Cook: Labor and delivery

Cook: Labor and delivery

February 8th, 2013 by David Cook in Opinion Columns

David Cook

Photo by Ashlee Culverhouse/Times Free Press.

Since 1979, Debi Church has attended the births of more than 1,200 area babies.

Nearly every one was born, not in a hospital, but in the laboring mother's home.

"Something magical happens when a mom reaches down and delivers her own baby and puts them right on her chest," Church said.

Church is a midwife, trained and licensed to accompany a pregnant woman (and family) through the journey toward birth.

"We're not just helping babies be born," said Church. "We're helping mothers be created."

Her profession, as old as time, is bathed in misinterpretation and fear, sacredness and beauty, the medical and natural.

Much like labor itself.

Tonight at 7, Barking Legs Theater is screening "Birth Story," a documentary on Ina May Gaskin, the globally recognized midwife and founder of The Farm Midwifery Center in Summertown, Tenn. The film will be followed by a panel discussion of local midwives.

At a time when inductions can be scheduled down to the day and time, many midwives talk of growing interest in natural and home births.

But Dr. Shevonda Sherrow says, "I don't think home births are safe."

Sherrow, a Chattanooga doctor who delivers more than 300 babies a year, believes hospitals are the safest place for laboring women and has seen how fast labor can turn from the best of moments to the worst.

"Minutes," she said.

The infant mortality rate in Hamilton County is one of the highest in the state. Out of 1,000 babies born in 2010, an average of 9.7 died before their first birthdays.

The nationwide average: 6.2. (In France: 3.4. Afghanistan: 121.6 deaths).

Midwives claim the hospital experience can be overmedicalized. Intervention begets intervention and soon, the mystery of birth vanishes.

"Hamburger, no cheese," one doctor told me. "People want things like they're going through the drive-through."

Sherrow said there's another issue.

"OBs are one of the most sued doctors in the business," she said.

Hospitals and physicians then are prone to conservatism: overprescribing not just to facilitate the safest outcome but to protect against possible litigation.

In a recent nine-month window, 40 percent of the 2,206 babies delivered at Erlanger's downtown campus (where high-risk pregnancies are routed) were Caesarean sections.

Midwives, according to hospital estimates, are present during 2 percent of deliveries.

At Erlanger East, during the same time, epidurals were included in 93 percent of deliveries; one-third of all births were done via C-section.

And last year, midwives delivered 12 percent of all births there.

"The birth of a child is generally the most important day of a woman's life," said Carley Morgan, a local labor and delivery nurse months away from becoming a certified nurse midwife.

(In our state, midwives are licensed after receiving board certification from a national body. Depending on certification, midwives can practice in hospitals, homes or birth centers.)

Morgan, 30, has an eloquence and fierceness to defend what is right for pregnant women.

"If the woman is empowered, respected, supported and in control, birth can be a life-altering, positive experience," she said.

"If she is disrespected, ignored or made to feel she does not know what is best for herself and her baby, then her birth may be always associated with the emotions she felt as a result of how she was treated."

Hospital or home, doctor or midwife, the solution is found when women are empowered.

"Educate women, and then let them choose what they want," she said. "This is what midwifery is about. The informed choice."