DETROIT — Steve Lucero drew in his first look at his baby girl under the ripples of water of the birthing tub at Hutzel Women's Hospital, her thick dark hair wafting gently as she began the descent from her mother's body.
The lights were dimmed in the delivery room. Jess Lucero dipped her fingers into the 100-degree water, until — at 10:20 p.m. March 12 — Aviana Cessalee's feather-soft 6 pounds and 15 ounces eased into the world.
There was no rush from attending staff. No bright lights and bustle. Nothing — except for the soft blue light inside the tub and Avi's intake of air as she lay on her mother's chest.
Jess Lucero, a 26-year-old doctoral student at Wayne State University, was ecstatic: "I gave birth, I delivered my baby. It wasn't delivered for me. It was wonderful."
Jennifer Kelley, 32, a bubbly nurse-midwife who had monitored and encouraged the Luceros in the last hour, cleaned out Avi's nose and mouth, then stepped away for the new family of three, Steve Lucero said.
The Luceros are among a steady percentage of moms who each year choose a midwife-assisted birth over a traditional medical approach. Midwife-assisted births can offer mothers more control over the delivery, a more personal relationship between patient and caregiver, and the option of fewer medical interventions.
Midwives attended 317,626 births in the United States in 2008, or about 7.5 percent of overall births. Of those midwife-assisted births, nine of 10 were delivered in hospital settings, according to the National Center for Health Statistics.
Jess Lucero said the midwife who helped her through her pregnancy, Mary Lewis, 68, who also heads the Wayne State University Physician Group's midwifery program, was "warm and wonderful."
"She always took time in my appointments to really sit with me and answer questions and make me feel like I'm not being paranoid. She was very maternal," Lucero said.
The mother-midwife partnership is often forged in first names and easy conversations about health and nutrition and pregnancy rather than through titles and quick conversations on an examination table.
LaCynthia Davis, 41, who gave birth to her fifth child May 12 at Hutzel, carried her midwife's personal cell number with her.
The relationship between mom and nurse-midwife feels more like a friendship, said Davis and her midwife, Mary Milkey.
"This is the difference for me" between midwives and a delivery room doctor, said Milkey, 36, a mother of three. During her own prenatal visits, Milkey said, " I felt like I was going to chat with a friend."
She added with a laugh: "When all my prenatal visits were over, I felt like we were breaking up."
Certainly, there are doctors who provide that type of personal interaction. But midwife philosophy is based on it. It's a holistic, personal approach to pregnancy rooted in the belief that birth is one of the most empowering moments for parents.
That understanding and control, in turn, brings the baby into a calmer world — whether the mother is on a hospital bed, being soothed by a warm shower, or trying to relax in a birthing tub as the Luceros chose.
Some moms want more control, fearing they'll be simply a number in a traditional medical setting. Or they worry they'll lose control against what they see as unnecessary drugs and medical interventions.
With one in three babies now born by cesarean section, many believe that traditional medicine is too quick with drugs and a scalpel.
"The evidence supports that many interventions today are overused. Births in the United States are over medicinized," said Eileen Ehudin Beard, senior practice adviser at American College of Nurse-Midwives.
"As women become more educated consumers and evidence comes out at the normalcy of birth," she said, they feel many interventions are "not only not necessary but also deleterious."
But what about the pain?
First, midwives can deliver pain meds. From time to time, a woman does opt for pain relief, especially first-time, anxious mothers.
For Davis, her midwife helped control anxiety and pain.
"I guess it was all natural. It was a mind thing. When the pain comes you just made a noise, breathed and go with it," she said. "I made a decision, and everyone knew I was going to stick with it."
Milkey provided Davis' prenatal care, so both were thrilled when Milkey was available for the birth.
Inside the Hutzel delivery room, Davis' partner, Ali Watson, pulled up a stool at Davis' side and held her hand throughout the pain. Milkey stepped in only when necessary, offering words of support and progress reports.
"There's a saying that midwives catch babies," Milkey said later. "And we do. Really, Mom" is in control.
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WHAT DO DIFFERENT MIDWIFE CERTIFICATIONS MEAN?
The expertise, education and credentials for midwives — even where they can legally attend a birth — varies, though most births now occur in the hospitals with certified nurse-midwives.
Knowing these differences can help consumers find the right fit.
Certified Nurse-Midwives: They usually deliver in a hospital or birthing center, though some also work in homes. They are registered nurses who have advanced training in a program accredited by the Accreditation Commission for Midwifery Education.
More can be found at www.midwife.org.
Direct-entry Midwives: They generally deliver in homes, and their education varies.
Some direct-entry midwives are Certified Professional Midwives who have met competency-based standards set by the North American Registry of Midwives. For more information, visit www.narm.org.
Some direct-entry midwives are not licensed at all, in part, because the paperwork would not authorize them to practice in some states, anyway. In other states, laws prohibit them altogether, said Willa Powell, president of the Citizens for Midwifery. Her group wants nationwide acceptance of certification for midwives.
The lack of recognition can create a "buyer-beware scenario," says Powell, and it reduces the options for women.
In worst cases, midwives attending home deliveries illegally may hesitate before seeking out a doctor in an emergency, fearing legal trouble.
Just 27 states license Certified Professional Midwives, and Michigan is not among them.
For more information on differences in midwives and state laws, visit www.cfmidwifery.org.
Sneak into your room, lock the door, and grab your Twilight book?
Or grab your ipod and run out the door?
