It will be her first child, but Barbara Jean Roberts knows exactly what her ideal delivery would be like.
“At home, with no doctors, with no medicine, with no IVs, no monitors, in an environment that is comfortable, not a hospital, sterile-feeling place where that’s not what you’re used to,” she said.
Unfortunately, insurance and other circumstances preclude that, so her next-best-case scenario involves the nurse midwives at Georgia Regents Medical Center.
Midwives were one solution that advocates put forth during a recent protest to call attention to the maternal mortality rate in the Augusta area, the highest in Georgia.
Those providers take a different approach to birth from the obstetricians they collaborate with and work alongside, said nurse midwife Courtney Gustin.
“It’s viewing it as normal until it is proven otherwise versus looking for what could go wrong,” she said.
That’s what attracted Roberts to the idea, because natural childbirth has been a tradition in her family.
“I definitely think that medicine is there for a purpose, but I think that women were made to birth babies, and we have to give them the chance to do it the way it was meant to be done,” she said.
It can be difficult for a nurse midwife to do so outside a hospital in Georgia, Gustin said. In states such as New York and Iowa, nurse midwives are free to practice without collaborating physicians. Georgia requires them for prescriptive authority and other services, she said.
“It is really difficult to find someone willing to do those things or somebody who wants to practice outside of the hospital environment,” Gustin said. Many people who contact her say they want her to aid a home delivery and she cannot accommodate that.
“It’s quite frustrating in that most people come to a midwife with the goal of providing a certain type of care and then in most settings you’re not allowed to provide it,” Gustin said.
Nurse midwives can practice outside a hospital or in a birthing center but it does take a lot more work, said nurse midwife Sarah Owens at GRMC, who is also president of the Georgia chapter of the American College of Nurse Midwives.
“The majority of people who are trying to be nurse midwives here in this state want to practice in a hospital, they want to practice with a hospital group,” she said, calling obstetrics is a “team sport,”
Coming from a nursing background also influences the nurse midwives’ approach.
“There is a lot more emphasis on relating to the patient, advocating for the patient, just really talking to the patient on the patient’s level,” Gustin said.
“I want to know about that whole person who is sitting there before me,” Owens said. “They are not a person who is in my exam room. They are someone’s wife or daughter or cousin. They are somebody who walks out into the outside world. And I want to know what’s happening to them. And how that affects their health.”
Walking into an exam room at the hospital, Owens scoops up 2-year-old Chantrice Hooper and has her help examine her mother, Quintrese, who is seven months pregnant with her second child.
“I want to do that,” Chantrice said, reaching for the doppler instrument and helping to guide it over her mother’s swollen skin.
“Good job, you found your baby,” Owens tells the girl.
The mother said she appreciates the nurse midwives.
“They help out more,” she said. “When you call them, you can get them.”
Continuity of care is a big emphasis for midwives, and they will stay throughout the labor, Owens said. It also means taking a different approach just after birth, such as placing the newborn directly on the mother’s skin afterward, Gustin said.
“The evidence shows babies transition a little more smoothly, they tend to have less respiratory distress, they tend to stay warmer, they breastfeed better, mom has a better transition,” she said. “It’s actually all around better for babies. When they put them in the little warmers and leave them there, they tend to actually not do as well. The science is pretty clear on that, but it is harder to get that into practice.”
Much of what the nurse midwife might do for the mother during labor might be subtle and might not even be billable for the hospital, Owens said.
“You have to be with other providers or be with an organization that respects that,” she said. “I’m not going to be somebody who is going to be a huge revenue source. I am going to be somebody that is going to provide quality care and quality outcomes.”