Special delivery

For modern midwives, birthing babies is a labor of love

BABY NOTION <br>Nicole Garcia, who was three days past her due date during her examination, got a clean bill of health from certified nurse midwife Camille Panighetti. Panaghetti works with Carolyn Paul and Karen Aronson at Chico Nurse Midwives.

Nicole Garcia, who was three days past her due date during her examination, got a clean bill of health from certified nurse midwife Camille Panighetti. Panaghetti works with Carolyn Paul and Karen Aronson at Chico Nurse Midwives.

Photo by Tom Angel

The birthing biz: Most midwives do a lot more than prenatal care and delivery. They’re also trained in well-woman care and can perform routine annual examinations for women.

Midwifery is a booming business, but in more ways than one it’s a business with real heart.

Far from being corporate-ladder types looking to move up the health care hierarchy, midwives are content to concentrate on treating pregnant women and their babies. Midwifery, while being one of the oldest professions in the world, has taken on a bit of a modern medical image, while keeping much of the mystique that makes it an old-world tradition.

This is a business, for example, where apprentice midwives are encouraged to keep journals about the births they attend. They’re often cross-trained in such practices as hypnosis (called “hypnobirthing"), homeopathic medicine, meditation and acupuncture, which many of them use for pain relief instead of narcotics.

And, at least locally, they tend to be pleasantly earthy, artistic and happy to discuss life on the labor front lines.

Take Carolyn Paul, for example. A certified nurse midwife for five years, she’s petite and extraordinarily friendly—the type who looks like she’d be equally at ease in a pottery class and while coaching a laboring woman through delivery.

Paul, who has delivered more than 500 babies in her career, works with two other midwives at Chico Nurse Midwives, located just across the street from Enloe Medical Center. She’s clearly enthusiastic about her profession and displays in her homey exam room a huge corkboard layered with pictures of the babies she’s helped deliver.

“Birth changed my life,” Paul said. “It is absolutely the most amazing and powerful thing in the world to be with a woman while she’s delivering.”

Paul got the birthing bug when she delivered her own two children. She describes the experience as “hands down the most exhilarating experience of my life.”

She was no stranger to birth, having worked as a registered nurse at Enloe Medical Center’s labor-and-delivery wing since 1980. She’d even delivered a few babies herself, when they came before the doctor arrived.

But becoming a licensed midwife required that she attend an intensive two-year program in the San Jose area (while that program is closed now, midwifery programs are offered in San Francisco and San Diego), and attend 40 doctor-supervised births.

Paul completed the program in 1996.

By the looks of it, Chico is a friendly place for midwives. There are 10 licensed midwives working in Chico and the surrounding area, and Paul reports proudly that they attend a full quarter of the 1,500 births in Chico each year. That’s far more than the national average of 7 percent, according to the American College of Nurse Midwives.

“I think people are getting the idea that midwives are well-trained and good at what we do,” Paul said. “This is a business that cares.”

While all midwives are well trained in the business of birth and well-woman care, there are several different types of midwife. All midwives have to have a doctor on call, in case of emergency, and are licensed only to deliver babies vaginally, Paul said. “If a woman can’t push a baby out, I have to call the doctor,” she said.

Certified nurse midwives (CNMs) are registered nurses with advanced training in labor, delivery and gynecology. They’re required to complete a two-year study program and pass an examination administered by the American College of Nurse Midwives. While allowed to deliver at home, the vast majority of CNMs attend births at hospitals.

Physician assistant midwives (PAMs) are licensed physician assistants with additional training in midwifery and women’s health. In California, PAMs complete an 18-month to two-year training course and generally work in hospitals, clinics or private practices, although it is legal for PAMs to attend home births.

Direct-entry midwives (DEMs) usually enter the practice of midwifery through apprenticeship, established midwifery schools, self-study and course work. They have traditionally attended home births and, since they also are licensed by the state, are often referred to as licensed midwives (LMs).

Licensed midwife Dianne Lawrence still remembers the first birth she attended. It was in the mid-1980s, and a midwife friend of hers asked Lawrence to come help. Although she’d given birth to three children, helping a woman give birth—being on the other side, so to speak—was a life-changing experience for Lawrence.

She was hooked, she said.

“It was just amazing,” Lawrence said. “Helping this woman get the baby out, assisting her in this important transition to motherhood. I’ll never forget it.”

Lawrence, who received her state license in 1996, works with another midwife in a practice located in Oroville called Birthdance. She charges about $2,000 for her services and has a sliding scale for those without insurance or having low incomes.

But it’s not the money or the business aspect of midwifery that draws Lawrence—it’s the special bond she creates with the women she treats. Because she attends only one to three births a month, Lawrence said she has the time to foster more of a friendship with her patients than usually occurs in a clinical caregiver-patient relationship.

“It’s really a custom service that I offer,” Lawrence said. “I feel like I really get to know these women, and then I get to help them have their kids. What better job is there?”

She bemoans the rising C-section rate in hospital births and is upset that so many women dismiss having a home birth without considering it.

Lawrence uses herbs and massage to help combat the pains of labor and said that warm water is the best pain reliever she knows of. While she emphasizes that most women with normal, uncomplicated pregnancies can give birth at home safely, roughly 10 percent of her clients are transported to the hospital while in labor because of unforeseen complications.

“I don’t hesitate to go to the hospital if there is a problem, and I think that’s part of what makes me a good midwife," she said. "The goal is always a healthy baby and a healthy mom."