By SHARI RUDAVSKY
INDIANAPOLIS (AP) — When their plans to buy a house in Greenwood fell through, Bailey and Clay Orander found themselves moving from the south side to Fishers. The one hitch was that Bailey, 26, was expecting the couple’s first child and the midwife she had seen for the first 30 weeks of her pregnancy worked at Community South Hospital.
Bailey knew she wanted her child delivered by a midwife, so she and Clay considered making the 30-mile trip down to Community South.
But there was no need, it turned out. Community Hospital North had just opened a four-person midwifery practice allowing Bailey to seamlessly switch providers. Just a few weeks later, on Dec. 13, Millie Kate Orander became the first child born to the practice.
“I wanted low intervention, to do it the most natural way possible, and I know midwives are a huge advocate for that,” Bailey Orander said. “They really listen to what our preferences are, and they try to work as they can with those.”
Two area hospital systems — Community Health Network and Indiana University Health — are also listening to what their women patients want. And what pregnant women want, they believe, is the option of using a midwife to deliver their babies. Midwives have cemented their reputation for offering a natural, woman-centered approach to birth.
Community North — which delivers about 3,800 babies a year, more than any other facility in the state — opened its midwifery practice in November. IU Health has one midwife on board, expecting to deliver her first baby at IU Health Methodist in the coming days, and plans to have three additional midwives on staff by April.
“Every hospital system should have midwives on staff delivering babies,” said Shannon Greika, a board member of the Indiana Midwives Association and a midwife on the south side. “I think moms are getting more fed up with how medical things have gotten with birth, and they’re seeking to go back to a natural experience.”
The rate of births by cesarean section has skyrocketed in recent years. Nationally it hovers around 30%, and in some Indiana hospitals almost half of the babies are not delivered vaginally, Greika said. Experts attribute the rise in c-sections to multiple factors, including provider preference, a decrease in vaginal births after c-sections, and women's own preferences.
Interest in home births also has increased in the past decade, said Greika, one of five midwives in Central Indiana who do home births. She helps about 25 mothers deliver in their own homes a year.
Traditionally, hospitals in the United States have not embraced midwifery care, leaving most deliveries to obstetricians. In other countries, though, midwives bear the responsibility for the majority of deliveries.
When IU Health decided to build a maternity and newborn center at Riley Hospital for Children, shifting deliveries from its Methodist Hospital, hospital administrators wanted to provide a full spectrum of care, from the lowest risk pregnancies to those that required the most comprehensive services.
“We have Riley Hospital on board; we feel like we have the high risk piece covered,” said Darla Berry, manager of midwifery services for IU Health. “Now we need to go to the other end of the spectrum. …. I think every health care system owes it to the women that belong to their system to bring midwifery services to the table.”
About a dozen midwives from HealthNet, a clinic that focuses on providing care to low-income patients, have been delivering at Methodist Hospital for years.
The new IU Health practice will cater to privately insured patients who might otherwise seek an obstetrician for their care, said Berry, who formerly worked at HealthNet. In addition, the IU Health midwives will work with medical students and residents, broadening the experiences they have on their obstetrical rotations.
Berry is looking for a downtown space to open the practice.
Community Health’s clinic, based on the fifth floor of its women’s center, which opened two years ago, is already up and running. The midwives can provide care not just for pregnant women but for all women and of any age.
In general, midwife care is cheaper than care provided by a doctor because the office visits are billed like those with an advanced practice nurse, said C’Aira Hermesch, the manager of operations for maternal fetal medicine and midwifery care.
The midwifery exam rooms do not look like typical sterile medical exam rooms but aim to appear more warm and inviting. The walls are painted purple, a hue often associated with midwifery, and instead of a bed, patients sit on a couch.
“We really wanted to make the clinic more of a calm environment,” she said. “We wanted to make it as homelike as we could.”
Care also differs from that provided by doctors, midwives say. Jill Kocher, one of Community’s certified nurse midwives, said that she spends half an hour to an hour at each visit with her patients, delving into a range of lifestyle issues to ensure that they are as healthy as possible during their pregnancies. She may address spiritual and emotional issues that arise, as well.
Women also can opt to meet with each of the four midwives so that they have met in advance with whoever winds up delivering their baby, said Amy Wire, Community’s vice president for women's care. When it comes to time to deliver, midwives spend a lot of time by the woman’s bedside, whereas some obstetricians do not enter the room until the final stage of birth.
“We look at it (delivery and birth) as a natural process versus a condition,” Kocher said. “We’re looking at the whole woman.”
Obstetricians prefer to have women deliver in stirrups on a labor bed, but midwives are more willing to let their patients labor on birthing balls or stools. At IU Health midwives give women the option of water births, allowing them to deliver underwater. At Community, women can go through labor under water, but when it comes time to push, they have to get out, Hermesch said.
If a woman needs a physician, there’s an obstetrician available 24/7 in the hospital and one who reviews all of the midwives’ charts. When needed, midwives might refer a higher risk patient to an obstetrician and provide care alongside the physician.
It’s not a matter of either a doctor or a midwife but often the two professions working in concert with one another, Berry said.
“The most important thing to emphasize is this is not about competing. Sometimes there’s a misconception that a midwife is trying to compete with physicians," she said. “Midwifery and obstetrics, we share a common goal: Supporting mom and baby, and we come at it from different sides.”
Not that using a midwife means sacrificing the possibility of an epidural or other pain management if that’s what a woman wants.
Midwives also frequently partner with doulas, who provide additional support to the laboring mother. The growing use of doulas at births in part led Community officials to open the new midwife clinics, hospital officials said. If patients were so fond of doulas, they realized, they might appreciate the low-intervention, relationship-focused care midwives offer.
“This is just another way we can deliver high touch care for our consumers,” Wire said. “This is one addition to a comprehensive women’s health program.”
In its first year, Community North midwives will deliver about 100 babies, Wire said. Eventually each midwife will deliver 15 to 20 women a month. Down the road, Community plans to extend the midwifery program to other hospitals, Wire said.
The parents of Community’s first baby birthed by a midwife could not be happier. When Bailey Orander started having contractions around 1 a.m. on her due date, she called her doula first, who monitored her over the phone for a few hours and then said, now. Around 8 a.m. Bailey and Clay headed to the hospital.
As Bailey labored throughout the day, her doula and midwife helped her with pain management, showing her different ways to position her body and offering her essential oils. Midway through the afternoon, they noticed that the baby was affecting a nerve in her hip, causing her great pain. They raised the question of an epidural.
“They did an incredible job at not pushing either way,” Clay Orander said. “It was whatever Bailey wanted to do and what we wanted to do.”
Although the midwife they originally saw was not on call, the Oranders bonded with Kocher, who stayed by Bailey's side for most of the day.
“I was very impressed with our midwife,” Orander said. “She was just able to come into the room, and it felt like having a sister, a mom there.”
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