D  e  s  e  r  t     E  x  p  o  s  u  r  e     May 2005

Born Yesterday

Heather Rische of Las Cruces epitomizes a new generation of midwives, who are bringing the birth experience back to basics.

By Jeff Berg

Babies have been born just fine without doctors for thousands of years. Certainly modern medicine helps to eliminate some of the dangers and such that childbirth can bring with it, but this modern world seems hell-bent on eliminating all forms of ancient medicinal practices, or making health a privilege for only the wealthy.

Midwife Heather Rische (right) checks on client Chauncey Cortland.

Ancient Jews referred to midwives as "wise women." The French call them sage femme, and the Germans use the term weise frau. All terms seem appropriate.

And Heather Rische is one of them. As a licensed midwife, now based in Las Cruces, she has been practicing and learning this ancient craft since 1997, and has delivered close to 100 babies to almost 100 mothers.

Rische first became interested in midwifery because of "a couple of born-again Christian aunts," she says. "A few of them were dedicated home-birthers, and some of my cousins and sisters are also. I'd say that about 10 of my cousins were born at home. I really loved hearing about their births—the non-home birth aunts didn't really talk about their births, but the natural birthers had such enthusiasm and loved talking about it."

When Rische was pregnant with her son, Eiden, who is now 9, she began studying the process of natural pregnancy and birth and the philosophy of midwifery and home birth. She hired Chicago Community Midwives for her pregnancy and delivery, but because her labor began five weeks early, she was transported to a hospital. There, she was frustrated because she was constantly forced to explain and defend her choice to use natural childbirth.

"My labor began very slowly," Rische recalls, "and I had many days in the hospital to reaffirm that it wasn't the ideal place for me to give birth. Eiden was born naturally after over 50 hours of labor, and was a healthy 6 pounds, 11 ounces. I knew my labor was so long and slow because of the unfamiliar hospital environment. This experience greatly drove my desire to become a midwife."

She soon became a member of the board of the Chicago midwife group she'd hired for her pregnancy. She became active in home-birth advocacy and began volunteering and observing prenatal exams at the residence in which the midwives practiced.

After moving to New Mexico in 1997, Rische began apprenticing with Katia Lemone, a local midwife. Lemone, who retired from the profession in 1999, ran Alternative Birth Choices in Las Cruces. Rische became a volunteer, and soon an apprentice. It didn't take long for clients to begin requesting Rische to be present at their births; some invited her son Eiden so they could be sure she would attend.

As an apprentice, Rische attended more than 30 births before Lemone retired. For a year and a half after that, she was able to continue to learn the process by teaching childbirth classes and attending friends' births as a labor assistant.

In the summer of 2001, Rische enrolled at Maternidad La Luz, a midwifery school in El Paso. The program has an intensive three-and-a-half-month curriculum, and includes prenatal and postpartum visits with the center's clients. At times, Rische says, she would attend as many as four births in a 24-hour shift. The staff at the school, which has been open since 1987, has attended more than 9,000 births. Rische says, "It is legal for women to come across the border to go to Maternidad. About half of the mothers I have worked with have been 'in Spanish,' and I can speak what I call 'midwifery Spanish.'"

Upon completion of the program, Rische studied for and received her license as a midwife in New Mexico. She also studied for the North American Registry of Midwives (NARM) test, which she passed in 2002. She recently became a Documented Midwife in Texas, and is also a Certified Professional Midwife.

"I got my New Mexico license first, because it was cheaper," Rische says. "The Maternidad program has a lot of hands-on work, and I appreciated learning more about the traditional methods of childbirth. Maternidad has as many as five births a day, and primarily serves women from Mexico. But middle- and upper-class women can also go there if they are paying out of their own pocket. That is legal, too."

The shift from midwives to physicians for childbirth—a trend that's only now slowly reversing—began in a way during the Middle Ages. Along with all of the Middle Ages' other lovely behavior, this era saw the killing of perhaps as many as several million women, many of whom were midwives and healers. "The midwife had knowledge and skill in an area of life that was a mystery to most people," according to the Midwifeinfo.com Web site. "Since women had no access to formal education, it was widely assumed that the midwife's power must come from supernatural sources, such as an alliance with the devil." A "frenzy of witch-burning" was promoted by both church and civic authorities.

According to Catherine Scholten in her book, Childbearing in American Society: 1650-1850, "In the half-century between 1770 and 1820, upper-class women in American cities started to favor 'male midwives,' or physicians. The presence of male physicians in the lying-in room signaled a general change in attitudes toward childbirth. With changing conditions of urban life, new perceptions of women and advancements in medical science, birth became increasingly viewed as a medical problem to be managed by physicians. At the same time, because medical training was restricted to men, women lost their positions as assistants at childbirth, and an event traditionally managed by a community of women became an experience shared primarily by a woman and her doctor. However, since the interest of the male midwife was an economic one, it did not extend to lower-class women, black women or immigrants. During the 19th century, midwives continued to care for these women."

Today, midwives operate under a number of restrictions that separate them from physicians. Rische is not allowed to attend to women who are pregnant with twins (or more), because of increased risk factors. The same goes for premature births, which the state of New Mexico defines as any baby born before 37 weeks of gestation.

Sadly, modern midwives are also faced with the issue of malpractice. In this year's New Mexico legislative session, three bills were introduced to address issues of midwives and malpractice, but none made it very far. Nor did another bill covering midwives and Medicaid issues.

"When a new client contacts me, I usually visit with them for two hours at the first appointment," Rische says. "We discuss her medical history and how the pregnancy is going to affect her life with her partner. I encourage the mother to bring a list of questions with her to ask me, and to also bring their entire family. I will also inquire as to who will be in attendance at the birth—the partner, any other kids and so on.

"It is just a way of getting to know one another to see if this is something that will work for both of us. My 'bedside manner' includes as much socializing as it does medical procedures. I really encourage the dad to be there, and really believe that they should be there. I also like to get the other kids involved in the process. Sibling rivalry can be eliminated if a child witnesses the birth of a new brother or sister."

Getting to know the pregnant woman really well is key for a midwife, Rische continues. "It is super important," she says. "A regular doctor can go to attend a birth without knowing little things that can become signs of complications."

Rische puts nutrition at the top of the list of things that she works on with her clients. Laughing, client Chauncey Cortland says, "During my first pregnancy, I felt that Peanut Butter Captain Crunch cereal was a good source of protein." Cortland's son, seven-year-old Joseph, runs by, looking none the worse for wear from his mom's former dietary habits. Rische attended Joseph's birth, which was her first as an apprentice. Rische also delivered Cortland's daughter, and will handle the birth of Cortland's next child, due in June. The two women previously worked together at the Mountain View Market in Las Cruces. Cortland was a buyer-manager, and Rische still works there as the special projects manager.

Cortland is proud of her dietary progress, as she proudly states that she has been having two servings of green vegetables lately, instead of one. "You know how food ideas change when you are pregnant," she notes. If she is still rendezvousing with Captain Crunch, it's not as often.

"Research has shown that nutrition can prevent and cure a number of things," Rische says. "A high protein intake can prevent rises in blood pressure. I love to have clients do the 'natural' food thing, and eat a lot of dark green leafy vegetables. A woman's blood volume doubles during pregnancy, but it is diluted, not as rich.

"I was a vegetarian when I had Eiden," she adds. "Veggie moms do okay, but they do better when they keep on top of the protein issue."

By contrast, Rische says, "A regular doctor barely gets any nutritional training."

If the initial meeting is a success, then Rische will visit with her client about 20 times, assuming the woman has come to see her during the first trimester of pregnancy. This also includes at least five postpartum visits, but there is no limit to the number of times that the woman can have an appointment.

"I will also refer out a patient if need be," she says, "and will also go with a client to a regular doctor, and be present as a support system when she is in the hospital."

So, the big day arrives. What happens when the contractions are coming on strong, or the mom-to-be's water breaks?

Well, besides the obvious, Rische monitors the woman's emotional state, and keeps an eye on all the vital signs.

"I spend a lot of time teaching massage during labor," she says. "Sometimes when I get a call from a woman who thinks she is going into labor, it turns out to only be 'practice' labor. The uterus is just exercising itself in preparation of what is to come."

And there is the food thing again! "I always tell them to eat a big meal while you can. I chowed down until a half-hour before Eiden was born."

Put those TV medical-drama images of the delivery room out of your mind. "I have attended water births both in a shower and in birthing tubs," Rische says. "I also try to encourage the whole family to participate. I ask the family to design the experience—do they want candles or music? Whatever they want to include is supported. And if the father catches the baby as it is born, then the process has gone full circle from conception. Sometimes a sibling will catch, and hand the baby to their mom. I also prefer that the mom cut the birth cord, as I think it is slightly sexist for the father to do so.

"I once worked with a young woman who stood up while she gave birth to her baby. She said, 'This is SO great! Look at me! I can do ANYTHING now that I've done this!'"

New Mexico says that a midwife has to stay for at least two hours after a birth, but Rische usually stays for four to eight hours while the mother and baby bond. "I try to get her to eat a meal and keep track of her vital signs. I also recommend that they see a pediatrician, and usually recommend Dr. Timothy Herndon [a Las Cruces-based pediatrician], who loves to see the newborns."

Natural childbirth encourages that maternal bonding, Rische believes. "Bonding is not as easy to do for a mother if she is not empowered or is drugged. A mother can think that 'giving birth was so hard, if I can do that no one is ever going to hurt this child, ever.' She will be protecting the work of art that she has made. If we disrupt the bonding process with drugs and interventions, these moms won't be as determined to be great moms."

Rische feels that being born peacefully can even change the baby's future. "Drugged babies are more apt to be addicts. And through this method, the mother is empowered, and her goddess side can come out."

And needless to say, Heather Rische is also a strong supporter of breast-feeding.

It also seems that Rische has an appeal to creatures with four legs that are about to give birth. "My cat actually came to find me for her birth," she says. "So I've been surrounded by an attitude of birth being something to have confidence in, it being a natural process like sleeping or, well, other bodily functions.

"The bottom line is this: Non-violent birth equals nonviolent future for our planet. I think if we go back to the way were meant to be born and give birth, we will behave as we were meant to behave on this planet. Empowered women need to be a part of this equation. I'm one of those who wonders what if would be like if more mothers/women were in charge."

Jeff Berg also wrote this issue's feature on "art cars."

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