Oh! Baby: Midwives becoming more popular for child-birthing experiences

Mar. 26—The very definition of midwife — to be with women — is what certified nurse-midwife Katie Melvin loves most about her role.

Melvin has practiced as a certified nurse-midwife (CMN) since 2018 with Owensboro Health Regional Hospital, having received her education from Yale University.

The midwife profession, Melvin said, which has grown in recent years, is vital to the maternal experience, especially for women who are seeking a more natural form of childbirth.

According to the "Journal of Midwifery and Women's Health," midwives, "partner with women to help make important health decisions. Midwives work with other members of a woman's health care team when needed, but a midwife may also be your primary care provider."

A midwife, Melvin said, assists with the birthing process in a variety of ways, including spending more time, overall, with the patients and ensuring they have all the resources they need and all of their concerns addressed.

"Generally, with midwifery, we're present more, we're with mom in the room a lot more, we try and be there to help with pain coping and also for certain the pushing phase of things," she said. "And really just be there for them as much as we can during the delivery experience."

Statistically, Melvin said midwives also help women achieve more natural birthing processes if that is a goal of the mother.

Deliveries attended by a midwife, she said, also tend to result in a lower rate of cesarean section births, which is one of the defining characteristics of the quality of maternity care.

A cesarean birth (C-section), according to the "Journal of Midwifery and Women's Health," is a surgery done so the baby is born through the abdomen. Cesareans are usually done when labor is not going normally or the baby or mother experiences a health emergency.

However, cesarean births can cause other complications, according to the journal, including a longer recovery period, pain, more bleeding and a higher rate of infection, meaning it is important only to undergo the procedure if it is necessary.

According to the World Health Organization (WHO), the ideal rate for cesareans is between 10-15%. However, according to the U.S. Centers for Disease Control and Prevention, the percentage of cesarean births in the United States in 2020 was 31.8%, a number that has not varied much in recent years.

"As a medical community who provides OB care, we are trying to lower that and part of that is by using more midwives and providing midwifery care because we do statistically have lower C-section rates," Melvin said. "I'm not sure that we've been able to pinpoint exactly what we do that's different, but it is generally our presence and our patience that provide in lowering that rate."

One of the reasons attendance by a midwife might result in lower C-section rates, Melivin said, is that midwives place an emphasis on awaiting the natural process, so long as the mother and baby are both looking OK and not facing any significant obstacles in the birthing process.

"The key oftentimes is patience and letting the body do what it's going to do, and that might take more time than a textbook says or what you thought, but if mom and baby look fine, then there's no reason you can't wait," Melvin said. "If either of those things change, you have your surgical option immediately on stand-by with a hospital birth setting."

Additional benefits arising from the use of midwives in recent years, according to the American Pregnancy Association, also include, reduced rates of labor induction and augmentation; reduced use of regional anesthesia, decreased infant mortality rates; decreased risk of preterm birth; decreased third and fourth-degree perineal tears; lower costs for both clients and insurers; increased chances of having a positive start to breastfeeding; and increased satisfaction with the quality of care.

Additionally, according to the "Journal of Midwifery and Women's Health," CNMs are vital in increasing access to care, especially in rural areas where workforce shortages limit access to care for pregnant women, something vitally important following national workforce shortage in the healthcare field.

"CNMs play a crucial role in the maternity care workforce in rural U.S. hospitals," noted lead author Katy Kozhimannil. "Interprofessional practice is common for CNMs attending births in rural hospitals, and administrators hope to increase the number of midwives in rural maternity practice."

Midwifery and a move to desiring more natural forms of birth in general, Melvin said, has already come more into fashion in recent years, especially in more urban areas where individuals are likely to have more access to different childbirth options, resources and information.

"That's really spread into culture as more people learn about midwifery," she said. "Around the world, most babies are delivered by midwives. The United States is kind of distinct in that most of our babies are born by OBGYNs, whereas if you go to pretty much any country in the world, they're mostly being delivered by midwives."

Midwives, she said, provide a unique experience for women, focusing on providing support during a time in a mother's life when things can become confusing and overwhelming, an aspect of her role that she enjoys the most.

"I think that phrase of what midwifery is — to be with women, just really encompasses what I love about my job," she said. "I really loved working with pregnant woman and helping them through that very interesting part of their life."

As far as how Melvin said she would like to continue seeing maternity care improve, she said creating an all-inclusive experience for everyone is one of the biggest things, especially for minority women who typically have a higher morbidity and mortality rate, overall when it comes to childbirth.

Additionally, she said she would like to see the development of a birthing center in Kentucky where women can get the experience of an at-home style birth with easier access to medical care, staff and facilities, should they be needed.

"That's certainly one of our goals, is to make labor and delivery safer for all women in this country," she said.

Christie Netherton, cnetherton@messenger-inquirer.com, 270-691-7360