home HEALTH More attention, more choices, lower costs

More attention, more choices, lower costs

More and more women turn to midwives to deliver babies

When Debra Graves and her husband, Randy, started their family more than seven years ago, she was a registered nurse in University Hospital’s neonatal intensive care unit. Every day she worked with highly specialized physicians to help save premature and sick newborns, many of whom were delivered by Caesarean section and whose mothers had complicated, high risk pregnancies.

But when she became pregnant, there was no indication that hers would be one of those high risk situations. Graves, then 26 years old, did not have a history of family medical problems or any conditions that would suggest problems during her pregnancy.

I wanted to view my pregnancy as a healthy, joyous experience, not as an illness, she said.

So instead of going to an obstetrician for her prenatal care and delivery, she went to a certified nurse midwife. Seven years and two healthy children later, Graves is pregnant again. And for a third time, she has chosen a midwife from University Hospital’s midwifery program to deliver her baby.

In recent years, more and more women who, like Graves, have low risk pregnancies and expect to have normal vaginal deliveries are turning to midwives rather than obstetricians, citing a different philosophy toward childbirth and pregnancy, more personal attention, more choices and lower cost.

Certified nurse midwives are registered nurses who are accredited by the American College of Nurse Midwives after completing graduate level training in normal prenatal care and birth, as well as well woman gynecological care.

We treat pregnancy as normal, unless proven otherwise, said Diane Roach, a certified nurse midwife at University Hospital. We take a low interventive approach to childbearing, and give (the patient) more control of her pregnancy and delivery.

While midwives’ delivery fees in Cincinnati are roughly the same as an obstetrician’s charge, the savings often come with their limited intervention, midwives and their patients say.

Using a minimalist amount of accessories saves money, said Jackie Gruer, a certified nurse midwife and owner of Midwives Care in Springdale. Gruer, who is affiliated with Bethesda Hospital, also performs home deliveries. Technology is expensive.

We don’t see technology as the enemy, said Ann Hegar, a certified nurse midwife and director of the University Hospital program. We try to balance the utilization of technology with the mother’s requests.

University Hospital midwives do require that patients use a fetal monitor, which tracks the baby’s heart rate and the strength and frequency of contractions, for at least 20 minutes during labor to make sure labor is progressing well. But women can request that the monitors not be used during the rest of the labor.

We’re not casual about labor and birth, Hegar said. But being continuously hooked up to a monitor doesn’t guarantee you a healthy baby.

Cynthia Stayrook decided that giving birth at a hospital wouldn’t guarantee a healthy baby either, and chose to have her first child at her home in Clifton Heights with the help of Midwives Care. She had been born at home in rural Pennsylvania and had never been hospitalized, and she didn’t want to start when she had her son, Anachie, who turns two Feb. 7.

Stayrook did have a minor complication late in her labor, but rather than transport her to a hospital for a Caesarean section, the midwife Gruer spent 30 minutes manipulating the baby until Stayrook was able to deliver naturally.

I was up walking around with just a few stitches, she said. If I had gone to the hospital, I could have had major surgery. To me, that’s scary.

Most women who turn to midwives do choose to have their babies in a hospital, rather than at home. According to the American College of Nurse Midwives, only about five percent of midwife attended births which numbered 147,293 in the United States in 1989 were home births.

I feel like the hospital births (by midwives) in Cincinnati are really growing, much more than the home births, Gruer said. The differences between hospital and home have gotten much more subtle. Birthing rooms are no longer all chrome, white and sterile. I think that people feel safest in a hospital with that technology available, but knowing they won’t necessarily need it.

Midwifery is becoming more popular not only with pregnant women, but in many areas of the country, with their insurance companies as well.

In Ohio, legislation passed in 1988 states that insurance companies that offer traditional indemnity plans must reimburse clients for services covered by the policy that are performed by certified nurse midwives if that service, such as delivering a baby or giving prenatal care, can be legally performed by the certified nurse midwife, according to the Ohio Department of Insurance.

Most managed health care organizations, such as health maintenance and preferred provider organizations, will reimburse for midwives’ services if they work with a doctor or hospital that is a participating provider in the HMO or PPO network.

In addition to the cost benefits, proponents of midwifery say that because midwives work only with healthy, normal pregnancies, they are able to spend more time with their patients.

High risk procedures are very time intensive, Hegar said, and many OBGYNs simply don’t have the time to spend 45 minutes working with a pregnant woman and her other children, whom Hegar encourages to attend prenatal appointments.

By working with a midwife, women do not totally forego the experience of a obstetrician, Hegar and Gruer said. All patients are required to see an obstetrician once during the pregnancy to make sure the woman and fetus are healthy.

There are a lot of people who believe that only an obstetrician can deliver a baby, said Graves. But I think you’re getting the best of both worlds with a midwife.

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