It is 8:44 a.m., and in 12 minutes, Michelle Wilke will give birth to her third child.
At home in her townhouse, surrounded by her family. Without drugs. Without an episiotomy. Without nameless technicians drifting in and out of the delivery room, probing her body without explanation, connecting her to cold machines and feeding her potent drugs.
Those were the turnoffs of her first two deliveries, and the reasons why she vowed to avoid hospitals this time. This, her third birth, is being attended by Adele Alexandre, a certified nurse-midwife; Cheryl Marian, midwife in training; and Sheryl McGrath, birth assistant.
There`s not a doctor in the house.
Alexandre is a registered nurse who is certified as a midwife, licensed to deliver babies. Marian and McGrath, her assistants, are not nurses; they`re laypeople training to be midwives. Even when they finish their training, they won`t be able to deliver babies on their own. Under current Florida law those who want to become lay midwives cannot be licensed.
Lay midwives are controversial. Doctors don`t like them. They say lay midwives endanger mother and child because they usually deliver babies at home, without access to emergency equipment or medical supervision. Doctors also question their training.
Midwifery is a hot topic around the nation. Eighteen other states, including New York, Pennsylvania and California, have midwifery legislation pending. In Illinois, registered nurses are licensed by the state and certified by the American College of Nurse Midwives, according to the Illinois Nurses Association. But lay midwives in Illinois are not licensed to deliver babies.
”We think when you have a baby it`s not a simple matter,” says Donald Jones, executive vice president of the Florida Medical Association. ”There should be a qualified individual such as a certified nurse-midwife or a physician. If there`s any kind of complication at birth, lay midwives are going to get into trouble.”
Many of Florida`s 300 nurse-midwives, 85 percent of whom deliver babies in hospitals, agree.
But lay midwives counter that birth is a natural process and should not be treated as an illness. They say doctors often perform unnecessary Caesarean sections and painful episiotomies just to speed up delivery. They oppose what they call assembly-line hospital births designed principally to fit a doctor`s needs.
Once, lay midwives could be licensed in Florida. But in 1984, the legislature changed the law so only midwives already licensed or enrolled in a midwifery school could legally practice. There are 37 licensed lay midwives in the state. Now no one in Florida can become a licensed midwife unless she first becomes a nurse.
The doctors who pushed for the repeal of licensing said they feared for patients` safety. But Rep. Elaine Gordon, a North Miami Democrat, says they also were guarding their turf.
”There was a fear that if another type of practitioner were allowed to enter the field there would be competition for patients,” she says.
For the last seven years, Gordon has introduced bills to re-license midwives. The Florida Nurses Association, the Florida Medical Association and the Florida Obstetric and Gynecological Society opposed her every time.
The bills always died, as did last year`s, which was passed by the House but defeated in the Senate.
Rep. Ben Graber, a Coral Springs obstetrician, pushed for passage because of the bill`s educational requirements. He says the midwives would receive almost as much training in obstetrics as obstetricians.
Lay midwives charge $1,300 to $1,600, compared with at least $5,000 at hospitals. And they make house calls. Many private insurance carriers and HMOs cover their services.
Poor women aren`t the only ones who might seek the help of midwives. Twelve percent of the nation`s obstetricians have quit delivering babies because of high malpractice insurance premiums or fear of being sued.
Some women, fed up with the rushed, impersonal feeling they get from their doctors, are turning to midwives for warm, friendly, leisurely attention. Others decide to use midwives simply because they want to have babies in the most comfortable setting possible-their homes.
”We think birthing can be a very empowering experience for women,” says Julie Snyder, co-chairman of the Midwifery Access Project of South Florida. Snyder`s two children were delivered by midwives.
And back in Tamarac, Michelle Wilke has given birth to a daughter. Ryan, her 5-year-old son, peeks in the bedroom door. ”Can I see the baby?” he asks.
