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PITTSBURGH (AP) — Numb from medication, Jaime Maceno felt nothing when she delivered her first child, Isabella, in a hospital room about eight years ago. She remembers "a million monitors" that confined her to a bed. Workers offered an epidural almost as soon as she showed up at the hospital.
"They make you feel like you can't do it without it," said Maceno, 32, of Plum, who switched to the Midwife Center for Birth and Women's Health when her next child, Cooper, arrived in 2013. She birthed him without a single painkiller — and "lived to tell the tale."
That natural touch and modest costs are helping drive hundreds of Western Pennsylvania women each year to use midwives, part of a national shift toward more personal maternity care in both medical centers and smaller birth clinics. The stand-alone practices can cut delivery costs by up to 50 percent over traditional hospitals, according to the American Association of Birth Centers in Perkiomenville.
"We give women the freedom to deal with labor the way they need to do it. They have a lot of intuition about how to manage labor," said Ann McCarthy, clinical director at the Strip District-based Midwife Center.
The nonprofit group is on pace to guide about 470 births this year, nearly double the number it handled in 2010, organizers said. State-licensed midwives assist about half those patients with hospital deliveries, while the other half give birth in the center's century-old building on Penn Avenue. Facility fees there run about a third of national averages for childbirth.
Although hospitals also offer natural births without painkillers, midwifery advocates say their approach gives patients more one-on-one attention, coaching and control over the process, often easing drug use and softening the clinical atmosphere.
The method isn't meant for pregnancies with complications, but the 85 percent of women who need little or no intervention can do well with midwife services, said Midwife Center executive director Christine Haas. About 12 percent of its patients have Caesarian sections at hospitals, less than half the rate among low-risk pregnancies nationwide.
At the American College of Obstetricians and Gynecologists, president Mark DeFrancesco said his nonprofit organization is comfortable with well-qualified midwives — as long as women understand the risks of non-hospital deliveries.
"They need to know that even if there's nothing in their history or their pregnancy that suggests it, there's still a chance something can go wrong," DeFrancesco said. Even low-risk pregnancies can face unexpected problems in labor, he said, though that's very rare.
He sees the best of both worlds in midwives who work inside a hospital, where specialists can intervene at once if an emergency develops.
"I think hospitals in general have tried to be more patient-friendly, mother-friendly and make it a more home-like experience," DeFrancesco said.
That's the pattern at West Penn Hospital in Bloomfield, where workers have installed birthing tubs similar to the Midwife Center's. Doctors said they are reshaping the maternity culture there to encourage more breast feeding, mobility and general comfort for mothers.
The hospital plans to start its own midwifery practice over the next few months. Midwives and nurse-midwives, who also are registered nurses, need to complete an accredited graduate program in order to be certified by the American Midwifery Certification Board.
"There's a growing effort for hospitals to look more like birthing centers and for birthing centers to have some of the same technology as hospitals, hidden away," said Ronald Thomas, who directs the maternal-fetal medicine division at West Penn.
Rival Magee-Womens Hospital of UPMC already offers an in-house midwife practice that assisted about 700 deliveries last year, not including births that involved Caesarian sections or visiting midwives, said chief nursing officer Maribeth McLaughlin.
"I think women are looking to be more engaged and involved and play a role with their provider," McLaughlin said. The midwife group helps with more than 6 percent of deliveries at the Oakland hospital.
Certified midwives attend about 8 percent of all births nationwide, reflecting two decades of near-constant growth, according to the National Center for Health Statistics.
Jessica Tang, 35, of Sewickley delivered two children at the Midwife Center in the Strip. She said preparation made a big difference.
"At the end of the day, birth is a very cultural thing," said Tang, holding her sleepy son, Connor, whom she delivered Aug. 16. "One of the things it gave me is a sense that I can do this."
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Information from: Pittsburgh Post-Gazette, http://www.post-gazette.com
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