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Planning home delivery

Christine Stanley
Courtesy photo With the help of her midwife, Susanne Scott Rosenfeld, Truckee resident Yona Trustman delivered her third child, Mariposa, at home with husband Ben, son Adrian, and daughter Arella, in April 2005.
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Midwives, the guardians of natural births, have been at the side of laboring women for millennia.In many nations, even the industrialized, midwifery remains a profession that is heavily used and highly regarded. So why is it that fewer than 5 percent of American women deliver their children at home into the waiting hands of a midwife?”American woman are afraid of the wrong things. [They] don’t think about it logically. Most women around the world don’t have a baby on their back in a bed,” said Susanne Scott Rosenfeld, a local licensed and certified midwife who owns Sacred Hoop Midwifery Service. “[Delivering] in a hospital is not the way it was meant to be. It can be simpler and better.” Rosenfeld, who has been midwifing for six years and has delivered – or “caught,” in midwifery terms – more than 150 babies, launched her new career path 12 years ago when she began attending births and after the home-birth of her own daughter.”It was a very empowering experience for me to give birth that way,” Rosenfeld said. “It was the most painful thing I’ve ever experienced, but I lived through it. Now I want to shake every pregnant woman I know and say ‘Have a home birth!”’By choosing to deliver with a midwife, clients and their families say they are afforded a more personal and comfortable birthing experience. If laboring women wish to soak in a hot bath, take a walk around the neighborhood, or curl up on the couch, they can do that. “We want to do this ourselves in the most comfortable setting we can think of – to be in each moment together and not be persuaded by a hospital’s agenda,” said Aaron Wolf, a Reno resident whose partner, Lindsay Severino, will be delivering at home with Rosenfeld. “Lindsay thought she might feel vulnerable in the hospital, partly because there is this hospital conceptualization of births as a medical emergency. You are on a time table and they want you in and out as quick as possible,” Wolf said. But is it safe?

Many American women don’t even know that midwives still exist as an option, others who do are fearful of complications that might occur outside of a hospital environment. Yet, even obstetricians often support the idea of home delivery. “For a normal, healthy patient with proper prenatal care, a home birth can be a safe experience,” said Dr. Shawni Coll, OBGYN at Tahoe Forest Hospital. “But precautions – not skipping necessary testing – need to be taken in order for that to occur.”But because Rosenfeld works in conjunction with Tahoe Forest Hospital, her clients have access to ultrasounds and all the normally recommended pre-natal tests. Rosenfeld, who is trained in neo-natal resuscitation, carries emergency medial supplies with her to all births, and, to minimize risk, will not take patients with medical conditions that could cause complications during delivery. “At-home birth has been proven to be as safe or safer for low-risk pregnancy women,” Rosenfeld said. “From what I have seen, birth has its best chance of being normal when it is in a home environment. You have to deliver where you feel safe.”Rosenfeld also said that she, and the majority of midwives in the United States, has a 1 to 5 percent cesarean rate for her clients. The World Health Organization recommends that no more than 12 percent of babies be born via C-section in any industrialized country. “Child birth is one of the most natural and ancient things to occur, and the fact that 95 percent [of babies] are delivered in the hospital, and a huge percent are C-sections, is rather telling to our detachment from the process,” said Wolf, the expectant father.Midwifery historyMidwifery is illegal in about one-third of the United States, and until 1993, California was one of them. An equal portion of states, including Nevada, are “A-legal,” meaning that there are no options for licensing. But there is legislation in place to protect midwives, so as long as they are skilled and able to defend themselves in court.Until about 250 years ago, delivering a child in a hospital was nearly unheard of and men were in no way involved in the process, said Rosenfeld. But with the development of obstetrics as a medical field, and the concurrent shunning of women from medical schools, the practice fell out of favor, and by the 1950s few midwives remained.”(By mid-century) midwifery had pretty much died out in the United States, other than ‘black granny midwives’ in the South who were serving the African American population who wouldn’t be served by white doctors,” Rosenfeld said.

The midwife revival began in the 1960s and ’70s, when progressive attitudes made it more common for men to attend the delivery of their children, Rosenfeld said. Midwifery has been gaining popularity since then, though the profession has continues to battle both state and federal legislation. Sidebars Becoming a midwifePeople interested in becoming licensed midwives in California must attend a post graduate midwife program at a cost of approximately $30,000 a year and gain extensive clinical experience followed by evaluations, according to Susanne Scott Rosenfeld, a licensed and certified midwife who owns Sacred Hoop Midwifery Service in Truckee. Students are also required to:• Passively observe 20 births• Assist with 20 births• Provide primary care for 20 births• Perform 40 new-born exams

• Conduct 75 prenatal visits• Conduct 45 post-partum examsIn Rosenfeld’s case, she served as an intern for three months in a birthing center in El Paso Texas. In 90 days she “caught” 101 babies, and in one 12-hour shift, once caught 14.To become certified nationally by the North American Registry of Midwives (NARM), students must pass the Registry’s 350-question exam.The deal with doulas Women who wish to deliver in the hospital, but who still desire the emotional and mental support of a midwife, might opt instead for a doula.Doulas provide the same comprehensive pre- and post-natal physical and emotional support as midwives, but do not perform medical exams or deliver babies.”We work from the waist up,” said Sherry Asp, owner of Aspiring Birth Doulas Services in Reno.Asp, who has been doulaing for four years, tends about 25 births a year, and is allowed to be in the hospital delivery room with her clients.”Through the entire process we help mom keep comfortable and relaxed, and help her with good positions for pushing,” Asp said. After delivery, doulas will stay with new mothers for a few hours to assist with breast feeding support.


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