When it comes to childbirth, the choice is more than whether to use pain medication or have a natural delivery.

“You’re brought up to think you need a doctor,” said Meshele Tomplait, 28, who delivered daughter Darbie Mae on Aug. 9 at her Edwards home with her husband, Timothy, alongside, and Velma McAllister, a Vicksburg midwife, attending. “It’s important for women to know that you’re stronger than you think you are. You can do it.”

In addition to being Tomplait’s midwife, McAllister has delivered about a dozen other babies locally since October, will tend to three others in the immediate future and has five more due in the next eight weeks.

To McAllister, of Vicksburg Midwifery on Clay Street, “birth is as natural as breathing.”

Though disagreement exists between doctors and some midwives on the subject of home births, about 1 percent of American women choose to have their babies at home.

In a statement issued in February 2007, the American College of Gynecology and Obstetrics opposed the practice, as it has for decades, “because complications can arise with little or no warning even among women with low-risk pregnancies.”

And pediatricians are also concerned. “In this day and age, it would not be my choice,” said Dr. Lisa Fairchild, a pediatrician at River Region Medical Center. “It’s risky. There are lots of things that could go wrong.”

But a national organization dedicated to achieving licensure across the country for professional midwives, the Big Push for Midwives Campaign, argues that with a normal pregnancy under the care of a trained midwife, home delivery is not only safe, but often better for both mother and baby, and proved to reduce the incidence of birth injury, trauma and cesarean section.

In 1900, about half of all births were at home with a midwife in attendance, according to Judith Rooks’ “Midwifery and Childbirth in America.” Within the first few decades of the century, hospital, and especially medicated, births became the rule.

At a glance

• Midwives are trained professionals who offer care, education, counseling and support to women and newborns during and after pregnancy.

• Two broad categories of midwives exist in the United States — nurse-midwives and direct-entry midwives. Direct-entry midwives enter the field of midwifery directly from their professional training, which focuses on midwifery alone. Nurse-midwives are educated in both nursing and midwifery and are also registered nurses.

• Certified nurse-midwives are licensed in all 50 states and the District of Columbia.

• Direct-entry midwives are licensed in 24 states, legal but unregulated in 16 states, including Mississippi, and prohibited in 10 states and the District of Columbia.

Source: www.naturalhealers.com

Online

thebigpushformidwives.org

Rooks cites several different classes of midwives, generally those with professional training, which includes direct-entry midwives such as McAllister, and certified nurse-midwives, who also are registered nurses. In some states, especially in the South, a few lay or so-called granny midwives can still be found.

Home birth appeals to some women for reasons including comfort, privacy, the opportunity for non-intrusive birthing care and the freedom to move around rather than be tied to high-tech monitoring machines. For healthy mothers with low-risk pregnancies, McAllister said, home births are safe, natural and meaningful for the mother and her family.

Tomplait’s three older children were hospital-born, after drug-induced, pain-medicated labors. Never having experienced a naturally occurring labor, Tomplait was at first nervous about the prospect of a home birth.

“My stepmother had four babies at home,” Tomplait said. “I was curious. I knew that Velma had been in school getting certified, but when I found out I was pregnant I just didn’t know if I wanted to do it.”

Tomplait and McAllister were part of the same homeschool group. Tomplait began asking her about organic foods, herbs and other natural preparations, and soon she was McAllister’s client.

McAllister will generally retain a client early in the pregnancy, offering exams in her office on roughly the same schedule as an obstetrician. She orders lab tests and blood work periodically, contracting with an outside lab to draw and test blood and other samples. Most women are asked to retain a back-up doctor in the event that intervention becomes medically necessary, and about half elect to have ultrasound and other medical tests, which McAllister, since she is not a medical professional, cannot offer.

What she can offer is longer, more in-depth exams. “If you leave the office within an hour of a midwife appointment, it’s a quick visit,” she said. She checks weight, blood pressure and other physical signs, but also develops a relationship with the woman. “I let her talk and try to learn how she’s doing. I want to spend time knowing the whole person.”

“Velma and I were acquaintances before this, and now we are friends,” Tomplait said. “There’s a connection there because she was there with me for the whole journey. That’s a special thing I definitely wouldn’t have with a doctor.”

When labor begins, McAllister gives over her entire schedule to aid the laboring woman, conducting physical checks of both mother and baby and suggesting various positions so that the mother can find what is most comfortable and effective.

Tomplait spent much of her labor in the shower. At one point she tried getting in bed and lying down, but that made her more uncomfortable. So, she went back to the shower. “If her bathroom had been larger, she would have had the baby in the bathtub,” McAllister said.

“It was not as scary as I thought it was going to be,” Tomplait said, “Once labor became very involved and intense, I wasn’t scared at all.”

After her own children were born in hospitals with plenty of medical intervention, McAllister knew she wanted to be involved in helping women find an alternative. She trained first as a doula, a labor assistant who helps a delivering woman in a hospital setting. Then she began studying to be a midwife and started nursing school, planning to earn a master’s degree. But after becoming disgruntled with the instruction she was receiving, McAllister dropped out of the program and concentrated on midwifery courses, which she completed two months later. She did her clinical work in Texas, then obtained the local and state board of health permits required to open her office. Mississippi does not require her to be licensed as a midwife.

“Our Legislature has not seen fit to address the licensing of midwives,” said Dr. Van Craig, head of the Mississippi State Board of Medical Licensure. “Neither the board of medical licensure nor the board of nursing wishes to address it. Midwives are required to register with the board of health if they have a center where a birth could take place, and they are required to refer complicated cases to a physician.

“Childbirth is not a simple procedure,” Craig continued. “Mothers need professional care, not just prenatally but also for the delivery. Problems can occur even in deliveries that seem routine. The (umbilical) cord can be wrapped around the baby’s neck, or there can be other cord complications. It’s not wise to trust somebody with no medical training.”

McAllister said she states up front for her clients that she is not a medical provider, does not have hospital privileges and cannot write prescriptions. She will not accept clients with potential complications, such as twins or maternal diabetes. She also will not attempt to deliver breech births, and will call for ambulance transfer of clients to a hospital if the mother’s blood pressure rises, the baby’s heart rate shows signs of fetal distress, if labor progresses too slowly or other birth emergencies occur. So far, she has not had to call for emergency transport.

Fairchild said, if a woman chooses home birth, the midwife should be trained in neonatal resuscitation, which McAllister is. Also, she said, a newborn exam is important as soon after birth as possible. The baby also needs a shot of vitamin K to prevent bleeding, as well as eye medication to prevent infection. Hospital neonatal exams routinely include a hearing screening for the baby, too, Fairchild said.

McAllister weighs and examines the newborn, applies antibiotics to the eyes unless the parents decline the medication and recommends a prompt visit to the pediatrician. She’s trained in newborn screening, but said most parents choose to have the pediatrician do the testing and the vitamin K injection during the child’s first doctor visit.

Tomplait’s daughter, Darbie Mae, now six weeks old, has had several pediatric checks already and is doing great, she said.

“The client makes an informed decision about what she wants,” McAllister said. “For a simple, healthy birth, where she has taken care of herself and made wise decisions, there is no reason she has to go to the hospital to have her baby.”

Medical insurance does not cover midwife services, McAllister said. Her fees are based on what services the client chooses, from $2,400 for midwife care backed by a physician to $3,800 for full and exclusive midwife care including lab and blood work.

Tomplait said she would “absolutely do it again. It was hands down better. You’re free to move around, work with your body, let gravity help. If you let it, your body just kinda takes over. It knows what to do.”