Reviving an age-old occupation

By Linda Valdez
The Arizona Republic
July 29, 1999

In a nation where birth is treated more like a disease than a natural event, there are few options for prenatal care and delivery.

Midwives and home delivery are the forgotten reproductive freedoms because of historical gender politics and modern economic realities.

Although there are two types of midwives in Arizona, the ones who do home delivery are the most endangered.

These are the philosophical great-granddaughters of the women who were run out of business by the medical profession decades ago.

Their story is told with bra-burning passion in a 1973 Feminine Press pamphlet by Barbara Ehrenreich and Deirdre English. Called Witches, Midwives and Nurses - A History of Women Healers, the little book chronicles how the ancient practice of midwifery was discredited and frequently outlawed to make way for the new practice of obstetrics:

"How did one particular set of healers, who happened to be male, White and middle class, manage to oust all the competing folk healers, midwives and other practitioners? . . . It's part of the 19th century's long story of class and sex struggles for power in all areas of life."

As a result, hospital birth, with its bright lights and frequent intervention, became the norm. The masters of medical technology became the heroes of childbirth.

Licensed midwives were making a comeback until modern economics struck another blow. From a low of 4 midwives in 1974 in Arizona, they began a slow climb in the back-to-nature days of Earth shoes and granola. There were 42 by 1984. In 1986, licensed midwives delivered 2,000 babies in Arizona.

Then something happened. Today there are only 45 licensed midwives in Arizona. Dorothy Hanson, manager of the state's licensed Midwife Program, says only about 12 of them can make a living. In 1996, they delivered only 500 of the 75,146 babies born that year.

Why the drop? The answer is managed care and HMOs, licensed midwife Carol Denny says.

"A lot of insurance companies will not let us be a provider on their plans," she says.

Efforts to require HMOs to cover home births have been met with vigorous opposition by obstetricians, says Denny, a board member of the Arizona Association of Midwives.

The other kind of midwife has had more success getting into the loop, possibly because she began with one foot inside the medical system.

Nurse-midwives are registered nurses with advanced degrees. Licensed by the state Board of Nursing, they often work for or with physicians.

Kathryn Schrag, a nurse-midwife at the Birth and Women's Health Center in Tucson, delivers babies in a collaborative practice that is co-owned by midwives and doctors. Women can give birth in the cozy setting of the center or across the street at a hospital - but not at home.

Because insurance generally pays for the service, the number of babies delivered by nurse-midwives in Arizona jumped from 2,200 in 1986 to more than 6,000 in 1996. There are about 150 certified nurse-midwives in the state.

Nurse-midwives have made great strides toward acceptance, Schrag says, but licensed midwives who deliver at home still face "huge obstacles."

Both groups may benefit from an organization known more for its defense of abortion than childbirth.

The National Organization for Women passed a resolution this month in support of midwifery for the sake of giving women "complete authority over their reproductive lives."

For the sake of mothers and children, midwives should ride this political support for all it's worth.

Linda Valdez can be reached at linda.valdez@pni.com or at 1-602-444-8474.