Before my children were born I thought I had a pretty good concept of normal birth. I'd seen it on TV plenty of times. I'd be chain-smoking Camels in a waiting room while a team of doctors were flinging instruments around an operating room. They'd see the head, and about five seconds later the baby would catapult straight into the hands of the surgeon, who would slap the kid around a bit and pass it off to the smiling mother. The whole thing would be finished in an hour, tops. Then we'd go home and go to sleep. Either that or the baby would be delivered in the back of our Hyundai by a helpful cop.
OK, so TV isn't reality. My wife's first delivery involved a fetal monitor and a C section. The average amount of time between when a baby's head crowns and when it's delivered is about two hours. And we had our second child delivered at home, by a doctor and a midwife.
In Europe, three-quarters of all births are overseen by midwives. In America that percentage drops to less than five, even though midwife and home-birth practices here are demonstrably safe and cost between a third and a fourth of a hospital birth presided over by a doctor. The U.S. is home to 200,000 obstetricians trained for high-risk pregnancies, and first in the world in use of fetal monitors and other expensive machinery, but we're number 22 in infant mortality. Illinois is 46th in infant mortality in the country. What are we doing wrong?
The Midwives' Alliance of North America thinks more midwifing is the solution, and it's holding its 12th annual conference this weekend at the Congress Hotel on that very subject. Through October 4, perhaps spurred on by the fact that the World Health Organization has declared 1994 the International Year of the Midwife, between six and seven hundred midwives from around the world will talk over the many medical, social, and spiritual issues affecting birth in the United States. Nonregistrants are invited to a few of the events on the roster, including a panel discussion called "Ask the Midwife," a performance piece called Vessels featuring pregnant women using speculums as castanets, and a town meeting on health care reform.
"In some states there are birth centers, places other than hospitals where women get care and give birth," says Valerie Koster, who helped organize the conference. Koster is a certified nurse midwife, which means she's an RN with advanced training in childbirth; she worked at Cook County Hospital before starting a small home-birth practice in 1989. "The existing birth centers have excellent records, but here in Illinois they're illegal. There's also no licensing procedure for direct-entry midwives." Direct-entry, or lay, midwives have taken on-the-job training but have no degree. "They're not illegal, but they're not sanctioned--they're in a kind of limbo."
Carol Bogard, another member of the conference planning committee, says one reason for that is opposition from medical groups and hospitals. "We've been sold a bill of goods in this country that midwife care is second-class care," she says. "If you're going to look at health care, the maternity system is the place to start. Birth is the first family encounter with the health-care system." Why not begin at the beginning?
Of course, it'd be nice if the debate on health care reform actually touched on health care. "So far the whole thing has been an argument about financing medical care; it's been about insurance plans and not about health," says Bogard. Not that insurance is irrelevant to MANA's concerns: According to an index printed in Mothering magazine in 1992, one-fourth of all women in the U.S. had no private health insurance. Exactly the same percentage received little or no prenatal care. Half of the babies born under these conditions were low birth-weight or premature; low birth weight was linked to infant death 60 percent of the time. Low birth-weight babies often need intensive care, usually costing somewhere between $20,000 and $100,000 per infant. According to the index, this could pay for prenatal care for 30 women.
Prenatal care is something Bogard thinks could use improvement across the board. "Doctors will talk about weight gain, but they don't give much guidance on nutrition." In Koster's practice, each mother sees the midwife between 12 and 15 times during pregnancy, and each visit lasts about an hour. By contrast, she says, most obstetricians see their patients three or four times for about five minutes each." She always has an obstetrician on call during deliveries she oversees in case anything goes wrong.
Hillary Clinton, Tipper Gore, and Donna Shalala have been invited to the town meeting on health care reform, hosted by Norma Swenson, coauthor of Our Bodies, Ourselves and cofounder of the Boston Women's Health Book Collective, Friday night at 8; anyone else with ten bucks is welcome. Vessels, written and directed by Abiogenesis director Angela Allyn, who first performed it when she was eight months pregnant, will be performed Saturday at 9; the $10 ticket includes admission to the Malukosamba concert that follows. "Ask the Midwife" is free and runs from 1:30 to 3 Sunday afternoon. All of the above events take place at the Congress Hotel, 520 S. Michigan.
The midwives are also sponsoring two art exhibits, both called "The Birth of Art, the Art of Birth"--one running through October 1 at ARC Gallery, 1040 W. Huron, and the other at the hotel for the duration of the conference. "Anyone who's interested in women's health issues should come to the conference," says Bogard. Single-day registration is $120-$130, the full weekend costs $380, and fees include all meals. Tipper Gore has already declined her invitation, but Clinton said she might come. Shalala hasn't responded.
Art accompanying story in printed newspaper (not available in this archive): photo/Randy Tunnell.