Delivering a More Personal Childbirth Experience

By Beacon Staff

While American movies often depict human birth scenes as comical events, a local midwife says the prevailing emotion felt is in stark opposition.

“There’s a huge amount of fear around childbirth in our culture,” Julie Bates, a certified nurse midwife, said. “Most of us, when we’re having our first child, have never seen a baby born, whereas in many cultures, younger women have been around women having babies.”

In the 1930s, the bulk of births in the United States migrated from homes into hospital settings. Today, 99 percent of Americans are born in hospitals. While Bates feels the clinical technology has benefited women and their children, emotional aspects of the event are often buried under the banner of medical progress.

“I believe that what happens to a woman when she gives birth, and how she and her child are treated, all of that affects them profoundly and permanently,” she said. “Our culture, and the medical system that we currently live with, do young families something of a disservice and I want to help change that.”

Julie Bates, a Certified Nurse Midwife, right, listens to the heartbeat of Beth Sandusky’s baby during a checkup at FamilyBorn at Kalispell Regional Medical Center.

Two years ago, Kalispell Regional Medical Center recruited Bates to develop a midwifery component within its obstetrics department. Six months later, FamilyBorn opened in Kalispell, along with satellite offices in Columbia Falls and Eureka.

Mindy Fuzesy, Nurse Manager of Obstetrics at KRMC, says Bates’ expertise adds a different dimension to the hospital’s care component.

“If people are looking for a more natural approach, midwifery services can offer that,” she said. “To a lot of people, its medical and natural combination makes it an appealing choice.”

FamilyBorn’s opening follows the expansion of midwife practices across the state. According to the American College of Nurse Midwives, licensed midwives delivered around 8 percent of all babies born in Montana in 2004. Meanwhile, Bates estimates that a half-dozen midwives practice in the Flathead Valley.

According to Bates, midwifery licensure in the state can be somewhat confusing because two different categories of midwife practitioners exist.

“From a consumer standpoint, it’s not clear what the different scope of the practices are and the differing sites of practice,” she said.

Licensed midwives, also known as direct-entry midwives, are not granted hospital privileges, so they typically deliver babies at a patient’s home or in a birthing center. Nurse midwives, meanwhile, with their formal medical training, may practice at homes, birthing centers or in hospitals. As a hospital employee, all births overseen by Bates occur at KMRC.

She says her interest in midwifery developed after her sisters endured agonizing birth experiences.

“I didn’t really know what midwives did, but I really felt that the system had really failed my sisters and I had the sense that the system was failing a lot of women,” she said.

Bates, who wasn’t in the medical field at the time, pulled out her phonebook and called a local midwife. She began working at the midwife’s birth center and shortly after assisted with a home birth.

“Seeing that woman give birth in her own environment, with confidence and grace and with birth attendants who were supportive and highly-skilled, it’s no exaggeration to say it completely changed my life,” she said.

In 1992, after completing nursing school and midwife certification, Bates became a certified nurse midwife.

Now, after almost two decades of practice, she says she has encountered numerous misconceptions and stereotypes about pregnancy and midwives.

“There’s a prevailing belief that [pregnancy] is dangerous, frightening and extremely painful and that women need a lot of medical help to get through it,” she said. “Meanwhile, most pregnancies and births unfold just fine on their own, without anyone having to do anything.”

Bates says the bulk of patients who nurse midwives see are healthy women undergoing normal pregnancies.

“The training of midwives is based on recognizing a deviation from the process and intervening then, but not necessarily intervening if the process is going normally,” she said.

When a prospective patient first meets with Bates, a complete health history is taken to see if any issues make the woman a better candidate for an obstetrician. The initial meeting takes place in FamilyBorn’s exam room, which was designed to make patients feel at ease. A colorful quilt sewn by Bates hangs on the wall and patients don spa robes rather than paper gowns. In the winter, a heated pad is added to the exam table.

Instead of “uncomfortable” hospital gowns, Julie Bates offers cotton robes to patients.

The clinic currently boasts a small patient roster, which Bates says allows her to give more personal attention to each client.

“We can afford to spend a half hour on a routine OB visit and we want to spend that time,” she said. “The most important part of prenatal care is getting to know her and she’s getting to know me, so when the day comes that she has her baby, we have that trust established.”

At the hospital, Bates collaborates with five obstetricians and several nurses, who all support her work.

“The nurses there are highly skilled and will do anything that my clients or I ask of them, whether that is asking them for more privacy or sitting with the client and breathing through every contraction,” she said.

The nurse takes a more active medical role if the patient chooses to have an epidural, as additional monitoring for complications is then needed. While Bates says that more than half her clients choose not to use any medication, she supports those who do want it.

“I support women’s choice for medication, but I do like to be as certain as I can about her understanding the choice,” she said.

Research suggests that having an epidural or the induction of labor doubles a woman’s chances of having a caesarean section. In 2007, the National Center for Health Statistics estimated that 31.8 percent of all births in the United States were caesareans. The increase concerns Bates.

“Some women are choosing to do that option for no medical reason other than convenience and not wanting to labor,” she said. “I’m glad to save a woman or a baby with a caesarean section, although that doesn’t mean I think it’s an appropriate tool to use because someone wants it.”

Overall, for an uncomplicated pregnancy, a midwife’s fee is several thousand dollars less than that of an obstetrician. However if complications require an obstetrician’s involvement, a fee is added.

Bates says that without high-tech machines and techs on the payroll to run them, FamilyBorn is able to keep its operational costs down.

“We try to make health care affordable and pass on savings,” Bates said.

Meanwhile, the business is set to expand. In July, the clinic will welcome another nurse midwife, which Bates says will offer more flexibility to patient scheduling.

Despite the sometimes hectic nature of her work, Bates said she loves being a midwife.

“It’s hard to describe if you’ve never been there, but to watch a woman access her full power as a woman to give birth is awe-inspiring and I never get tired of being witness to it,” she said. “It’s an honor to watch that transformation take place.”