At Deaconess Medical Center Womens Clinic, hundreds of photographs of babies who were delivered by the clinics certified nurse-midwives are featured prominently on the walls. Those pictures bear testament both to the midwives pride in their profession, and to the rising popularity of midwifery services here and nationwide.


The Womens Clinic has operated in a modular home at West Central Community Center, located at 1603 N. Belt in Spokane, since it opened in January 1993, says Catherine Shields, a certified nurse-midwife (CNM) at the clinic. It has three CNMs, including Shields, Lauren Armstrong, and Kathleen Bentley, and two other employees.


Shields says the clinic delivered about 25 infants in 1993. It now delivers 200 a year, and its service area has grown to include patients from around Eastern Washington and North Idaho, including Ritzville, Moses Lake, Coeur dAlene, and small communities north of Spokane.


The clinic has outgrown its 1,500-square-foot modular home, she says. West Central currently is building a $2 million addition to its main building, and Deaconess plans to lease about 2,000 square feet of space in that structure for the Womens Clinic.


Despite the clinics modest base of operations in a lower-income area, its patient population includes women from a wide range of socioeconomic backgrounds, Shields says.


In its early years, the clinic served mostly low-income patients who typically didnt have health-care insurance, she says. It still sees such women and works closely with other agencies that serve that population, but now has nearly equal numbers of patients who have higher income and education levels, she says.


The change in the types of patients the clinic serves reflects an overall shift in attitudes toward midwifery services, claims Armstrong, who came on board last May. She moved here from San Diego, Calif., where she worked as a midwife at the U.S. Naval Medical Center there. She has delivered 1,500 babies during her career.


Traditionally, midwives have served underserved populations, Armstrong says. But in the last 10 years, thats changed dramatically as we serve a growing population of well-educated, professional women.


The demand for self-determined care has been increasing among women of all ages and backgrounds, she says.


The average woman is deciding that she has a right to the kind of care that she wants, and a more personal kind of service is important to women, she says.


A CNM has an associate of science, bachelors of science, or masters degree in nursing and also has completed specialized training in midwifery. CNMs in the U.S. must earn certification from the American College of Nurse Midwives (ACNM). They deliver services to women and their babies, including prenatal care, labor and delivery management, postpartum care, newborn care, and well-woman gynecology.


CNMs attended more than 300,000 births in the U.S. in 2002, or about 7 percent of all births that year, according to the latest figures from the Washington D.C.-based American College of Nurse-Midwives (ACNM). That was up from about 132,000, or 3.2 percent of all births, in 1989. Data compiled by the Maryland-based National Center for Health Statistics shows the number of midwife-attended births grew to 8 percent of all births in 2003.


Midwifery misperceptions


Shields, who has delivered 776 babies, says that even though midwifery has been gaining popularity, midwives still are battling a few common misperceptions about their profession. The majority of people think midwives primarily deliver babies in a womans home and mothers cant be medicated during labor, she says. Most midwives now deliver babies in hospitals, due to the litigation concerns associated with in-home deliveries, she says. The Womens Clinic only delivers babies at Deaconess, she says.


Women have a much broader range of options now when it comes to their deliveries, from standing on their heads to having an epidural (anesthesia injection given in the lower back), she says. What the mother wants the mother can have, as long as its in the realm of safety standards.


Shields says delivery situations can differ from the typical hospital bed procedure. Some of her patients have delivered their babies in the bathtub or even on the kitchen counter. Those settings, she asserts, are natural and comfortable for some women. When a pregnancy isnt normal, or there are complications, the midwives consult with physicians, she says.


The Womens Clinic works with patients to determine the nature of their prenatal care, and has them write down a plan for the pregnancy and delivery. She says patients are invited to bring their entire family to the clinic. They discuss the pregnancy with the family so that the midwife can look at the whole woman and assess her individual situation.


We look at the whole picture, Shields says. Its different from a physician who asks how far along you are and how big your uterus is and says, Thank you very much, well see you in a week.


Armstrong says midwives start by looking at a patients social network and background and talk about the pregnancy within that context, she says.


A continual dialogue occurs between a woman and her midwife so that the patient knows what a midwife is doing and why shes doing it, Armstrong says. A lot of women who dont have midwives feel unsupported during their pregnancy and dont know enough about the process, she contends.


Patients often come to us and say, I dont know what happened during my last pregnancy, Armstrong says. We dont want that to happen to patients at our clinic.


Midwives at the Womens Clinic will stay with their patients from the moment they go into labor, typically when a womans cervix becomes dilated by five centimeters, until they deliver their babies, Armstrong says.


We feel fortunate to have this job, says Shields, who has a stuffed white stork hanging from her office door and baby pictures covering her office walls. We get to stand in on one of the most intimate experiences that humans can have.


Plans can change depending upon what happens during a pregnancy, however, and sometimes patients risk out of midwife services, meaning they have a high-risk pregnancy and are referred to a physician. Even when women, risk out, either during the pregnancy or the delivery, the clinics midwives stay with them throughout the birthing process, Shields says. They provide follow-up care for the woman and her child as well.


The Womens Clinic also offers womens wellness services to women of all ages, she says. The midwives dont offer primary care, but do fill the same role as that of an obstetrician-gynecologist and can write prescriptions. Theyre the only medical-care provider for many of their low-income patients, she says.


Most health insurance companies cover nurse-midwife services because those services typically are affiliated with a hospital. In recent years, CNMs have become increasingly recognized as legitimate health-care providers, Shields says.


Several other clinics here have CNMs who deliver babies at local hospitals. Community Health Association of Spokane has CNMs at its Maple Street and Spokane Valley clinics; Group Health Cooperative has CNMs at its Riverfront Medical Center, located at 322 W. North River Drive; Woman Health, which is located in Deaconess Health and Education building, has a CNM on staff; and Northwest OB-GYN, located at Sacred Heart, has a CNM.


Women can look on the American College of Nurse-Midwives Web site to find accredited nurse-midwives in their area. In all, there are believed to be about 15 CNMs working in the Spokane area.


Shields expects the number of nurse-midwives here and nationwide to increase even more in response to the growing demand for midwifery services. She hopes the Womens Clinic will continue to flourish as well.


This clinic is becoming everything Id hoped for, she says. One day I hope there will be a midwife for every mother.