I have been reading with great interests all the posts re  how few newborns are normal because of multiple interventions at birth.

I am a Certified Nurse Midwife in Milwaukee, WI.  We strive in our practice to preserve the normalcy of birth, and we largely, but not entirely, succeed.  Our eepiduralrate is less than 10%, our episiotomy rate is 1.5%, our C/Sec rate is 9-10%.  We do not induce for trivial reasons, and generally wait ttillour patients are 10-14 dates postdates to induce.  Some of our patients end up with IVs, largely because of beta strep.  A fair number, but less than half receive IV pain meds.  Our population is ethnically very diverse, and nearly all low-income.  Attendance at childbirth classes is rare among these women.

Our ppracticeis NOT an exception among nurse-midwives--most practice the way we do.  They do so despite often intense political pressure to follow the medical model, and in communities where the docs have all the power and can (and have) put CNMs out of business, or prevent them from practicing altogether.  This job is never easy, yet there are CNMs who have been out there fighting to do the best they can for women for years.

BF advocates need to join forces with CNMs and direct entry midwives to help each other.  We need you to speak out and demand access to CNM care in your communities, and then actively support it.  We must work together to let women know they have choices, and that birth can be a powerful event in their lives.  We need you to help our patients really succeed at BF when they have little or no family and social support.  And keep in mind, they don't have money to pay LCs, and are unlikely to call a stranger to ask for help.

I too get discouraged by the atmosphere in many, but not all, hospitals today.  But one of the the places where I practice has responded to market pressure by becoming more mother and baby friendly, more welcoming of midwives, more open to prolonged skin-to skin contact, better and better at establishing BF.  Are there still lots of epidurals and inductions?  You bet.  Not among our patients, but more and more of the nurses are thrilled to see us, because we practice what they now know is the ideal approach to birth.

All is not lost, but if you fail to support and form relationships with the midwives in your area, don't be surprised if our model of care becomes more and more rare.

Janet DeCoopman MS, CNM



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