2017-02-17 / Family
Modern-day midwife says one size doesn’t fit all
Describes practice as led by ‘informed consent’
A black-and-white photo of an elated young woman, partially submerged in water as she holds a newborn baby up to her chest, graces one of the walls at PUSH Midwifery and Birth Center in Thousand Oaks.
At her side is Conejo Valley resident Robyn Pool, smiling broadly and using her hand to help support the infant born just minutes before the photo was taken.
The baby is one of more than 500 that Pool has delivered since earning her credentials as a certified professional midwife (CPM) and a California licensed midwife (LM) six years ago.
“Some of the best times are when the siblings meet their new babies,” Pool, the mother of three, told the Acorn.
Pool opened the center on Rolling Oaks Drive three years ago and said it is humbling to have a hand—literally and figuratively— in such profound and personal moments.
Midwives are experts who provide holistic care to expectant mothers who wish to give birth naturally and without pain medicine. They assist women with low-risk pregnancies in childbirth, usually at home or in a birth center.
Pool, who lives in Thousand Oaks with her family, said her interest in midwifery began in middle school when she became close with a family whose children had been born at home.
She recalled flipping through an album containing photos of their births and feeling “captivated.”
“They were a very loving family,” she said, “and I remember wondering if their births had contributed to that.”
Before pursuing a career in midwifery, Pool began assisting expectant mothers as a childbirth educator and doula in the early 2000s. Doulas provide emotional and physical support during pregnancy and childbirth.
She began studying at the National College of Midwifery in 2005 and after obtaining her degree and earning other credentials needed to practice, she opened PUSH in May 2014.
Licensed by the Medical Board of California, she assists with home births, though the majority of her patients choose to give birth at the center.
Pool said that while hospital births can be “wonderful,” midwifery provides a much-needed alternative that is led by “informed consent.”
Mothers are empowered to make informed decisions about their pregnancies and childbirths— something Pool said the “one-size-fits-all” model of traditional obstetrics cannot provide.
Pool said hospital and insurance company policies place major limits on what doctors can and cannot do, even when that care does not align with what the patient wants or needs.
“Women have reported a lot of bullying and a lot of feeling as if they don’t have a lot of say, whether it’s not wanting to be on their back, not wanting an induction or not wanting a cesarean section,” she said. “Out-of-hospital birth is really for families who want to maintain some autonomy in the decision-making . . . with what is going to be happening with them and their birth.”
As is the case at most midwifery practices, appointments at PUSH are scheduled for an hour, part of which is spent talking about things such as diet, water intake and emotional well-being. The pros and cons of doing certain tests and lab work are also discussed.
Home births with midwives are more common in European and Asian countries. In the United States, where studies show doctors deliver the majority of infants, the practice is still somewhat controversial.
Amy Tuteur, a former clinical instructor in obstetrics-gynecology at Harvard Medical School, wrote an opinion piece last spring for The New York Times titled “Why Is American Home Birth So Dangerous?”
Tuteur described midwife attended home births as a “fringe practice” in the United States, with only 2 percent of babies being born at home.
“Childbirth is inherently dangerous, and if an emergency occurs, the baby or even the mother may die,” the former instructor wrote. “Indeed, in the United States, the switch from home birth to hospital birth over the 20th century was accompanied by a more than 90 percent decrease in neonatal mortality and nearly 99 percent decrease in maternal mortality.”
Tuteur said statistics show home births are safer in certain countries like Canada, where she said several studies have shown there is no difference between the number of babies who die at home or in the hospital.
She said home births in the U.S. are riskier because there are two types of midwives.
While certified nurse midwives (CNMs) undergo extensive training in making diagnoses and managing complications, she said, certified professional midwives (CPMs) with fewer qualifications handle the majority of American home births.
In countries like Canada, where there are more mothers using midwives, she said, there are fewer problems because midwives must undergo training similar to that of a CNM.
“(CPMs) seem to believe they don’t need more training because they are ‘experts in normal birth,’” Tuteur wrote.
“As I often say, that makes as much sense as a meteorologist being an expert in sunny weather.”
Tuteur made her case that “all American midwives meet international standards, keep women at increased risk of complications from giving birth at home, insist on transfer to a hospital at the first hint of potential problems, and require that midwives have hospital privileges.”
California has more stringent restrictions than in some other states, as all midwives are required to obtain their licenses and be cleared by the State of California Medical Board to practice legally.
Wendy Steiger offers another alternative for expectant mothers.
A certified nurse midwife for more than three decades, she delivers babies at Community Memorial Hospital in Ventura.
Steiger said she is the “happy medium” for women who want to have their babies as naturally as possible, while still having access to a hospital.
“One of my biggest roles being a hospital-based provider is that I advocate for my patients so they can have as natural of a childbirth as they can,” she said.
“I go to bat for them and sometimes remind certain hospital staff that . . . birth is normal. Most of the time, if we just keep our hands off and let them do it naturally, they’ll be just fine.
“I help people have really happy births the way they want to have them, and I don’t think that’s something that can only happen at home.”
That said, the midwife respects a woman’s choice to give birth where she wishes and took issue with Tuteur’s argument that CPMs should not be allowed to practice.
Steiger also questioned statistics relating to home births, as she said they are not tracked as well in the United States as they are in countries like England and Canada.
“I completely support all options with safe providers and low-risk patients in all settings,” Steiger said.
Pool, who said she underwent extensive training to become a midwife, said it all comes down to choice.
For some moms-to-be, she said, the potential for a hospital doctor to prescribe a drug like Pitocin to unnecessarily “snowball” a normal labor into something more dramatic like a cesarean section is more troubling than not being within feet of an obstetrician or operating room if complications arise.
“I ask, ‘Where are you most comfortable setting your risks?” the midwife said.
“That’s the decision you want to make. That’s the decision I expect you to make, so when you come into care here, you’re doing what is best for you.”
Pool said it’s too bad many obstetricians don’t see the value in maintaining a respectful dialogue with midwives regardless of their personal views—a sentiment echoed by Steiger.
When PUSH opened, Pool sent a letter to all the labor and delivery doctors at Los Robles to let them know she would be bringing patients in as needed.
She invited them to visit the center and learn more about what she does, but she didn’t get a single response.
“I’m not looking for any of them to say, ‘I think what you do is great,’ but if I was that doctor and I was on the receiving end, I would want to be informed,” she said.
Pool said that when she does bring a patient to the hospital— less than 10 percent of the time— they respect hospital policies.
St. John’s Regional Medical Center declined to comment, and calls to media liaisons for Los Robles Hospital & Medical Center and Community Memorial Health System were not returned.
Despite the critics, Pool said, the demand for midwives is increasing.
“I think we are a good start for families,” Pool told the Acorn. “And I think that starts with a healthy mom.”