Seeing the benefits of midwifery from both sides

By Louie St. George III

Mary Elizabeth Winters knows all about the collaborative care model that has come to define midwifery in the 21st century. That’s because Winters herself is a certified nurse-midwife at Essentia Health-St. Mary’s Medical Center. Her appreciation for that willingness to combine disciplines on one care team intensified during the September birth of her daughter. What started as a normal delivery morphed into a “scary situation” when the baby girl’s umbilical cord came before her head, or prolapsed. This can prevent oxygen and blood from reaching the fetus. An emergency cesarean section ensued.

Eventually, a healthy Charlotte Winters entered this world safe, sound and full of life.

That’s the beauty of a modern-day midwifery program. If things go awry, there’s a multi-faceted safety net ready to intervene. At Essentia Health, that includes an obstetrician, anesthesiologist, physician and a neonatal intensive care unit team.

“If things go great, we can work through that whole process together, but if some things don’t go as planned, they also have that trust built with us to say, ‘OK, what are your thoughts? What are my options?’” said Amity Heinbuch, Winters’ colleague at St. Mary’s and also her midwife. “And we can talk through them together. It’s not building these new relationships right at the time they’re coming in for labor or birth.”

An umbilical cord prolapse is rare.

“It is nice that when it did happen, it happened in a hospital that was fully prepared for the emergency,” Winters said.

That scenario bucks many of the long-held midwife misconceptions. One of the most common myths is that midwives only deliver babies at home. Others presume that they don’t have any formal education or training, or that they’re the same as a doula. And there are those who believe midwives only allow natural births, free of pain medicine.

“We’re more focused on a positive pregnancy, a positive birth experience for the patient and her baby,” said Winters, who has been a midwife for about two years. “We’re there to support the mom’s desires.”

Winters relishes the opportunity to build relationships with expectant mothers ahead of “the most phenomenal, Earth-changing time in their lives.” It’s a process that starts early in the pregnancy — if not before — and continues throughout. Midwives devote extensive time to patient education. They provide guidance on things like nutrition, exercise and overall health, and answer any questions that surface.

Those relationships allow midwives to more effectively advocate for their patients.

“It can be really comforting and reduce a lot of fear when they have someone there that they know is looking out for them and knows what their wishes are, and knows how to get them a safe and positive birth experience,” Winters said.

On average, midwifery results in higher success rates. But the practice isn’t as entrenched in the United States as it is elsewhere. A 2018 Reuters article reported that about 9 percent of 2015 births in the U.S. were “attended by certified nurse midwives with advanced training or other midwives.”

That number is between 50 and 70 percent in most other countries.

The 38-year-old Winters joined Essentia Health’s holistic midwifery program in June 2019. She’s constantly learning from her colleagues, who are generous with the knowledge they’ve accrued. That spirit of sharing benefits the team’s patients. As does Essentia’s 24/7 on-call service, which ensures that a midwife will always be available to meet the patient bedside for delivery.

Asked her favorite aspect of the job, Winters laughed.

“Just one?” she joked. “I think my favorite thing is that moment that every woman gets to right before she’s about to birth, where she feels like she can’t give anymore, that she’s ready to tap out. Being there with her and being able to give her the encouragement and watch her push through the hardest part of her birth is very special.

“Watching that warrior come through. Every woman reaches that point and every woman makes it past it.” D