On Wednesday morning at Española Valley Women’s Health, Sarah Matthews of Los Alamos lay flat on her back on an exam table. Matthews is 37 weeks pregnant, and midwives Jessica Frechette-Gutfreund and Elena Stauss gently pushed and prodded at her stomach.
“It feels like the baby’s a lot lower, pressing on your pelvic bone,” Frechette-Gutfreund said. “He’s all shoulders.” Frechette-Gutfreund applied jelly to a fetal Doppler and the room filled with the fast, fluttering sound of a heartbeat, muffled as though emanating from underwater.
Matthews said she chose a home birth for her second child (her daughter is 4) because, “My pregnancy is low-risk, I’m healthy, I’ve done this before, and I live close to the hospital.” She added that the personalized care offered by Española Valley Women’s Health was appealing. Matthews went on to say that while many people view home birth as “a hippie thing to do,” she feels that it is the right decision for her and her family.
Though hospital births are the norm in this country for the vast majority of expectant mothers, midwifery and home births have gained traction in recent years. A January 2012 study from the Centers for Disease Control and Prevention indicated that the rate of home births rose 29 percent from 2004 to 2009, from 0.56 percent to 0.72 percent of the total number of births.
The study found that the greatest increase in home births occurred among non-Hispanic white women, and that home births are less common among women of other racial and ethnic groups. It also found that women who are older than 35 or have already had a child are more likely to choose home birth. The study states, “Home births have a lower risk profile than hospital births, with fewer births to teenagers or unmarried women, and with fewer preterm, low birth-weight, and multiple births.”
“One of the reasons [home birth is comparatively popular] in New Mexico is because we have so many rural areas,” said Sally Wait, program manager for reproductive health with the Medical Assistance Division of the state’s Human Services Department. “[New Mexico] has always pretty progressive in regards to reproductive health, both in terms of family planning and midwifery.”
New Mexico is unique in the amount of regulation afforded to midwifery. According to the Midwives Alliance of North America, it is one of only 10 states that accept Medicaid for home births. Many states do not regulate midwifery, and in some states, the practice is prohibited.
“New Mexico is one of the most midwifery-friendly states because we’re regulated and licensed,” said Stauss, who has participated in about 110 births.
There are two types of midwife certification in New Mexico: certified nurse midwife (CNM) and certified professional midwife (CPM), also called a licensed midwife.
CNMs are nurses who specialize in midwifery and almost always deliver babies in the hospital.
CPMs are trained to take care of mom and baby until, during and up to six weeks after the birth under normal conditions.
According to the North American Registry of Midwives, a national nonprofit that administers certification, all CPM applicants “must participate in a minimum number of specified clinical experiences; demonstrate competency in a specified set of knowledge, skills and abilities; and pass the NARM written examination.”
Both Stauss and Frechette-Gutfreund are CPMs.
“For me, what was so attractive about becoming a licensed midwife [a CPM] was the training path,” Frechette-Gutfreund explained. “You jump right into the apprenticeship model, and do tandem academic study simultaneously. We spend double or triple the time doing clinical work than CNMs do. Nurse midwives’ education is institutionalized, which lends it a certain kind of academic credibility, but for me, getting a vast amount of clinical experience outside the hospital before I began practicing was very important. I was trained in the context [in which] I wanted to work.”
According to data compiled by the state’s Bureau of Vital Records and Health Statistics, in 2010 there were 321 home births out of a total of 27,795 live births in the state. In 2011, there were 310 home births out of 27,251 live births.
Frechette-Gutfreund came to New Mexico in 2007 to attend the Northern New Mexico Midwifery Center in Taos. She co-founded Española Valley Women’s Health with Michelle Peixinho, also a CPM, in 2010. So far, the center’s midwives have delivered about 30 babies at home, and Frechette-Gutfreund has attended more than 200 home births.
“We’re working on how we can address people accessing care through culturally congruent options in the valley,” Frechette-Gutfreund said. “Our radius is one hour from here, but we emphasize the valley and target its population, mostly Chicano-Hispanic, the six Tewa pueblos and the Spanish-speaking immigrant community. How can we create an out-of-hospital birth model that works for this community? One way is to offer walk-in prenatal care.”
In addition to its present work providing prenatal care, home births and well-woman care (PAP smears and STD testing) Española Valley Women’s Health is working on creating a birth center called Breath of My Heart Birth Place. Currently, there are no birth centers between Taos and Albuquerque.
“There’s been a high level of receptivity [to creating a birth center], especially compared to other low-income communities, like the one I’m from in Ohio,” Frechette-Gutfreund said. “One issue for many folks is the place they’re living. For a variety of reasons, their housing is an undesirable place for them to give birth. That’s the impetus behind [creating] a birthing center, a home away from home.”
“We want to reach the Spanish-speaking community,” said Stauss, who is originally from Argentina. She had all four of her children at home, two in Brazil and two in Miami. While Stauss often works with Española Valley Women’s Health, she also has her own practice, Santa Fe Midwifery and Women’s Health. “I offer free birthing classes in Spanish,” she said. “A lot of people are going to the hospital just to have their babies, but prenatal [care] is very important. And it’s fine to [give birth] at the hospital—I want women to have babies in the way that they want.”
“It’s a partnership,” Stauss continued. “It’s important to do it your own way, but [I] don’t believe in pharmaceutical pain killers because it all goes to the baby. … At home or in a birth center, [you’re] protected from viruses. No option is 100 percent safe. But when you have your baby at home, you don’t go anywhere. We stay until everything is stable, the baby is nursing, and mom is OK.” CPMs also conduct a series of follow-up visits following a birth.
Stauss estimates that 15 percent to 20 percent of the births she has participated in resulted with transfers to the hospital. “If we see something that’s not OK, or the baby is under stress, we go to the hospital,” Stauss explained. “This doesn’t mean [the mother] is going to have a C-section. After a transfer, our role becomes more like a doula, supporting the mother in her decisions.
“I really believe in what I’m doing. I don’t feel it’s unsafe.”
After Matthews’ appointment at the clinic, Julia Topete dropped in for a visit with her 1-year-old daughter, Ixchel, who was delivered by Frechette-Gutfreund and Stauss. Topete also has a 10-year-old son who was born in the hospital.
“My experience in the hospital was not the best,” Topete said. “I felt neglected. … I was 16 years old when I had my son, and when you’re 16, you listen to your parents. I had no idea home birth still existed.”
When Topete was pregnant with her daughter, her mother had misgivings about Topete’s plan to have a home birth. “My mom is from Mexico, one of 14 kids born at home,” Topete said. “I told her, ‘I understand your concern, but this is what I’m doing.’ ”
Topete said giving birth at home was “beautiful, and it gave me a sense of empowerment. … Ixchel] also belongs to Jessica and Elena, because we shared all those months. We need to educate women and our community about home birth. It happens all around the world, and for the most part, it’s very safe.”
Visit Española Valley Women’s Health online at www.espanolavalleywomenshealth.org or call 508-7209.
Contact Santa Fe Midwifery and Women’s Health at 206-9594 or email firstname.lastname@example.org.
Contact Adele Oliveira at 986-3091 or email@example.com.