Midwifery: Ancient model for giving birth gets modern remake

From the dawn of human civilization until recent times, midwives attended to women giving birth. In the last century, births have tended to be in hospital delivery rooms and attended by physicians.

The pendulum is swinging back in recent years. Even hospital births are in environments closer akin to a bedroom than a sterile surgical room.

More and more women are returning to the ancient tradition of midwifery, but with a foundation of modern medical science.

Denise Rubinfeld is one of two full-time and one per diem certified nurse midwives based in the Saint Mary’s Women’s Health Center.

Reno has a small community of midwives based in doctors’ offices, Saint Mary’s and Renown Regional Medical Center, she said. Each setting has different working models.

For the women who chose to become midwives and the mothers who chose to have their prenatal and delivery care provided by midwives, the field provides a more personalized approach to giving birth.

“Midwifery follows a nursing model,” Rubinfeld told the NNBW during an interview at the Women’s Health Center. “It’s a little more individual approach, more holistic.”

They work with the patients to determine what level of care they are comfortable with.

“We tell them, ‘here’s the risks and benefits of option A and option B. What’s the best option for you?’” she said.

Many women prefer autonomy during the birth experience, with minimal involvement of the midwife.

“We’re more than just on standby, we are the guardians of safety,” Rubinfeld said. “If the need arises, we’ll skillfully intervene.”

That’s a style many of the patients at the Women’s Health Center prefer.

“They come to us looking for a holistic approach, looking for a place where pregnancy isn’t treated like a disease, but as a natural passage of life,” she said.

“It’s normal until it’s proven otherwise.”

When “otherwise” happens, when a pregnancy or delivery develops complications, physicians are called in.

“Any essentially healthy woman expecting to have a normal pregnancy should start with a midwife,” Rubinfeld said. “Women with a midwife are less likely to have interventions (like a cesarian section or episiotomy).”

In Europe, the midwife model is the main model for delivering babies, she said. “Midwives take care of 80 to 90 percent of pregnancies. Physicians take care of the 10 percent with problems.”

Like choosing to see a nurse practitioner in a primary care office, choosing a midwife comes with cost savings too.

“Midwives on a (medical) team have training to do 80 to 90 percent of what a physician does at a decreased cost,” she said.

Saint Mary’s midwives typically each deliver two babies per week, Rubinfeld said. But it varies tremendously.

“It can be zero or it can be six,” she said. “We’ve had marathons with six deliveries in a day.”

A large part of their weekly workload is seeing patients in the office for more standard care.

The midwives not only provides prenatal to delivery services, but also basic women’s health exams. Their job is similar to a nurse practitioner or physician’s assistant. Though specialized in pregnancy and delivery, the certified nurse midwives also are trained to provide a broad range of medical services and work closely with physicians in the office, communicating regularly on patient care.

The midwives at Saint Mary’s Women’s Health Center provide annual gynecologic exams, care during teenage years, care during pregnancy, labor and birth, family planning, general health care, menopause care, and treatment of sexually transmitted infections.

They may see a patient for many years.

“I really enjoy building lasting relationship with patients,” Rubinfeld said. “I came to midwifery because I really loved catching babies, but it’s grown into much more than that.”

Rubinfeld began college on the premed track, she explained. During that training, “I realized I didn’t want to go that route.”

She saw midwifery as a perfect blend of what she liked most about medicine and being involved with people.

“I went to nursing school to become a midwife,” Rubinfeld.

After receiving her degree as a registered nurse, she went on to graduate school at the University of California, San Francisco for a masters in nursing.

She graduated as a certified nurse midwife six years ago. Rubinfeld started her career in the Bay Area until answering the call of the mountains and making the move to Reno. In Reno, she worked at a physicians office for a few years before joining the Saint Mary’s team.

The Saint Mary’s midwifery program began three and a half years ago.

Jamii Uboldi, Saint Mary’s director — business development & marketing/communications, explained that midwives with private practices have been able to deliver at Saint Mary’s Regional Medical Center for many years, just not employed by the health network before the Women’s Health Center began the program.

While maintaining the ancient view that giving birth should be treated as a natural process, the modern midwife looks to science to improve care.

“At conferences, we’re not hippies dancing around,” Rubinfeld said of a stereotype of midwives. “As a profession, we’re a lot more cutting edge. Because we’re passionate (about our profession) we tend to keep up with the science.

“Midwifery as a blend of science and the older practice is fairly new.”