Tenderness or tradition?

Kimberley McGee

Thursday, Nov. 19, 1998 | 10:18 a.m.

Corrine Flatt didn't have a choice when it was time for her baby to be delivered.

"(The doctor) stood over me and said, 'We don't have time, we have to do a C-section or your baby will die,"' she recalls. "He thought I might have an infection. But it wasn't true."

Flatt looked forward to experiencing her first birth and instead was left angry: Her fear and ignorance of birth and her body left her idle in the doctors hands, she says.

She decided a home birth with a local midwife would best suit her for her second child and she reached out to Lydi Owen, a seasoned midwife, to help her through her pregnancy and ensure the health of her and her baby.

Owen, a local midwife with more than 25 years experience, understands the anger and the fear, and has helped more than 2,000 women bring their babies into the world successfully at home.

"The minute you walk in they relax, you tell them this is how you breathe, this is what is happening," Owen says of the natural childbirth process and the bond it brings between mother and child. "She feels empowered."

Owen sits in her living room, her small frame nestled in an overstuffed armchair. She gestures passionately, her graceful hands punching the air.

"This is an age-old art that I will defend to my dying day," she says. "You have to believe in it, you have to be dedicated to it. Women themselves think that it is a dangerous thing to do, but it is so natural."

Owen had three of her own children in hospitals before deciding to go at it alone. Her first son was born with club feet, a flipper-like hand and an arm that had to be amputated because the umbilical cord had wrapped around the underweight baby's left elbow -- all problems related to bad prenatal care, she says.

"He (the physician) told me not to gain more than 17 pounds," she says. "I don't know if he wanted me to be skinny for after the baby or what. A woman should gain 35 to 40 pounds for a healthy baby."

Owen's career in midwifery began after a "horrific child birth experience" of her own at a local hospital in the early '70s. Left alone through most of the birth in a sterile, white room, she felt victimized by the hospital system and her physician. She decided she could do better delivering her fourth baby alone at home.

"I was so empowered by that," she says.

In 1972, she began helping other mothers who also believed that home was better than the sterile -- and sometimes more painful -- environment hospitals routinely offered.

"So many women were becoming dissatisfied with the lack of control they had in hospitals," Owen says. Currently she delivers between 10 and 15 babies a month, "unless it is a full moon" which effects tides and, Owen says, the water in a womb.

She has trained nine women as midwives. "A true midwife has intuition, it is an unseen thing but a very, very real thing," she says. "She is totally tuned into the woman and her baby and you pick up on things."

Lay midwives are not certified or licensed, and do not use ultrasound or other electronic monitoring devices. Instead, Owen says, they rely on age-old techniques such as the movement of the baby, timing of growth and movement, heart rates and physical exams.

Owen's instincts and intuition have helped her through many births. She recalls a mother who was reluctant to birth her baby during a long labor, a difficult situation, and had issues that were keeping her from allowing the birth. Owen found that talking through the psychological aspects with the mother of what she was experiencing helped significantly.

"She had had an abortion three months before this baby," Owen recalls. "She felt guilt over what she had done and that she didn't deserve her baby. After I talked to her about what she was feeling ... she had that baby like that."

Conflicting opinions

To Owen and many midwives, physicians don't belong in "90 percent" of births and, in fact, actually prolong the delivery with drugs as well as the arrival of the doctor to the scene.

"There is a baby ready to be born and it is stuck in the (birth) canal until the doctor gets there to catch it," Owen says. "That's ridiculous."

That is the crux of the debate for Owen: Most women don't trust their bodies and the intuition of women who have birthed babies, they trust men and machines.

"I'm touching you, I'm helping you ... we talk about anything," she says. "One of the more important things about pregnancy is the psychological issues the mother deals with. We talk about whatever she needs to, so that she can mother her child better."

The bond between mother and child begins at childbirth, Owen says, and when a baby is whisked away from the mother soon after birth, a break occurs that can never be mended.

"People think that midwifery or home births are dangerous, they think that everything is going well and then it just isn't -- but it's not like that," Owen says. A midwife can tell what if something is wrong and seek medical attention if required, which Owen says happens in approximately five percent of births.

For those who want natural childbirth with medical backup, birthing centers are available with a nurse midwife to monitor the pregnancy and birth.

As of June, there were 17 licensed nurse-midwives in Nevada. Each works with a consulting physician and must renew their certification every two years.

"Birthing centers are glorified hospitals," Owen says. "They are a little better, but they run on the same principle. A true midwife holds your hand, talks to you, lets you walk around, facilitates the birth of your baby. Birthing centers have nothing to do with that."

A woman should be able to move to whatever position is comfortable while in labor, not lie on her back and wait for contractions, Owen says, which is often the case with hospital births.

Flatt says the birth process is not something you can pick up in books, it is learned through touch and experience with a seasoned midwife.

"Training to be empathetic with the mother cannot be passed down," Flatt says. "It is not something you can learn out of a book or in school."

With the right coaching, birth can be an enjoyable experience, midwives say.

"Doctors don't say, 'Relax, this is normal, everything is OK with you,"' Owen says. "It would make such a difference to so many women."

But for many women, the safety net of doctors and high-tech tools is a much more modern and sensible choice for a possibly dangerous situation.

Otto Ravenholt, who recently retired after 35 years as Chief Health Officer for the Clark County Heath District, has done studies on local midwifery.

"The numbers don't provide any evidence that (mother or child) were not better off at home," he says. "The question of who is in charge is the heart of all this. It is the desire of women to be more involved in their own birthing experience."

The medical community does not always accept midwives as viable options for women and, according Owen, has given a cold shoulder when a midwife brings a possible high-risk patient to the emergency room.

"In terms of human relations, it is sometimes a very difficult interface (between doctors and midwives)," Ravenholt says. "There is the feeling (of) 'Why should we treat you when you didn't come to us in the first place?"'

Ravenholt knows Owen well, along with other regional midwives and says he respects their "calling."

"The lay-midwives have standards that are admirable," he says. "It is an example of an individual carrying out the service for her life's work."

When interviewing for a midwife, the same careful choosing one would use to pick a physician should be taken into consideration. Also, some insurance companies cover home births, which range from $500 to $1,200, compared to hospitals births which can range from $6,000 to $15,000 depending on complications, if any.

"Midwives are more of a seasoned coach to distinguish when something may need (medical) expertise," Ravenholt says. "Not all individuals providing service in lay-midwifery mode are equally seasoned."

Jeanie Jenkins, a management assistant for the Nevada Board of Nursing, explains a nurse midwife must have a four-year degree in nursing and be a Nevada-licensed registered nurse, as well as obtain additional yearly education in their chosen field.

"All nursing midwives in this state have master's (degree), at least," Jenkins says.

Nurse midwives may work from their home, but most use a birthing center.

"Our law doesn't speak to that, but I don't know of anyone practicing at home," Jenkins says. "In rural areas (maybe) more so. Nurse midwives are primarily found in a clinical setting. You would treat nurse midwives as a physician."

Nurse midwives must also give their backup physician a set of written tasks that she and the physician have agreed upon practicing such as prenatal care, ultrasounds and a schedule of visits with the mothers.

"It outlines for everyone concerned what the (nurse midwife) is doing," Jenkins says.

'Ignorance is scary'

Flatt says a lay-midwife, however, allows the mother and baby to bond and fully experience the pregnancy and birth by coming to a woman's home and discussing any questions the mother-to-be may have.

"A midwife is involved," she says. "I found Lydi and she was wonderful to be around."

Flatt looked in the phone book and made inquiries to other mothers she knew had birthed at home. After some research, she made the choice to be in a natural setting so that her second birth would be less traumatic for her and her baby.

"It didn't even occur to me to be scared," she says of the labor and birth experience. "I had prepared myself mentally and I trusted my midwife. What makes it scary is what we don't know; ignorance is scary."

Flatt has since birthed two more children at home with a midwife. She was enthralled with the process, and jumped at the chance to apprentice with Owen.

"For me, birth is exciting all by itself," she says. Midwifery is "just a calling, it's one of those ministries where you are called from the community or you are not."

Although Flatt did lose her own baby girl at full term (it was stillborn), she does not blame the lack of technology.

"I checked her out personally," she recalls, explaining how she monitored the baby's growth, heart rate and activity. "Everything was perfect for her. On (a) Friday night I felt something was wrong. I listened for the baby, but she had died."

Ravenholt reminds: "There are some risk factors that should not be ignored. Even in the hospital, one is not assured of (problems not) happening in every case."

"We will take 100 percent responsibilty for our part," Owen says of care dispensed by midwives throughout the pregnancy. "(Parents) have to take theirs, too. I'm not going to talk anyone into it because all births carry some risks."

Owen has never lost a mother or baby during an actual birth, and has delivered only about five percent of her mothers to the hospital.

Flatt, meanwhile, has recently started a birthing service and plans to educate women on the fundamentals of having their babies.

"For most women it is not nearly as painful as we make it out to be. It is the ignorance and the fear that create the situation," Flatt says.

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