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AMIDWIFE IS SOMEONE who assists women in childbirth. In the United States nurse-midwives attend women who are expected to have normal pregnancies which present little risk to the mother or infant. Women with special health problems, such as diabetes, kidney or liver disease, seizure disorders, or heart problems are usually not eligible for midwife care. In addition to delivering babies, nurse-midwives provide prenatal and postpartum care, “well woman” gynecology and family planning, and infant-care up to one year of age. What distinguishes a nurse-midwife from many physicians is the individualized care she provides her patients. Under a nurse-midwife’s supervision, prenatal care, for example, becomes more than just a periodic check on the progress of a pregnancy; it is a comprehensive educational experience. Jeff Davis CNM Frances Crites, who has had no bad outcomes in more than 300 deliveries, described the approach this way: “It is important to make the patient feel part of the health-care team. . . . There are no good patients or bad patients, just educated and uneducated patients.” This cooperative approach helps to break the mold of the passive patient who blithely and often ignorantly follows a doctor’s orders or doesn’t follow them because she doesn’t understand them. Recognizing that patients are more than the sum total of blood pressure 8 AUGUST 20, 1982 readings, weight checks and urinalysis results, midwives pay particular attention to a patient’s emotional and cultural needs and predispositions. For example, an Hispanic patient who follows a traditional Hispanic diet but who needs to increase her protein intake would be advised that instead of flour tortillas with her beans, she should eat corn tortillas. Nurse-midwives also make a point of knowing a pregnant woman’s home situation and her personal life so that her spouse, partner, mother, or other family members or friends can be involved in the prenatal care and birth. As for the actual labor and delivery, the midwives at Jeff Davis are less tied than most physicians to the standard flat-on-your-back-until-it’s-over method of managing a birth. If a patient finds it more comfortable to deliver lying on her side, she may do so. Nurse-midwives will sometimes have a patient walk around until she is ready to deliver. If a patient wants her family in the delivery room, or if she desires a non-standard delivery procedure such as a Leboyer delivery,* her wishes will be respected as much as possible. Nurse-midwives have re-evaluated many traditional obstetric procedures, and those that are not essential are no *Leboyer delivery is a procedure developed by a French obstetrician, Frederick Leboyer, designed to reduce the trauma of birth and allow time for maternal-infant bonding. The method involves dimming the lights in the delivery room and placing the infant in a tepid bath soon after birth to lessen the shock of leaving the womb. longer required as routine. The often dreaded pre-delivery “prep” \(shaving of episiotomy \(an incision to widen the vagnurse-midwife deliveries. The CNMs at Jeff Davis do have their preferences. They encourage the Lamaze method of natural childbirth, though it is not required. They avoid using pain medication or local anesthesia, but will use them if the patient desires or if the situation indicates their use. Crites summed up the program’s philosophy by saying, “As long as it’s safe, we’ll do whatever the patient wants. In a standard hospital delivery a physician is normally present only during the last phase of labor, when the woman is almost ready to push the baby out. As soon as the baby is born, it is transferred to the newborn nursery where its temperature and respiration can be easily monitored. A nursemidwife, by contrast, typically stays with a woman from the time she is in active labor until after the baby is born, anywhere from four to 24 hours, and sometimes longer. She then monitors the baby’s vital signs while it is in the arms of its mother. In the Jeff Davis midwife program, the baby remains with its mother for an hour after delivery. By general midwifery standards, even this amount of time for parent-child bonding may not be enough. Most nurse-midwives, and certainly lay midwives too, believe that leaving the baby with its parents is a necessary and appropriate conclusion to the often arduous labor and delivery. It also provides an appropriate beginning to family life. Interestingly, in a recent survey by Parents magazine, women said that being allowed to spend more time with their baby after birth was high on the list of things they would change if they had another baby. Some 77% said they had been given less than an hour with the baby after delivery. Though the hour given new parents in the Jeff Davis midwife program is longer than most hospitals allow, it still represents a concession to hospital policies set up for the convenience of the institution rather than of the patient. At Jeff Davis, after the first hour the baby is taken to the nursery and returned to the mother six to eight hours later. The mother may have the baby stay with her from then until her release from the hospital. S LATE AS 1910, midwives at tended half of all U.S. births. Be fore 1800, midwives occupied an indisputable place in society, for throughout America’s colonial and early republican period almost all babies were Midwife, Carolyn Nelson, with Mrs. Maria Franco, and her son Mark, age 5. She is about to have a baby; she is 36 weeks along.