SEATTLE _ Deep in the throes of labor, Amie-June Brumble is still able to crack a joke.
"I forgot why this was a good idea," the Seattle woman gasps between contractions. Brumble is curled on a hospital bed where she will soon give birth to her second son without benefit of painkillers and with minimal medical intervention. There's no doctor, either.
The health care professional in charge is a midwife _ who responds in kind to her patient's wry comment.
"Because babies are so cute and cuddly," says Mary Lou Kopas, holding a cold washcloth on Brumble's neck. "And when they come, labor is over."
Kopas leads a group of six certified nurse-midwives who deliver a third of the babies at UW Medical Center-Northwest, formerly Northwest Hospital. Two-thirds are delivered by physicians, mostly obstetricians. If Kopas and other women's health advocates had their way, those fractions would be flipped. Midwives would oversee all low-risk pregnancies, like Brumble's. Obstetricians would handle only the complicated cases.
It sounds revolutionary in a country where physicians preside over 90% of births. But that's the division of labor in many other developed countries _ where women and babies fare much better. Half the babies in the U.K. are delivered by midwives, including Kate Middleton's royal offspring. In Norway, Denmark, France and Sweden, midwives supervise most births. There's ample evidence midwifery offers a partial solution to some of the thorniest problems in American health care: The worst maternal and infant mortality rates of any wealthy nation, with risks up to three times higher for black and Native American women; rising levels of complications and premature birth; C-section rates more than twice the recommended level; a looming shortage of obstetricians; and sky-high spending.
"For women who are low-risk, costs would be lower, and outcomes would be better if midwives were managing the majority of births," Kopas says _ a conclusion backed by a mountain of research, including some of her own.
A recent study that found lower rates of C-sections, prematurity and infant mortality in states where midwives are well-integrated with the medical system also ranked Washington best in the nation for midwife-friendly policies. Certified nurse-midwives (CNMs), like Kopas, don't have to be supervised by physicians, and practice in most major hospitals. And while many people assume giving birth with a midwife means doing it like Brumble, with no pain relief, hospital midwives have access to a full range of medical technology and drugs _ including epidurals.
For women who want to give birth in a cozier setting, licensed midwives (and a few CNMs) oversee deliveries at home or in free-standing birth centers. Most insurance policies cover midwifery _ and the field has passionate supporters statewide. When the UW School of Nursing considered closing its midwife training program in 2012, the deluge of legislator mail rivaled the number of comments on same-sex marriage. The proposal was dropped.
Yet even in Washington, midwives attend only about 11% of births, slightly more than the national average of 10%. "People aren't even aware the option exists," Kopas says. "The status quo is that when you get pregnant, you go to an obstetrician."
Brumble, 37, chose the UW midwives for both her deliveries because she likes the profession's approach to birth as a natural process _ not a medical disaster waiting to happen. She didn't want to be hustled through a system that can feel impersonal, or have her baby delivered by an obstetrician she might never have met. But she also liked being in a fully-staffed hospital _ just in case.
"One of the things I appreciated about Mary Lou is that she was 100% present for me ... the whole time," Brumble, a law firm supervisor, said a few weeks after her son's birth. "If I needed anything, she was there. If I had a question, she answered it. I think if I'd asked for an iced latte, she would have had it in my hand before I finished the sentence."
Midwifery care is holistic, focusing on each woman as person. Labor is allowed to unfold on its own time frame, with no pressure to speed things up. The goal is to give the woman a rewarding experience while never compromising safety.
"I used to tell the ladies that I worked with that I have two pairs of eyes," says Ceci Cordova, a CNM and lactation consultant at Rainier Valley Midwives in South Seattle. "I have eyes that look at you with love and just rejoice with you and celebrate, and I have another pair of eyes that's evaluating and making sure everything's OK."
While Brumble labored in her hospital room, Kopas kept a close watch. Earlier, the pregnant woman paced the room and leaned against her husband as her contractions intensified. Now, as she enters the final stage, she hefts herself onto her hands and knees and begins to push.
We're getting so close now," Kopas says. "Just listen to your body." The midwife presses on Brumble's back to relieve pressure. Brumble's water breaks with a gush. She howls and pushes, then does it again and again. In less than 10 minutes, her newborn son slides into Kopas' hands, crying like he's always known how. The midwife immediately passes him to his mother, who gazes into his eyes and welcomes him into the world.
