap.

The relationship between midwives and “OBs” is positive, both Baker and Midstokke said, though they say the doctors would prefer that women give birth in the hospital setting, in case something went wrong.

Therein lies the fundamental difference in philosophy between traditional midwives and traditional medicine.

“Our philosophy is that we’re going to think everything is OK until you prove that it’s not,” Midstokke said.

“There is a bit of philosophical difference between medicine and midwifery, but the two are, at times, overlapping,” said Baker. “I think that we will see, in the future, a greater benefit from and need for collaboration between the two. There is no reason they should be mutually exclusive — I think there is potential for a symbiosis, a system where all parties feel there is a good balance and benefit from having both medicine and midwifery available in the community.”

The decision to give birth at home or in a birth center, as opposed to the hospital setting, requires considerably more responsibility on the part of mothers, in particular, as they become the key player on a team whose goal is to deliver a healthy baby.

In some ways, it’s in polar opposition to the days when mothers were expected to be passive participants — if participants at all — in the birth process.

One positive outcome, according to Midstokke, was the way women began to turn the tide of public opinion through their own personal choices.

“It was a time for women to take back birth and become empowered,” she said. “I see it as a vision quest for women.”

“Birth is a rite of passage whose beauty has been lost amid the sequestering of birth to the philosophical realm of fear and illness,” Baker said.

“Women need to know they can be both vulnerable and strong, active and accepting, humbled, empowered and enlightened by the journey that is birthing our children.”

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