Joys of a Midwife: Nurse’s Calm Demeanor in the Delivery Room

Austin American Statesman

Midwife Lisa Carlile's 24-hour shift that starts at 7 a.m. Thursdays at St. David's Women's Center of Texas has been uneventful lately. "I've been baby-repellent," she says, making a face, about a recent streak of not delivering babies.

That wasn't the case a couple of weeks ago. Expectant mom Cheryse Phillips had called her doctor at 6:30 a.m. to be admitted. Upon arriving, Phillips was emphatic she was ready to deliver. Her cervix had dilated to 3 centimeters but she shot to 8 or 9 in no time (10 centimeters means a woman is ready for delivery). The baby wasn't waiting for the formalities of hospital paperwork.

Phillips, who'd delivered her two other children naturally, had chosen to use a midwife (a specialized nurse who focuses on natural childbirth without medical intervention or drugs to relieve pain). But because she was thinking she might need medical intervention this time around, she was a little apprehensive.

"Oh, my God; the next 20 minutes were unbelievable," Phillips says. "I kept telling everybody the baby was ready, and when I lost control, Lisa took control. I decided I wanted an epidural, but Lisa held my hand and said, 'Look at me, Cheryse. You can do it. You're strong. You can do it.' Before I knew it, I pushed and the baby was out."

Two weeks after the birth of her daughter, Kennedy, Phillips is filled with praise for Carlile, 45.

"Lisa handled it perfectly," she says. "She made it feel relaxed like I was in a yoga class. She took her time about everything. She was gentle, but most of all, she took control."

Had Phillips needed epidural anesthesia or if problems had arisen during delivery, the midwife was backed by a doctor on call who could arrive within 30 minutes. She and two other midwives work in collaboration with a doctors' group — it's the only way the hospital permits them to do deliveries. (St. David's North Austin Medical Center, where the new Women's Center is located, also has four doctors who don't have outside practices and work at the maternity ward. They, too, are available in case of emergencies.)

After delivering Phillips' baby, Carlile induced labor for two other patients and began her usual postpartum rounds. Then a migraine headache hit Carlile about 10 a.m. Medication helped, but other symptoms hinted at a stomach bug, she says. Carlile was relieved by colleague midwife Lianne Miller later that day. And, of course, Carlile missed out on the delivery of two babies.

Carlile, who has been delivering babies on and off for the past 11 years, has had her share of action-filled days. The most deliveries in one day was five — with three of those in a span of 20 minutes.

"That was pretty exciting," she recalls. "You catch the first one, then the second and the third. You run from room to room and concentrate on managing it well."

Carlile is a registered nurse with a certification in midwifery. She is certified to prescribe medicine. A graduate of the University of Texas School of Nursing, she worked in oncology and pediatrics but found her niche in labor and delivery beginning in 1990. In 2002, she joined a doctor in Austin who sold the practice to her current employer, obstetrician-gynecologist Christina Sebestyen. It was Sebestyen who spearheaded a campaign to allow midwives to deliver babies at St. David's. Sebestyen worked with midwives in Boston before opening her practice here. Today, she's joined by another doctor, Andrea Campaigne, and three midwives, including Carlile. Because the midwives work in collaboration with supervising doctors, patients' health insurance covers the cost. From August through mid-December, 67 babies have been delivered by midwives in the group.

Carlile cannot be happier with her situation. "It was frustrating before. I'd provide prenatal care for women but I couldn't close the deal," she says. "I love everything about this job from prenatal care to delivery to women's health in general."

When she's not at the hospital, she sees women at Sebestyen's practice.

Stephanie Garland was at the offices recently because she was overdue and the baby wasn't moving (she would eventually deliver later that day). She chose the midwife option because it "presented me with the best of both worlds: No medication — that's my goal — but if I need it, it's available."

"There's just a different philosophy of using a midwife. I didn't want my pregnancy to be treated as an illness but something that was natural," she says.

During the visit, Garland shared some of the wisdom she'd heard about coaxing along an overdue baby. "I read that eating pineapple or papaya might help," she says.

Carlile smiles. "There is a lot of information out there, like going on a long walk or eating spicy food. Does it work? Not so much. I'd rather you rest before because you will need that energy during labor. And your brain has a lot to do with the way your body responds. You have some control in the way you approach and manage labor. The women who do best are the ones who leave it up to their bodies."

Childbirth is an emotional time for a family, and Carlile admits to getting caught up in the moment. "I tear up at every one of them, especially if I see a father cry," she says.