It is nothing short of amazing when a child is born. Through the long months of waiting, through the hopes and fears, through the powerful tumult of labor; suddenly, a new life emerges – small and wet – and a family is transformed.
“It’s such a magical moment when that baby comes into the world,” says Ruby Corrigan Anastasio, a doula birth attendant who lives in Brewster. “It’s like the world stands still and takes a breath.”
For generations, aunts, sisters and midwives have helped women through the passage of childbirth. While advances in obstetrical medicine have saved lives and the health of mothers and babies, among a growing number of women the desire for “high touch” support and letting nature lead the way is equally as important as “high tech” care. Today, professional midwives, nurse-midwives and doulas who attend births at home or in a hospital carry on the tradition of nurturing, holistic care.
There’s No Place Like Home
For some, the choice of a home birth reflects a desire to treat birth as a natural process rather than a medical condition. Attended usually by a certified professional midwife, a laboring woman can move freely around her home, take a soothing bath, eat what she wants and, cocooned with family and loved ones, set the scene that brings her serenity and focus as she prepares to give birth.
Besides wanting the comfort and freedom of their own surroundings, some women choose home births because they fear that being in a hospital will lead to interventions that result, perhaps unnecessarily, in a Cesarean section. This is a real possibility now that C-sections occur in nearly a third of all deliveries.
Home birth advocates say it is as safe as hospital birth for low-risk women working with well-trained midwives, who have transportation and access to a hospital. The American College of Obstetricians and Gynecologists argues that although the risk of planned home births is low, it carries an increase in the risk of newborn death compared with planned hospital births. It also advises that if a woman does choose home birth, she should be healthy and low-risk, work with a certified midwife or nurse-midwife and be able to get to a hospital quickly.
While the policy debate continues, including a bill pending in the Massachusetts legislature to license and regulate midwives who perform home births, some expectant mothers on Cape Cod are choosing home birth with one of a few certified professional midwives who provide personal care and work from what one calls “a huge base of ancient and modern knowledge.”
When Anastasio gave birth to her first two children over a decade ago, she felt the hospital nurses were too busy with paperwork and other patients to give her the nurturing she felt she needed. She had been born at home and had been looking forward to that same type of personal birthing experience within the hospital environment. Instead, she felt betrayed.
Anastasio’s experiences inspired her to train as a doula and help other women feel supported during their birthing process. When she became pregnant with her third and fourth children, she decided to give birth at home in her own bathtub, with her husband and children around her.
Paige Eastman Dickenson, a certified professional midwife, attended Anastasio throughout the home births. “The atmosphere was so different: I laughed the entire time I was in labor,” Anastasio says. “I felt so cared for and so safe. I felt so much power in my body.”
Midwives who attend home births say that they simply facilitate the innate knowledge of a woman’s body to give birth; and that power is awe-inspiring. Rebecca Taylor of Wellfleet, a certified professional midwife and doula, says, “I pride myself on providing evidence-based care and letting the mother lead. I give the mother and her partner the tool bag; but she’s powerful and she’s doing the work.”
Anastasio felt her midwife’s care was attentive and respectful, yet she felt assured that if she needed to, she would get to the hospital. She had toured the hospital maternity unit with Dickenson and shared her medical records with them ahead of time, in case complications arose. Her home births went quickly and smoothly. Afterward, Dickenson let Anastasio’s older boys help with the newborn exam. “It was just such a whole family love experience,” Anastasio says, beaming.
“The highlight of my experience is getting to know the amazing families I work with and getting to know from them the power of women and the power of parenting,” Dickenson says. “It’s an empowering experience no matter what happens in your birth.”
Dickenson starts building trust with her clients during hour-long prenatal visits in her offices in New Bedford or Harwich, or in the client’s home. In addition to testing, measuring and educating, she spends much of her time listening to clients’ stories. “It’s so important to have that information. We get to know each other very well,” she says.
When labor begins, Dickenson says it’s as exciting for her as for the family. She arrives with another midwife and prepares to spend whatever amount of time it takes with the mother – no rushing labor along artificially if it’s progressing normally. What makes midwifery different, according to Dickenson, is that it treats each woman and each labor uniquely. She adds, “This is how I want to be treated.”
Doulas And Coaches: Speaking Up For Mothers
Sometimes, pregnant women hire a professional midwife or doula to support them during a hospital birth. “In hospital births, it’s so clinical. I want to bring nurturing back to hospital births,” says doula J Clark of Dennisport.
Doulas serve as advocates for laboring mothers, educating and empowering them about the birth process. They might get food for a woman’s partner so he can support her, and they fend off intrusions from relatives or disturbances such as bright lights or hallway noises. When attending as a doula, Anastasio says, “I feel like I’m a protective bubble for the mother, to make sure the things outside don’t interfere with the rhythm she’s in. I’m kind of protecting their experience.”
Tricia Duffy of Orleans is a yoga teacher and medical massage therapist. Although she’s not trained as a doula, she’s been invited to attend 13 births in hospitals and at home. “To me, that’s like being asked to win an award,” Duffy says. “I just have a kinesthetic sense with women in labor – it’s beautiful.” When she’s with a laboring mother, she becomes unusually quiet, tuning in with her eyes and letting her spirit lead the way. She catches the natural rhythms of birth like a dance.
Alison Flynn of Orleans invited both Dickenson, as a doula, and Duffy to support her during the hospital birth of her second child. “During my first birth, a lot of things happened unexpectedly. It was hard to know what were the right decisions to make,” Flynn says. She trusted Dickenson’s experience to help her make decisions the second time around.
While Dickenson provided guidance, Duffy helped Flynn maintain a calm focus so she could work with her body as it labored through the waves of contractions. She set a soothing tone by playing an endless loop of the Dalai Lama chanting, creating an ambiance of reverence and silent grace that was palpable even to the nurses who would come and go. The chant, loosely translated, repeated: “Please allow us to appreciate the beauty, simplicity and complexity of life with ease. May we stay in grace and move through discomfort and death as effortlessly as the ripe cucumber falling from its vine.”
With Dickenson and Duffy’s support, Flynn labored for 36 hours before Abel Atwood Wilkinson arrived by C-section. For Flynn, the power to labor as long as she did was a gift. “I don’t feel disappointed about the C-section,” she says. “I felt engaged and empowered with all the decisions. We did everything we could do. He ultimately was born the way he was supposed to be born.”
Family-Centered Care In The Hospital
The Family Birthplace at Cape Cod Hospital in Hyannis, which performs around 900 births a year, launched a certified nurse-midwife program in 2009 to augment its addition of a female “laborist” obstetrician, who provides weekend labor and delivery coverage for the four obstetricians on staff. Now, whenever a patient arrives, she’s evaluated by one of three certified nurse-midwives who follow her through labor. Patients with uncomplicated pregnancies can choose to have the nurse-midwife attend the delivery too, or they may opt for the physician.
“They can still get pain meds and get medical care, but we have that midwife touch. We work with physicians – that’s the team,” says certified nurse-midwife Janice DiGioia.
Each of the 14 rooms at the Family Birthplace is an all-inclusive labor, delivery, recovery and postpartum suite, with private shower. There’s a sleep chair for a partner, and children and doulas are welcome. DiGioia says, “Some have music going…It just unfolds. We try not to put any pressure on them.”
The nurse-midwives offer women a variety of approaches including bouncing on an exercise ball or squatting on a birthing stool to help labor along. When a healthy baby is born, instead of rushing it to a warmer, the team places it on its mother’s abdomen and lets the cord blood pulse before clamping it.
“We try to provide a more home birth experience here in the safety of a hospital,” says Dr. William Agel, Chief of Obstetrics and Gynecology. “Our first priority is healthy babies and healthy mothers, but as long as we can make sure things are safe and healthy, we give them the experience they want.” He adds that Cape Cod Hospital is one of the few community hospitals to still do vaginal births after C-sections.
Family care continues after the birth, according to social worker Mary Rocha, who meets with each new mother and lines her up with a home visit from a visiting nurse. A lactation consultant also checks in to offer breastfeeding support.
Angie Valli of Wellfleet, who recently gave birth at the hospital to her second child, Preston, with DiGioia managing labor and delivery, says, “It was more nurturing being around women with more of a feminine touch. I think it was a great experience.”
Valli’s husband, Olaf, who was holding his day-old son while their two-year-old daughter played with the birthing bed, says, “It was very exciting. This one was a lot easier for me.”
Whether a baby arrives with the help of a nurse-midwife or physician, family members can press a button at the nurses station that plays “Twinkle, Twinkle, Little Star” over the hospital’s public address system. “It makes people stop and pause for a second,” says Director of Women’s and Children’s Services Diane Birch. “It’s a celebration of a new life.” -cha
Writen by Susan Spencer, Fall 2011
A Glossary of Birth
Attendants and Terms
Certified Professional Midwives (CPM) are independent practitioners who have met the clinical and academic requirements set by the North American Registry of Midwives. The CPM is one of the only midwifery credentials that requires both knowledge and experience in out-of-hospital settings.
Certified nurse-midwives are registered nurses who hold at least a master’s degree specializing in midwifery and women’s health care. They generally work as a team with physicians, both in and out of the hospital. They may prescribe certain medications.
Doula comes from the ancient Greek, meaning “a woman who serves” and is used to refer to a trained professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period.
VBAC – Vaginal birth after Cesarean section.