The health care providers at Spokane-based Rockwood Clinic PS's recently established Midwifery Center firmly believe that during a woman's pregnancy there should be a continuous dialogue between the expecting mother and her provider.

Following that model, the Rockwood Midwifery Center's six certified nurse midwives seek to establish an emotional connection with each woman they care for before, during, and after her pregnancy.

The new specialty clinic is located at 910 W. Fifth, on the third floor of the Deaconess Health & Education Center, which is just west of Deaconess Hospital.

The midwife model of care follows a holistic approach to health care, the providers say, which looks at a woman's overall psychological, emotional, social, and physical health.

"We become closer to them through education and insight through their pregnancy, and clarify their expectations," says Renata Gruber, a midwife and an advanced registered nurse practitioner with Rockwood's Midwifery Center.

Aside from providing care to pregnant women, the providers at Rockwood's Midwifery Center also perform gynecological exams for low-risk patients and offer menopause management and contraceptives.

While some people might think of a midwife as a woman who delivers babies in a home setting or without the use of any labor intervention methods—that type of practitioner is referred to in the health care field as a lay midwife—the providers at Rockwood's new clinic say that isn't the case with their work.

"There's more than one right way to have a baby," Gruber says. "Our job is to help them figure out the right way and what works best—all or no intervention or some hybrid in between."

Intervention methods during a mother's labor include pain medication, such as an epidural; labor-inducing drugs; or the use of any intravenously-administered fluids.

Dr. Scott Schade, a gynecologist and the section head of Rockwood's OB/GYN services, says one of the benefits for a woman who's seeing a midwife in lieu of a physician during her pregnancy is that the midwife model of care allows a deeper patient-provider connection.

"Patients don't lose anything by having the midwives manage their labor, but they get more closeness and more involvement in the decision-making process," Schade says, adding, "Some patients might not think they could have that if they go to a midwife."

Leanne Zilar, a midwife and nurse practitioner at the Midwifery Center, which began seeing patients in January, says that the practice of midwifery is more centered around a feminist model of care than a traditional medical model.

The feminist model, Zilar says, follows the assumption that a woman knows her medical needs and should have the power to choose what type of care she receives. Zilar says that the traditional medical model assumes that the patient doesn't know what she needs and comes to a health-care provider for the answers.

"You didn't question anything; it was just a matter of faith," Zilar says of the traditional medical model. "Now, people know what they need and just want help taking care of that."

Schade adds that while the Midwifery Center seeks to offer its patients more control and a decision-making role in their care, Rockwood always has followed, and continues to follow, the medical model so as to offer its patients a complete spectrum of care.

Lauren Armstrong, who's also a midwife and a nurse practitioner at the center, says, "In no way do we want to say that because of the way we practice that we don't value the physicians, because we are all part of a team."

She adds, "I think that is the beauty of it, because a lot of practicing lay midwives don't have that physician support ... we value the expertise and the support of our physician partners, and we love that they allow us to practice as we do."

Five physicians, including Schade, practice at Rockwood's OB/GYN Center, which is located in the same newly remodeled suite as the Rockwood Midwifery Center. Each practice takes up about half of the 10,500-square-foot space.

Most of the providers at the midwife center were relocated from other Community Health Systems Inc.-owned practices that had been affiliated with Deaconess Hospital, also owned by CHS, the Franklin, Tenn.-based hospital network operator.

The two now-closed practices that the majority of the midwives transferred from include Woman Health and the Deaconess Women's Clinic that operated in the West Central Community Center, at 1603 N. Belt.

The Midwifery Center employs a total of nine people, and aside from the six midwives, it has two medical assistants and one scheduler.

The six health care providers all have both their bachelor's and master's degrees in nursing, with specialty credentials in midwifery.

The center's nurse midwives care for women who don't have a high health risk or a high chance of developing a health risk during their pregnancy.

"They can have some health problems but that don't affect the pregnancy," says Gruber. "The main focus is to care for a healthy pregnancy and to view it as a normal passage of women's health."

The benefit of being located in the same suite as Rockwood's OB/GYN physicians, Armstrong says, is that if any patient at the Midwifery Center should develop a complication with her pregnancy, those doctors are available.

"Because of our limited scope, it's part of our safety net that we have standing behind us a team of supportive physicians who trust us and know when things aren't as they should be," Armstrong says. "We can defer to them when it's appropriate."

While midwives practicing elsewhere might offer patients the choice to have a home birth, Armstrong says that isn't an option for Rockwood's patients.

"We only deliver in the hospital where all the safety options are there," she says.

She says, however, that many of the midwifery center's patients do opt to have completely non-interventional labors and deliveries at Deaconess Hospital.

Rockwood's nurse midwives say that they make sure each patient rotates through the six providers so that when she goes into labor, whoever is on-call already would have seen the woman before and thus there aren't any surprises for the patient when she's admitted to the hospital.

Because at any given time at least one of the practice's midwives is on call for patients who might go into labor, the center's patients are guaranteed to have a midwife during their delivery. Also, the on-call physician at the time for Rockwood's OB/GYN Center would be available to the nurse-midwife overseeing a patient's delivery in case of complications or the last-minute need for a cesarean section.

Rockwood's nurse-midwives say they often see repeat patients who had babies previously delivered by one of the midwives. In other cases, women who, during their pregnancy, were past patients of one of the midwives bring their daughters to the Midwifery Center for annual well-woman exams, says Kathleen Bentley, who's been a midwife for 14 years.

"I've delivered all five of one patient's children—we do see a lot of repeat patients," Bentley says. "It's rare for them to leave our service unless they have a medical reason."

Bentley says the Midwifery Center sees a mix of patients whose ages and socioeconomic statuses vary widely.