Ask midwife Rhonda DiCostanzo if her profession is misunderstood and she responds with a short laugh.
“Well, we don’t trade chickens for deliveries,” she deadpans.
Historically, midwives were first mentioned on papyrus in Egypt beginning in 1900 BC. They worked in ancient Greece, in the Roman Empire, throughout European history.
Today, Catholic Health Initiatives Franciscan Health supplies midwives to St. Joseph Medical Center in Tacoma, and last year half the babies born there were delivered by midwives.
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“We have 13 midwives working with St. Joseph, two more at St. Francis (Federal Way) and two in Enumclaw,” said Jennifer Riffel, Franciscan midwifery director. “And there are other midwife groups as well.”
No, they don’t swap livestock for delivering children — and in Washington, midwives must be certified nurse midwives and nurse practitioners.
“That means we can write prescriptions, care for patients throughout their pregnancy and deliver babies,” Riffel said. “We can do everything but surgery.”
Why would a pregnant woman choose a midwife over a physician?
“It’s a collaborative effort,” DiCostanzo said. “The docs take care of the higher risk patients; we take care of the healthy, not the sick.”
DiCostanzo, 55, has been a midwife for 10 years and, in that time, delivered 1,020 babies. A divorced mother of four, she was an Army linguist, then a California baker before coming to the Northwest and the University of Washington.
Today, midwives need a bachelor’s degree, then a master’s in science and nursing.
“Each state is different, and the Northwest accepts midwives about as well as anywhere in the country,” DiCostanzo said. “In some place, midwives are illegal. In Washington, we only deliver babies in hospitals — our malpractice insurance requires that.”
For all the science and technicalities of the jobs, DiCostanzo said she and most midwives she knows do the work because they love it and the relationships they form with their clients.
“One of the reasons most of us didn’t go on to become doctors is a preference to take care of the healthy, not the sick,” DiCostanzo said. “Doctors sometimes look at pregnancy as if the woman is sick. We look at it like she’s well unless proven otherwise.”
In her Lakewood office where she sees clients three days a week, DiCostanzo pulled down one of a handful of white binders and flipped it open.
“I keep pictures of all my clients, the information on their births,” she said. “I care about each one of them. I love repeat patients — I’ve delivered four babies for one patient, and the first child of her sister.”
Being a midwife is not issue-free.
“It’s not all fun. I’ve had a patient whose husband died during her pregnancy,” DiCostanzo said. “I’ve had a patient who came to appointments drunk. I’ve been to funerals with little tiny caskets.
“I am not the police. I am not their mother. I tell them the options, but I don’t make decisions for them.”
DiCostanzo admits, a bit slyly, that she has come to look like what the world expects a midwife to look like.
“I’ve got gray hair pulled back in a bun,” DiCostanzo said, dressed in casual, Mother Earth clothing. “I look like everyone’s grandmother. In truth, the main difference between having a midwife instead of an OB-GYN might be the relationship we form with the women we work with.”
Comforting a patient is part of the job description, DiCostanzo said. And, occasionally, so is a dose of reality.
“Every day you get a heartbeat during pregnancy is a good day,” she said. “I’ll sometimes remind a woman who’s complaining about being uncomfortable, that heartbeat sometimes isn’t there.
“A happy, healthy baby is a gift. For all of us.”