The Coastal Star

Health & Harmony: Midwives and doulas make home deliveries possible

LEFT: Delray Beach resident Michelle Cerami, a licensed midwife, gave birth to her daughter, Natalie, 5, at home.
RIGHT: Zeresh Altork of Boynton Beach studied to be a doula after the in-home birth of her son, Eiden, 9. She and her husband, JP Piqué, also have a daughter, Leila, 5, and dog, Dolsa. Photos by Tim Stepien/The Coastal Star

By Lona O'Connor

    A home birth is a rare occasion in the United States — only 1.36 percent of births, according to the Centers for Disease Control and Prevention.
     But for those who choose to employ midwives and doulas, they are as close as a Google search. Or word of mouth.
    “It’s not a service I’m out there selling to people,” says Michelle Cerami, 33, a Delray Beach midwife who has been in private practice for three years.
    Her clients seek her out, and they come from all walks of life.
    “It surprised me that women come to me from penthouses on the water and little apartments, single moms and married women with big families, which is cool,” she said.
    A midwife is a health care professional, and a doula acts as a counselor and support system for mothers during pregnancy, labor and breastfeeding.
    “It’s a lot of hard work and it’s extremely satisfying,” says Cerami, who has attended more than 250 births, 116 as primary midwife. “But for me, it’s more about the moms and the families I serve, giving them that experience, giving these babies a gentle transition into this world.”
    Cerami trained at the Florida School of Traditional Midwifery in Gainesville. She is licensed as a medical practitioner by the state of Florida and has earned national certification.
    “I didn’t think of midwifery as a career option until I had my son,” she says. “My aunt is a nurse midwife, and she gave me the idea. I had my son with midwives.”
    Originally from New York’s Long Island, Cerami has been in Florida for eight years with her children, Noah, 11, and Natalie, 5.
    Her clients come from all over Palm Beach County.
    The right candidate for a home birth is someone who has no serious health problems.
    If the mother develops gestational diabetes or has high blood pressure or is anemic, has low blood iron levels, if the baby has genetic abnormalities or if labor starts before 37 weeks, home birth is not a good option.
    “A premature baby definitely needs the support of the hospital and all the equipment,” says Cerami.
    
A woman’s choice
    Otherwise, midwifery is a matter of preference.
    “Some people just don’t want to go to a hospital,” Cerami says. “At home, you’re relaxed, your family can be there and you can surrender to the birth. Some women just want to feel what it is to be in labor.”
    Cerami’s son slept through his sister’s birth, but “when he woke up, he got to meet her right away. Home birth demystifies the process. I can just speak for myself, but I think it’s a gift I’ve given to my kids.”
    Cerami’s fee is $5,000. Her clients pay her either out-of-pocket or through Medicaid and a few participating insurance companies. As a licensed midwife, she is eligible to work with insurance companies.
    By comparison, the average cost of a hospital birth is $8,800, more for premature birth, caesarean section or other complications, according to a study done for the March of Dimes.
    About half of Cerami’s clients choose underwater births, either in a bathtub or a purpose-made inflatable tub.
    “It’s comforting and relaxing and it takes all the weight,” says Cerami. “And the babies are much calmer. Sometimes they don’t even cry. My son was a water birth. He just made a little noise and started breathing.”
    Cerami meets with the mother once a month until 28 weeks, then every two weeks, then weekly until the birth, where she is accompanied by a trained birth assistant. Both the midwife and the assistant are certified to provide CPR and neonatal resuscitation.
    “It’s pretty rare that complications happen at home, but there are things that are unpredictable,” says Cerami.
“I once had a baby transferred to a hospital because his breathing rate was too high,” she says. “And we had a mom in early labor whose blood pressure was really high, so we had her transported by ambulance.”
    Among developed countries, the United States is alone in having so few home births. In Europe, more than 75 percent of births are attended by midwives, according to the World Health Organization.
    A study of 79,000 home births in 2012 and 2013 in Oregon and Vermont, the states where the most home births occur, showed a higher mortality rate for home births: In planned out-of-hospital births, 3.9 out of 1,000 cases resulted in a baby’s death during the birth process or within four weeks afterward, compared with 1.8 deaths out of 1,000 in planned hospital births.

Emotional support
    Some home births may have both a midwife and a doula.
    Zeresh Altork, a doula, acts as a counselor to mothers and families during and after pregnancy.
    “The midwives give the medical support and doulas are there for emotional, physical and informational support,” says Altork. “Our sole responsibility is the emotional well-being of the woman.”
    Altork, 42, lives in Boynton Beach with her husband, JP Piqué, son, Eiden, 9, and daughter, Leila, 5. She has been in practice for nine years and has supported about 275 births.
She provides doula services to women who give birth at home and in hospitals.
    “Doulas take care of the mother so she can take care of the baby,” says Altork. “A doula is a kind of mother figure.”
    Altork was a school counselor and family therapist for 10 years. “When I became pregnant with my son, I started investigating my options for the best possible birth,” she says. “It doesn’t have to be routine, it is not to be feared, it can be a very empowering moment.”
    She was so enthusiastic on the subject after Eiden was born at home with the help of a midwife that a friend suggested she train to be a doula.
    “I just wouldn’t shut up about it, she told me. So a month or two later, I was training. I loved it. I found my passion.”
    Her biggest influence was Barbara Harper, a nurse, midwife and internationally known advocate of warm-water home births.
    Altork met Harper seven years ago at a home-birth workshop in Spain, where Altork was living. Fluent in Spanish, Altork acted as Harper’s translator.
    “She told us that women have everything they need to give birth. They just need information,” Altork says.
    Some couples hire Altork even before the woman becomes pregnant, but it’s more common for her to start her work during the second trimester of a pregnancy.
Altork charges a basic rate of $1,050, but her fee can be higher if the mother needs more attention before or after the birth.
    “I get to know the mom and the dad and see how they work together,” says Altork. “I need to understand their needs and help them make their birth plan.”
    
    For more information on midwifery and home birth, contact Michelle Cerami at michelle@eastcoastmidwifery.com. Her website is www.eastcoastmidwifery.com.
    For more information on doula services, contact zeresh@alovingbirth.com.Website:  www.alovingbirth.com.

    Lona O’Connor has a lifelong interest in health and healthy living. Send column ideas to Lona13@bellsouth.net.

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