Call the Midwife
Rebekah Natanov was nearing the end of her first pregnancy when she switched from an obstetrician-gynecologist to a hospital-based midwife. Having studied maternal and women’s health when she was in graduate school, the Silver Spring, Md., resident was concerned that her ob-gyn would be too hasty to do an episiotomy and put her at risk for infection, too ready to push her to take drugs to induce labor if she went too many days past her due date and too quick to do a cesarean section.
“Midwives in general have a more natural outlook on birth,” says Natanov, 35, a research analyst at the Centers for Medicare and Medicaid, whose oldest daughter, Michal, is 4 years old. Midwives “rarely do episiotomies. You don’t have to fight to have something to eat or drink in labor.”
Midwives have been assisting women in childbirth for millennia. The best known in Jewish tradition are the biblical Shifra and Puah, the midwives recalled in the Passover story who defied Pharaoh’s order to slay the newborn sons of Hebrew women and have been known through the ages as the saviors of their people. According to some rabbinic teachings, Shifra was Moses’ mother, Yocheved, and Puah was his sister, Miriam.
The two women “symbolize the ability to look at a situation and be able to assess what’s different that needs to happen,” says Yael Silverberg-Urian, 56, a certified nurse-midwife affiliated with an inner-city hospital clinic in northern New Jersey. “In my eyes, they looked at a situation and really understood what needed to happen to save the Jewish people.”
As the daughter of a physician who was long interested in women’s health, Silverberg-Urian could easily have pursued the traditional medical route and become an ob-gyn. But she chose midwifery, she says, because it allowed her to incorporate her respect for the holistic nature of birth.
Like many ob-gyns, today’s midwives tend to women throughout pregnancy and delivery, providing nutritional information, counseling and health education. Certified nurse-midwives also provide regular gynecological exams. In addition to being less inclined toward medical interventions, midwives also typically spend more time with their patients. Chana Luba Ertel, a certified professional midwife in Pittsburgh, notes that while an obstetrician might spend an average of six minutes with a woman during her prenatal exams, a midwife may spend an hour.
More and more women have been turning to midwives over the past few decades, though they still represent a minority in the United States. Although it’s hard to know the exact number of Jews who seek out midwives—or the number of Jewish midwives—anecdotal evidence suggests Jewish women are fully part of this movement and, in some cases, are making use of Jewish teachings and prayer as part of the experience.
Some 15,000 midwives currently practice in the United States, according to the Midwives Alliance of North America. An estimated 2 percent of them are men. Licensing practices and requirements differ from state to state, and several paths are available for individuals seeking midwife status.
In 2015, midwives attended 371,504 births, or slightly more than 9.3 percent of the total 3,978,497 births in the United States, according to the National Vital Statistics Report issued in January by the Centers for Disease Control and Prevention’s National Center for Health Statistics. These numbers represent an increase in the use of midwives, up from 5.4 percent
in 1994, when the federal government began requiring Medicaid to pay for the services of certified midwives, and an increase from 1.1 percent in 1980, according to the journal Midwifery Today.
Women who choose midwives often do so because, like Natanov, they’re seeking a less invasive, more intimate and more natural experience that gives them greater control over their pregnancy and birth—and, they often say, makes it less likely they’ll have a cesarean section. Cesareans comprise nearly one-third of births in the United States, according to the National Vital Statistics Report.
Yamit Presman, a 37-year-old Lubavitch woman in Pittsburgh, gave birth to her seventh child in February 2016. All but her first, now 13, were born with the assistance of a midwife: Her 11- and 10-year-olds were delivered in a hospital; her 7-year-old in a freestanding maternity center; her 5-year-old in a birthing center affiliated with a hospital; and her youngest two, now 5 and 3, at home.
For Presman, the experiences outside hospitals were the best. “A midwife who is allowed to practice her midwifery is going to be more flexible” than those in hospitals with doctors overseeing them. “The clock is ticking” in those cases, she asserts, and medical interventions become more likely.
Despite midwives’ natural approach to delivery, they most often are part of a labor and delivery team at a hospital or a hospital-affiliated clinic. In 2015, according to the latest CDC report, 88 percent of midwife-attended births were in hospitals; 4.8 percent in freestanding birth centers, clinics or doctors’ offices; and 7 percent at home, with the remainder of births elsewhere.
Linda Sosman, 55, a certified nurse-midwife at a clinic in Chicago, says that in her more than two decades of practice, she personally has seen an increase in respect for midwives among medical professionals. “Years back, we really had to clarify who we are, what we do, what our training is,” she says. Now, the hospital sends “medical students to watch our deliveries.”
For many women, it’s the best of both worlds, she says, noting that “anything high risk, we transfer” to an ob-gyn.
Dr. Robin Hilsenrath, 56, an ob-gyn affiliated with Newark Community Health Centers in New Jersey, says that with “good training and experience, there are midwives that are just as skilled as a physician when it comes to” caring for women during labor and delivery.
“Women’s bodies are naturally designed to conceive, grow, birth, breastfeed and care for babies,” says Wendy Kenin, a Berkeley, Calif., resident and doula who founded Imeinu, Hebrew for “our mothers.” Imeinu’s 25 members include doulas as well as a network of women in the health and spiritual field, some of whom are midwives. (The use of doulas has also become more popular in recent decades. They do not have medical training, but rather support the woman physically, emotionally and with personal tasks during labor and postpartum.)
“Medical interventions are needed when there is a glitch in this system,” Kenin says. “However, when we medicalize birth we unfortunately see unnecessary interventions leading to adverse health outcomes.”
A 2012 study by the American College of Nurse-Midwives found that “midwifery care of low-risk women improves the infant mortality rate in hospitals and birth centers compared to physicians caring for women of equally low risk.”
Protocols midwives have used for years often make their way into the hospital setting, according to Kenin. She cites as examples the increased prevalence of skin-to-skin contact between babies and mothers within moments of delivery as well as the practice of delaying umbilical cord clamping until the cord stops pulsating or the placenta is delivered to ensure that the baby receives as much placental blood as possible. In fact, in January, the American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice recommended delaying cord-clamping, citing increased hemoglobin levels and improved iron stores for the first few months.
In their work, both Kenin, 45, and Ertel, 40, the Pittsburgh-based midwife, offer Jewish teachings to interested women. “As much as they want, we can offer them Jewish sources of inspiration,” says Kenin, whose website includes links for such books as Expecting Miracles: Finding Meaning and Spirituality in Pregnancy Through Judaism and B’Sha’ah Tovah: The Jewish Woman’s Clinical and Halachic Guide to Pregnancy and Childbirth.
Expecting Miracles, for example, provides a kabbalistic birth meditation that teaches breathing exercises based on phrases that have the numerical values of the Hebrew word hedva, which means joy.
In helping women to prepare for delivery, Ertel says she turns to that teaching and others, including one from the Lubavitcher rebbe, the late Rabbi Menachem Mendel Schneerson, on the concept of lashon nekiya, positive language. “How we speak influences how we relate, think and feel,” she says. She weaves that biblical concept into the language of HypnoBirthing, a technique that speaks, for example, of a uterine surge instead of contractions; pressure, not pain; and water releasing, not water breaking.
As Jews, Ertel says, “how we eat, how we calculate time, everything we do is infused with purpose,” but Westernized medicine has turned pregnancy and delivery into a medical event. Her aim is to turn the process into something spiritual so that during pregnancy and delivery women never forget they’re bringing a neshama, a soul, into the world.
Debra Rubin is an editor and writer based in Maryland.