Making Births More Comfortable for Mom

A now retired midwife from the practice with post-birth glow. Photos courtesy of The Midwifery Practice at Stony Brook University Hospital

More than 20 years ago, Dr. Vita Alamia welcomed a baby into the world — his own child.

Three days later, he would say goodbye.

“I was in the business world, and I had a baby that passed away from congenital heart disease,” he said. “I decided that I really didn’t want to do what I was doing before — I couldn’t do it. I started the whole medical school process when I was 28.”

He has always kept his newborn with him, he says — and the subpar quality of care he and his wife experienced in the back of his mind — as medicine continues to evolve and revolutionize maternity care and delivery options, explained Dr. Alamia, vice chair and service chief of Hamptons Gynecology & Obstetrics, which maintains four offices across the East End as a subsidiary of Stony Brook Southampton Hospital.

“The way we do delivery at Southampton Hospital is a minimally invasive style. Because we’re a community hospital, we don’t do a lot of the interventions that people don’t like at a bigger hospital,” Dr. Alamia said. “The things that people like about a holistic delivery — like immediate skin to skin, immediate breast feeding, delayed cord clamping, sparse use of episiotomy, ambulating during labor — we do that for everyone.

“We have more people asking about it, but since that’s how we do things anyway, I don’t see a big upswing in that,” he continued. “But people still get their epidurals. They really, really do, especially first-time moms. It’s a long, hard process.”

For expecting mothers, the most crucial decision surrounding maternity care is choosing a provider and delivery option that feels most comfortable for them, according to Liza Tremblay, a founding board member of the East End Birth Network. “I think the more options, the better,” she said. “When we start to limit women’s options is when we start to see a lot of birth complications and a lot of women who have had traumatic birth experiences.”

An overuse of technology and unnecessary interventions could be to blame, according to Dr. Christina Kocis, division director of The Midwifery Practice at Stony Brook, at least for low-risk, healthy women, she said.

Stony Brook University Hospital midwife Kristen Clemens, CM, MS, with one of the babies she helped deliver.

“The U.S. spends the most money per capita on maternity care of all the developing nations and we have the worst outcomes,” she said. “There’s a huge energy that’s happening now around looking at this, and why is this the case, and how do we address the issue in this country? One of the suggestions that’s been made by several groups of experts is that the midwifery model of care is what should be provided to most of the population that is healthy and low risk.”

Based on relationship building, midwifery is practiced by trained health professionals who help women during the labor and delivery of their babies, as well as with prenatal and postpartum care, according to Dr. Kocis.

“We have started providing centering pregnancy, which is group prenatal care,” she said. “You cohort women who have similar due dates and they move through the pregnancy in terms of their care as a group. There is some individual time in the beginning, but the bulk of the time, which is a two-hour block, is spent in group, discussing the concerns of the moms and topics of interest.”

While physicians have a broader scope of practice — they perform cesarean sections or hysterectomies, for example — midwives are able to spend more time with their patients, providing prenatal education and more continuous support during labor. Most are nurses with years of experience, and also practice full women’s health care, from adolescence to menopause.

But while midwife popularity is on the rise — The Midwifery Practice at Stony Brook has grown from one midwife to 10 over the last 20 years, Dr. Kocis said — general knowledge surrounding midwifery is still scarce.

“If you ask anybody on the street, ‘So tell me about midwives,’ they’ll say, ‘Oh they catch babies in people’s houses. They do home births,’” she explained. “And the reality is that 98 percent of the midwife-attended births in this country have been in the hospital. That’s the fact. Less than 3 percent of births in this country that are attended by midwives happen either in birth centers or at home. It’s a very, very small portion, yet that’s the common myth held by the public — and by many women.”

Tremblay used to be one of those women, she said. “If you had asked me 10 years ago, ‘Do you think you’ll have your babies with a midwife or a doctor?’ I definitely would have said a doctor,” she said.

She was skeptical of more holistic birthing methods and, before the birth of her son seven years ago, she feared the pain. She wanted access to an epidural, and began to do her research.

“The more that I learned and the more I spoke to other women and heard about their experiences, I really became a convert to the midwifery model of care,” she said. “I had my son with a midwife at Southampton Hospital, which in those days, they had two midwives on staff. Unfortunately, they don’t anymore. And then I had my daughter with the Stony Brook Midwives, and I had wonderful experiences both times.

“We’re definitely seeing a shift over the past five years, where women you wouldn’t necessarily think would be a midwife or homebirth kind of person are exploring all their options,” she continued. “We’ve really seen home birth out on the East End explode in the past five years. The demand among mainstream women has really changed. It’s no longer a fringe way to deliver and it’s become something that’s much less frowned upon.”

Whether in a hospital or at home, midwives support the physiologic birth process, or birth that happens spontaneously. It is a miracle that has fascinated Colleen Heinze since she was a child, she said, guiding her toward midwifery and, eventually, the Gaia Midwives, which recently expanded their practice to Riverhead.

“Women should know their provider, they should know what they’re getting into, and they should know what’s happening to their bodies and their babies throughout the entire process of pregnancy and birth,” she said. “That’s what you really want in a provider — someone who will partner with you in this journey, and be your guardian in this journey, and not somebody who is going to manage you in this journey, unless your journey needs management for some reason. If you’re a healthy person, you should really be looking for a partner and a guardian and an educator.”

Rumors surrounding homebirths are still running rampant — “That it’s unsafe is a very common sentiment,” Ms. Heinze said — and as a homebirth midwife, she strongly encourages her patients to deliver where they will be comfortable. If that is not at home, it shouldn’t be there, she said.

“As far as the safety goes, as long as you’re a healthy individual with a healthy pregnancy, for many women, homebirth can be a good option,” she said. “In other countries outside of ours, it’s viewed very differently, and the rates of homebirth are much, much higher. Home births happen every day, and it happens safely every day. It’s growing in the United States and we’re seeing more women — although, still, an extremely small percentage of all birthing women — choosing home over hospital, and more women choosing it for their first baby, where it used to be more of a second or third baby thing.”

Since the mid-2000s, the number of women electing to use midwives in the United States has grown from around 7.5 to 10 percent, according to Heinze. “I believe ob-gyns are great and everyone has their place, but we know babies and moms tend to do better — the low-risk ones — when treated like low-risk individuals,” she said. “Having an expert in low-risk helps that out, and having professional managers of problems, like ob-gyns, should be saved for the people who truly need that care.”

According to Dr. Alamia, the most significant development in obstetrics care is cell-free DNA testing, which massively amplifies the chromosomal make-up of the fetus at as early as nine weeks, allowing doctors to screen for extra chromosomes, such as Down Syndrome, Trisomy 13 and Trisomy 18.

“The way we used to do it is we used biochemical markers and ultrasounds, and there was a very high false positive rate for that,” he said. “Five percent of people had abnormal results, even though a very small percentage of those babies were affected. With the cell-free DNA testing, it’s 99-percent sensitive and specific. It’s a very, very low false positive rate, and it’s very accurate. If you have a pregnancy that is not compatible with life, you could find out as early as 10 weeks.”

Dr. Alamia’s voice lights up when he discusses his work. He is fueled by his passion for his job, he says — a profession he could have never imagined, born out of the most unimaginable circumstances.

“I didn’t think I was going to be an obstetrician. I thought I was going to be a pediatrician and then I was thinking I was going to be a surgeon,” he said. “And then I did OB-GYN and I was like, “Whoa, no, this is perfect for me. I love this.’ I kid around with my wife and I say I was born to be an obstetrician. I just love it.”

He paused. “So, yes, I’m sorry it happened, too. But you know what? Because of that, I was able to make a big difference in a lot of people’s lives.”