Sensitive Midwifery - Issue 44 - October 2019

Birth was in the black south where the poor could not a ff ord to go to the hospital, and hospitals refused to help birthing women who could not pay. The highly skilled black 'granny midwives' continued to deliver the majority of poor families until the 1960s. Another pocket of traditional midwifery that survived was in rural and remote places, such as northern Wisconsin, Idaho and Alaska. With access to hospitals di ffi cult (due to rugged landscapes, long distances, bad weather and shortages of doctors), people continued to birth at home with traditional midwives. As Alaska became a US state and became more populated in the 1960s, the Indian Health Services (IHS) dominated its health care. IHS is a government entity that provides socialised medicine to the indigenous and their descendants. Unlike the mainstream medical system in main US, the IHS system adopted a more culturally competent system to childbirth by keeping and training midwives within their system. The modern IHS hospital midwives provide all care for low-risk patients, prenatally, during birth and postpartum. Since IHS hospitals function with limited funding and don’t rely on the 'pay per service' model, lower intervention and lower cost of employing midwives makes sense financially as well as culturally. The Alaska Native Medical Center in Anchorage boasts a C-section rate under 18% and a VBAC rate of over 80%, despite serving a high-risk population. A strong midwifery presence Alaska not only boasts the highest number of midwifery births but also the highest out-of-hospital birth rate in the US. One area called the Mat-Su Valley has a population of just 100 000 yet is home to five birth centres. A whopping 20% of the births in that area are out-of-hospital. Anchorage has six freestanding birth centres that serve a population of 380 000 people. In contrast, the State of Illinois has 13 million people and only three birth centres. Our state was one of the first to establish licensure of direct-entry midwives and birth centres in the early 1990s, which may be another reason our midwifery presence is so strong. In my personal practice, I serve a wide range of races, cultures and socioeconomic classes but all are low risk. We serve everyone from recent immigrants who don’t speak English to high-income professionals, as well as commercial fisherwomen who spend most of the year living on boats or o ff the grid in the wilderness. I base my practice out of a small birth centre in Anchorage with two other midwives. We o ff er birth centre delivery but prefer home birth because of its intimacy. We think it’s important to provide a facility for people who don’t have a good place to give birth. My travelling practice is mostly to the Island of Kodiak where there is no resident midwife. I plan to open an informal ‘birthing suite’ there in the future. I have worked many years to forge a good relationship with the medical community. I do co-care with all my clients so they have a doctor to see when I am not in town and in case they need transfer. My clients see the back-up physicians about four times before birth and bring the baby in during the first week after the birth to establish baby care. We are autonomous providers in Alaska and this back-up is not required in Anchorage, but sharing care with the doctors has helped me build an excellent level of trust and my clients benefit greatly from it. Birth stats to boast about A fairly recent study from the University of British Columbia paints a beautifully accurate picture of the relationship between access and integration of midwifery care and the quality of outcomes state- by-state in the US. Not surprisingly, the states with the highest access and integration of midwives also enjoyed the best outcomes and lowest intervention rates. As Alaska has the highest midwifery births per state, we have almost the lowest C-section rate at 23.3%. Alaska’s neonatal mortality is 2.6/1 000, half of Alabama’s at 5.6/1 000, which also has the lowest number of midwifery births in the nation. This relationship is no surprise to us! I encourage you to explore the results of the AIMM study, including interactive maps, which can be found at www.birthplacelab.org. I hope you enjoyed learning a bit about Alaska’s midwifery scene. Follow me on Instagram (@birth. goals) or check out my website (www.birthgoals. com) to learn more about my practice. Feel free to drop me a line. Or better yet, come visit! 19 eSensitive Midwifery Magazine Issue 44