As NoCo mothers-to-be seek more personalized birth experiences, Certified Nurse Midwives and freestanding birth centers are at the forefront of a growing movement.

Before Emily Isaacs went into labor in June, she knew giving birth would be demanding. But the hours of endurance and strength required to deliver her first child, Taylor Rose, pushed the 36-year-old NoCo resident’s limits in ways she never imagined possible.

“I believed that because I’d done some tough physical things, I could do this,” says Isaacs, who is the executive director of the Women’s Wilderness Institute. “But birth was so much harder than what I expected.”

Tempering the intensity was Angela Stevens, a Certified Nurse Midwife and co-founder of the Birth Center of Boulder, a two-year-old freestanding birth center where Isaacs delivered her daughter. As Isaacs labored through contractions, she climbed in and out of the deep porcelain tub, on and off birthing stools and balls. She shut her eyes and went deep within. She did this all without any pain medication—at freestanding birth centers, epidurals, which are administered by anesthesiologists, are not available. And throughout, Stevens midwifed her through the process. Equal parts coach, trusted companion, and guide, Stevens assured Isaacs that everything she was enduring was part of the process. And her presence, says Isaacs, made all the difference.

“It was really nurturing,” says Isaacs. “I imagine birth would be powerful and mind-blowing no matter what, but the support from Angela, from everyone at the center, made the entire experience feel really sacred.”

There’s a joke that midwives are the second oldest female profession in history (the first being prostitution). And yet, despite its longevity, the career still remains something of a mystery. For ages, midwives fell into a mythical realm where they were lumped in with witches and other wild women. But in the 20th century, birth came to be considered a medical specialty, with medical schools offering specialization in obstetrics. This was extremely useful in emergencies or situations requiring surgery to deliver a baby. But it also created a dynamic that wrested power and knowledge away from pregnant women and into the hands of doctors. Eventually and for many reasons, among them the women’s movement, changing societal perspectives on birth, and others, some pregnant women sought out a different experience, one that treated them as a partner in birth, not a patient. And that’s where midwives come in, says Dian Sparling, a Fort Collins-based Certified Nurse Midwife (CNM) and founder of Womancare Nurse-Midwifery.

“There’s definitely a renaissance of interest in midwifery,” says Sparling.

When Sparling opened Womancare in 1982, she was the only practicing CNM in Fort Collins. Today the city has nine spread across three separate practices. Boulder has the two-year-old freestanding birth center (a separate CNM practice, Boulder Nurse Midwives, which offered midwife-assisted hospital deliveries, closed in 2014). Two new freestanding birth centers have opened in the Denver metro area since 2014, bringing the total number of Front Range birth centers to four; a fifth Colorado birth center operates in Grand Junction on the Western Slope. This reflects a national trend; according to federal data, the number of babies born each year in birth centers has increased 56 percent since 2007.

One explanation for this surge is the midwifery philosophy: that everything about the birthing process is normal until proven otherwise. The desire for midwife care is also reflected in the increased time patients get with their practitioners. With a midwife, prenatal appointments can range from 30 minutes to an hour and cover not just the standard measurements to ensure the growth of a healthy baby, but also the woman’s emotional state of mind, any questions she might have, and in-depth discussion of her concerns. This invested time results in a trusting partnership, say both Stevens and Sparling, but it doesn’t guarantee that women who choose a midwife over a physician will have a natural birth (i.e. unmedicated and a vaginal delivery).

“A lot of the women who select Womancare desire vaginal deliveries and a normal approach and no medical interventions unless medically necessary, but delivering with a CNM does not guarantee a vaginal delivery,” Sparling says. “What it does mean is we will have a partnership in pursuing that goal.”

Initially, everything did go as planned for Emily Isaacs. Once the baby emerged, midwife Stevens handed the newborn to her mother, who cradled her on her bare chest. But Isaacs had a retained placenta (following the birth of a baby, a woman also delivers the placenta; a retained placenta is one that does not emerge on its own), a potentially life-threatening condition. The midwives summoned an ambulance. Isaacs’s husband, Erik Greensfelder, climbed into bed and took baby Taylor Rose onto his chest, offering “skin to skin” contact, believed to be important for bonding between a newborn and her parents. And Isaacs, not even an hour away from delivering her first child, sped by ambulance to Boulder Community Foothills Hospital to have her placenta removed. By her side, clenching her hand and assuring her that she would be fine, was Stevens.

“Midwifery has everything that is important to me, It’s made up of these micro-moments of life and connecting with people. Once you’ve been part of a birth, it’s addictive.” — Angela Stevens

“A lot of the women who select Womancare desire vaginal deliveries and a normal approach and no medical interventions unless medically necessary, but delivering with a CNM does not guarantee a vaginal delivery,” Sparling says. “What it does mean is we will have a partnership in pursuing that goal.”

Initially, everything did go as planned for Emily Isaacs. Once the baby emerged, midwife Stevens handed the newborn to her mother, who cradled her on her bare chest. But Isaacs had a retained placenta (following the birth of a baby, a woman also delivers the placenta; a retained placenta is one that does not emerge on its own), a potentially life-threatening condition. The midwives summoned an ambulance. Isaacs’s husband, Erik Greensfelder, climbed into bed and took baby Taylor Rose onto his chest, offering “skin to skin” contact, believed to be important for bonding between a newborn and her parents. And Isaacs, not even an hour away from delivering her first child, sped by ambulance to Boulder Community Foothills Hospital to have her placenta removed. By her side, clenching her hand and assuring her that she would be fine, was Stevens.

“It would have been really scary to be alone on the bumpy ride to the hospital at four in the morning,” says Isaacs. “But with Angela there, I trusted everything would be fine in the end.”

Fostering such trust and connectivity is one reason Stevens founded the Birth Center of Boulder, along with four other women. “In order to give birth the way we do it here, you have to feel completely safe and held,” says Stevens. “It’s so important for these new mothers to be seen and to be listened to, and that’s what we do.”

It’s also important to have a good working relationship with the physicians at Boulder Community Health, the nearby hospital that is two miles from the center. In an emergency, a laboring mother will be taken by ambulance along with either the nurse midwife or registered nurse (sometimes both) who were attending her at the center. Those transfers are rare, says Stevens, largely because the women they admit at the birth center have low-risk pregnancies, and also because the prenatal appointments are extensive in their preparation for birth.

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An emergency isn’t always required for a transfer. Mothers may opt to go to the hospital if their labor is stalled or they discover they want more pain management. In those rare scenarios, the mother is taken by private car, again with either the midwife or nurse and sometimes both. Regardless of where the baby is delivered—at the center or the hospital—the midwives will support the mother throughout and after the experience, says Stevens.

“To do this work well you need to put your heart and soul into it, and it only feeds me if I have relationships and true connections with the families that come to us,” Stevens says.

To hear Isaacs, the mother who had the retained placenta, tell it, Stevens and her team are expert at forging those connections. After delivering her placenta at Foothills Hospital with Stevens by her side, Isaacs returned to the birth center to her husband and daughter. The midwives tucked her into bed with her family. They fed her a rich porridge, and then prepared a herbal bath in the 25-inch freestanding porcelain tub. The team struck a balance between providing the family “alone time” and coaching Isaacs on things like nursing and how to care for Taylor Rose.

When Sparling opened Womancare in 1982, she was the first Certified Nurse Midwife to receive hospital admitting privileges in Fort Collins. Her business was also the first midwife-owned midwifery practice to open in the state. As a pioneer, she expected that she’d have educate the public and the medical establishment on what she offered, and she was right.

“Were women lined up to get in the door in 1982?” Sparling says. “No. They were not. But there was a small group of very interested women and nurses who wanted this kind of care, and they helped spread the word.”

Now, 34 years later, the midwives at the Birth Center of Boulder are also relying on word of mouth to attract patients, and it has spread rapidly. Two years after opening, and the practice has already met the five-year goal the founders set out in their business plan—to have between 17 and 21 births each month. Already at capacity, they may have to start a waitlist if demand continues to grow, says Elizabeth Irvin, one of the birth center’s founders.

Desire for births with Certified Nurse Midwives will continue to grow, predicts Sparling, but demand may be limited by health insurance companies. “The clientele base is there, but there are constraints, which are insurance company-driven,” says Sparling. Kaiser, the insurance company used by the University of Colorado system and some large businesses such as New Belgian Brewing Company in Fort Collins, will not cover CNM deliveries in Colorado. Consequently, even families that want to deliver with a CNM practice may not be able to without risking their insurance coverage, which is not an option for most people.

It costs $7,000 to deliver at the Birth Center of Boulder, and that includes all prenatal appointments, birthing and parenting classes, and two postnatal appointments. The center accepts some health insurance and other expectant parents pay out of pocket.

When a birth center patient goes into labor, she and her partner arrive at the center where she is free to eat or drink and to move at will, though she will be assigned to one of the center’s three birthing rooms (each is outfitted like a bedroom that looks like a love child sprung from Dwell and Real Simple magazines, and is stocked with all sorts of contraptions to aid in labor, from stools to swings). The lights are dimmed and her partner, who has likely attended many of her prenatal appointments and developed his or her own relationship with the midwives, is actively involved.

Once she births her baby, the new mother is encouraged to bond with the infant through skin-to-skin contact. The umbilical cord won’t be cut until it stops pulsing blood. After some time, the new mother will be served an ayurvedic porridge loaded with rich, nutritious foods. Within a few hours after birth, the mother leaves the birth center with her child. A nurse will visit the new family later that night.

Having such dedicated care or a nearby hospital is not an option for the majority of birthing women in the world. Many women in developing countries birth at home, and the lack of adequate medical care results in preventable maternal and infant deaths. It’s a reality that haunts those called to the midwife profession.

Sparling encountered this reality as a young Peace Corps volunteer in Sierra Leone, an experience that convinced her to pursue a nursing degree and CNM certification upon the completion of her service (prior to the Peace Corps, she was a French teacher). Stevens experienced it in Nepal and, when she and her team founded the Birth Center of Boulder, pledged to try to help address this reality. To that end, they have partnered with One Heart World-Wide, a non-profit organization with a mission to decreasing maternal and neonatal mortality and morbidity across Nepal. They plan to send a midwife each year to collaborate with One Heart World-Wide’s mission and contribute to the education of Nepalese birthing assistants.

For Stevens, the connection to Nepal was a critical component of the business. Before she went to nursing school, Stevens and her now-husband, Chris, spent several months in Nepal. There she spent time in rural villages, attending births and hanging out with women. She and Chris explored the country’s large, open spaces together, and they also got married during their time there. It was during this period that Stevens realized she must go to nursing school if she was to follow her dream of becoming a midwife.

“I felt a huge freedom to follow my path,” says Stevens of the couple’s time in Nepal. “The spaciousness of the country, and being among the women but not really being able to participate made me realize I really wanted to come back and contribute in a meaningful way.”

That contribution encompasses her world in back home in Northern Colorado. Stevens envisions the birth center as a community resource, not just a place to deliver babies. The center itself is a welcoming space, with a large classroom used for yoga classes and the weekly “milk café,” a nursing support group led by Tessa Kazcor, a certified lactation consultant and also a member of the birth center’s office and business team.

An acupuncturist and herbalist have shared office space in the center, and the midwives encourage their new mothers to utilize them. The energy of the birth center is unequivocally welcoming. When you walk in, chances are you will be hugged, at least several times. The staff, including the midwives, wears regular clothes (no scrubs here), and the typical division between doctor and patient isn’t apparent.

In one prenatal appointment this summer with Carrie Bigford, a woman in the midst of her third pregnancy, Stevens played with Bigford’s young daughters, ages three and seven. As she fiddled with the tail of a My Little Pony, Stevens asked her patient, whose family had only recently moved to the Front Range, if she needed help finding childcare during her delivery.

“Or will the girls be there?” Stevens asked thoughtfully.

“Oh no,” said Bigford. “I can’t mother as soon as I hit transition. I want to be mothered.” Stevens nodded.

After the appointment, Stevens reflected on the center’s holistic approach to pregnancy. She notes that pregnancy affects entire families—not just the pregnant woman—adding that she sees the birth center’s role as supporting the entire unit, not just address the biological changes taking place within the womb.

Sometimes that means helping track down a babysitter. Sometimes it means taking extra time with a pregnant woman’s partner and answering all the questions that crop up. Sometimes it just means letting a pregnant mama’s daughters transform an examination room into an imaginary world and allowing them to gallop their plastic horses across the walls and over the window sills as their mother reclines on the comfortable couch, puts her feet up, and concedes that her hips do seem to ache more than usual this time around.

This level of engagement is not limited to the birthing center. For Fort Collins’s Sparling, one of the most rewarding aspects of her career is connecting with the pregnant woman and her partner. She describes it as “patient-centered care,” where the practitioner gives the control to the mother instead of superimposing her vision of what should happen during the birthing process.

“That’s where the power needs to be—with the birthing mom,” says Sparling.

Done successfully, the outcome is typically a new family that has a positive birthing experience, regardless of whether the baby was born vaginally or via C-section. This compassionate, woman-centered model is universal among Certified Nurse Midwives, which helps explain its popularity among women in northern Colorado.

As for the future of midwifery in the state, Sparling predicts a stand-alone birth center like the one in Boulder would thrive in Fort Collins (“It’s absolutely possible up here and there’s a patient population that would love it … a birth center would be a lot of legal and prep work, but whoever does it would succeed.”). And in Boulder, Stevens says she is grateful to fulfill an obvious need in the community. But it’s not entirely selfless; the midwives, registered nurses and other staff at the Birth Center of Boulder seem to get as much out of the experience as the delivering mothers, often greeting pregnant patients and new mothers who return for follow up appointments with their infants with sincere enthusiasm and hugs.

“Midwifery has everything that is important to me,” says Stevens. “It’s made up of these micro-moments of life and connecting with people. Once you’ve been part of a birth, it’s addictive.”

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