In Tosi Marceline’s practice, prenatal checkups happen in the living room.
Marceline is a home birth midwife. Today, her very pregnant client lies on the couch in her Sacramento home. Marceline kneels on the floor beside her. She takes out her battery-powered, handheld, ultrasound machine and puts it on her client’s belly.
"Why don't you wiggle the baby a little bit," Marceline suggests to her client, Shannon Kenealey, who is past her due date. Kenealey gently nudges her belly.
"That's a good acceleration [of the heartbeat]," says Marceline.
Tosi Marceline monitors pregnant ladies in their homes everyday – and eventually, she delivers their babies there too; dozens, every year. She’s been doing this for 30 years – and it shows through her calm assurance and her stories.
A Day in the Life of a Midwife
Marceline’s style of health care is very different from what you’d get in a doctors office. Instead of a white coat, Marceline is dressed casually. She drives her prius to her clients’ homes, so they don’t have to wait in an office. Marceline will spend an hour with her clients, for whom she cares before, during and after the baby’s birth. Her client today, Shannon Kenealey had her first child in the hospital.
"The experience in the hospital was very invasive, I was trying to relax, and the nurse would come in and she'd flick on the lights and talk really loudly and we were trying to talk soft so that I could relax."
Kenealey chose to have her second child at home with Marceline as her midwife. She wasn't hooked up to an IV, and she wasn’t hooked up to a monitor. She sewed before she gave birth in a giant tub of water. Kenealey is having her third child at home, too.
"I feel that birth is a natural thing, and they’re trying to make it a hospital emergency every time," says Kenealey.
When Home Births Become Emergencies
But sometimes, home births do become more urgent situations. Marceline says about 8% of her clients are transported to the hospital for a c-section or complications.
"I still firmly feel that the best place for delivers is in a hospital," says Dr. Ruth Haskins, a practicing obstetrician in Folsom.
"We’ve got an operating room next store. When things unexpectedly go bad, we’ve got a hematologist down the hall. When fever spikes, and a rash breaks out, we've got an infectious disease specialist that can come take a look at her," she says.
Haskins works with the American Congress of Obstetricians and Gynecologists. She says planned home births that unexpectedly need hospital care can create complex medical situations.
"And so now a physician doesn’t have any information about the patient, doesn’t have any input about the initial care that is so important, and suddenly is completely responsible for the out come. That’s the situation that we would like ultimately to remedy," Haskins says.
Can Midwives and Obstetricians Collaborate?
That situation is part of a decades long history of non-collaboration and sometimes outright antagonism between homebirth midwives and mainstream obstetricians. Current law says midwives should be supervised by a doctor, but in reality, physician liability insurance in California doesn’t cover homebirths. But one California lawmaker is trying to foster a better working relationship between the two groups.
"The bill started as really just saying licensed midwives could go order tests and buy medical supplies they needed," says Democratic State Assemblymember Susan Bonilla.
Bonilla is proposing to rewrite the law to allow midwives to attend to normal pregnancies without physician supervision. But a doctor would be involved if a woman has certain risk factors.
"My hope is that more and more women will really be able to experience birth with a midwife. And whether they choose to do that at home or in the hospital, I believe that midwives have a passion and a commitment to the prenatal care process and the labor and deliver process that’s really excellent," says Bonilla.
If passed, the bill may not resolve decades of differences between obstetricians and midwives, but it would be a baby step towards more collaboration.