Maryland moves to expand midwifery care

Naomi Gottleib-Miller, who chose to work with a midwife and a doula for health care and childbirth coaching, kisses her daughter, Milly.Photo by Naomi Gottleib-Miller
Naomi Gottleib-Miller, who chose to work with a midwife and a doula for health care and childbirth coaching, kisses her daughter, Milly.
Photo by Naomi Gottleib-Miller

By Cheryl Kravitz

When Naomi Gottlieb-Miller became pregnant, she knew she wanted to deliver her firstborn at home.

“I was pretty sure I didn’t want to have my baby in a hospital or birthing center. I had friends who had home births, and I knew that was what I wanted. It seemed for me the most natural thing to do,” she said.

Gottlieb-Miller, of Silver Spring, saw an obstetrician during the first few months of her pregnancy, but opted to continue with a midwife and doula — though she had no complaints about her doctor. Her midwife always gave her the option to go to a hospital during labor if she wanted. She didn’t.

“I remember so clearly the moments before my daughter was born. I was in a place of exquisite peace, connected to my child, every mother on the planet, my family. I knew the midwife, Nathan (her husband) and my doula were there for me. What a moment for all of us to welcome Milly to the world,” she recalled.

Gottlieb-Miller said her midwife and doula both followed up with her consistently after Milly was born.

Arielle Mir, of Washington, is working with the same doula who coached her during her first pregnancy and the birth of her son.

She chose to have a doula when she gave birth to her first child in a hospital.

“I had an awesome obstetrician, but the practice she was in rotated who was on call when a woman gave birth. I really wanted someone with us who knew me and my family,” she said. “I wanted an advocate in the labor and delivery room and support through my pregnancy. I decided to hire a doula to be with me.”

Mir said she considered home birth, but needed care that was covered by her insurance.

These women are part of the growth in the use of midwives and doulas. A midwife is health care provider; midwives can deliver babies in hospitals, birthing centers and at home. A doula is a childbirth coach.

This year, Maryland became the 29th state to license midwives who are not nurses and who specialize in births that do not take place in hospitals, such as home births.

The law is the result of a growing movement among women and families calling for greater access to midwifery care at home and in birthing centers.

The measure was introduced by Delegate Ariana B. Kelly (D-Bethesda) who is a member of Tifereth Israel Congregation.

She said it will more than a year before Maryland’s regulations are in place for these midwives, who are known as certified professional midwives, or CPMs.

Virginia already licenses and regulates them, and the District of Columbia is looking into it, Kelly said.

“Now a certified professional midwife will be licensed [in Maryland]. This empowers women to make a choice between a licensed CPM [and] a nurse-midwife. The state license will recognize midwifery as a profession, and it helps the consumer,” said Kelly.

“With licensure, there are rules to follow, liability language and appropriate forms for the CPM to bring to the hospital. Before licensure, personnel at hospitals might not listen to the [midwife] because she held no license,” Kelly said.

Maryland’s new law has detailed guidelines for educational requirements, transfers of mother and baby to hospitals from home, care of the newborn and what the certified midwives are allowed to do. A committee will draft the regulations.

However, women who have had home births in Maryland have not been breaking the law, nor have the midwives.

Midwifery has a long history in Judaism. For example, the Passover story begins with the bravery two women who disobeyed Pharaoh’s decree to kill all Hebrew male babies born in Egypt. These women, Shifra and Puah, practiced midwifery. Their skills provided safe and secret deliveries, including that of Moses.

Alice Bailes joined the resurgence of natural childbirth in America both as a midwife and as co-editor of The Handbook on Home Birth. Originally from Arlington, she now lives in the Shenandoah Valley. (Her mother, Ida Jervis, was a photographer who years ago worked for Washington Jewish Week.)

Bailes took Lamaze classes before the birth of her first child, and says she was made to take postpartum sedatives and had her newborn taken from her for the first 24 hours due to hospital policies.

She became a Lamaze teacher in 1971, and eventually a nurse-midwife. She began observing her students’ home births before becoming a certified midwife, attending nursing school at George Mason University and being trained in midwifery at Georgetown University.

“I don’t think my motivation to become a midwife came as a calling. It came because of my own experience. I believe birth works best for mother and baby when a midwife is present. I think midwives understand the process women go through physically and emotionally, and are giving the guidance needed so the [birthing] process can be gone through safely,” said Bailes.

She practiced as a midwife at Family Birth for five years before co-founding BirthCare, a birth center and home birth service incorporated in 1987 in Virginia.

“One of the things I love about midwifery is that I really do fall in love with my clients. We know each other so well. There is a trust there. And being Jewish, I think, has had an impact,” she said. ”I think we, as Jews, see the world from a unique perspective; it is the piece of tikkun olam. It is allowing me to repair the world by helping women and their families.”

Eileen Ehudin Beard, a senior practice adviser with the American College of Nurse-Midwives in Silver Spring, was the co-owner of the Baltimore Birth Center for 27 years and attended more than 1,000 births in her career. The center served many Orthodox women; Beard, who is Jewish, said she “became accustomed to the sensitive needs of Jewish birth customs.” The center was the first of its type in Maryland.

She said that 96 percent of nurse-midwives attend hospital births.

She said that nurse-midwives are licensed, independent, primary health care providers. They are registered nurses who have graduated from a nurse-midwifery program accredited by the Accreditation Commission for Midwifery Education and have passed a national exam. Nurse-midwives have been practicing in the United States since the 1920s.

Certified midwives, in contrast, are individuals who begin with a background in a health-related field — but not nursing — and then graduate from an accredited midwifery education program. They take the same national certification examination as nurse-midwives, but receive the professional designation of certified midwife.

Kate Connors, director of media relations and communications for The American College of Obstetricians and Gynecologists (ACOG), said her group endorses the International Confederation of Midwives education and training standards and strongly advocates using them as a baseline for licensing midwives. She said that women in every state should be guaranteed care that meets these minimum standards.

Carrie Ganz, the doula who coached Gottlieb-Miller, was raised in Reston and holds degrees in anthropology and social work, but her mother’s work as a labor-delivery nurse always fascinated her. She completed her studies in the Bradley Childbirth Method, which certified her to become a doula.

“I’m there to support the mom and her partner with emotional comfort. Sometimes, I even make them all dinner,” she said.

Michelle Cohen, like Ganz, is a doula, and teaches prenatal and postnatal yoga classes. She was the doula for the birth of Mir’s first child and plans to be there in a few weeks for the second.

Cohen, who studied event planning and association management in college, about 10 years ago became more involved with women’s issues.

Some of her clients contract with her as their doula and also attend her yoga classes. Now a mother of two and studying to become a postpartum doula, she said she wants to help women as they heal after childbirth.

When she meets with the mother-to-be, and often with the woman’s partner, she makes certain the she knows what the birth plan is, what their fears might be and what is happening in the pregnancy. She works at hospital birthing centers.

“I’m there for education, advocacy, physical and emotional support. I am the coaching partner,” she said. ”I like to say that I know birth and the partner knows the woman.”

Both women agreed serving as doulas allows them to nurture mothers and help give them a stronger start to motherhood.

“Judaism is about asking questions, said Cohen. “I think births with a doula or midwife gets to the heart of spirituality of knowing yourself.”

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