Article first published in Vol. 10, 1992.
By Thomas L. Bryant
La Partera, the midwife. What does this unique woman offer pregnant women? Why, with all the advantages in medicine and an abundance of doctors, do women choose to use the midwife over a doctor?
Old family traditions, the personal touch, feeling comfortable with a woman delivering the baby and big financial advantages - these are the reasons women choose a midwife over a doctor.
Midwives have been around for centuries. During colonial times in America the midwife was the primary caregiver when it come to childbirth. Not until the late 18th century did significant numbers of physicians start delivering babies. Previously, doctors were only called in to deliver a baby when an emergency arose.
A family tradition of using a midwife contributes to the continued use of a midwife in modern times. The expectant mother and her brothers and sisters were most likely brought into the world by a midwife.
Since using a midwife was good enough for her mother, it is good enough for her to use now that she is expecting a baby. In some cases the expectant mother may actually use the same midwife that delivered her and cared for her mother.
Image caption: Casa de Nacimiento was established in 1985.
About 97% of the women who use a midwife are poor, working Hispanic women. These women frequently work in factories for very low wages and have very little or no insurance. The cost of the birth will be one of the family's biggest expenses of the year. Therefore, the cost of $700 at a birthing center is considerably lower than the several thousand dollars it would cost for a doctor and hospital. The $700 includes prenatal, delivery and postpartum care.
A large portion of midwives' clients are Mexican nationals. But contrary to popular belief, the attainment of American citizenship for their baby is not the reason for crossing the border. These women cross the border in search of better medical care. Often these women have lost a previous baby due to premature birth or inadequate health care services available to them in Mexico. These women are often middle to upper-middle class women who are able and do pay for the services they receive.
Linda Arnold, a lay-midwife and owner of Casa De Nacimiento birthing center, says that a special relationship often develops between the midwife and client.
The expectant mother will often discuss other problems with the midwife that don't relate to the pregnancy, such as the husband losing his job or other children being sick or misbehaving in school. Slowly a bond develops between the midwife and expectant mother that will last long after the birth of he baby.
An expectant mother often prefers that a women deliver the baby instead of a man for reasons of modesty and comfort in a situation that is already very stressful .She does not need the added stress of a man who is not her husband in attendance at the birth.
The women of El Paso who choose to use a midwife for the birth of their baby have two types to choose from. The first is a lay-midwife, who works out of a private, free-standing birth center. Casa de Nacimiento is a free-standing category "B" birth center, which means that it is run entirely by lay-midwives. A category "A" birth center would be run by doctors or certified nurse-midwives, who are highly trained registered nurses.
Casa de Nacimiento birth center is also a teaching birth center. Women wishing to become lay-midwives can enroll at the center and learn to become a midwife. Linda Arnold requires that the students meet certain requirements before she will accept them a students.
The students must be able to speak Spanish, have taken curses in microbiology, anatomy and physiology, and studied several medical books dealing with midwifery. Arnold would like the student also to have attended several births as a labor coach.
After completion of the course, students take a test with the County Health District, and if they pass with a score of 80% or better, they are then given a license to practice as a lay-midwife in the county of El Paso. The State of Texas does not consider the delivery of a normal baby to be practicing medicine. Therefore, the state has no laws governing the activities of lay-midwives.
The lay-midwife can deliver babies of women who are age 15 and up and who are expected to have normal deliveries. Women over the age of 35 must sign a letter stating that they have been advised of the risks that are associated with their age and problems that could occur with the baby such as Down's syndrome. If problems are expected with the delivery or other medical conditions exist that could affect the health of the baby or mother, the patient will be referred to an outside physician.
Arnold says that though prenatal care and screening, the staff can detect expectant mothers who might have a problem and refer them to appropriate medical professionals for treatment. If complications occur during labor or postpartum, such as a baby becoming stuck in the birth canal or the mother hemorrhaging, patients are transported to a hospital for higher medical treatment.
The second type is a certified nurse-midwife, the training for which can be found at the Texas Tech School of Medicine, in conjunction with the Master of Science in Nursing degree at UTEP. A certified nurse-midwife is a registered nurse who has gone back for higher education in labor and delivery, postpartum care and well-woman gynecological care. Certified nurse-midwives function as advanced practitioners regulated by the Texas State Board of Nurse Examiners. The certified nurse-midwives enroll in a program approved by the American College of Nurse-Midwives.Completion of advanced education enables a nurse to sit for the certification exam. Successful completion of the exam permits the practitioner to use the title of Certified Nurse-Midwife.
Certified nurse-midwives offer many services other than delivering babies. They can practice preventive medicine such a pap smears and PKU test (a genetic screening).
The midwifery program at Texas Tech is also able to take high risk patients such as epileptics, diabetics, substance users, women prone to premature delivery, women over the age of 35 and women with hypertension. Doctors from the Texas Tech School of Medicine also monitor these high risk cases.
If any problems arise during the prenatal, delivery or postpartum stages, the nurse--midwives have the full support and backing of the doctors from the Texas School of Medicine and the nursing staff at Thomason Hospital. Certified nurse-midwives perform about 20% of the 5,000 plus deliveries each year at the Thomason Hospital. The cost of using a certified nurse-midwife and a hospital is considerably higher than using the services of a lay-midwife. The average typical cost with no complications for prenatal, delivery and postpartum care at Texas Tech and Thomason Hospital is $3,450.
Times has changed since the early colonial days when a midwife would accept payment in forms of animals, food or other forms of barter.
El Pasoan Lori Boyce had her first child at home by a midwife. When it came time for her second child to be born, she could not find a suitable midwife to do a home delivery. She was referred to Sister Sharon Becker, a certified nurse-midwife at the Texas Tech Medical School, by a doctor at one of the school's associated clinics.
Boyce's mother used a midwife to have her and most of her siblings, so she felt more comfortable and relaxed with a midwife. When her son was born with a cord around his neck and required some immediate medical attention, Boyce was glad that she decided to have the birth of her second child at the Thomason Hospital.
Pregnancy is not a disease nor is the birth of a baby. As long as no problems arise that would endanger the health of the mother or the baby, there is no reason a women should not be allowed the choice to have a midwife deliver her baby. The border holds firm to its traditions, and the economic benefits of using midwives to deliver babies cannot be denied. As long as it's legal, midwifery will remain a popular way to bring life into the world.
