Midwifes are scarce in Wyoming despite demand

Dec 5, 2011

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Last year, Wyoming legalized midwives. Until then, you could only deliver babies if you if you were already a nurse or doctor. Now, you can become a certified midwife by going to midwifery school and observing a certain number of births.  Advocates of home birth were delighted by the new legislation. But not much has actually changed. Only three women have gotten certified as midwives since the law changed … and none of them actually live in Wyoming. That’s not because of a lack of interest here. There are simply a mountain of barriers to setting up practice.

HOST: Last year, Wyoming legalized midwives. Until then, you could only deliver babies if you if you were already a nurse or doctor. Now, you can become a certified midwife by going to midwifery school and observing a certain number of births. Advocates of home birth were delighted by the new legislation. But not much has actually changed. Only three women have gotten certified as midwives since the law changed … and none of them actually live in Wyoming. That’s not because of a lack of interest here. There are simply a mountain of barriers to setting up practice. Wyoming Public Radio’s Willow Belden reports.

WILLOW BELDEN: Shawna and Josh Hahn had their second baby five months ago. Instead of going to the hospital, they decided to do a home birth.

JOSH HAHN: We actually had friends over. And Shawna came up to me while they were still here, and she said, ‘I think this might be the time.’ … So then about 11 o’clock, when Shawna was actually getting pretty good into labor, I tried to convince her to call Penelope.

BELDEN: That’s Penelope Caldwell, the midwife.

SHAWNA HAHN: She gets here. … About midnight, I decided that I wanted to take a bath. … I just had my favorite soft music playing and all the lights off, and it was just nice and quiet.

JOSH HAHN: And then just at the point where I thought this is going to get kinda hard because it was getting pretty rough for Shawna, Penelope came back in and said, ‘Yup, we can go.’

SHAWNA HAHN: So I got up and into a squatting position, and she’s like, ‘OK, well just let your body do what you want. And push if you want to, if your body is telling you to.’

JOSH HAHN: Literally it seemed like a second later, the baby was out.

SHAWNA HAHN: The first thing I said was, ‘Oh my gosh, that was so easy.’ Through the whole thing, nothing hurt.

BELDEN: That was very different than the birth of her first daughter, in the hospital. Hahn says they gave her a drug called Pitocin to induce labor. That made the contractions stronger, so she got an epidural for the pain. Because of the epidural, they wouldn’t let her eat. So by the time the baby was born, she was too weak and hungry to nurse her daughter.

HAHN: Yes, that moment that she came out and I got her was probably the greatest moment of my life. But everything leading up that moment and then everything afterwards was just stuff I don’t want to remember.

BELDEN: In contrast, after her home birth, Hahn says she felt invigorated and empowered. And she’s not alone.

At a recent get-together in Laramie, about a dozen parents shared similar sentiments. But there are fewer than 10 midwives in all of Wyoming, so home births are hard to arrange. Some women leave the state to have their babies. A few find midwives who agree to travel to them. Others give up and settle for hospital births. Not that there’s anything wrong with hospital births – and in fact for some women, medical care is crucial.

But Hahn liked her home birth experience so much that she’s now considering becoming a midwife. Setting up shop isn’t easy, though. To get certified in Wyoming, you either have to have been practicing in another state for five years, or you have to attend midwifery school and be an apprentice to a practicing midwife. The problem is, there are no midwifery schools in Wyoming, and there are no midwives in Laramie.

HAHN: My options probably would be traveling a lot down to Fort Collins, or even just moving to find somewhere that had midwives that I could work under.

BELDEN: Even if she did get licensed, Hahn is worried that she wouldn’t get much support from doctors. Penelope Caldwell, the nurse midwife in Laramie who delivered Hahn’s second child, recently stopped practicing in large part because she perceived hostility from the medical community.

PENELOPE CALDWELL: Midwives are the experts in normal. But I have to be able to call the expert of abnormal up at all hours of the day or night and say, ‘I have this situation, and I think this and this, and what do you think? How about if I bring her in tomorrow and we talk together?’

BELDEN: Caldwell says she couldn’t find a doctor in Laramie to be her backup. So when there were complications with a home birth, the mother had to go to the Emergency Room. Caldwell says when she brought women in, doctors would chide her for doing home deliveries. Some of her fellow midwives around the state say they’ve even been told to leave, in similar situations.

Sheila Bush with the Wyoming Medical Society says that doesn’t mean doctors are hostile to midwives.

SHEILA BUSH: Taking a patient on cold in the middle of a crisis is a terrible situation for the patient and for the physician. Because they’re really going in blind.

BELDEN: Bush says the medical community has traditionally been wary of midwifery out of concern for the patients.

BUSH: Physicians believe that the safest place to have a baby is in a hospital because of all the complications that can arise, and how critical timing can be.

BELDEN: Timing can indeed be critical, especially in a place like Wyoming, where many women live hours away from the nearest hospital. But midwives typically advise against home births for women in such remote areas, and they don’t let high-risk mothers deliver at home.

Research varies widely about how safe home births are, compared to hospital births. The biggest study that’s been done, which looked at half a million births in the Netherlands, found that the two were equally safe.

Nonetheless, midwives say, many doctors here in Wyoming are still skeptical. So while home-birth advocates feel that legalizing midwifery is a big step, they say it could take years for robust doctor-midwife partnerships to evolve, and for Wyoming to certify enough midwives to satisfy demand. For Wyoming Public Radio, I’m Willow Belden.