Choices in Childbirth: Midwives

NOTE: This story is the third in a series about childbirth options available to women in Door County. This series is to offer resources to mothers as to the choices they can make pertaining to how they want to experience birth. Links to the first two stories, about doulas and the Door County Ministry Birthing Center, can be found within the online article.

Midwifery may sound like a career of the past, but for Jill Coulter, a certified professional midwife (CPM), her midwife services are becoming more widely sought moving further into the 21st century.

Coulter practices her profession with her company BirthWise, a midwifery practice that helps women in the greater Northeast Wisconsin area grow and birth their babies in their homes.

For the first five years of her practice, Coulter did home births exclusively, until she opened BirthWise Health and Birth Center in Appleton in 2008, offering onsite birthing options. Now in 2016, Coulter is transitioning BirthWise back into home births only.

She is also one of few midwives who offers her home birth services to the women of Door County. She serves a handful of women in Door County every year. Midwife birthing options can be at a birth center, at home or at a hospital, depending on your choices and the midwife you work with.

“When I first started out, I didn’t have any advertising – people found me by word of mouth, because people are seeking this service out,” Coulter said. “It’s becoming more popular.”

She has been a registered and licensed midwife for 12 years on the North American Registry of Midwives. Coulter works alongside Certified Nursing Midwife (CNM) Samantha Greenlee.

Midwife services are different from those of a doula, a trained support professional to assist birthing mothers physically and emotionally during pregnancy, birth and postpartum. In comparison, OB-GYNs are trained to manage pregnancies and birth, including those of high-risk nature.

Doulas act as support during childbirth

Since she became a certified midwife, Coulter said she has helped around 700 babies come into this world between the BirthWise center and clients' homes. She said most parents come to her for her services because they have researched their options and want a midwife experience and a natural birth.

A natural birth is intended to be done vaginally with no medical intervention such as epidurals, cesarean sections or other drugs. The midwives with BirthWise work with mothers who have low-risk pregnancies, and all Wisconsin-based midwives must consult with a licensed physician when a mother shows significant deviations in pregnancy. (Wisconsin Administrative Code, Ch. SPS 182) Midwives also do not do cesarean sections.

Coulter said she believes Wisconsin has great laws pertaining to midwives.

“They are reasonable laws, keeping midwives accountable, and ensuring there is safe care for women outside of a hospital setting,” Coulter said.

Coulter’s goal as a midwife is to assist mothers by offering a standard of care including labs, ultrasounds, access to information, individualized care, a lot like in a hospital. She believes, however that medical interventions used at a hospital birth are unnecessary and sometimes unsafe.

“In the last 15 years, there has been this picture of hippies using midwives, but it’s a choice many people with many beliefs and careers have chosen,” Coulter said. “I’ve helped lawyers, nurses and many kinds of mothers give birth.”

Another reason people have been known to seek out midwives is the reduced cost compared to a hospital. Billing from BirthWise and other midwives is typically at about one-third of the cost of a hospital birth.

She feels that people get the drive to seek out a midwife because they want to experience a natural birth.

“I’m here to support women who want to have the option of giving birth with a midwife, but I don’t want to convince someone,” Coulter said. “It’s not for everyone.”

The most important part of being a midwife for Coulter is the relationship she builds with the mother and baby. During pregnancy, she requires visits for checkups, and getting to know each other to make the birth process more comfortable for everyone. Care extends through the birth and six weeks postpartum for physical exams, breastfeeding assistance and related services.

Ministry's Birthing Center caters to Door County moms

Coulter recently had the opportunity to be the midwife of her sister-in-law, Sarah Bonovich, and brother Brian, when Sarah gave birth to their second child, Lilah, in their Sturgeon Bay home.

Lilah and her brother Niko, 2, were both born with Coulter as the midwife; Niko was born at the BirthWise Center. Bonovich said she did not know much about midwifery until she met Brian and was introduced to Jill.

“Her profession intrigued me, and I wanted to learn more,” Bonovich said. “Once we researched, we knew it was the route we wanted to take.”

Lilah was born in the morning in early April 2015, and Coulter was at the Bonovich home by 2 a.m. She inflated a portable bathtub in their living room and had their fireplace and a few candles lit, and after about five hours of labor Niko had a new baby sister. Bonovich said there was pain and pressure, but she said her daughter’s birth was a beautiful and calm experience made even more wonderful that Coulter was the one helping her with the water birth.

“I wanted to be in a calm, safe space and not in a more institutional feeling hospital,” Bonovich said. “I was a low-risk pregnancy, and I believe that birth is a natural experience. I feel everyone needs to do what is right for them.”

Bonovich said she did have the option to work with both Coulter and a physician if she wished, but declined and worked with just Coulter throughout the pregnancy.

Coulter is trained and capable of handling urgent birth matters including infant resuscitation. When there is a reason for a mother of Coulter’s to need a hospital during birth, transfers are almost always non-urgent, usually for women who have long labors or want an epidural.

“I don’t depend on hospitals for urgent scenarios; we manage the situation and transfer,” Coulter said. “I wouldn’t do what I do if I found myself with my hands tied.”

Before birth, BirthWise clients are encouraged to educate themselves on the natural birth process, and are referred to courses for birth, breastfeeding and more.

“Half of the time, the battle with childbirth is removing fear,” Coulter said. “Education is the best way to combat that, in whatever form.”

Coulter said that the biggest fear her clients have is whether they can get through natural birth without drugs, not if it is safe.

“Most women who give natural home births aren’t at home lying in beds having babies,” Coulter said. “Some kneel, squat, and have water births, all to help manage pain.”

As a mother who has had two children by midwife, Bonovich said she is asked a lot of questions, primarily about pain management.

“I did have pain, and I did wonder if I should have gone the pain medication route, but I learned about how to manage pain in other ways,” Bonovich said. “Everyone is different, and has different needs. It’s important to research and find out what you want and take control of your birth experience.”

Coulter is the mother of five children, four who were born at home, and all of them with the help of a midwife.

There are midwives located in the Green Bay area, including those at Oak Grove Midwifery and a four-person CNM program is offered in partnership by Prevea Health, HSHS St. Mary’s Hospital and St. Vincent Family Birthing Centers.

To contact Jill Coulter, CPM, visit her website at www.wisconsinbirthcenter.com/.

-abloechl@doorcountyadvocate.com, Twitter@alyssabloechl, FacebookAlyssa Bloechl

Update: This story was changed to fix the error originally reported of the number of babies Coulter has helped deliver. Also two of the photos were incorrectly attributed, and were submitted courtsey of Veronika Richardson/Fox Valley Birth and Baby, LLC.