A pregnant woman has nine months to get used to the idea of being a mother and expand her knowledge of birth and baby care.
Building a bridge from her early confusion to comfortable understanding usually falls upon a medical professional. But it doesn't have to be an obstetrician/gynecologist who answers the questions and gives the treatment.
It could be a certified nurse midwife.
At the Eldersburg practice of Drs. Esposito, Mayer, Hogan & Associates, P.A., three certified nurse midwives -- Ellen M. Ray, Jackie Notes and Lauren E. Pohler -- practice side by side with six doctors.
"Patients can receive the benefits of a midwife experience, but with the safety of hospital backup, without being intrusive and invasive in the process," Dr. William M. Mayer said.
Typically, a midwife adds two years of specialized training to her education and experience as a registered nurse.
After six years as an obstetric registered nurse, Ms. Ray took a two-year master's program at Georgetown University in Washington to become a midwife.
"We consider our care more personalized," said Ms. Ray, who is in her eighth year as a midwife. "We give more prenatal and delivery care, and can focus more on labor and delivery and what the patient wants to get out of it. We listen to their needs. They get to know their care provider better."
Drs. Esposito, Mayer, Hogan and Associates, P.A., was established 20 years ago in Columbia by Dr. Mayer and Dr. Anthony A. Esposito. They recently created a second full-time office, the Women's Health Center, at 6210 Georgetown Blvd. in Eldersburg. Their phone number is 549-7345.
At the Women's Health Center, patients can also choose from four female physicians. Ten years ago, Dr. Mary P. Hogan became the first woman in private practice in Howard County. Dr. Francoise Abrams, a native of Belgium and fluent in French, and Dr. Phyllis P. Winfrey joined the group about five years ago, followed by Dr. Margot E. Watson two years ago.
The group practice is associated with Howard County General Hospital. As the number of patients giving birth has increased, doctors have been invited into the practice.
"The ideal is from seven to 10 deliveries per doctor per month," Dr. Mayer says. In April, doctors in the group delivered 103 babies. In July, Dr. Mark A. Esposito, Anthony Esposito's son, will become the seventh physician to join the group.
Eldersburg was chosen as the site for a second office after statistics compiled in 1991 showed that one-third of the births in the Eldersburg-Sykesville area took place at Howard County General.
The doctors participate in most health maintenance organizations, including Maryland Independent Practice Association, the largest HMO in the area. They are not associated with CareFirst or Columbia Medical Plan.
"We were one of the first [in Maryland] to incorporate midwives into our practice," said Dr. Mayer, counting back to 1985, when Ms. Ray was invited to join the group.
"We felt midwifery was changing -- becoming a nursing specialty, believing in fetal monitoring. The two [physician and midwife] found common ground," he said.
Midwives have been assisting mothers in giving birth for centuries. Certified nurse midwives often can take the place of the physician in the office and the hospital.
They can provide most of a woman's health care except surgery, giving routine examinations, treating vaginitis and prescribing birth control. For new mothers, they have time to spend discussing nutrition, breast-feeding and social issues.
"The general public envisions the midwife as less interventionist," Dr. Mayer said. "Our basic philosophy is as long as everything is going OK, the patient is the boss."
During birth, the midwife is the medical professional at the hospital who stays with the mother in labor and delivers the baby. The midwife doesn't replace the spouse or friend who is usually participating. A physician is called in if complications arise.
"The midwife will actually scrub up with us on a [Caesarean] section," Dr. Mayer said. "She can replace the surgical assistant or doctor who would assist."
"Of course, not every glove fits every hand," he said. "Some patients feel more comfortable with a doctor. It's part of the spectrum of services we provide."