Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, May 4, 1993 TAG: 9305040153
SECTION: EXTRA PAGE: 1 EDITION: METRO
SOURCE: Jane Brody
DATELINE: LENGTH: Long
At the same time, the rise of consumerism and the women's movement have prompted many affluent women to choose to have their babies either outside or within hospitals aided by professionally trained and certified nurse-midwives, with doctors acting as consultants should a complication of pregnancy or delivery arise.
According to a recently issued analysis of 15 studies of births assisted by either certified nurse-midwives or doctors, the babies delivered by the midwives fared as well as or better than those delivered by doctors, even though those cared for by doctors were at no greater risk for a poor outcome. Babies who were considered to be at risk were not included in the study.
The analysis, undertaken by researchers for the American Nurses Association, revealed, perhaps not surprisingly, that the babies delivered by midwives were more likely to be born vaginally without induction of labor, fetal monitoring, forceps delivery or episiotomy (a surgical cut of the vaginal opening).
But midwife-delivered babies, the study found, were also less likely to be born prematurely or with an abnormally low birth weight and tended to have higher scores on the Apgar scale of several signs of a newborn's condition five minutes after birth.
Women whose babies' births were assisted by midwives also had shorter hospital stays and were more than twice as likely to breast-feed their babies. Roxanne Greenstein of New York, the daughter of a doctor, chose to have midwives deliver both her children at St. Luke's-Roosevelt Hospital in New York. "For a healthy young person, it was the most natural way to go," she said in an interview.
"The deliveries were very competently handled, and since they took place in a hospital, not at home, I knew there was no danger. Michael, my husband, was very much a part of it all, and the midwives made childbirth feel natural and comfortable for both of us."
Other parents complain about the high-tech atmosphere of many doctor-assisted hospital deliveries, which can strip a woman of her sense of dignity and responsibility and turn childbirth into an event that more closely resembles a medical emergency than a natural occurrence.
Even though more than 87 percent of births attended by certified nurse-midwives occur in hospitals, the setting (often the labor room) and the techniques used by midwives tend to far less clinical.
And for those who worry that they may be getting short shrift if assigned to a nurse-midwife instead of a doctor, a study published a year ago in The American Journal of Public Health should provide comfort. Midwives who practice in hospitals serve women who are at higher than average risk of birth complications, the study showed.
These pregnant women tend to be younger and are more likely to be members of minority groups. They receive less prenatal care than pregnant women in general and are more likely to be unmarried and foreign-born.
Yet, the report by Dr. Eugene Declercq of Merrimack College in North Andover, Mass., stated, "judged by birth weight and Apgar score, mothers and babies have distinctly better than average outcomes when births are attended by midwives, either in or out of hospitals."
Although midwives were traditionally self-taught or learned at the elbows of older midwives, modern midwives are nearly all registered nurses who have completed advanced training in gynecology and obstetrics.
Those who are certified (known as CNMs) and licensed can practice midwifery in all 50 states. They must first pass a national examination and then attend continuing education programs.
Since 1975, the number of births in hospitals that were attended by certified nurse-midwives increased sevenfold, from nearly 20,000 to nearly 142,000 in 1990. But this still represents only 3 percent to 4 percent of hospital-based births.
Nurse-midwives attend about a third of deliveries at free-standing birth centers. And a growing number of obstetricians in private practice are hiring nurse-midwives to provide continuing care for their patients, as well as to see the women through labor and delivery.
And while midwives have traditionally cared only for pregnant women, today's nurse-midwives are trained to perform a broad range of gynecological services, including Pap smears; breast and pelvic examinations; contraceptive and menopausal counseling; teen-age pregnancy prevention; tests for infections of the vagina, pelvis and urinary tract; assistance with breast-feeding, and screening for menstrual irregularities, premenstrual syndrome and preconception problems.
In more than half the states, certified nurse-midwives can independently prescribe medications like antibiotics and birth control pills.
For much of this century obstetricians regarded midwives as poorly trained competitors and backed laws to forbid them to practice in or out of hospitals, but in 1971 the American College of Obstetricians and Gynecologists helped pave the way for the current revolution by officially approving nurse-midwives.
Now, as third-party payers, including the federal and state governments, look for ways to reduce medical costs, midwives are expected to flourish.
The main problem today is that there are not enough nurse-midwives to meet the growing demand, according to Melissa Avery and Georgeanne DelGiudice, certified nurse-midwives in Minneapolis.
The American College of Nurse-Midwives has called for the training and certification of 10,000 nurse-midwives by the year 2001, which would more than double the number now in practice.
And since the word midwife does not mean wife as in man and wife (rather, it is derived from the Middle English for "with woman"), there is no reason for men to exclude themselves from this growing and important profession.
Jane Brody writes about health issues for the New York Times.
by CNB