Nurse Midwife Has Benefit Of Backup; [All Editions]
Beth Loechler / The Grand Rapids Press.
The Grand Rapids Press. Grand Rapids, Mich.: Feb 22, 2005. pg. E.1
Copyright Grand Rapids Press Feb 22, 2005

When Natalie Morant said she'd be having a midwife deliver her second child, some people looked at her kind of funny.

"Their first reaction was kind of a panic. They'd say 'Oh, my gosh. Are you going to have your baby at home or in a hospital?' " she remembers. "They thought because it was a midwife, it was going to be some sort of underwater experience or something.

Morant wouldn't have considered delivering a child in a nonmedical setting. She wanted pain medication, machines monitoring vital signs for her and the baby and lots of medical professionals nearby in the event of an emergency.

She got all that and a midwife, too. She gave birth to Pier Elise 15 days ago at Spectrum Health Butterworth Campus with the help of certified nurse-midwife Gail Heathcote.In greater Grand Rapids, CNMs practice at Spectrum and St. Mary's Health Care. Nationwide, 99 percent of them are not involved with home births. They are the other kind of midwife -- registered nurses with a post-graduate degree in midwifery.

Last week, The Press featured home births done by a midwife who is not a nurse, leading to concerns from doctors who believe women should not give birth outside of a hospital, at least not voluntarily.
There's a big difference between the two types of midwives, although Heathcote said she has referred patients to a non-nurse midwife for a home birth and vice versa.

"There is no right or wrong," Heathcote said. "The reason I practice in a hospital setting, in collaboration with physicians, is because I have backup. I have 24-hour backup of obstetrical surgical services as well as other resources of a hospital, like doctors, nurses and neonatologists.

Having that support available was important to Morant, who also used a CNM for the birth of her first child, Will, in Chicago in 2002.
"There is no difference in the medical care you get" with a CNM, Morant said. "Where there is a difference is in the personalized care.

Only three months ago, the Morants moved to Ada Township from Evanston, Ill. So Natalie hooked up with Heathcote and CNM Maureen Chrzanowski late in her pregnancy.

"They knew me, they knew my situation, more than just related to the pregnancy. A lot of their questions were just about how things were going in my life, whether things were stressing me out," Morant said. She liked Heathcote staying with her during labor. She didn't want an obstetrician who would rush in at the last minute, relying on the delivery nurse for updates and perhaps not even knowing her name or medical history.

Always on call
Constancy of care is important to her patients, Heathcote said. She or one of the other CNMs at Associates in Obstetrics, Gynecology and Infertility in Grand Rapids always is on call. The three of them delivered about 200 babies in Grand Rapids last year.

Nationally, nurse midwives assist about 10 percent of all vaginal births, she said. And the numbers are growing, Heathcote said, because more and more women are learning they can have a close and nurturing relationship with the person who delivers their child.

"This is a democracy, not a dictatorship. I tell my patients they have the responsibility to question, to dialogue, to research," Heathcote said.

It doesn't happened often, but Heathcote will summon a doctor quickly if she feels the delivery is getting complicated. Chiefly, that's if a Cesarean section is necessary or if the baby must be delivered with forceps.Also, she won't fly solo with a high-risk patient. When a recent ultrasound showed a patient was pregnant with twins, she insisted on collaborating with an obstetrician in her office.

Medical support
That's why obstetricians, neonatologists and other medical professionals support the work of certified nurse midwives.

"I think midwifery is wonderful, and it's a very nice way to go in a hospital setting," said Dr. Russel Jelsema, on obstetrician who specializes in high-risk pregnancy.

He has no such compassion for midwives who do home births. Jelsema fielded a call recently from a fellow obstetrician who was called into action when a home birth went awry.

"A woman was having twins and had had a prior Cesarean -- that's two risk factors," he said. "The midwife brought her in (to the hospital) because she was having problems."
The first baby did not survive.
"The doctor was just beside herself," Jelsema said. "She said, 'Why would somebody do this?' It's a real frustration."

Dr. Ed Beaumont, a neonatologist at Spectrum Health Butterworth Campus, echoed Jelsema's concerns about home births. Breech births, infections, problems with umbilical cords, breathing problems, heart defects and other challenges during delivery are dealt with most effectively in the hospital, he said.

Another potential problem for mother and child is bleeding.
Beaumont, who has worked with sick babies for more than 20 years, remembers treating a newborn who had bleeding in his brain because he had not received a Vitamin K shot, a hospital-delivery routine.

"You need a system to back you up, Beaumont said. "That can't be duplicated in a home setting. That's why we're here 24 hours a day, seven days a week."

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