.Labor of Love

wellnessSanta Cruz, a mecca for Nurse Midwifery, celebrates 40 years of practic

When it comes to giving birth, women in Santa Cruz have access to some of the best care in the country. Women travel from neighboring counties just to have their babies here. And a large part of the attraction is our devoted team of Certified Nurse Midwives—which currently numbers 14—and a growing demand to be in their care.

As the Monterey Bay Chapter of the California Nurse-Midwives Association (CNMA) gears up to celebrate 40 years of Nurse Midwifery in Santa Cruz—with an Oct. 4 bash at Kuumbwa, complete with a silent auction and SambaDá—I connected with three of Santa Cruz’s baby catchers (a total euphemism, really), for an eye-opening brain picking on what it really means to be a Nurse Midwife in Santa Cruz.

“When that baby’s born, and I get to hand that baby to the mom, it’s just one of the joys of my life to sit back and watch how she greets her baby, and how that beginning of love starts,” says Kate Bowland, CNM, who has caught some 2,000 babies in Santa Cruz since she began attending births in the early ’70s.

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Tired, but still glowing with the vivid memory of an all-night birth the night before, Bowland is obviously passionate about what she does—a characteristic, I soon find, common to all of the midwives I talk to. The other is that they are extremely busy women: In addition to home births, which make up around 2 percent of births in the county, Santa Cruz’s small team of Nurse Midwives attend about 30 percent of births in North County’s two hospitals—Dominican Santa Cruz Hospital and Sutter Maternity & Surgery Center—compared to 11 percent in California and 10.8 percent nationally. And while the rate of cesarean section births hovers around 18 percent in California, and 34 percent nationally, midwife-attended births in California have a less than 10 percent primary cesarean rate in California.

“If you’re having fewer medical inductions, if you’re having fewer epidurals, if you’re having fewer IV’s, less pain medication, the net sum of that is going to result in fewer cesarean births, and cesarean births do have an increased risk of complications to the mother,” says Timmi Pereira, CNM, who has also caught more than 2,000 babies, primarily working at the two local hospitals. “The outcomes for babies who are under the care of Nurse Midwives for their mother’s care are also outstanding. There’s fewer preterm births, there’s fewer low birth-weight births, and there are fewer stillbirths,” she says.

Of course, midwifery is not just about catching babies, Pereira points out. “What a lot of people don’t realize is that Nurse Midwives do well care in clinics,” she says. That includes reproductive health care, annuals, and primary care. “And most of us have the ability to prescribe drugs and devices, including controlled substances, and assist women to avoid damage to their bodies during birth, but also repair it if that should occur,” says Pereira.

But today’s cutting-edge midwifery practice and its seamless collaboration with local hospitals didn’t happen overnight, or without some serious pushing. While midwives have existed since, well, probably the dawn of time, they traditionally practiced in a gray legal area in California until 1974, when Nurse Midwife certification was passed by law—a law that birthing rights advocates, (many of them local), presented to legislature for 11 years before it passed. In 1987, Dr. Paula Holtz became the first Nurse Midwife in Santa Cruz to be granted hospital privileges. Since then, they’ve come a long way.

“One of my observations throughout the women’s movement was that the rights of women’s choices in childbirth were not really talked about in the public media,” says Bowland. “You know, our choice for abortion was talked about, but the right to give birth, and to give birth humanely, with supportive midwives, with supportive staff, with real help, wasn’t talked about.”

Bowland remembers a time when women had very little say in the process. She quietly recounts sinister details of past birthing practices—isolation from loved ones, including the husband. Routine episiotomies. The drug scopolamine, which, in addition to leaving the mother with no recollection of the birth, often caused women to “flip out,” sometimes resulting in a straightjacket. Forceps to drag the baby out, since the drugs interfered with the ability to push. The standard spank-on-the-bottom welcome, since lung function is depressed in newborns born under the influence of hospital narcotics. The whisking away of the baby to the nursery—sometimes for 24 hours while the mother recovers.

“Birth is a very powerful part of a woman’s life. And it can be empowering, or it can be ecstatic, or it can be traumatic.” says Bowland.
More and more, hospitals are becoming “baby friendly,” meaning they support breast feeding and bonding, and keeping the mother and baby together in those golden hours after birth. “And really, that came from nurses and midwives really pushing for that work, you know it was a long time coming,” says Bowland.

And even as the thriving midwifery community in Santa Cruz has a great amount of progress to celebrate, what they’re most excited for is the future; including expanding their ability and autonomy of practice.

“I think we’re going toward an even more physiologic birth, and we’re going toward even more midwifery care. And part of the reason for that is driven by demand, and part of the reason for that is the realization on the part of obstetricians that they have a shrinking workforce, and there’s a national drive for more collaboration with Nurse Midwives, that’s definitely a trend,” says Pereira.

In peppering Bowland and Pereira with questions about what it’s like to bring a new life into the world, I quickly realize that their knowledge is bottomless. I too, would want them on speed dial. I learn that epidurals, as painless as they sound, limit the mother’s mobility—which is key to delivering a baby. And that immediate clamping of the umbilical cord before it stops pulsing denies the baby of about 50 ccs of blood—blood which not only helps to fill the baby’s lung bed, but was also recently discovered to contain stem cells that enhance the myelin sheath in the nervous system, providing positive lifelong consequences, says Bowland.

“We’re at a time when women are very vocal about what they want,” says Anabel Albano, CNM, who has caught around 500 babies since moving to Santa Cruz from the Midwest in 2007. Pereira echoes that the parents she interfaces with today are better informed than ever before. And they’re requesting midwives more and more, says Albano. “I think midwifery is poised to help shape the way that women’s healthcare changes and moves in the next 10 or 20 years.”

Albano, who works with Palo Alto Medical Foundation and serves South County women one day a week, is looking forward to a prenatal group-education program called Centering Pregnancy, which will begin in the spring or summer of 2015. “We’ve seen across the country that women find themselves feeling more supported, more nurtured and much more informed when they’re in a group, and they leave these prenatal education sessions with a greater understanding of what’s going to happen with their lives and feeling much more empowered,” says Albano.

“We want to see the community receive the kind of care and attention that is so deeply deserved, regardless of income, regardless of background,” says Albano. “And I think the midwifery community as a whole is highly motivated to make things better for moms, and, by extension, their babies and their families.”

The 40 Year Celebration of Nurse-Midwifery in Santa Cruz is 1-4 p.m. on Saturday, Oct. 4 at Kuumbwa Jazz Center. Doors open at 12:30 p.m. for Silent Auction. Tickets are $15 adv/$20 door. brownpapertickets.com/event800337. PHOTO:  Certified Nurse Midwives Timmi Pereira, Anabel Albano and Kate Bowland (left to right) are part of Santa Cruz’s cutting-edge team. CHIP SCHEUER


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