CA: One-third of births at Palomar Medical Center attended by midwives

From SignOnSanDiego.com:

ESCONDIDO – Tatiana Sanchez was 8 centimeters dilated and having rapid contractions as midwife Kelly Walsh coached her along.

“Largo y duramente! Largo y duramente!” Walsh said, urging Sanchez to push her baby out with strong, sustained attempts.

“Wait for the contraction,” a nurse added. “There you go, more like that.”

Walsh is one of 15 certified nurse-midwives on staff at Palomar Medical Center in Escondido. More than merely coaches, midwives serve as a mother’s gentle, knowledgeable guide from pregnancy to birth. Midwives offer prenatal care in one of five Neighborhood Healthcare clinics, attend the birth and provide postpartum care.

A midwife is on staff in the hospital’s birth center 24 hours a day, usually in 12-hour shifts. At times, a woman’s first birth can take up to 12 hours, Walsh said.

“We have some incredibly stressful days,” she said. “Last Monday I didn’t sit down for more than five minutes. I think I had five deliveries that day.”

Candace Curley, regional representative for the San Diego chapter of the American College of Nurse-Midwives, said there are 75 certified nurse-midwives practicing in San Diego County, about 40 to 45 of whom attend births. The county has one male nurse-midwife, based at Camp Pendleton, Curley said.

About 1,400 of the 4,200 births at Palomar Medical Center last year were attended by midwives instead of physicians. Midwives typically see those with little or no health insurance.

“The people that the midwives see are Medi-Cal patients,” Walsh said. “I know at other hospitals the midwives can see a private insurance patient.” Midwives typically make 65 percent as much as obstetricians, about $75,000 to $100,000 per year, or $55 to $60 an hour, Curley said.

Escondido resident Nadia Ventura said the midwife attending her delivery Oct. 6 was just as good as a doctor.

“She helped me, told me everything would go good and would be easy,” said Ventura, 27, clutching her newborn son, Isaac Sanchez. “She would say, ‘Don’t give up, don’t give up, everything will be all right.’

“I think it’s almost the same thing (as an obstetrician),” Ventura said. “A midwife is skilled. If there is a problem she can check with the doctor. … I feel confident with her.”

Nurse-midwives must have a bachelor’s degree in nursing, then obtain a two-year certificate in midwifery. Most midwives at Palomar Medical Center, including Walsh, have master’s degrees.

Sarah Starling, a midwife-in-training at Palomar Medical Center, delivered a baby Oct. 6 with Walsh’s guidance.

“I have a lot of respect for the midwives that I’ve seen and worked with,” said Starling, a labor and delivery nurse.

The hospital started using midwives in 1996. Susan Bass, a nursing professor at San Diego State University, has worked as a midwife at Palomar Medical Center for five years. She started there as a nurse’s aide in the 1970s after obtaining her license as a registered nurse through Palomar College.

Bass said she had longed to be a midwife since her daughter’s birth in the ’70s.

“It was back in the time when midwives were looked at very differently … as home birth midwives,” Bass said. “We refer to them a lot of times as the Birkenstocks midwife – the long dresses, long hair, much more earthy.”

Though the educational requirements are more stringent for today’s midwives, Bass said public perception hasn’t necessarily kept up with the profession.

“When you say midwife, they sort of think, ‘Oh, somebody’s going to do these deliveries at home,’ ” Bass said. “It’s still thought of as counterculture.”

Most midwives suggest natural, healthy birth options, Walsh said.

“For the most part we would prefer to use the (least) intervention possible – pain medication or internal fetal monitoring,” she said. “If you’re stuck in bed, your pain is probably going to be more intense, but if you can get out of bed and move around a little bit, the pain might not be that bad. … What can we do instead of just jumping to a Caesarean section?”

Midwives are trained to look for complications, such as toxemia, in which case an obstetrician or other attending physician would be called in to take over.

Like obstetricians, midwives know to let pain-induced insults and expletives roll off their backs.

“It would be so easy to just kind of get upset at the experience and be annoyed with her,” Walsh said. “Instead, we really work with her and provide compassion and reassure her that it’s a normal process and she’s doing a great job.”

When the pain is gone and women are left in charge of a new life, their transformation is remarkable, Bass said.

Giving birth can have a profound effect on a woman who has suffered physical or sexual abuse, Bass said.

“Labor and birth can be a really healing process, because now (their) body is working the way it’s supposed to be working,” Bass said. “That’s one of the most rewarding things … to see how it empowers them.”

October 18, 2008 | Filed Under Hospitals, Midwives/Midwifery 

Comments

3 Responses to “CA: One-third of births at Palomar Medical Center attended by midwives”

  1. Potty training infants on July 10th, 2009 10:29 am

    Thanks for sharing this. Yes a delivery is magical!

  2. Allied Tech on July 22nd, 2009 6:59 pm

    Hello,
    I am a nurse in sacramento, Uc davis hospital. I have seen many births and have even delivered a few as a Paramedic. I really must say that my hat goes off to these midwifes, they perform an essential duty, and I am sure they provide just as much care as an obstetrician does. After all the body is meant to give birth, often times the patient does all the work. Thx for this post was interesting.

  3. Medical Assistant Training on September 29th, 2009 1:36 pm

    I work in a clinic at the moment. And my friend who is a medical assistant says that she has found a program in which they give medical assistant training to become a midwife. I dont know if maybe she is becoming a midwife assistant or what. But does this seem right?? I would expect someone to have some pretty serious medical skills in order to do what midwifes do, or at least have some LPN Training.

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