Midwives have been delivering babies for most of human history. In modern times, midwives tending to homebirths have largely been marginalized from mainstream medicine. But a bill moving through the California legislature could foster stronger links between midwives and obstetricians. Capital Public Radio’s Health Care Reporter Pauline Bartolone has more.
In Tosi Marceline’s practice, pre-natal check-ups happen in the living room.
Marceline is a homebirth midwife. Today, her very pregnant client lies on the couch in her Sacramento home. Marceline kneels on the floor beside her. She takes out her battery-powered, handheld, ultrasound machine and puts it on her client’s belly.
“We’re going to wake it up a little bit,” says Marceline.
They’re doing a non-stress test on the baby. The mother gently nudges her belly so they can monitor the baby’s heartbeat.
“ Normal heartbeat is 120beats,” says Maceline.
Tosi Marceline monitors pregnant ladies in their homes everyday – and eventually, she delivers their babies there too; dozens, every year. She’s been doing this for 30 years – and it shows through her calm assurance and her stories.
TOSI: “You’re baby is fabulous. “
My babies are movers.
TOSI: “so he’s what we know about humans…”
Marceline’s style of health care is very different from what you’d get in a doctors office. Instead of a white coat, Marceline is dressed casually. She drives her prius to her clients’ homes, so they don’t have to wait in an office. Marceline will spend an hour with her clients, for whom she cares before, during and after the baby’s birth. Her client today, Shannon Kenealey had her first child in the hospital.
“ The experience in the hospital was very invasive, I was trying to relax, and the nurse would come in and flick on the lights and talk really loudly and we were trying to talk soft so that I could think of being at home and not at a hospital,” says Kenealey.
Kenealey chose to have her second child at home with Marceline as her midwife. No IV, and she wasn’t hooked up to a monitor. She sewed before she gave birth in a giant tub of water. Kenealey is having her third child, at home too
“I feel that birth is a natural thing, and they’re trying to make it a hospital emergency every time,” says Kenealy.
But sometimes, home births do become more urgent situations. Marceline says about 8% of her clients are transported to the hospital for a c-section or complications.
I still feel that the best place to deliver a baby is in a hospital. The safest place to deliver a baby is in a hospital, says Dr. Ruth Haskins, a practicing obstetrician in Folsom.
“ And when things unexpectedly goes bad, we’ve got an operating room next store. When things unexpectedly go bad, we’ve got a hematologist down the hall. When she’s got a rash, we have a XX that can come take a look at her,” says Haskins.
Haskins works with the American Congress of Obstetricians and Gynecologists. She says planned home births that unexpectedly need hospital care can create complex medical situations.
“So now a physician doesn’t have any information about the patient, doesn’t have any input about the initial care that is so important, and is suddenly is completely responsible for the outcome. And that’s not a good outcome. That’s the situation that we would like to remedy,” says Haskins.
That situation is part of a decades long history of non-collaboration and sometimes outright antagonism between homebirth midwives and mainstream obstetricians. Current law says midwives should be supervised by a doctor, but in reality, physician liability insurance in California doesn’t cover homebirths. But one California lawmaker is trying to foster a better working relationship between the two groups.
“The bill started as really just saying licensed midwives could order tests and get medical supplies they needed,” says Democratic Assemblywoman Susan Bonilla. She is proposing to rewrite the law to allow midwives to attend to normal pregnancies without physician supervision. But a doctor would be involved if a woman has certain risk factors.
“ My hope is that more and more women will be able to experience birth with a midwife. And whether they choose to do that at home or in the hospital, I believe that midwives have a passion and commitment to the prenatal care process and the labor and deliver process that’s really excellent,” says Bonilla.
If passed, the bill may not resolve decades of differences between obstetricians and midwives, but it would be a baby step towards more collaboration.