Midwife crises

Baby Zoie flashes a wide grin, shows off her new front teeth, then sprints on all fours—she’s too fast to call it “crawling"—across the shiny wood floor in her Northwest Reno home.

As Zoie’s first birthday approaches, her mother, arts administrator Sara Gray, recalls her baby’s birth. After 52 hours of labor, 15 of them spent at Washoe Medical Center, she had a Caesarian section. She remembers having five tubes attached to her. An intravenous feeding tube, one for an epidural, one to monitor contractions, one to replenish amniotic fluid and one to monitor the baby’s heartbeat. As births go, that’s not a particularly unusual situation—but it’s not exactly what she’d had in mind.

Home birth seemed a little too far off the grid for Gray, a healthy 30-year-old, and her husband, Nick Tucker, but they weren’t altogether comfortable with the idea of delivering in a hospital, either. Many women prefer having the latest in medical equipment and a staff of doctors nearby as they give birth, but Gray is among a growing number who favor natural childbirth. She’d hoped to deliver her baby in a place where it would be OK to eat and drink during labor, where maybe she’d labor floating in a tub of warm water instead of lying on a hospital bed. A place where the same practitioner would attend to her for the entire time she was there.

Her friends in northern California had their babies in midwife-run birthing centers, and Gray knew the field of midwifery had been making a national resurgence since the early 1970s. So she was surprised to find, while looking into her options for Reno birthing centers, that there aren’t any.

There are two midwives in Reno who attend to home births, but state regulations make birthing centers unfeasible.

“It’s not necessarily illegal,” says Sherry Asp, a midwife’s apprentice from Red Rock, who is studying to be a licensed midwife.

Licensed in California, that is. Nevada does not legally recognize midwife certification. But the state does not prohibit midwives from delivering babies or providing prenatal and postnatal care.

In most states, midwifery is either expressly permitted or forbidden, regulated or not regulated. Nevada is one of five states the National College of Midwifery lists under “Statutory Provisions Unclear.” Midwives are accounted for in the legal code not by specific regulations, as in many states, but only by inference. For example, requirements for postnatal care and recordkeeping refer to “doctors or midwives.”

The lack of governance means a midwife-run birthing center, fast becoming a happy medium between home births or hospitals in many locations, is not on the drawing board in Nevada. Since midwives’ credentials are not recognized by the state, a birthing center would have to have an obstetrician on staff. So far, a design for that situation has not arisen.

Diane Schaub, a Reno midwife who’s delivered about 900 babies in 25 years, says, “I think the bottom line is that there are probably no doctors who are willing to go out on a limb and do a birth center. Doctors are very restricted by the laws of malpractice and insurance companies.”

In some states, midwives and hospitals combine resources to provide patients with the best of both worlds: the benefits of personalized, holistic health care and hospital-based technology. In Nevada, however, those two approaches remain separate.

“It’s so black and white here,” says Sara Gray. “Doctors have their field. Midwives have theirs. There’s no in-between. You don’t know where to go.”

Midwife-in-training Sherry Asp says she often gets calls from women asking about alternatives to hospital births. The nearest birthing centers are in the Sacramento area, but there are three options available closer to home, she says.

Home birth

Asp assists midwife Diane Schaub with about 60 home births a year in the Reno/Tahoe area. A question they commonly field: “What if something goes wrong?” Asp notes that with Schaub’s certification and decades of experience, she’s qualified to distinguish between a complication that can be addressed at home and an emergency that requires hospitalization. When the need arises to transfer a client to a hospital, she does. That happens 5-10 percent of the time.

Doulas

Asp and Schaub both sometimes work as “doulas,” advisors and advocates to women during pregnancy and birth. Doulas can augment doctors’ advice with information about natural birthing procedures and can help with decisions about labor and birth. (Asp was present as a doula for Zoie’s birth.) They tend to accompany their clients to the delivery room to help them make decisions and offer emotional support, but they have no jurisdiction in hospitals. Asp and Schaub say sometimes doctors and nurses welcome doulas, sometimes they don’t. Asp says that on occasion, she’s announced herself as “a friend.”

Tahoe Forest Hospital

This hospital in Truckee, Calif., with its “Family Centered” obstetrics unit, takes some cues from the natural childbirth movement. Standard intravenous tubes aren’t required for women during delivery, as they are in Nevada. That means potentially more freedom of mobility during labor, which can help ease pain. The hospital also has a birthing tub that some women use during labor, though not during delivery. And, by policy, they welcome doulas in the delivery room.Asp advises women who are expecting or planning a pregnancy, “Research your options. Interview the players. See which is the best option for you.”

As for Gray, she praises Washoe Medical Center’s nurses for their care and compassion, but she says what she most remembers about giving birth is being discouraged by the feeling of being a cog in the wheel of a big system. “When you’re in that hospital bed, and you’re naked, and all these tubes are attached to you, you have no power,” she says. “You can’t argue.”

It’s possible that Gray, giving birth to a 10-pound baby, may have ended up in the hospital having a C-section even if she’d started out planning a home birth. But she says she’s already considering her options for baby No. 2, and she’s likely to seek out a practitioner whose sensibilities lean toward natural childbirth.

At the moment, though, she’s mostly concerned with being a mom to the young speed demon racing through the house in pink pajamas, about to learn how to walk.