baby.html

WHAT'S BEST

FOR BABY

written by Maria Maldonado photos by Astrid Reiken

It’s 10 p.m., and 20-year-old Faith Gibson waits for her husband to return. Earlier this evening, after playing pinochle with friends Bob and Lorretta, Gibson’s contractions begin. Realizing there’s no gas in the car, her husband rushes to the station. The drive to the Orlando hospital is long ý, but since Gibson is a labor-and-delivery nurse she’s not worried. Being three weeks early, she thinks it may just be a scare. It’s 1964 and Gibson, determined to have natural childbirth, knows drug-free is possible only if she arrives while delivering -- too late for them to "knock me out," she says.

"Women didn’t have an option of being anesthetized or not," she says. "Questioning it would be similar to questioning a brain surgeon’s reasons for anesthesia."

As her husband arrives, Gibson, dressed in a green shirt-waist dress and pink sponge curlers, walks to the car. Climbing in the black Renault and laying on the turquoise-blue back seat, Lorretta decides to come along. Still in the car, her contractions get stronger and closer together -- she realizes this is it. "Don’t push!,&qu; ýot; her husband yells as he’s trying to drive. "Don’t push!" For everyone involved -- pregnancy, delivery and adjusting to a new baby can be exciting and scary.

A century ago midwives were the primary maternity caregivers. But today families have many choices as to who will deliver their children. Whether an obstetrician, a physician or a midwife, the choice lies not in the title but in what the person feels most comfortable with says Maria Iorillo, a licensed midwife who had her baby at home. "Hospital beds are uncomfortable, and I wanted to be surrounded by friends," she says explaining her reason.

However, Gibson, both a licensed and certified professional midwife is concerned her profession has a widespread prejudice against it. She was arrested in 1991 for practicing without a medical license continues practicing under a rel Óigious exemption clause. "They thought I’d be a good test case and a good little Christian and just go off to jail," she says. But instead she became a political activist.

"Many people consider traditional midwifery old fashioned, inadequate and unsafe," says Gibson. "When in reality just the opposite is true." The misunderstandings are a result of medical politicians’ propaganda claiming childbirth is dangerous and shouldn’t be done at home, she says. According to her web site, which contains extensive research and information on midwifery, "In 1900, 50 percent of births in the United States were midwife attended.

And most European countries, especially Sweden, Denmark and Norway, had an 85 percent rate of midwife-attended births. But by 1972 the United States had dropped to 1 percent. Present Óly those same Scandinavian countries have 70 percent midwife-attended births." And according to the American College of Nurse-Midwives, certified nurse midwifery, of which 90 percent now work in hospitals or birth centers, increased dramatically between 1970 and 1980.

Other propaganda that makes the demand for home-based midwifery care almost extinct today is the myth that obstetric care is a safer and superior form of maternity care, Gibson says. "There are many reasons for obstetrics such as high blood pressure, triplets, or premature babies, but for low-risk pregnancies, obstetric care doesn’t make a difference."

Addressing fears many have surrounding home-based delivery and traditional midwives not being licensed to do Caesareans, she says: "Midwifes have no problem referring high-risk clients to obstetricians. It’s ä part of the midwifery model." And says another misunderstanding is that traditional midwifes want to deliver babies no matter what the risks. Further, she says since midwifes tend to spend more time on the whole with clients, it’s more likely they will catch a precursor to a complication. Other differences that set midwives apart from obstetricians are paradigm, education and training. Midwives look at pregnancy as a normal process most likely to go well. Obstetricians look at it as a pathology -- most likely to be complicated.

Comparing the views to lifeguarding, Gibson says: "You wouldn’t make everyone in a pool wear water wings or scuba gear if they knew how to swim. Well, that’s how obstetricians treat pregnancy, whereas the traditional midwife refers the nonswimmers to an obstetrician pool." Originally a labor-and- ãdelivery nurse, Gibson believed she could change the system from within. But after being fired numerous times, she realized she couldn’t. "People deserve to know childbirth can’t be improved by intervention; however, complications can be helped," she says. And claims the public and doctors need to be better educated on the safety of home-based birth services.

Being licensed as a midwife entails reading many of the same books used in medical school, Gibson says. "Doctors need to be educated on the education of midwives. Biology isn’t owned by any discipline. Individual doctors are just as much exploited. The issue is so complex; nobody understands. Women with no-complication births don’t even need to be in the hospital. You just need to be cared for. Get out and have care at home," she says. "If you take ¯ responsibility for a child being born ... you should have a formal education," says Desiree McCloskey, a certified nurse- midwife, who works on staff at UCSF’s pilot program in Fresno. She says she has many non-nurse-midwife friends whom she highly respects but still wishes would do formal training. "There’s something rebellious about those people. I just never was."

According to the Licensed Midwifery Practice Act of 1993, the license to practice midwifery authorizes the midwife to perform low-risk deliveries under the supervision of a licensed physician and surgeon, as well as provide family planning, prenatal, intrapartum and postpartum care.

However, the supervision requirement is "the medical politicians way of preventing home births," she says. "It creates a vicarious liability for the obstetrician, ã" which she says is unfair and impedes doctors from giving medical care. "It just doesn’t work." Most malpractice carriers don’t cover doctors if delivery is done outside the hospital, so without exactly making home birth illegal it definitely creates a hurdle, Gibson says. "It’s like any other type of discrimination, especially considering some malpractice carriers are doctor-owned companies." Paul Lewis, a midwife and academic head of midwifery at the University of Gournemouth, England, agrees. "The domination of American maternity care by a powerful medical profession has nothing to do with the best interests of women or babies and more to do with the self-interest and financial gain of the medical profession," he says in the October Minnesota Parenting Magazine.

But medical director of obstetric $s at the University Medical Center, David Feldman, says it’s about safety.

"Home delivery is for pizza. Certified nurse midwives have extensive experience and excellent training, so why would someone trust their most precious thing to someone who’s less qualified?" he asks referring to traditional midwifery. "Delivery is a very critical moment." He agrees with Gibson that some doctors are threatened by midwives because of competition, but says he’s not one of them and believes only certified nurse midwives are extremely valuable.

He disagrees that more time with patients means better outcomes. "Normal pregnancies don’t need a lot of time." He says he doesn’t understand the desire to seek care from a midwife with no nursing background. "Can I push," Gibson’s client Janice says standing in the bathtub. "Yes, go now," says Gibson. Just as Gibson delivered naturally 20 years earlier, so is Janice. Laying in warm bath water hours earlier to relax, husband Tim, and Gibson, wait patiently. Later, push after push, Gibson kneels by Janice coaching her. "You’re doing fine," Gibson supports. Then Janice, pushing one last time, lets out a loud scream, and her baby is born. Gibson believes the accomplishment of giving birth deserves more recognition. "Childbirth is the original Olympic event," she says.