MIDWIFERY
Taking childbirth from trauma to treasure
By Joan Tupponce

Sara Fariss Krivanec felt robbed of the joy of childbirth when she gave birth to her first child by Caesarean section.

“I had a posterior baby and a really hard birth, but I felt like I wasn’t getting many alternatives,” she explains. “I had a long recovery and post-partum depression. I felt like I lost some self-esteem. It was a traumatic experience.”

When she became pregnant with her second child, Krivanec started researching midwives and doulas. “I really got interested in that model of care where they educated women and empowered them,” she explains.

Krivanec liked the fact that midwives individualize their care and also focus on nutrition. “I didn’t find that in the medical model,” she says. “Some of the complications you hear about like high blood pressure and gestational diabetes can be prevented.”

Armed with her research, Krivanec began to explore the options available to her. She knew she wanted a home birth because her first experience in the hospital wasn’t the experience she had anticipated. The second birth “was a long labor,” Krivanec recalls, adding that again she did have to deliver in the hospital. “My home-birth midwife went with me to the hospital and I was able to have a vaginal birth.”

With her third child, Krivanec once again chose a midwife who could deliver a home birth. After a 19-hour labor, Krivanec delivered her third child at home. “About halfway through labor he flipped to posterior so we had to deal with that,” Krivanec says. “The midwife was able to turn him. He was born in my living room. It was such a great experience. Everything was so normal. I went from the birthing chair to the sofa where I stayed for more than an hour holding him.”

Often women like Krivanec who learn about midwifery choose to have a midwife provide their care before, during and after labor.

“Now that it’s more public, women are saying, ‘This is what I have always wanted,’” observes Juliana Van Olphen Fehr, coordinator of the nurse midwifery graduate program at Shenandoah University. “Women want to be cared for and supported. They want someone to be with them.”

Fehr has been a certified nurse midwife since 1983. She pursued her degree after working as a special education teacher for severely handicapped children. “I wanted to help pregnant women remain healthy and strong and decrease the likelihood that their children would end up in my classroom,” she says. “I enjoyed the fact that I was making a difference in women’s lives.”

The number of women studying midwifery is increasing, albeit slowly. “We currently have over 20 students in the program here,” Fehr says. “Since 1996 we have graduated more than 35.”

In the 1980s, Fehr was appointed by then-Gov. Gerald L. Baliles and later Gov. L. Douglas Wilder to sit on a statewide council on infant mortality. “Midwives are associated with decreased mortality rates and decreased morbidity rates among infants,” Fehr explains.

There was concern that Virginia’s infant mortality rate was too high. The end result: Two resolutions from the General Assembly. Those resolutions helped initiate a certified nurse midwifery program in the state and promoted collaboration between physicians and certified nurse midwives. “Those two things are the core of what I do,” Fehr says.

Certified Nurse Midwife Jessica Jordan took a long-distance program at Frontier School of Midwifery and Family Nursing in Kentucky years after a nurse midwife delivered her third child. “I wanted to have care where I wouldn’t have many interventions,” Jordan says, explaining why she chose to use a midwife. “I had my baby at home. At the time, there were no nurse midwives that practiced in hospitals but now most of them are in the hospital.”

Jordan was the first midwife to have hospital privileges in Richmond, at Henrico Doctors’. “Within three years there were two other midwives in hospitals in Richmond. Currently there are six nurse midwives practicing in Richmond,” she says. “It’s grown very slowly.”

She went to midwifery school in 1992 and started working for a physician in Richmond in 1994. During her career, Jordan has delivered more than 600 babies. For the past year she has been working as a consultant for the state trying to establish two pilot project birth centers – one in Emporia and one in the Northern Neck. “We are looking at areas where they have lost their inpatient maternity services,” Jordan says, adding that they hope to open the Northern Neck center in late 2008 and the Emporia center in 2009.

Midwives provide gynecological care that includes annual exams, birth control, STD testing and treatment as well as prenatal and midwifery care during labor and delivery and postpartum care.

Jordan likes the birth-center model. “These are places for low-risk women to have their babies,” she says. “The centers have no surgical facilities, no anesthesia. They are generally run by midwives.” If there are risk factors, they coordinate care with VCU Medical Center.

Midwives provide gynecological care that includes annual exams, birth control, STD testing and treatment as well as prenatal and midwifery care during labor and delivery and postpartum care. They talk to women about everything from their fears to nutrition. “We give women emotional support,” Jordan says. “Our goal is to prevent complications. We are there at a time in a woman’s life when she needs someone to hold her hand. It’s wonderful to be there and see these women become mothers.”

Certified Nurse Midwife Leslie Fehan believes women have a lot of misconceptions and fears about the birthing process. “Some people have the misconception that midwives are out there all alone with no guidelines or that if you use a midwife you can’t have pain relief,” she says. “That’s not true. Some women want personalized women-centered care but they do want an epidural.”

Fehan works with The Women’s Center, part of Bon Secours St. Francis Family Medicine Center. She was the first midwife at MCV, now VCU Medical Center. “I started the program there and stayed for seven years,” she says. “Then I worked to develop the program with Bon Secours. They wanted to meet the community need.”

At St. Francis, Fehan shares patients with CNM Nicole Carlson – both attend births only in the hospital. “The majority of women who come to us are seeking natural unmedicated birth,” she says. “Eighty-five percent achieve that.”

For Fehan, working as a midwife is a calling. “You have to have a passion for this because the hours are so bad and it’s emotionally demanding. There are lots of battles that have to be fought because not everybody is in favor of this,” she says. “I think something really spoke to me.”

The birthing process can be as exhausting for the midwife as it is for the new mom. Fehan recalls attending one birth that took 36 hours. “That’s usually first-time moms,” she says. “They need more support. They don’t have a perspective on birth and their labors are longer. We try not to bring them in until they are in active labor.”

Fehan sees a growing awareness of midwifery. She credits part of that increase to the film on midwifery, “The Business of Being Born,” by actress Ricki Lake. “We are at a point now where we need to do more education,” Fehan says.

Kathryn Beaton, CNM at VCU Women’s Health, hopes there will be a trend toward more midwifery care in this country. “I’m not seeing it yet,” she says. “I think a change for more midwifery care is going to need to be consumer driven.”

Beaton studied nursing in order to become a CNM. “I was living in an intentional farming community (commune) near Scottsville, Va., where I met women who had their babies at home attended by CNMs,” she says. “When I was at Trent University in Ontario, I did a project on birth for my sociology class. I interviewed many women about their birth experiences. I was amazed at the detail of their accounts and the importance of these experiences in their lives.”

According to Beaton, medical systems around the world that incorporate skilled midwifery care have much better birth outcomes than in the U.S., where only about 10 percent of infants are delivered by midwives.

“Midwives are partners with women in the provision of health care,” she says. “We are trained to provide safe, holistic care. In birth, we protect a woman’s right and ability to give birth in her own way. When a woman is in charge of her own birth experience, she is empowered to take charge in other areas of her life.”