Another Option: Midwifery Clinic Opens in Central Texas

Waco women have a new option for receiving midwife services while still delivering in a setting with easy access to clinical care.

The Waco Tribune-Herald reports Ascension Providence Hospital recently opened a midwifery clinic in its Waco Center for Women's Health, located in the Medical Tower Plaza adjacent to the hospital. A team of three certified midwives and clinical support staff provide care for women's health needs.

"We are excited to offer the freedom and flexibility of midwifery care with the safety and security of hospital birth," said Dr. Richard Haskett, vice president and executive director of Ascension Providence Health Alliance. "We feel this is the best way to surround mom and baby with the safest environment while delivering the natural and personalized birthing experience that so many families desire."

A 2018 study found that states with laws that make it easier for midwives to treat pregnant women and deliver babies may have better birth outcomes than states where it is more difficult for midwives to provide care, Reuters reported.

Haskett said there is a growing trend in women seeking midwifery care and that about 8 percent of deliveries are performed by certified nurse midwives.

"People want to be able to make informed choices about a wide variety of care options, not just women's care," he said. "I think having an option that's a little different from the traditional physician-patient office model is certainly a reasonable choice for patients."

Stephanie Lockhart, 25 of Groesbeck, decided to go to the midwifery clinic for the birth of her second child, Ellie. She said the doctor who delivered her first child was not supportive of natural birth, the route she wanted to take for her second birth.

Lockhart went into labor at about 5 a.m. Feb. 8 and delivered Ellie at 2 p.m. The midwives helped her fight through the pain of her contractions and supported Lockhart's decision for delayed cord clamping, which increases hemoglobin levels at birth and improves iron stores for the first several months of life, according to the American College of Obstetricians and Gynecologists.

"When I was in my contractions, she would help me do different positions and help me breathe through it," Lockhart said of the midwives. "They're more like a coach."

She said the doctor who delivered her first child did not help her find natural ways to relieve pain but instead relied on pharmaceuticals. That was one of the reasons she went with a midwife the second time.

The clinic averages 20 births per month.

"We try to figure out what they're wanting with their birth, the experience they're wanting to achieve," certified nurse midwife Morgan Estes said.

The clinic offers a cozier atmosphere than a typical doctor's office. A diffuser fills the air with the scent of lavender, and the two obstetrician rooms have sofas so the patients can bring family members to appointments. The rooms in the labor and delivery department are spacious, with birthing balls, squat bars and large labor tubs for hydrotherapy.

But what really sets the midwifery team apart is its approach to patients. The team listens to the patient's desires, and together they come to a decision on care, from the type of birth control a woman wants to the degree of pain management she receives during labor, nurse midwife Audrey Patterson said.

"Because we have a nursing background, we are really interested in providing patients with lots of education, spending a lot of time with them, understanding their wishes and desires, and drawing from their past experiences and culture," she said. "We want to empower patients to be the experts in their care and know their options so they can make the best choices for themselves and their family, and we, more or less, are their guardians of safety."

Appointments with the midwives are longer, providing them ample time to get to know their patients' needs and wants. In addition to pregnancy care, the clinic offers well woman exams, sexually transmitted disease treatment, contraception, ultrasounds and breast exams.

The midwifery team makes sure prenatal patients meet all three midwives, because the on-call schedule rotates between the three. That way, it will not be "a stranger who shows up to deliver your baby," Estes said.

Unlike the traditional labor and delivery experience in which pregnant women "hand over the reins to their provider," the midwifery team takes direction from their patients, Patterson said. If the patient wants to move around during labor, she can, and she can be in any position she wants to give birth.

Often, OB-GYNs want patients to have an epidural during labor or will induce their patients so the physicians can keep to a schedule, Estes said. They also might be quick to resort to a cesarean section, which can be dangerous.

Nationally, the C-section delivery rate is 32 percent, but Texas ranks slightly above that at 34.4 percent, the seventh-highest rate among the states, according to the Centers for Disease Control and Prevention. The midwifery clinic's rate is 11 percent.

"There's a lot of risks associated with a C-section because it is a major abdominal surgery, and though it's quite common, it still carries risks," Patterson said. "In trying to promote vaginal birth, we are attempting to do that in a safe way. We're watching the baby's heart tones throughout the labor process, making sure that mom and baby are tolerating the process well.

"Even when things become difficult, we do try to give it our very best effort to achieve vaginal delivery because we know that this sets up the mother in the future to have another C-section and another C-section and possibly another C-section, if she's wanting a large family. Every time we repeat that abdominal surgery, it carries even more risks to mom."

Sometimes, a C-section is unavoidable, and the team must consult with an OB-GYN. That is where Dr. Erin Wait comes in. As an OB-GYN, she describes herself as "backup" for the midwifery team and only intervenes when the team asks her to when there is a complicated birth, possibly involving pre-eclampsia or postpartum hemorrhage.

Wait said midwives represent a middle ground between home births and a sterile hospital environment. They provide patients with the appropriate medical care, while allowing them the birth experience they want without the patients feeling pressured into getting a C-section, even if that is only a stigma for OB-GYNs.

"Having a nurse midwife who is trained properly and can provide that level of trust and level of care that's necessary, I think that helps bridge the gap," she said.

Wait said she highly regards the midwifery team and enjoys working with its members. She believes they provide a level of trust the patients need, especially when giving birth.

For the midwifery team, care does not stop with birth. Each midwife works with mothers after birth, helping with breastfeeding and monitoring for symptoms of postpartum depression.

"We're trying to empower patients," Patterson said. "People think about birth as making babies, but really it's about making mothers and making families."

Copyright AP - Associated Press
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