The birth of Margo Powell's second baby was a much different experience than her first. Powell had hypertensive issues while giving birth to her older daughter, Erin, two years ago, and Powell said her doctor was unceremonious in handling the delivery.
"My first birth was pretty traumatic. It felt like it was so much more busy," Powell said, comparing that experience to the recent delivery of her second child, Lala, at University of Maryland Upper Chesapeake Medical Center in Bel Air. "It felt like they weren't rushing everything; they weren't pressuring me."
The first time, Powell, 21, was giving birth in South Carolina, where she left in October 2015 after moving to Aberdeen Proving Ground with her husband, Daniel, who is in the military.
The second time, Powell was in the hands of nurse midwives from Susquehanna Ob/Gyn & Nurse Midwifery, a private practice that contracts with Upper Chesapeake.
"Last time, I felt more like I had a doctor. This time, I felt like I had support," Powell said.
Lala's birth on April 8 marked the 10,000th delivery for the four-midwife team at Upper Chesapeake, which has delivered nearly half of the approximately 21,000 babies born at the Family Birthplace since its 2001 opening, hospital spokesperson Christina Cottrell said.
The Susquehanna team has been celebrating the milestone, as the only midwifery program in the county since its launch in 1995 by Janice Emerling and Jasmine Lampadarios.
"I think, at least in Harford County and throughout the country, people are beginning more and more to realize that a midwife is a safer – probably, in my opinion, the preferred – way to go if you are low-risk," Lyn Gant said.
Gant, a midwife with Susquehanna for the past 14 years and at Rosedale's MedStar Franklin Square Medical Center for a year before that, recently helped deliver three of her five grandchildren, which she called "the biggest thrill in the world."
She and her fellow midwives said the stereotypes or skepticism about midwifery are fading as people learn what nurse-midwives really do.
They do not do home births, which Gant said only about 5 percent of nurse-midwives nationwide can do. More than 75 percent of Susquehanna's patients also choose an epidural.
"Some people think midwives are just for your hippie moms or your 'granola' [moms]. No, we have people in who are drug abusers, doctors, lawyers, teachers. Our patients come from every walk in life, and I think we give excellent care," Gant said.
"I think a lot of it is our approach to the patient. We are more holistic. We look at the whole person, not just a pregnancy. We look at a person, who happens to be pregnant. Our approach is, we want patients to be involved with the decision-making," she said. "They can have the type of birth they want to have. We tend to spend more time with their labor and pushing, and we are less interventionist."
Nurse-midwives, whose profession dates to 1925 in the U.S., are nationally certified and the National Institute of Medicine has recommended they be given "a larger role in delivering women's health care," according to the University of Maryland Medical System.
They can manage most perinatal care, as well as most family planning and gynecological needs, and they work with obstetrician-gynecologists on higher-risk pregnancies.
Midwives continue to gain traction in the Baltimore area, as well as nationwide.
Johns Hopkins Medicine has the largest midwifery practice in Maryland since 1986, according to its website.
The University of Maryland Medical System said it would not be accurate to compare midwife-assisted births among different hospitals, spokesperson Michael Schwartzberg said, because of differences in statistics tracking and the lack of a midwife program at sites like the UM Charles Regional Medical Center.
In the University of Maryland system over the past year, certified nurse-midwives oversaw about 55 percent of births at Shore Regional Health and 40 percent of births at St. Joseph Medical Center, Schwartzberg said.
At Baltimore Washington Medical Center, they have handled at least 25 percent of all deliveries since coming on board in 2012, Schwartzberg said.
"My husband tells me every day, 'You need to change your name,'" Lori Antinozzi, a nurse-midwife with Susquehanna for almost five years and a registered nurse for 10 years, said with a laugh about her job.
"A lot of people come to us and they don't really understand what a midwife is. They think, 'I'm not going to be able to have an epidural, or have to do it at home,'" Antinozzi said. "People will say, 'Oh, are you kind of like a nurse practitioner?'"
"Midwifery itself is just a different type of ob[stetrical] care," she said, explaining they are advanced practice nurses, and that statistics show far fewer rates of mortality and comorbidity, meaning the presence of two chronic conditions or diseases, in a population where there is midwifery care.
Nurse-midwives can serve as surgical first assistants and all have certifications in procedures like ultrasounds.
"In most states, we practice independently, meaning we do not have to practice under the supervision of a physician. I think all of us have a strong desire to provide full-scope care to women."
"We spend more time with our patients, we concentrate a lot on teaching, we spend a lot of time understanding" what type of experience they want, Antinozzi said. "We are with them through the course of the labor and the birth, we don't just come and go... We try to provide that birth center experience in a hospital setting."
Upper Chesapeake does not offer water births, but "we are kind of working on that," she said.
Ruthie Weifkoph, 30, of Jarrettsville, who is Gant's daughter, had both of her two children, Mckenzie, 3, and Clayton, 2, delivered by midwives.
She said she got to be in the tub during her labor, "so it kind of helped with contractions," although she had to get out for the birth. The midwives also knew different techniques to help with labor, such as sitting on a special ball.
"They are very open to, you don't have to just stay on the bed. You can go for walks, you can bounce on the ball, you can try to use different things to try to deal with it, and it's very peaceful," Weifkoph said, noting she brought her own soundtrack to use for the Clayton's birth and the midwives let her play it.
"Clayton had a little bit of trouble coming out, so his heart rate went down every time I had a contraction, and I did end up pushing before I was dilated," she said.
The doctor was there to support the situation, and everything ended up turning out fine, she said.
"I am a huge advocate for them and I definitely do suggest them to people," she said about the midwives. "They do their deliveries in the hospital and it can be a completely natural [process]. It's definitely the best of both worlds, I think."
Powell, meanwhile, said she chose a midwife just "because I am pretty sure all of their doctors were male and I always had a female."
She chose to have an induction, and was very pleased with the whole experience. She said her mother is a registered nurse, and "I know the nurses really do a lot more than the doctors... When I heard I get a midwife, I was excited."
"I would definitely recommend it. I liked it better than having a doctor," she said. Lala, her new baby, "was a lot bigger than I expected," at 10 pounds, and her other daughter, Erin, slept through most of the delivery nearby.
Cottrell, the hospital spokesperson, said the 10,000th milestone "is huge considering those are births done solely by the midwives, not the physicians with the Women's Care team or any other OBs with hospital privileges."
Powell was definitely surprised when the midwives shot off confetti and brought in huge pink balloons to mark her delivery as the team's 10,000th birth.
"It was awesome," she said.