By Claire Stuart
The oldest female profession isn’t really the one that is “x- rated.” Rather it is the midwife, an essential part of the birth experience since before there were written records.
Until the middle 19th century, midwives delivered the majority of the babies in the United States. As new scientific knowledge came through medical schools (which had excluded women), it was not passed to midwives who learned informally from each other.
As medicine grew more sophisticated, midwives fell out of favor, and most women gave birth in hospitals attended by obstetricians. Soon, birth had gone from being considered a natural process to a medical procedure, with anesthesia, forceps delivery, and episiotomy becoming commonplace.
Formal education of nurse-midwives in the mid 20th century began to turn the tide. Nurse-midwives were proving effective in improving outcomes of births in underserved rural areas. In the 1960s and 70s, the women’s movement increased interest in nurse-midwifery, alternative birthing centers, and limited use of artificial techniques and intervention.
In February 2014, Berryville Midwives, a satellite of Loudoun Community Midwives, opened for business. Heather Swartz, certified nurse midwife (CNM) holds a Masters in Nurse Midwifery, and says that in Virginia, CNMs are licensed the same as nurse practitioners. They can prescribe most medications and deal with minor female health issues. They manage contraceptive options ranging from pills, IUDs and diaphragms to natural family planning.
Nurse-midwives do a lot more than attend births. They offer well-woman annual exams, prenatal care, breast care, and general wellness counseling for women from teens to menopause and beyond. Swartz says she became a midwife because she finds a balance between the medical and nonmedical care.
Throughout history, knowledge about women’s bodies and reproductive cycles has been shrouded in mystery, even from women themselves, with misconceptions, ignorance and old-wives tales abounding.
“Our job is to educate and empower women regarding their bodies,” says Swartz. “I like it when young women just come in and talk about their reproductive systems—their bodies and their cycles—in a supporting and loving atmosphere. This begins a relationship if they later decide they want to have children. We talk to women during and after menopause, too—all spans of a woman’s reproductive life.”
Swartz explains that a midwife is trained to see what is normal in the birthing process and what isn’t, and what to do if it isn’t. “We are trained to see pregnancy as a normal physiological function in a woman. Most women are healthy—pregnancy is not a disease and should not be pathologized. They need reassurance of what is normal.”
She says there is a common misconception that a midwife-assisted birth cannot have an epidural. “There are lots of options for a woman giving birth, and we support her wishes. Some definitely want an epidural. Some want no medications or interventions at all, and we support that as well. A backup doctor is always on hand in case of complications. Most patients never see the doctors unless there is a complication.”
The Berryville Midwives do not do home births. They do not attend births in Winchester, although women come in from the Winchester area. Their births all take place in the Loudon Inova Hospital Birth Center or its new free-standing birthing center that opened in November of last year.
Anyone the mom wants to be a part of the birthing experience is welcome, including grandparents and other children.
“We insist that dads are involved,” says Swartz. “They are an integral part of the birth process. We educate them, give them ways to help the mom. If children are going to be present, we ask that they have received age-appropriate information about birth, and we trust the parents to make the decision.”
Swartz stressed that there must be another grown-up, not mom or dad, to take charge in case children become frightened and have to be removed from the birthing room. There are other options for children so that even if they are not in the birthing room, they can still be a part of the process. The birthing center is very homey and not medical and scary-looking, and even includes a living room and kitchen.
“This is different from the model of being told what to do by the doctor,” says Swartz. “The midwife tells the mom what she needs to know to make decisions. Each birth is different. We support the mom through the whole pregnancy.”
Midwife-attended births are becoming widespread and mainstream, says Swartz, especially since nurse-midwives have good relationships with backup doctors. “Our backup doctors are in a group, and there is always one doctor in house 24 hours a day. Our practice has delivered about 400 babies per year and is growing.”
There are six delivery nurse-midwives and two non-delivery in the practice. The non-delivery nurse-midwives do routine gynecological care, and are also certified for deliveries. Midwives are on call 24 hours a day.
And yes, Swartz says that it is true that babies frequently come in the middle of the night and during snow storms. Drops in barometric pressure bring babies, she says!
For information: Berryville Midwives; 3 ½ East Main Street, Berryville; 703-726-1300.