When Robyn Lanci gave birth to her son in 2019, she sought the care of midwives who guided her and offered emotional support as she progressed through labor. One midwife strung handwritten notes of encouragement in her hospital room as Lanci, wearing a cotton birthing dress instead of a hospital gown, listened to calming music from a playlist.
Lanci, 41, formerly of Lindenhurst, said her experience with midwifery care at Stony Brook University Hospital was "a game-changer,” especially after she felt rushed by her doctor when delivering her first son. With her midwives, who paired holistic and medical options, such as a birthing ball and medication when her labor stalled, she didn't feel like she was "on a clock" during her 30-hour labor, said Lanci, who now lives in Long Valley, New Jersey.
The shared decision-making that Lanci found empowering is a hallmark of midwifery care, Long Island midwives told Newsday.
Women have relied on midwives for millennia to assist with pregnancy and childbirth, but that changed as medicine advanced and male doctors became the go-to for births. On Long Island, since the area's first nurse-midwife was hired 45 years ago by Good Samaritan Hospital in West Islip, several hospitals, including at Northwell Health and Nassau University Medical Center, have launched midwifery programs. Employment prospects for midwives also look promising, with the field expected to grow, according to recent data from the U.S. Bureau of Labor.
WHAT TO KNOW
- Long Island has 128 licensed midwives. Midwives can practice in hospitals or private practices. The field is expected to add 800 new jobs nationwide by 2030.
- Experts say the model of care practiced in midwifery is listening-based, which can help overcome health disparities and lower maternal deaths.
- Of the 41 pregnancy-related deaths in New York in 2018, the state health department found 78% were preventable. Discrimination was identified as a probable or definite circumstance surrounding the death in almost half the cases.
'A more personalized relationship'
While OB-GYNs and midwives may offer similar services, their training and credentials vary. Midwifery operates on a listening-based model of care, said Martine Hackett, founder of Birth Justice Warriors, a group dedicated to lowering maternal morbidity and racial health inequities in Nassau County.
New York law requires that midwives complete a master’s or higher degree program in midwifery or a related field. Nurse-midwives earn a nursing license while certified midwives earn a master's degree. Obstetricians are required to complete medical school and a residency program. Both obstetricians and midwives deliver babies, but midwives do not perform surgery.
Jennifer Baierlien, the director of women's and children's services at Huntington Hospital, said the philosophies and skills related to the different trainings enable midwives to emphasize emotional connections while doctors focus on a higher level of care. Midwives typically see lower-risk patients while doctors can tend to patients with complicated or high-risk pregnancies.
The two make "a perfect symphony," Baierlien said.
Hackett, also a Hofstra University public health professor, said, “You have a more personalized relationship with your midwife. ... You also are offered the opportunity to have more agency with your own birth.”
Support and empathy
Amy Dekeris, 40, of Smithtown credited her midwife for her support and empathy. The midwife consoled her and her husband after she lost one of her twins in 2017. Dekeris delivered both babies — a healthy girl, and a boy who died in utero around 20 weeks. Feeling despondent, it was her midwife at Stony Brook University Hospital who consoled the couple, Dekeris said, holding their hands and crying with them.
The midwife "wasn’t even supposed to be working that day,” Dekeris recalled, “but she made sure she was there for this delivery, because she didn't want me to have to tell the story [of my twins] to anyone [else].”
Lanci said midwives were her source of strength as well, especially as she navigated an ectopic pregnancy that ruptured a Fallopian tube. The midwives checked in after their shifts, shared their personal phone numbers and offered support as she mourned her lost pregnancy.
"It just absolutely blew my mind that they cared that much to take time out of their day to talk to me, to see how I'm doing," she said.
'A listening ear'
Long Island has 128 licensed midwives, according to the state Education Department. And Rakiya Watts, of Freeport, is one of them. She had planned to attend medical school but instead enrolled in a midwifery program after working in an OB-GYN's office with midwives and witnessing a birth in 2006.
"There is just something so miraculous about watching a woman … give birth," she said. "It never gets old."
Watts, a Stony Brook University educator and practicing midwife at the hospital, said midwifery stresses “the importance of being a listening ear."
The latest state health department report on maternal mortality shows there were 41 pregnancy-related deaths statewide in 2018, 78% of which were preventable. All deaths caused by hemorrhage, mental health conditions and cardiomyopathy were preventable. The report also said Black women were five times more likely to die than white women; discrimination was identified as a probable or definite circumstance surrounding almost half the deaths.
“I think one of the ways that we really help to decrease those statistics and the disparities is we spend time with our patients, we get to know our patients and we hear our patients,” Watts said. “I think that some of the disparities and the gaps in care have to do with patients not being seen or heard by their providers.”
Jessica Hilsenroth, the midwifery supervisor at Huntington Hospital, a Northwell Health facility, was a labor and delivery nurse for 10 years before she became a midwife. She said she values midwifery's goals of working with the patients to create a safe birthing experience.
Hilsenroth, of Centerport, said she keeps a “box of goodies” for her patients, including a galaxy laser show that plays on the ceiling and electric candles for ambience. She also encourages the women to craft a playlist. The small touches go a long way in cultivating a better birthing experience, she said.
Midwives interviewed by Newsday were optimistic about the promising employment prospects in the field and hope midwifery becomes the go-to care for low-risk pregnancies while doctors focus on high-risk pregnancies.
"Our physician colleagues are really great at dealing with problems and disease and complications," Watts said.
Hilsenroth said when she joined the Huntington Hospital practice in 2018, midwives delivered about 75 babies a year. Now, it's up to 200. She expects the field to grow as more women learn about their birthing options.
In New York, licensed midwives can also provide gynecological and primary care, so patients can see a midwife for needs other than childbirth. This creates a “beautiful lifetime relationship,” said Christina Kocis, the director of Stony Brook’s midwifery division.
Kocis, at Stony Brook since 1998, said the hospital’s program has grown to 17 midwives, and now includes lactation consultants and a midwife who also is a psychiatric nurse practitioner.
Field faces hurdles
Today, hospital midwifery programs have become more common and more midwives have admitting privileges at Long Island hospitals, said Kocis, of Huntington. The collaboration expands the types of care women can receive.
The U.S. Bureau of Labor expects the field of nurse-midwifery to grow by 11% by 2030 and add 800 jobs to the industry nationwide, a small step in overcoming the midwife shortage. The World Health Organization estimates the global gap of 900,000 midwives will shrink to 750,000 by 2030.
A June White House report detailing initiatives to improve maternal health outcomes found that the United States lags behind peer nations when it comes to employment of midwives. Boosting the field is a top goal identified by the report, which called midwives "critical pieces" of the maternal care workforce, adding that communities with midwives have better maternal and neonatal health outcomes.
But the field faces hurdles, including educating and licensing enough midwives, Kocis said. The limited education programs also curtail the number of midwives entering the field, Watts said.
Hackett hopes to see midwifery become more diverse to better serve all patients. The New York State Association of Licensed Midwives, an advocacy group, listed diversifying the profession as part of its mission.
“We really believe that every woman should have a midwife as their first option in seeking health care,” Kocis said.