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DNT



In the middle of it all
BY JANE BRISSETT
NEWS TRIBUNE STAFF WRITER

Like his six brothers and sisters, Henry George Moeller VI was brought into the world by a midwife, but with one difference.

They were born in the hospital. He was born in the comfort of his parents' bed.

The 8-pound baby was perfect, healthy and squalling as his mother, Beth Moeller, cradled and nursed him. After dad, Henry Moeller V, and sisters Ellie, 11, and Annaka, 10, held him, he was passed to his grandmother and friends who had watched his birth.

It was a joyful ending to a long night for the woman who delivered him, certified nurse-midwife Katie Sandell.

Sandell wasn't more than a few feet away from Beth from the time she arrived at her home about 9:30 p.m. April 14 until she left after 5 a.m. April 15. She had planned to leave to celebrate Easter weekend with her family in the Twin Cities, but Beth was intent on having an Easter baby.

After a little manual stimulation of Beth's cervix and administration of a couple of homeopathic medications early Friday, labor advanced during the evening, and Sandell's plans for a Good Friday departure were dashed.

'SUPPORT AND ENCOURAGE'

Sandell is one of about 7,000 certified nurse-midwives in the nation.

Midwives see their role as attending to the woman and letting nature take its course. They try to avoid intervening or using technology unless it's called for.

"The midwifery model of care really looks at the woman and her health in a family context," Sandell said. "It's our job to support and encourage, side by side with the woman and her family, instead of being in a position of power over the woman, or dictating to the woman."

Sandell charges $2,900 per delivery, and insurance sometimes pays for her services. A local hospital delivery without complications can cost more than $14,000, including physician and hospital bills.

Nurse-midwifery practice is legal in all states and Washington, D.C. In most states, including Minnesota, nurse-midwives can prescribe medications. They also perform annual exams and provide reproductive health care for women.

Prenatal office visits typically last an hour. While following the pregnancy during monthly appointments at her office early on -- and more frequent visits later -- Sandell talks with expectant mothers about what's important in their lives, not just the physical state of pregnancy.

She accepts only women with low-risk pregnancies -- "the cream of the crop," she calls them -- because she only attends home births. Midwives in this region who deliver at home don't perform Caesarean sections, deliver twins or take on other difficult cases.

Sandell has a bachelor's degree in nursing and a master's degree in midwifery from the University of Minnesota. She said she has delivered more than 100 babies.

HANDFUL OF MIDWIVES

Sandell is one of a handful of midwives in the Duluth area. Another one, certified nurse-midwife Mary Johnson, is affiliated with the Min-No-Aya-Win clinic in Cloquet.

Two others, who have independent practices, are Monica Liddle of Duluth and Leah Hatcher of Solon Springs. Liddle and Hatcher are certified professional midwives, having met the requirements of the North American Registry of Midwives, which include written exams and experience. About 800 people have been issued certified professional midwife certificates, according to the American College of Nurse-Midwives.

Minnesota has voluntary licensing of midwives, and Wisconsin recently passed a licensing law last month that has not yet taken effect.

Certified nurse-midwives such as Sandell attend about 10 percent of the nation's births, or about 300,000 of them in 2003. Ninety-six percent of those births take place in hospitals, 2 percent in free-standing birth centers and 1 percent at home, according to the American College of Nurse Midwives.

"For a (certified nurse-) midwife to be in an independent practice like me is very unusual," Sandell said.

Sandell worked as a nurse-midwife at Fairview Riverside Medical Center in Minneapolis in the 1990s. Fairview and other large Twin Cities hospitals give nurse-midwives the right to deliver babies in their hospitals.

In Duluth, Johnson is the only midwife with hospital privileges. She has had them at St. Luke's for about five years. "I do everything that any other family physician would do when delivering a baby," she said.

St. Mary's Medical Center had a nurse-midwife, but she left a few years ago, spokeswoman Kim Kaiser said.

POLITE AND HELPFUL

In England and other countries, midwives routinely deliver babies. They aren't as well-accepted in the United States, but the National Institute of Medicine has recommended more use of nurse-midwives to provide women's health care.

The American College of Obstetricians and Gynecologists and the American College of Nurse-Midwives issued a joint statement in 2002 urging "mutual respect and trust" when the physician specialists and nurse-midwives work together.

Sandell, Liddle and Hatcher say that the local physician community, while polite and helpful, in general doesn't favor home births. Some doctors, however, provide backup for midwives and take over if a birth turns complicated.

"When it comes to home birth, it's hard to find an OB that would embrace home birth. They tend to think it's not safe," Sandell said, referring to obstetricians.

If an expectant mother were brought to a hospital in a crisis situation, "I think everybody would respond to the best of their ability," said Dr. Gary Peterson, vice president of medical affairs for St. Luke's hospital and a family physician at the Denfeld Medical Center.

"Many of us have had experiences when things have gone bad and we've been very glad to have the resources of the hospital," Peterson said, emphasizing that he wasn't speaking for the entire medical staff.

Sandell, Liddle and Hatcher don't have hospital privileges, so they always have a backup physician, in case the patient needs to be admitted.

Some physicians might not be willing to participate in care related to a planned home birth, Peterson said.

DIFFERENT APPROACH

Beth Moeller said that during her experiences as a labor and delivery coach, she has observed "huge differences" in traditional physician-attended births and those attended by midwives.

For example, she remembered one time when a nurse pushed the baby back until the doctor arrived. "I vowed I would never, ever, ever witness something like that again," she said.

Midwives tout a safe and natural approach to birth, saying their care is unrushed. They say they approach childbirth as a normal function, not an illness.

Last summer, the prestigious British Medical Journal published a study of home births that involved certified professional midwives in the United States and Canada.

Twelve percent of the mothers who expected to deliver at home were taken to the hospital for interventions such as epidurals, forceps assistance or Caesarean sections.

"These rates were substantially lower than for low-risk U.S. women having hospital births," the study said. Death rates for mothers and babies in the study were similar to low-risk hospital births.

A study by the American College of Nurse-Midwives found that the Caesarean section rate for clients of certified nurse-midwives was 4.8 percent lower than that of obstetricians and 7.8 percent lower than family physicians. The Caesarean delivery rate was nearly 28 percent in 2003, the study said.

Bridgitte Baker, one of Sandell's clients, intended to have her baby at home, but she ended up delivering Nolan Trey Baker in the hospital last June.

It was a disappointing, emotional decision to have a Caesarean after 38 hours of labor; Sandell and Baker were in tears before the surgery.

But last week, Baker said Sandell's decision was for the best. "I think she made the best choices she could. I guess if I had another baby, I'd do it with a midwife if I could," she said.

The Moellers definitely would have another home birth if they were to have more children, Beth said.

Sandell examined Beth and baby Henry at the Moellers' home two days after the baby's birth.

The baby was still a little jaundiced and black-and-blue from his birth, but he passed muster with Sandell. His mother was in high spirits, feeling good and chatting with Sandell as though she were a close friend. By that time, she was.

As Sandell left, her client gave her a long hug. "I love you. I do, I do," Beth said.
News Tribune staff writer Janna Goerdt contributed to this report.