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Popularity of midwife services on the rise

After giving birth to her first child 11 years ago, Nikki Coraggio said she was convinced “there had to be a better way.” A pre-medical student at the time, she wasn’t sure what any other options may entail. But after moving to Washington state, she found the solution: midwife-assisted births.

“This is a more progressive state compared to others,” she said. “It’s licensed and regulated through the Department of Health, which helps to ensure there’s quality practice.”

This past January, the Gig Harbor resident (now a mother of four) opened her own practice called Gig Harbor Midwifery. She said being a midwife allows her, as the prenatal provider, to interact more with the expectant parents than physicians traditionally do. “This is a time that’s incredibly special for the families to be going through,” she said.

According to the American College of Nurse-Midwives, the number of births attended by certified midwives and certified nurse-midwives has risen every year in the United States. The latest available statistics show that 7.5 percent of all births and 11 percent of all vaginal births were attended by midwives in 2008, though the majority of those births were still in a hospital, with about 2 percent occurring at home and another 2 percent in a facility such as a birth center.

“Most people grow up with the idea of going to the hospital to give birth, and they may have gone and had that experience then looked for a midwife (the next time). But now, more are already thinking of that (alternative) before getting pregnant. Using midwives is becoming more common for first-time parents,” Coraggio said.

She thinks part of the trend is due to the rising popularity of “green living,” which is focused on a natural lifestyle, but some is also due to increased visibility of midwifery. In a state like Washington, the practice of home births is especially more accepted since midwives are licensed and their services are covered by insurance plans, including Medicaid.

A 2008 study commissioned by the Washington State Department of Health estimated that licensed midwifery care resulted in $2.7 million savings to the healthcare system (the estimate was based only on costs of avoided C-sections and not the potential additional savings from avoiding other interventions). The cost is lower to the families as well due to lower facility fees (a birth center can cost as little as half a hospital stay and the home is free) and baby delivery fees.

The state requires midwives to complete three years in an accredited program, including participation in at least 100 births, before becoming licensed.

“I have access to a lot of the same tools as the physician and the same information,” Coraggio said.

A midwife provides prenatal care much the same way an obstetrician does. The women are prescreened first to make sure they are good candidates — midwives do not take high-risk pregnancies or women with medical problems who are more likely to have complications. The visits are generally longer and often also focus on emotional wellbeing and birth preparedness instead of only physical indicators. At least one visit is scheduled at the home, to make sure it’s appropriate. In Coraggio’s practice, she also does two postnatal visits at home including one within 24 hours of birth. She only accepts three new clients per month, devoting about a day and a half to clinic hours every week.

Some women choose to use a birth center instead. In either setting, the midwives are ready with emergency equipment in case resuscitation is needed, and are also prepared to transport if the delivery is not progressing as desired.

A new birth center opened in Port Orchard in July after several years of planning, and has already received reservations for a few births. The Poplar Heights Birth and Wellness Center includes two birthing rooms, a media/teaching room for classes and an office space where a certified nurse midwife will provide general women’s health care.

The non-profit center is the only independent birth center in the area, and currently has three licensed midwifes on board. The facility, which includes a full kitchen and waiting room for families, is equipped with an ultrasound as well as birth tubs, and could accommodate as many as a dozen births a month.

Corragio said a big difference with a non-hospital birth is that the women use other pain-coping mechanisms instead of medical interventions. But they still have a choice. “It’s not an all-or-nothing (arrangement),” she said. “We can transfer to a hospital if the pain is too much.”

Kendra Machen, a certified childbirth educator and a midwife assistant, said pain-coping techniques are one of the aspects the women can learn in childbirth classes. Machen also teaches hospital birth classes and she said in many respects, the classes are the same, but not when it comes to pain and comfort.

“You learn more about the fear-pain-tension circle. We rely heavily on learning to relax, change position, use different senses like heat and cold, guided imagery,” said Machen, who is on the Poplar Heights board and one of the organizers.

She thinks the appeal of a midwife-assisted birth is different from woman to woman, but primary reasons include cost, comfort and privacy. Some women also feel safer at home and more respected. There has also been a growing trend of more Caesarian deliveries in hospitals so some women are looking at home births because they want to deliver naturally.

“When women can’t get what they want at a hospital and are becoming more educated, they want to go somewhere else,” she said. “…I don’t think, in my heart, that going to the hospital is wrong or a midwife is always best — what we need is for women to have choices.”

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