BIRTH OPTION OF MIDWIFE SLIPPING AWAY

Ever since my sister Jenny delivered my nephew, I knew that if I had a baby, I would want a midwife to do the delivery. To me, her story was incredible: no drugs, no episiotomy, no invasive medical procedures at all, in spite of a moment - a dropping baby heart rate remedied, not by C-section, but by putting my sister on all fours - that would have sent a traditional obstetrician running to the operating room. In fact, Jenny was up and out of her hospital bed in record time after my very healthy nephew was born - in large part because of the expert care she'd received from her certified nurse midwife.

So when I became pregnant with my first child, there was no question who I wanted to take care of us; Truus Broner, a certified nurse midwife at UAB Family Medicine, later joined by Joyce Weichmann, CNM, who eventually helped me deliver my sweet Lucy a little more than a year ago. When I was pregnant, my sister was reflecting on her experience with her CNMs, and she told me they'd since dismantled the program at the hospital where she'd been. "I'm just glad I'm done having my kids," she said.

Suddenly, I wish I could say the same.

Losing choice

As a result of diminishing residencies, attendant budgetary effects and the as-yet unwillingness of UAB to adequately fund the program, UAB Family Medicine is slated to terminate its OB practice in October, and the practice of the last certified nurse midwives in northern Alabama.

What does this mean for the women of Birmingham - and all the women of northern Alabama, for that matter? It means that in a city that prides itself on offering a virtual buffet of medical options to its citizens, our choices of childbirth caregivers have dwindled from two to one.

In other words, we will no longer have any choice about the kind of childbirth experience we want to have.

But why a midwife? Images of witchy old women hovering over bloody kitchen tables may come to mind. In reality, certified nurse midwives have all the expertise, training and experience of any OB; they do routine gynecological care and all prenatal care, as well as deliver babies. Plus - unlike most OBs - they operate under the belief that a woman can, and should, as much as is medically feasible, guide her own childbirth experience. Admittedly, most women today are more than content to put that control in someone else's hands. But for those of us in Birmingham who haven't been, there have been midwives to listen, work and stay with us as our children were born.

None of this is to say that one needs to have a midwife to have a positive childbirth experience; in fact, the majority of women in town choose traditional OBGs. And that's fine; that's what having a choice means. But midwives are an option that many women prefer and that they will seek out, even to the point of forsaking the medical profession altogether and hiring a lay midwife to facilitate a home delivery. Certified nurse midwives, though, offer all the benefits a license and modern medicine can provide, including insurance coverage and hospital privileges. And for those of us not comfortable with the back-ally birth, Turus and Joyce offered an opportunity to have our babies the way we wanted to, but in a hospital - just in case.

Stay different

UAB is working hard to distinguish itself in an increasingly competitive medical market, making much of its ability to provide all the medical options any patient could ever want or need. But unless it financially empowers UAB Family Medicine to continue its excellent midwife prenatal / birthing program, the days of having any choice about how to have a baby in Birmingham are rapidly coming to a close. Ironically, the only thing that's made giving birth at UAB unique among other area hospitals was the opportunity to work with a certified nurse midwife.

Unless UAB puts its money where its mouth is, its maternity ward really will look like everyone else's. How shortsighted, how terribly sad for those of us wanting a kinder kind of birth.

Linda Frost, Ph.D., is an associate professor of English at the University of Alabama at Birmingham. For your turn at "My Turn," mail your 600-word commentary to Editorial Page, P.O. Box 2553, Birmingham, AL 35202; e-mail us at epage@bhamnews.com; or send a fax to 205 325-3345. Please include your telephone number.