Southwest Austin-based Certified Professional Midwife Erica Hope performs a routine fetal heartbeat check on one of her patients, who is expecting her third child.[/caption]

Pregnant women choosing to deliver their babies outside of the hospital setting are discovering numerous options for midwifery care in Southwest Austin.


The Austin Area Birthing Center celebrated its 30-year anniversary in April. The midwives at its location on William Cannon Drive have delivered over 2,500 babies since its opening in 2010, according to Vicky Meinhardt, the center’s clinical director and certified professional midwife.


“We are able to serve over 30 women a month,” Meinhardt said. “What that does is creates community for the women being served.”


The six midwives employed at the center’s south location hold either certified nurse midwife or certified professional midwife licenses. The former attends nursing school and earns a master’s degree in midwifery, and the latter gains certification through didactic learning and apprenticeship.


“To have numerous women responsible for a woman’s well-being brings different ideas and thoughts to the table,” Meinhardt said. “I find that is a real benefit of a birth center.”


The center operates on a group practice model of care, which involves a sharing of patients among midwives. This guarantees the midwives time off, a luxury not often enjoyed by home-birth midwives, Meinhardt said.



STATUTES AND STATISTICS


According to the American College of Nurse Midwives, since 1989 the percentage of midwife-attended births has risen nearly every year. In 2014, the most recent year for which data is available, certified midwives attended 332,107 births, according to the National Center for Health Statistics.


Certified Professional Midwife Erica Hope opened her second practice on Manchaca Road in March. She credits the rise in midwifery care to the unique bond formed between midwife and expectant mother.


“More of your emotional needs get met,” Hope said. “Our care is more personalized.”


Midwives take the place of obstetricians by providing prenatal and postnatal care as well as labor and delivery services, Hope said. One of the primary differences between a hospital birth and a home or birth center delivery is the absence of an anesthesiologist, eliminating the possibility of an epidural.


Under Texas law, midwives are only permitted to accept patients who are at low risk for complications. Women with risk factors such as hypertension or pre-eclampsia, for example, are required to be seen by a doctor.


If complications arise during labor, patients are transported to a nearby hospital, Hope said.



THE ALLEGED RISKS


The stigma associated with home or birth center deliveries has placed a strain on the relationship between midwives and physicians in Austin, Meinhardt said, although much progress has been made in remedying that relationship.


“There were only a couple of physicians who would talk to midwives when I was training,” she said. “There has been a lot of work done in this town to have midwives accepted when they come in [to the hospital].”


According to a committee opinion released in April by the American College of Obstetricians and Gynecologists, planned home births are associated with more than twofold risk of infant death during or immediately after delivery and a threefold risk of neonatal seizures or serious neurological dysfunction.


The statement goes on to say that the college believes hospitals and accredited birth centers are the safest settings for delivery.


But, while referencing a 2014 study conducted by the Midwives Alliance of North America, Hope argued that planned home births actually result in a low rate of medical intervention and adverse outcomes for mothers and babies among low-risk women. The study also determined the home-birth cesarean rate to be 5.2 percent, compared to the national average of 31 percent for full-term pregnancies.


“[Home birth] is a safe and valid option,” Hope said. “Midwives have been here forever, even before
doctors.”



WHY SOUTH AUSTIN?


At least 12 midwives and two birth centers exist in South Austin, according to the Association of Texas Midwives.


Meinhardt links the area’s prevalence of midwives to the pervasiveness of individuals who embrace alternative health care practices.


“South Austin has always been a little alternative, a little funky and different, and we appeal to that particular population of people who doesn’t want to follow the mainstream,” she said.