Looking back on her first delivery, nothing went as planned for midwife Deborah Marin.
“One morning I got a call, landline, of course,” she mused.
At the time, Marin was studying under another midwife. She had been advising the sister of one of her employees at the health food store she owned in upstate New York. The couple had decided early on that they wanted a hospital birth. When the time came, they were in the mountains — 45 minutes away from the hospital and frazzled enough that the only person they could think to call was their friend, the unlicensed midwife.
Reflecting back to her first delivery, Marin says she jumped in her car and raced to their house.
“There was no time to call the midwife that I worked with, because she was a good hour away,” Marin said. “When I got there, you could see the top of the baby’s head coming out!”
According to Marin, the experience was amazing, but her post-delivery high was short-lived once her midwife found out what she had done.
“She was a little upset with me,” Marin said. “I was like, ‘they would have had the baby in the car,’ because they had the baby in 10 to 15 minutes of me getting there. It was beautiful.”
That day marked the first of many births for Marin, who later got her midwifery license and moved to Florida to establish the Hollywood Birth Center in 1993. Since then, 2,000 babies have been delivered at her facility.
“I had a woman give birth up at the front desk at the reception area,” Marin said. “And then we’ve had a couple of parking lot births where they never made it in the front door, never made it out of their car.”
According to the American College of Nurse and Midwives, a midwife is someone who specializes in health care for the female body. They are not doctors, but they are specifically trained to assist women during birth and have been doing so for centuries.
For Marin, midwifery is about empowering women with control over their own bodies when they are at their most vulnerable.
Nashira Williams says this is precisely what she needed when she sought out a doula for the birth of her first child in 2016.
A doula is someone, unlike a midwife, who is trained to provide consistent emotional and physical support to a mother during pregnancy and labor; Someone who is able to provide answers for any questions the mother may have.
According to DONA International, a doula certification organization, while doulas are there to help mothers reach their “healthiest” outcome, they are not medically trained to deliver infants in the way that midwives and obstetricians are.
Williams had what is considered a “high-risk” pregnancy and, by Florida law, could not deliver with a midwife. After interviewing several different women, she found someone who she trusted and connected with. Her doula was there for her every step of the way and rushed to her side when she was admitted to the hospital on bed rest.
“It didn’t essentially go smoothly,” Williams said. “But she was there to help along the way.”
According to Williams, doctors were “rushing” her to make a decision. They told her that if she was not dilated past a certain point within the hour, she would have to undergo a cesarean section.
This occurs in labor when a vaginal delivery would put both mother and child at risk and commonly involves a spinal anesthetic. Doctors make an incision into the mother’s abdomen and uterus, typically creating a horizontal cut above the pubic bone. Recovery time for a c-section can range anywhere between six to eight weeks.
A c-section was not, Williams said, a part of her birthing plan. Her doula knew this and was able to calm Williams by reminding her that she had some control over what was going on.
“She could sense that I was uncomfortable with that,” Williams said. “She said, ‘Well, do you want a minute?’”
It was a question Williams did not expect, and once her doula reminded her that she could take the time to mull it over before making a decision she felt instantly more in control.
“Something as simple as reminding me that I have the ability to think longer about decisions and what the doctors or nurses are presenting me was really impactful,” Williams said.
This, Marin said, is a cornerstone of midwifery practice that is often left out of the medical conversation about birth.
“We don’t do things to them,” Marin said. “We make them part of their care. And so, we’re working with them and not telling them what we are going to do to them. It’s not a management situation.”
Marin clarified that doctors have a point when they decide to take certain precautions.
“I understand the idea, you know, behind why the hospitals are so nervous about birth,” Marin said. “It’s because they see a lot of disasters and they take care of some very high risk, scary women.”
When it comes down to it, Marin explained doctors are simply trained to handle birth and delivery a certain way.
“Basically, they are treating everybody as if they are a walking disaster and so they are treating you like the woman down the hall who is maybe 44 years old having her first baby and she has a heart condition,” Marin said.
These safeguards, while needed in the cases of pre-existing conditions or complications, Marin explains, are unnecessary for healthy, “normal” women and are not in the best interest for a woman seeking a natural, vaginal birth.
“Everybody gets an IV, everybody has to have the blood pressure cuff on them continuously, and it is basically taking away the power of the woman,” Marin said. “Because, bottom line, women are walking miracles.”
Midwifery is something that has been consistently debated across the country, especially in Florida where lay midwives were almost banned from receiving licenses.
And while there remains debate over how to approach birth, there are many doctors like Dr. Sabriya Ishoof who would say that midwives are safe and medically skilled. Ishoof, who trained in New York and Philadelphia, had numerous midwives on staff that she learned alongside and thinks that they can bring about better outcomes and should be overseen by physicians. Now practicing in Miami, Ishoof claims the state’s history with midwifery and the lack of tradition within the state are to blame for unease surrounding the practice.
“They have that holistic component, and they are very empathetic,” Ishoof said. “I think it helped me as a physician and a young doctor in training fresh out of medical school to work with midwives and have that perspective.”
Ishoof was also quick to mention a recent study that showed midwives have better outcomes with patients.
“I can’t help but smile to myself,” Ishoof said, “even though I practice traditional medicine and I’m a regular OB-Gynecologist, I still incorporate a lot of things that midwives taught me.”
Still, Ishoof often notices discomfort. Most people in Miami aren’t that comfortable with midwives. But Ishoof highly recommends patients employ midwives if they want an alternative birth method. However, she advises against patients giving birth at home due to the possible dangers associated with pregnancy.
“I’ve seen cases where a baby got stuck, or was coming foot first,” Ishoof said. While on call once, she was told a patient was giving birth with a midwife and wasn’t aware that the baby was coming out foot first. This kind of situation, she said, warrants the need for a C-section, and is why she suggests it’s safer to work with a midwife in an outpatient hospital setting before the big day.
Today, midwifery is overseen by the Council of Licensed Midwifery which determines training, the exam and responsibilities. Licenses are given by the state Department of Health and can also be denied, depending on training and or the failure to practice with proper skill and safety.
According to Alberto Moscoso from the Florida Department of Health, 26 applications were received from 2018 to 2019, and 16 were granted a license. Moscoso said that there were 245 midwives practicing in the state in 2019.
“A healthy pregnant woman that wants to pursue having an out-of-hospital birth, that should be available to her because that’s what we’re built to do,” Marin said.