In Coupeville, Washington, Sarah Meyer is pressing a fetal Doppler on Christine Meyer’s belly to check the baby’s heart rate.
Meyer, no relation to Christine, then checks her ankles for swelling. Christine is 25, and this is her first baby. She says she chose Whidbey General because the hospital offers what she was looking for – a midwife.
“I love it,” she says. “I love Sarah. I’ve heard great things about her from the nurses at the hospital. They just think she’s fantastic. So I’m excited to have her there while I’m giving birth.”
Increasingly, Washington hospitals are adding midwives to their roster. Whidbey General is one of the more recent ones.
The state is trying to reduce the number of low risk C-sections that are not medically necessary. Whidbey General had one of the highest rates of low-risk C-sections last year. The reasons listed are many, according to nurse manager Trish Nilsen: higher rate of obesity, vacationing pregnant women, moms from the Navy base nearby.
But that number is going down. In 2012, nearly half of first time, low-risk moms had C-sections.
So far this year it’s one-third. The hospital made some changes, and that included hiring a midwife.
Sarah Meyer, a certified nurse midwife, joined the hospital last February. She delivers babies and can order epidurals or pain meds like obstetricians. But her approach is more focused on using natural remedies, fewer drugs.
“All interventions we have are important, and there are certainly times when we need to use it, and use all of it, but not at every birth,” she says. “Women have lost the kind of rite of passage that birth can be and we need to remember that this is a life-changing event that can be very powerful for women.”
Meyer started practicing in her native New Zealand where it’s common for midwives to work alongside obstetricians. But there are clear boundaries. Midwives care for women like Christine – normal pregnancy, no complications.
“Obstetricians are the specialists who would look after women considered high risk,” Meyer explains, “so they would have medical conditions that would affect them in pregnancy, or if they had problems in labor, then the midwives would consult the obstetricians and they would be called.”
In the U.S., midwives and obstetricians don’t often practice together. But the walls are slowly coming down. At Whidbey General, Meyer works with two obstetricians. Patients can choose Meyer to deliver, but if complications come up during pregnancy or a delivery requires specialized care, one of the obstetricians steps in.
Dr. Robert Burnett has worked with midwives throughout his 35-year career, so it wasn’t a big adjustment. He says having a midwife provides a different option for those who want it.
“They do a lot more hand holding the whole time during labor where we tend to have labor and delivery nurses manage those sort of things,” he says. “We’re sort of the overseer to make sure things are going well and no complications are happening.”
Burnett doesn’t believe having a midwife alone has made an impact on lowering the hospital’s C-section rates. He says the state has new guidelines, like allowing women more time for their labor to progress.
Many of those steps are consistent with midwifery practices, and the combination has made a difference. And it has helped providers like him when they counsel women who are anxious to speed up their delivery.
“They’re tired, they’re uncomfortable, they’re swollen, they don’t feel good and they want to be done, 'my due date was yesterday' — it’s hard to put them off,” he says.
“Now it’s actually easier. We say we have these policies. 'I know you’re uncomfortable but everything’s normal with your pregnancy, and it’s safer for us to give you more time to go into labor.'”
Burnett expects to see more of this type of integration as health care costs continue to rise. The big drawback, he says, is that a midwife can’t take calls for him; it has to be another obstetrician.
Trish Nilsen, the nurse director at Whidbey said she believes the obstetricians learned from Meyer while credentialing her for deliveries. “As they proctored her, they observed her techniques and started picking them up,” she says. Those techniques help to reinforce the new statewide guidelines.
When Meyer arrived at Whidbey General, there were some initial adjustments in the office and in the delivery room. Now they’re at a point where their practice more resembles her experience in New Zealand.
“What I love about this practice is that the obstetricians and I really work collaboratively and so we support each other,” she says, “and I think that’s actually the best way midwives and obstetricians work, it’s if we are together as one team.”
The hospital staff may be on board, but some patients are still learning about midwifery. Meyer says it’s going to take a little time and word of mouth before expecting mothers know the service is available in their community.
Map: Click on the map to see how C-section rates at hospitals in Washington state. The red dots indicate hospitals where the rate for low-risk, first time moms exceeds 20 percent -- about what the World Health Organization recommended in a 2010 report.
This series on cesarean sections in Washington state is a collaboration between KUOW Public Radio in Seattle and the Northwest News Network.