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Tennessee center offers alternatives for mothers-to-be
By Joseph D. Bryant
Staff Writer
October 13, 2002
Bundrant will not deliver her baby at home, but it's as close as she can get. "I chose to go there because of the homey environment," said the soon-to-be first-time mother, who chose to deliver with a midwife instead of the standard hospital physician. "I didn't want to be fearful about the birth process." Bundrant is among a growing number of women who have turned to midwives for prenatal care.
At the Natchez Trace Maternity Center in Waynesboro, center director and midwife Elaine Wakeland said her clients often choose the birth center for the intimacy that may not be available in the institutionalized environment of a hospital. And Wakeland's only rule about crowds is that they don't get in her way as she catches the baby. "It's very important to have the people you want there with you to support you. The families are so comfortable here," Wakeland said. "This is just like being at home, but with the medical safety."
While the term might bring to mind images of early medical practitioners of more than a century ago, modern midwives are actually registered nurses with additional training and certification from an industry-approved midwifery program. Tennessee midwives provide an option for women seeking natural deliveries. Since they are not doctors, Wakeland and her staff cannot administer epidurals for pain. "We are really awesome creatures; we are capable of doing so much more than we give women credit for," she said. In defense of natural childbirth, she cited one study that concluded the absence of extra medication makes for a better delivery. Wakeland said medical personnel often turn to drugs as a convenience rather than a need. This "cascade of events" results in an inflated amount of Cesareans and other complications, she said.
The Tennessee State Nursing Board regulates the industry. Wakeland's center only takes low-risk pregnancies, which she said are the majority of pregnancies. While the center cannot offer medicinal relief, Wakeland said there are other procedures to provide comfort. "They talk about epidurals, this is an 'aquadural,' " she said, pointing to a large whirlpool in the suite's bathroom. A few melted candles sat on the ledge. "We had one baby delivered in the tub," she said. "Water birth is more comfortable; it's just a more gentle birth."
After investigating the birth center, Bundrant said she finally decided to use a midwife after learning her doctor might not be available to deliver her baby. "I thought if I was going to get used to someone, I would want them to be there," she said. "(The center) calls me twice a week to check on me. They want to be part of the experience."
Now in her 30th week of pregnancy, Brandi Bundrant is not worried about the absence of painkillers. At least not yet, she said. For her, the comfort and intimacy of the service is more important than medical convenience. "I felt really safe the first day. I never had any question about the safety," Bundrant said. "Women have been having babies at home for years."
Wakeland's entry into midwifery follows the path of her ancestors. And she didn't even know it. Her great-grandmother was a German midwife, as was her grandmother. "My aunt remembers her grandmother going out for deliveries," Wakeland said. "I think it's in the genes - this is what I was always supposed to do and didn't even know it." Before graduating from the Frontier School of Midwifery and coming to Wayne County in 2001, Wakeland had spent 28 years as a registered nurse, most of that time in obstetrics. "We were doing everything but catching the baby," she said. They did that when the doctor was late.
When Wakeland arrived at the Natchez Trace Center, the facility was already there, but there was no midwife. "There was a big lack of access for prenatal care," Wakeland said. With just a handful of doctors nearby, women in Wayne and surrounding counties often traveled hours to the nearest provider. County health officials had long sought an alternative by establishing a midwife center. The center would be a cheaper way to provide some of the same services offered by a physician. Yet, there was no money to form the center, and the idea remained dormant until 1998. That's when a grant was secured from Vanderbilt University. With the funds, officials transformed an abandoned house into a birth center.
The addition was a welcome one for Waynesboro obstetrician Dr. Nancy Armetta. "Traditionally, with any mid-level practitioner, I think the doctors feel threatened," she said. "I'm thrilled that I don't have to take care of all the deliveries. I can't take care of all of Wayne County." Armetta was a founder of the center and remains its backup doctor. She said the maternity center's function goes beyond what its name implies.
The staff also makes scheduled trips to health centers in neighboring counties to provide women's health care. And the 120 patients Wakeland and her staff have at the center include those who are pregnant and not pregnant.
"I've been amazed at how many women have come so readily to the birth center knowing they can't get an epidural there," Armetta said. "We can show them other ways to get comfortable without being strapped to the bed."
The capabilities of the center expanded recently when Wakeland was granted privileges to work in Crockett Hospital in nearby Lawrenceburg. "Some people want to be in a hospital. They can have that also with midwifery care," she explained. "Now we can literally follow through with everything." Previously, Wakeland's services ended once a patient entered the hospital doors.
Across the state line in Alabama, the rules are much different. There are no birth centers operated by midwives. "It's not the best state as far as being a midwife," said Vicki Brooks, a Montgomery nurse and state chairwoman of the American College of Nurse Midwives. Brooks said state law prohibits planned births outside of a hospital. Like their neighbors in Tennessee, Alabama midwives are regulated by the state Board of Nursing and must be registered nurses and graduate from an approved midwifery program. However, the similarities end there. Midwives in Alabama must work under a doctor's supervision and are usually hired by physicians rather than operating independently. "Any patient that we take care of is going to be admitted under our M.D. sponsor," Brooks said. She said the midwives do offer natural alternatives during childbirth, yet the births must occur in a hospital under the auspices of a doctor. There are about 54 certified nurse midwives in Alabama, although Brooks estimates the number of practicing midwives is much lower.
While Wakeland sees growth of free-standing birth centers run by midwives in Tennessee and across the country, Brooks said the market remains slim in Alabama. Tiny head shots decorate a knit tree hanging on the wall in Wakeland's center. There are 27 pieces of fruit on the baby tree so far.
"I always said I would quit when I did not get excited when I saw a baby being born, " she said. "I'm very happy. I hope that I've got 20 years left of doing this." Wakeland said she wants to remain ready for the next delivery, whether it's at the center or at the hospital. That's why she has started lifting weights.
Joseph D. Bryant can be reached at 740-5745 or E-Mail: joseph.bryant@timesdaily.com .
Natchez Trace Maternity Center 720 Hwy 99, PO Box 974 Waynesboro, TN 38485 (931)722-2229 info@natcheztracematernitycenter.org