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Historically, Maine women haven’t had many choices about their birth environment. Before the 20th century, most births happened at home with midwives. Then the trend reversed, and a doctor-attended hospital birth was basically the only way to go.
But now, Maine women have greater choice than ever before about who to have at their bedside and where their bedside is going to be. Bangor Metro took a look around Ellsworth to learn what midcoast Maine woman can expect for birthing options when expecting. In alphabetical order:
Certified Nurse-Midwife. Certified nurse-midwives are nurses who specialize in women’s health and birth care. They are usually connected with a hospital or birth center, and many practices also have an obstetrician on staff.
Nationally, nurse-midwives attend about 11% of all non-caesarean births, but at Maine Coast Memorial Hospital in Ellsworth that figure is much higher at 87%.
Renata Reich Moise, one of four nurse-midwives at the hospital’s Maine Coast Women Care, attended some 50 births last year and over 500 in the last 10 years.
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“I stopped counting,” she said.
Moise has been surrounded by the birth process all her life. She grew up on a farm and her mother was a family physician. As a child, she once gave mouth-to-mouth resuscitation to a just-born poodle pup who wasn’t breathing. The pup made it.
Maine Coast Women Care gives women what one website testimonial called “the warm fuzzy care of the doula” with a “strong and reassuring clinical base.” Women who choose the nurse-midwife option do so, Moise, says, because it provides both a hospital setting and lower rates of medical interventions. “They want a more natural option.”
She and the other nurse-midwives can provide all the needed prenatal care. During labor, they also can provide a popular birthing-tub option and some pain medication. If a c-section is needed, an obstetrician would take over, but nurse-midwives would assist during the surgery.
Moise and the other nurse-midwives rotate on-call shifts, and patients usually meet each midwife at least once during prenatal visits. The rotation is necessary, Moise says, because attending a birth can be exhausting. “It’s very inspiring, too,” she adds.
Doula. In the not-so-distant past, births usually were attended by one or two experienced women in addition to a midwife. In recent years, doula services have revived that tradition.
Doulas are experienced attendants who assist women throughout the birth process and relieve tired birth partners during long labors. Doulas do what’s needed to be done, whether it’s holding a hand, helping a laboring woman remember to breathe, or getting sterilized water.
Doulas usually work with both hospital and home births. Although some homebirth midwifes also work as doulas, doulas are not hired to deliver children. But some do stay on and help with the household chores, which can sometimes seem equally invaluable to weary new parents.
Doula Anna Fernandez runs Mother Bloom Midwifery and Doula Service in Blue Hill. She says she became a doula because she loves the whole birth process. “I just couldn’t get enough of it when pregnant,” she says.
Fernandez says doulas guide families and help laboring mothers understand their medical choices. “Studies show the presence of a doula lowers the rate of medical interventions.” But perhaps the most important thing a doula provides, says Fernandez, is a calm and reassuring hand to squeeze. “A doula is a constant familiar face,” she says.
Fernandez will usually meet with clients at least three times before the birth, but she once met with one family 15 times. She’s also willing to travel quite a distance to meet clients at their homes. It all depends on what’s needed. That’s especially true when it comes to the labor. “I’m there for the whole thing, whether it’s three days or three hours,” she says.
Family Physician. The family doctor who delivers generations of children is a firm image of American small-town life. He or she is also an endangered species.
Because of escalating malpractice insurance rates, many larger hospitals are discouraging family physician deliveries. And the high insurance costs and long hours are causing new family physicians to think long and hard before offering birth services.
But in rural Maine, there’s still a birth niche for the family doctor. Dr. Joe Nabozny is one of five physicians at the Eleanor Widener Dixon Memorial Clinic in Gouldsboro who still do deliveries at the Ellsworth hospital. He’s been “catching babies” for 20 years.
“The advantage of family physicians is they know a family’s full medical history,” says Nabozny. They also provide a seamless transition once children are out of the womb.
Nabozny says expecting mothers and babies kicking in bellies are the most uplifting patients he sees. “It turns out being a nice break in your day,” he says.
Homebirth Midwife. According to government statistics, about 1% of all births in Maine take place at home, but those births are often no accident. Some mothers plan to deliver at home, attended by well-trained homebirth midwives, because they feel a healthy birth is not a medical event.
Most Maine homebirth midwives, either certified nurse-midwives or certified professional midwives, are part of the professional organization Midwives of Maine. All certified homebirth midwives go through a long apprenticeship, and rigorous study and testing before receiving certification.
Some studies have shown that planned homebirths with trained attendants have the same success rates as hospital births. Some of that is because of careful prescreening, says Julie Havener, a certified professional midwife with First Light Community Midwives of Northeast Harbor.
“We only work with low-risk pregnancies,” she says. “There are times we might steer [mothers] to the hospital.”
Homebirth candidates enjoy long prenatal visits; by 36 to 38 weeks in the pregnancy, homebirth midwives often come to clients’ homes for those visits. During labor, midwives usually can provide birthing tubs, oxygen, and a limited number of drugs.
Although homebirth midwives technically are barred from formal associations with local hospitals, they often have informal arrangements if the birth ends up at the hospital. The most recent birth Havener attended was in the hospital, and she says everyone did fine.
“It was gorgeous,” she says. “We have the best job in the world.”
Obstetricians. In a way, there should be a sign on an obstetrician’s door that says, “The Buck Stops Here.” Even though obstetricians handle many normal births, they also are called in for the severest complications during pregnancy and delivery.
That sign would have double meaning for Dr. Robert Walker at Blue Hill Women’s Health Care at Blue Hill Memorial Hospital. At the beginning of his 35-year career, Walker was one of only two or three healthcare providers who did deliveries in Washington and Hancock Counties. That meant he sometimes averaged 300 to 400 deliveries a year. He actually says it wasn’t as busy a schedule as it sounds.
“I came home for dinner every night,” he says, but then adds, “I might have had to leave in the middle.”
Obstetricians with delivery schedules like his are a vanishing breed, he says, as midwives take over for normal births. Walker himself wants to semiretire to a part-time schedule, if he can just find a replacement who can match his enthusiasm for the profession.
It may be a busy job, he says, but the benefits at the end of the day, or the middle of the night, are as priceless as a baby’s first breath.
“For me, it’s the perfect profession,” he says.
