The Rise of Midwives
Written and photographed by Sana Ullah. 2015.
Decaf with steamed milk for the expectant mother in one hand and an overflowing bag of prenatal necessities in another, Camilla Yrure prepares herself for a home visit with her client. To her, it’s not just about the check-up, but creating a personal relationship with the mother as well. It is also about making the mother feel comfortable throughout the entire pregnancy.
Yrure is one of the Certified Professional Midwives (CPM) practicing in Northern Virginia. Though she often works inside a chiropractic office located in Alexandria, Va., most of her appointments are at the homes of her clients. Yrure started as a doula, someone who provides emotional and physical support to an expectant mother, and practiced for eight years. After some time, Yrure decided to take a larger step in her career and earned her license to practice midwifery in Virginia in 2015.
"Working as a doula, I've seen some awful things...
“Working as a doula, I’ve seen some awful things—D.C. has an incredibly high volume of educated women and wonderful insurance packages, yet women do not get good (prenatal) care in the hospitals,” said Yrure. She believes that often times, pregnant women can get lost in the processes used in hospital systems and receive little prenatal attention. “--all women are coerced into doing things they don’t want to do, like Cesareans.” Yrure says that women are also coerced in to making decisions throughout pregnancy that often lead to inductions in labor, based on a time frame that is unrealistic, rather than the mutual decision-making process and informed choice that the midwifery model offers.
Speaking from her own experience, Yrure feels that she received awful care as a pregnant woman. She felt that her pregnancy was being treated more as an illness than a natural part of life. Nicole Tailleart, a naval research scientist in Alexandria, Va. and a client of Yrure's felt the same way. “It’s a pregnancy, not a disease!” exclaimed Tailleart.
Tailleart is currently pregnant with her second child and decided to try something new after being induced with her firstborn in a hospital by an obstetrician. She feels that with a midwife, there will be less pressure on her and she will have more of a personal influence on the birthing process. Tailleart also felt that with an obstetrician, she would have unnecessary checkups that were more about money than her health.
On Nov. 11, 2015, Nicole Tailleart lies on her back inside her home in Alexandra, Va. for a prenatal checkup with midwife, Camilla Yrure, while her husband stays close by her side.
Tailleart smiles as she listens to her 36 week old baby's heartbeat during a prenatal checkup with friend and midwife, Camilla Yrure.
Camilla Yrure, a Certified Professional Midwife (CPM) from North Virginia, measures Tailleart's fundal height--the distance from the pubic bone to the top of the uterus.
With the rise of midwives within the D.C., Maryland, and Virginia district alone, it is only reasonable for one to question: why? It is possible that the increase of midwives may be tied to the increase of maternal death rates and unnecessary usage of Cesarean births.
According to Tom Miles from Reuters, “having a baby in the U.S. is twice as dangerous as in Canada.” Data from the World Bank and the United Nations show that the United States of America was one of thirteen countries that had a worse maternal mortality rate in 2015 than the 1990s. Not only that, but while the majority of countries reduced each of their maternal mortality rates by 34%, the U.S. doubled in theirs.
“For a country that spends more than any other country on health care and more on childbirth-related care than any other area of hospitalization—U.S. $86 billion a year—this is a shockingly poor return on investment,” stated members of the Association of Reproductive Health Professionals (ARHP).
The ARHP claims that the leading causes of increased maternal death rate in the U.S. are uncontrollable hemorrhaging, pregnancy-related hypertensive disorders, and infection—all of which can be consequences of a Cesarean birth.
Peggy Franklin, a Certified Professional Midwife (CPM) in North Virginia, poses in front of her center's logo on Oct. 27, 2015. Franklin started practicing home births in 2005 and expanded to the NOVA Natural Birth Center in 2011, where she provides expecting mothers with a variety of services including chiropractic care and yoga.
Peggy Franklin, another CPM from Northern Virginia, opened the NOVA Natural Birth Center in Chantilly for women wanting 100% natural births. The center does not use any form of epidurals or pain medication other than herbs and homeopathic medicine. It also offers water births that can act as a form of natural pain relief as well.
There are prenatal visits at the birth center almost every day of the week. The midwives go to the mothers’ homes two to three days after the birth and encourage moms to stay at home and rest. The center has an average of 15 to 20 births a month, about 180 to 240 births a year.
“More and more people know what a midwife is,” said Franklin. “My son said, 'Mom, now when I tell people what a midwife is, they know what I'm talking about!' because it wasn't too long ago people would say, 'what?'”
Though her center is about half an hour—without the traffic—outside of D.C., women from all over the DMV area come to visit and learn more about natural births. If a client were to go into labor before reaching the center or before a midwife reached the expectant mother, Franklin reassures her clients that there will be one of the five midwives on staff on the phone guiding the client throughout the entire process.
According to Yrure and Jo Crawford, another CPM at Franklin’s center, some women are turning to natural births because it is becoming “trendy.” Although midwifery has been around for centuries and practiced in all parts of the world, increasing numbers of women are now beginning to search birthing options besides an obstetrician at a hospital.
“First time you experience a home birth, it’s like one of those things where when you experience first class, you don’t want to go back,” said Crawford.
For Crawford, becoming a midwife was never on her agenda. She initially worked as a newborn photographer for hospitals when a friend sent her an article on doulas. Thinking that it might be “fun money,” she eventually ended up befriending midwives that led her to venture out and become one herself.
"When you experience first class, you don't want to go back!"
The NOVA Natural Birth Center in Chantilly, Va. provides several services to their clients. In addition to private, personalized rooms in which women can choose to give birth in, the center also has a chiropractor and a yoga instructor for those interested. The center also provides deep bath tubs for expectant mothers interested in having a water birth. When the woman is near active labor or a phase of transitioning, it is recommended for her to get into the water. The warmth helps relax her muscles and balances the weight, allowing the woman to move her hips around more freely.
During her first pregnancy, Crawford’s labor was labeled as “failure to progress”, which led to an emergency C-section. “They actually wrote on my chart that I had a true case of cephalopelvic disproportion (CPD) which means your pelvis is not shaped right, so, you know, not optimal for pushing out a baby, basically,” explained Crawford. Her second child also had a C-section because of the previous chart details. Both babies were about six pounds in weight.
Crawford began her apprenticeship between the births of her second and third child, and she learned that it’s rare to have CPD unless you have rickets or some kind of malnutrition as a child. Curious to know whether the outcome would still be the same, Crawford decided to have a natural birth with a midwife for her third baby. Smiling at the memory, Crawford said, “She was almost eight pounds. So, they were wrong.”
Crawford has been at the NOVA Natural Birth Center since it began and received her CPM license last July. She was a birth assistant and apprentice for the five years prior and a doula for the two years prior to that.
On Nov. 20, 2015, Jo Crawford presses gently around Melody Glenn's stomach while she lies on a bed at the NOVA Natural Birth Center in Chantilly, Va. Through this process, Crawford is able to locate the baby's position and keeps track of any possible changes in his/her movements.
Crawford explains to Glenn how to use the GBS Culture swab.According to the American Pregnancy Association, Group B Streptococcus (GBS) is a type of bacterial infection that can be found in a pregnant woman's vagina or rectum.
Crawford draws blood from Glenn to test iron levels. During pregnancy, iron levels tend to increase by 50 percent to keep both mother and baby healthy.
Franklin, the founder of the NOVA Natural Birth Center, would recommend natural birth to everyone. There is an application process for women to get accepted into the birth center because they only take low-risk women. If an expectant mother is interested in natural birth, she is first encouraged to come to a free information session held at the center which involves an informative film on natural births, a one-on-one consultation with a midwife, and a tour around the facility.
“I've been doing births since 1971,” explained Franklin. “When I started, the moms had deliveries in a delivery room and were put to sleep and the babies came out with forceps and the dad was not involved and the babies were sent to the nursery and bottle-fed.”
As midwives, Franklin and Yrure emphasize the importance of a mother’s touch immediately after birth. They also encourage the father or partner of the mother to be involved in the birthing process.
In the film “Natural Born Babies” shown during Franklin’s information sessions, the majority of women said that they decided to have natural births because they wanted to avoid interventions and C-sections. Franklin does not offer the option of Cesarean births within her center and feels that it is rarely needed.
Source: U.S. National Center for Health Statistics
In 2013, the New York Times covered the increase in hospital costs attributed to unnecessary surgical procedures at birth. If the mother and her child are susceptible to injury or death, a Caesarean is needed. However, according to the New York Times, most experts do not believe that most women who receive a C-section actually need one.
If the maternal death rate or the use of Cesareans does not reduce within the next few years and an increase in practicing midwives continues to grow within the U.S., it is possible that most women will turn to natural births. Whether it’s through a home birth with Yrure or a birthing center with Franklin, one thing stays the same: it’s all about the mom and her baby.
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This project was written and photographed by Sana Ullah in 2015 as part of her Master of Arts in New Media Photojournalism's Research, Writing, and Reporting class with Manuel Roig-Franzia.
Camilla Yrure passed away on Friday, August 11, 2017. May she rest in peace.