ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Sunday, April 28, 1996 TAG: 9604290001
SECTION: CURRENT PAGE: NRV-18 EDITION: NEW RIVER VALLEY
DATELINE: BLACKSBURG
SOURCE: CLAYTON BRADDOCK STAFF WRITER
Phyllis Turk smiles a lot as she talks to the red-haired, mother-to-be in the bed. The trait comes naturally and helps her bond with her patient. Her friendly brown eyes help, too.
Contractions increase. Soon the younger woman's face is etched with pain.
"She is frightened," said Turk, who has witnessed more than 400 deliveries. "But you expect that from most first-time mothers."
Turk's job as a certified nurse-midwife is to help Stephanie Johnson do what mothers have done for millennia: have a baby. Stephanie, a senior at Virginia Tech, has been waiting a long time for this day in the birthing center of Columbia Montgomery Regional Hospital.
Down the hall - where six other women are in labor - a baby's squall splits the air, protesting its sudden arrival. Johnson doesn't react. She is waiting to hear her own infant's first cry.
Others are waiting, too.
Kevin Price, the baby's father, and two nurses stand by.
Price leads Johnson through the aerobic cadence that pregnant women know too well: "Deep breath. Hold it: one, two, three, four, five, six, seven, eight, nine, ten. Let it out. Deep breath. One, two, three ...."
When he flags, a nurse picks up the count, then turns it back to him.
Johnson's grunts and occasional cries are signs of pain, but they're also a signal that a 7-pound, 11-ounce baby is about to sing the cry of the newborn. Mother and father, who aren't married, have already named the child, a girl, Genesis Kristina.
Turk knows the routine well, but also has her own routine for these busy moments. She sits on the edge of the bed with Johnson, watching the baby slowly emerge.
As the baby makes her way out, Turk plays cheerleader: "You're doing great; keep it up," she encourages.
When the infant is out far enough, Turk guides the baby out of the birth canal. Her smile is still there, but she is serious as she watches the emerging infant to make sure she is breathing.
Instead of handing the baby to Johnson, Turk places her on her mother's belly. With Turk's guidance, the father cuts the umbilical cord. The baby's sudden cry is not from a a slap on the bottom but from the quick change from 98.6 degrees inside the womb to 70 degrees in the birthing room.
It's another successful delivery for Turk, but the moment also carries the sadness of an ending. "It's a big letdown," Turk said. With the baby and mother doing well, "there's no reason to continue the frequent meetings with both of them, no reason to get together," she explained.
Turk has lived this cycle as a nurse-midwife for 16 years. She had thought about doing it for even longer.
As a nursing student in New York, her dream was to help the poor in the rugged mountains of Eastern Kentucky. She pictured small hollows, unreachable except by horseback, and nurses and midwives who spent days in the saddle, sometimes helping deliver babies far from hospitals and doctors.
Turk never made it to Kentucky. But she's worked hard as a nurse to help women deliver healthy babies, mostly in hospitals and birthing centers.
Most nurse-midwives can trace their heritage back a half century to the old Frontier Nursing Service that provided help to women in rural areas.
The growing trend of certified nurse-midwives is just beginning in Southwest Virginia. Forty-two certified nurse-midwives now practice in the state, but Turk, a former Radford University teacher and a registered nurse with a master's degree in nursing, is the only one between Galax and Lynchburg.
When her husband, Glen Martin, began teaching philosophy at Radford University, Turk taught nursing there. She stayed for eight years, she said, before midwifery called again.
"My dream was romanticized, mostly because of those images of riding on horseback," she said.
The midwife of long ago - and indeed, current day - was a different kind of health professional, a woman's best ally and friend, Turk said. Her job was to be there, mostly in times of crisis. But times and medicine changed. Births have moved from homes to hospitals.
It was only in the 1950s that the midwives and hospitals came together with the certified nurse-midwife - a registered nurse who also has graduated from one of 30 advanced education programs in the nation. To become certified, the nurses also must pass a national examination.
As of now, Virginia has no colleges training nurse-midwives.
That will change next year.
"We hope to begin a midwifery program in the fall of 1997," said Pam Webber, who heads planning for the program at Winchester's Shenandoah University. The program is undergoing accreditation reviews. Nurses in the program will focus on learning how to manage an early pregnancy, the economics of nurse-midwifery, and care of newborns. The program will admit 10 students a year.
Nationwide, some 400 nurse-midwives are certified each year, according to the American College of Nurse-Midwives in Washington.
Many of the programs for midwives, like one in the small town of Hyden in southeastern Kentucky, are community-based and encourage their students to practice close to home.
The job of the nurse-midwife is simply to help mothers do their jobs. "The mother delivers her own baby. She's the one who does it," said Turk. "We just help them."
And that goes beyond being there in the ninth month of pregnancy.
"It's about education," Turk said. "Spending more time with women, not just teaching them to eat better but taking the time and energy to find out where the mother is coming from, what she eats, about her family, the economics of her life, her social life."
Her goal, she said, is to have a comfortable relationship with the patients, and to understand them.
Johnson says she feels comfortable with Turk. "I can really talk with her and she listens to me." Price, the baby's father, agreed. Although he and Johnson are not married, he was there meeting with Johnson and Turk through most of the planning, learning and birthing process. (I TOOK THIS OUT NOT OUT OF ANY SQUEAMISHNESS ABOUT THE CHILD'S BEING ILLEGITIMATE, BUT BECAUSE THE PASSAGE IS POORLY WRITTEN AND UNNEEDED -mfk-.)
Turk has delivered 90 babies in her two years practicing in Southwest Virginia and her patients come from all over the region.
Nationally, certified nurse-midwives have a good record, according to the Public Citizens Health Research Group. The 1991 infant mortality rate for nurse-midwives was 4.1 percent; the national average is 8.1 percent.
Nurse-midwifery practice is legal in Virginia and the other 49 states, and private insurance companies cover their care in 31 states. More than half of all certified nurse-midwives work primarily in offices or clinics. Many of them are associated with hospitals, according to the American College for Nurse-Midwifery.
Turk works closely with Dr. Robert J. Young, an obstetrician/gynecologist practicing at the Women's Health Center of Virginia behind the Montgomery County hospital.
It's a different environment from the early 1900s when about half of all births in this country were attended by traditional midwives. By 1986, only about 4 percent of pregnant women were getting nurse-midwife care, according to Jessica Mitford, who wrote "The American Way of Birth."
Gene Wright, chief executive officer at the Montgomery hospital until a transfer last month, says Turk is meeting a need in her community. She provides "that kind of straight talk that patients like," he said.
And she bonds with her patients.
Dana Cudney of Newport knows that feeling.
"When I had my first child, I wanted a midwife, but one was not available in this area," she said. With her first baby, she used an office with four physicians "and you never knew which one you'd get.
"When I was pregnant with my second one, I knew I wanted a midwife," she said. "I did research, read books, studied the issues. I asked Phyllis to help me with my boy, born last year."
The old image of nurse-midwives delivering babies at home, however, is rapidly vanishing. All of Turk's deliveries are in an area hospital.
Back in Montgomery's birthing center, where Johnson delivered Genesis Kristina, Price is a proud father.
"It's over," said the Blacksburg Transit employee after the four-hour labor.
Someone asks about the baby's weight, but Price doesn't know - Johnson isn't ready to let go of her new daughter just yet.
Finally, the infant is weighed and measured, while Johnson speaks quietly to Turk.
The midwife smiles, turns and hugs the new mother, who smiles back, drained and exhausted.
Another new life has entered the world.
LENGTH: Long : 163 lines ILLUSTRATION: PHOTO: GENE DALTON/Staff. 1. Nurse-midwife Phyllis Turkby CNBexplains to Stephanie Johnson how her baby is positioned the day
before birth (ran on NRV-i1). 2. In photo at left, Phyllis Turk
(right), along with a nurse and Stephanie's family, monitors
Stephanie's labor as the contractions grow stronger and more
frequent. 3. Turk watches as a nurse (right) weighs and measures the
baby. 4. Stephanie Johnson gets a good look at her newborn baby,
Genesis Kristina. 5. Midwife Phyllis Turk points out the baby's
position to father Kevin Price. 6. (headshot) Turk. color.