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Midwives An Alternative to Physicians in Area Hospitals

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By: Hilary Powell

January 21, 2015 — Elizabeth Ray was born at home in Carmel, Ind. last year — literally.

“I think it’s going to be pretty amazing she knows that she was born at home and that it was such a neat experience,” says her mother Johanna Perez Ray.

Ray, 35, says when she moved to Indiana a few years ago from Chile, she wanted to use a form of birth culturally frowned upon to deliver her child at home.

She used a certified professional midwife, a care provider who is legally licensed but not medically. A recent interaction with a hospital profession confirmed her fears that some experts still think twice about a home-setting birth.

“I think the doctor was very, I don’t know. I don’t want to read into her reaction but she looked at us as parents as if we didn’t know what it was what we were doing. It was like, ‘oh, homebirth, oh,’” she says.

Mary Ellis is a hospital-based midwife, also called a certified nurse midwife.

“We are made to be with women, which is what midwifery means, ‘with the wife,’” she says.

A certified nurse midwife can provide primary care for moms-to-be. Ellis says homebirths are less frequent in the state and thinks a hospital setting is safest.

“Things right down the hallway within steps is, to me, really important,” she says. “Also, [we have] access to these wonderful physicians that we have. If there is a problem, we have access to highly skilled physicians.”

Both certified professional and nurse midwives are still used in the state with a majority practicing in hospitals.

Indiana Deputy State Health Commissioner Jennifer Walthall says the state advises women to opt for hospital births. That’s where they can access care from obstetricians and from midwives who’ve earned medical certification, she says.

“We endorse national guidelines that in hospital births are the safest for babies,” Walthall says via phone. “Homebirths although a viable option for many do not undergo the same type of regulation and licensures as those that occur in a hospital where quality metrics that we endorse are applied.”

Perez Ray says that environment is not for her.

“I wasn’t against the idea of having a home birth, it’s just that I didn’t like it,” she says. “You have the doctor, you have the assistant, you have the blah,blah, blah. Then, people come and look at you and [say] ‘open your legs, let me see,’” she says with a laugh. “I wanted to have peace, and I thought being in my home, you know, just going through the whole process in my home. I mean, what could be better than that,” Perez Ray asks?

This week First Lady Karen Pence and officials from the state health department launched the $1 million public health campaign, “Labor of Love” to promote education for pregnant women and new parents. It’s created to combat a dismal statistic: An Indiana baby dies every thirteen hours according to Walthall’s office.

A growing body of health policy experts say midwifery care, which often includes comprehensive prenatal care in addition to delivery, can be lifesaving. A June 2014 report from the world health organization and its health partners calls midwives essential and reports their services could cut maternal and newborn deaths by two thirds worldwide if properly trained.

“If we can get her to be the healthiest she can pre-pregnancy that would be great and then keep it going.”

Midwives like Ellis think midwives provide vital prenatal care, especially for low-income women.

“We are called to work with the poorer woman, that’s just how we are,” she says. “To grow a society we need our birth rate to keep going and keep going up.”

NorthShore provides their services with sliding scale fees. Lake Co. has a higher below poverty rate than the state with one in five people living in poverty, according to U.S. Census data.

“Where can we do the most good,” Ellis asks of their income requirements? “They go and speak to our counselors about presumptive Medicaid and if you are here and you live here and this is your birth home, then you are eligible for this. Basic service but still service.”

And says though birth settings should be a choice, prenatal care is a definite priority.

“If you have the option to have a homebirth, it’s very empowering for women because in a way you’re not forced to do something that you just feel inside that you shouldn’t. But if you choose a hospital birth, it’s your choice,” Perez Ray says.

For Ellis, the end result of her job is a sensation that always feels new.

“I love that part,” she says. “A family is made right before your very eyes. There were four people in this room and now there are five. It’s like working around miracles every day. It’s pretty cool.”

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