University of Delaware Office of Public Relations The Messenger Vol. 5, No. 4/1996 Welcoming New Life Dorinda Dove, Delaware '84, records her career highlights in what looks like a guest book. "Here is the first birth I attended," the certified nurse midwife says, pointing to a handwritten record in a large, white book. The book includes 103 births, the last chronicled as carefully as the first. "I keep this for myself," Dove explains, "with any details that made a birth memorable for me." Given her intimate "guest" record, it's only fitting that Dove's workplace, the Birth Center of Delaware, resembles a private home. The center welcomes about 150 new babies each year at a small, brick house in Wilmington, Del., where it has operated since its founding 14 years ago. All the modern medical equipment required for prenatal care and births is available. But, the center also has marks of a home: Three cozy bedrooms, a living room, kitchen and shelves of children's and parenting books. This home-like setting is key to a midwife's unique role. "We view birth as a natural life event, not an illness," Dove explains, "so, our focus is on wellness, prevention and wholeness. That perspective affects how we make decisions and approach each client." Dove shares this perspective and her work with Edie Wonnell, certified nurse midwife, founder and director of the Birth Center. Two registered nurses complete the staff. As Delaware's only independent birth center, the center provides families with an alternative to hospital delivery and with the advantages of a midwife's care during pregnancy. It was while serving as a Peace Corps volunteer in Malawi, Africa, that Dove first encountered midwifery. "I gained a lot from working with the midwife there," she recalls. "She was a powerful presence to the women she supported in labor, and she made a strong impression on me." At the time, Dove was a new UD graduate, with a B.S. degree in nursing. "Delaware prepared me well for an expanded practice role," says Dove, who followed her Peace Corps service by working as a hospital labor and delivery nurse. With that experience, she entered a 14-month, midwife certification program at Baylor College of Medicine in Houston. When she became certified in 1992, she joined the ranks of some 4,000 nurse midwives nationwide in a profession that has gained popularity and acceptance in recent years, as more people have come to appreciate the midwife's special emphasis on a woman's responsibility for her own pregnancy. "A big part of our work is empowering our clients," Dove says. "We trust a woman to participate in her care. She is free to have input, and we respect her choices." This approach requires a low-volume practice and personalized care, with many hours devoted to client counseling. The Birth Center offers a range of courses for expectant families, including such topics as prepared childbirth, sibling preparation and infant assessment. "We educate people to help them make their own decisions. It takes time, but it's a priority," says Dove. Another difference: "We see the routine use of technology as interfering with the birth process," Dove explains. "Technology is essential when necessary, but not always best if it's not really needed." As an example, Dove cites the fetal heart rate monitors used in hospitals, which can slow labor by restricting a woman's mobility. The Birth Center's intimate setting also can help a labor progress more easily. There, a woman knows the midwife and registered nurse who attend a birth; in a hospital, she would probably deal with strangers. "People birth best when they feel safe and familiar," Dove says. Most Birth Center clients return home after a postpartum stay of only about six hours. "Generally, women want to get home, where they can rest better. And, because we put so much into educating our new mothers, they are ready," Dove says. "We follow up closely-the mom needs to call us daily, and, on the third day, a registered nurse makes a home visit. People can't fall between the cracks here, as they might in a bigger system." Growing acceptance of midwifery practices has influenced hospital labor and delivery rooms. Dove explains that hospitals now are much less likely to whisk a newborn away from its mother and may be slower to introduce the use of technology during labor. "It's gratifying to see the changes since I first worked in hospitals," says Dove. "They are working to become much more in tune with people, and many hospitals now have midwives on staff." Non-hospital births also have become more accepted, as, over time, statistics have shown superlative safety records for birth centers. In fact, many people maintain that, for low-risk pregnancies, birth centers are safer than hospitals because their caesarean rates are much lower. According to Dove, Birth Center clients are carefully screened. High-risk pregnancies (cases involving twins, breech positions or high blood pressure, for example) are referred to the center's back-up physicians. "Emergencies rarely come out of nowhere," says Dove. "We always look for signs and symptoms of a problem, and we have the necessary training if one arises." Dove's greatest challenge, she finds, is balancing her work with her family commitments. "Of course, babies always come in the middle of the night," she says. "It's great to have a supportive husband who jumps right in." Dove and her husband, Ron Ozer, Delaware '84, have two young children. Dove limits her work schedule to only one 24-hour shift per week and one long weekend a month when she is on call. But, her work is necessarily unpredictable. "When I walk out the door [to deliver a baby], I don't know when I'll be back." The exhilaration of her work keeps Dove energized. "It's very satisfying to welcome new life into the world," she says. "Being present at a birth is a real high." She also enjoys getting to know her clients. "I form a relationship throughout the pregnancy and am part of the process. I consider it a privilege." -Mary B. Hopkins