Story URL: http://news.medill.northwestern.edu/chicago/news.aspx?id=90827
Story Retrieval Date: 10/24/2014 6:51:24 PM CST

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Midwife attended births on the rise in Illinois

by Shannon Donohoe
May 29, 2008


Lise Hauser, a practicing nurse midwife, delivers babies at home, at hospitals and at birthing centers. She has helped deliver 700 babies over the past 14 years and is the supervisor of  nurse midwifery at Advocate Illinois Masonic Medical Center. She also educates expectant mothers on exactly what kind of care a nurse midwife can offer. 

The number of Illinois births attended by nurse midwifes is on the rise, according to the Journal of Midwifery and Women's Health. Illinois midwives attended a total of 8,881 deliveries in 2004 alone, the most recent year for which figures are available. And although the national number of midwife-attended births has been declining, the numbers increased by 6.8 percent between 1990 and 2004 in Illinois. Part of reason is the growing number of midwifes at medical centers here. Hauser talked about her profession. 

Q. What is a midwife?

Hauser. The strict definition of a certified nurse midwife is a person who is trained in both disciplines of nursing and midwifery.  I like to say that a midwife is a specialist in normal pregnancy and birth. 

Q. What kind of health services do nurse midwives provide?

Hauser. Midwives provide gynecologic care from the onset of menses through menopause.  We provide prenatal care and attend labor and birth for appropriate selected patients who meet the criteria for midwife care.

Q. What kinds of patients meet the criteria for nurse midwife care?

Hauser. Well, there's a long list of medical conditions that put women in high-risk categories, so I can simply say generally, we care for women who are having normal pregnancies and then we co-manage and consult for women with complications that can still be managed by midwives working together with physicians.  For certain high-risk conditions, we will transfer care to a medical service. 

Q. How does a midwife's job compare to the care of an OB/GYN?

Hauser. OB/GYNs are physicians who are trained in a surgical specialty of medicine [in addition to traditional gynecological and obstetrical care]. The way I put it to patients is that OB/GYNs are specialists in surgery and in complications of both gynecology and obstetrics.  Now that doesn't mean that they cannot do normal gynecology and obstetrics but what they specialize in is the complications and the surgery. 

Q. What do midwives specialize in?

Hauser. What midwives specialize in is the normal care of women throughout the childbearing cycle.

Q. Do nurse midwives assist at home births as well?

Hauser. Yes, nurse midwives can attend births at home, at birth centers and at hospitals.  We need to have a collaborating physician and we need to have malpractice insurance. 

Q. What do you say to those who think home births are out of the ordinary and perhaps even dangerous?

Hauser. For properly selected women with the properly trained nurse midwife home birth may be safer than a hospital birth. There's less exposure to other people's germs.  There are fewer restrictions on ability to eat and move around.  A woman who's at home and wants to be at home is generally more relaxed and calm. 

Q. What’s a birth like at home?

Hauser. Throughout the process of a woman delivering at home, you reassess the risk status of her pregnancy. There's an additional level of looking at how the pregnancy is going, are there problems we have to deal with and does this women continue to be a good candidate for home birth.  And there are people we have to tell 'I'm sorry but, because of this complication, you are not a good candidate for home birth.'  And same thing goes during home delivery. We are constantly evaluating how things are going and if things are no longer safe at home, then we transport women to a hospital.

Q. What is midwife assisted birth like at a hospital?

Hauser. The vast majority of nurse midwife attended births are done in the hospital.  We always work in collaboration with an OB/GYN. I can't always say the process is the same because we have a different philosophy. Our philosophy is that labor and birth are normal.  Medicine tends to see it as a problem waiting to happen.  We are trained in labor support and evaluation. A women being able to be up and mobile, to be able to eat and drink when possible, all these things contribute to a more normal outcome. But [at the hospital] it can be a very medical birth where we're inducing someone's labor because she's got some medical complications involving her pregnancy. And it's a co-management situation where the midwives are working together with the doctors to care for the woman.  But even when a woman is on a continuous monitor, even if she has an epidural, we're still conscious of how her position and her emotional state and her hydration is contributing to how her labor is going to go.  Even when there are medical interventions, midwives are really working to keep the process as normal as possible. 

Q. Does insurance cover midwife expenses?

Hauser. Yes.  Most insurances cover midwifery services.