Gundersen Midwives

Certified nurse midwife Amy Belling-Dunn checks on the status of Erin Woods of Spring Grove, Minn., and her infant, Cooper Garrett Schulte, on Nov. 20 as Cooper's dad, Dalton Schulte, looks on in her room at Gundersen Health System in La Crosse. Belling-Dunn cared for Woods during the delivery on Nov. 18.

“Call the Midwife” has a two-pronged significance for Amy Belling-Dunn: The popular PBS series is one of her favorite TV shows, and she answers expectant mothers’ calls for midwives at Gundersen Health System in La Crosse.

The TV show “is pretty accurate” in portraying birth situations and the interactions of moms and midwives in real life, said Belling-Dunn, who lives in Viroqua and has been a certified nurse midwife at Gundersen for four years.

Belling-Dunn relishes her role as a certified nurse midwife, achieved when a registered nurse takes advance education and training in women’s health issues.

“It really lets you be more in control of what happens, and you protect that space for women and their families to have an optimal experience,” Belling-Dunn said.

She and the seven other certified nurse midwives at Gundersen are performing the role well, too, according to the American College of Nurse Midwives, which gives the program accolades in three out of eight categories for a high-volume practice (more than 500 births a year) for its “best practices” honors:

  • First in the nation for lowest primary cesarean delivery rate, a ranking that puts it in the top three. (Gundersen deliveries overall, also including those performed by obstetricians, have a low primary cesarean rate, which mean deliveries of first babies.)
  • Second in spontaneous vaginal births, which means births that begin on their own, without using drugs or techniques to induce labor.
  • Third in nation for least number of third- and fourth-degree lacerations, which are the most severe forms of perineal or vaginal tearing during childbirth.

Last year, Gundersen midwives maintained a vaginal birth rate of 94 percent and a primary cesarean delivery rate of 4 percent. By comparison, the national rate was 21.5 percent in 2012 in the 38 states where midwives are licensed, according to the January 2014 National Vital Statistics report.

“We encourage women to be mobile and upright during labor and to use various positions which can help labor progress naturally,” Belling-Dunn said. “We also encourage women to be patient at the end of pregnancy and to wait for labor to start on its own and induce labor only if medically indicated.”

A woman whose patience was rewarded is Erin Woods of Spring Grove, Minn., who had been scheduled to be induced on Nov. 20 if 8-pound, 11-ounce Cooper hadn’t arrived, which he did two days before that. Belling-Dunn, who had seen Woods most frequently during her pregnancy, happened to be on duty for the delivery.

“We just connected from the beginning, and it worked out” nicely that Belling-Dunn was there for the delivery, Woods said.

Woods was complimentary of the overall process, saying, “It was fantastic. I had the opportunity to see all of the different midwives. It was a good continuity of care.

“I felt like I wasn’t just another number, but a person,” she said.

Cooper’s dad, Dalton Schulte, endorsed the assessment, saying, “I liked how much calmer she was whenever Amy was around. She definitely was calmer.”

That observation was similar to the experience of a man who recalled putting pillows behind his wife’s back and fluffing them up to make her more comfortable during labor.

The woman shooed her husband away, indicating his maneuvers hadn’t been all that helpful. When the midwife came into the room just seconds later and did the same thing to the pillows, his wife not only welcomed the midwife’s actions but hailed them as being much more comfortable.

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Woods noted that they had options of where to go, with Spring Grove being about the same mileage from La Crosse as it is from Decorah, Iowa, where Gundersen also has a clinic where babies are delivered.

“I’m really glad I ended up here,” she said.

Midwifery, once one of the most common methods of baby delivery, began to wane in the 1800s because midwives had little power relative to physicians, and many regarded midwives as untrained, according to Midwifery Today.

By 1900, midwives generally were relegated to delivering babies of women who could not afford doctors. As births moved increasingly to hospital settings, midwife deliveries declined because hospitals tilted even more toward allowing only doctors to provide care.

The practice of midwifery has surged again in recent decades with pushback against physician dominance and increasingly strict education and licensing requirements for midwives.

Midwives provide care in cases of half of the 1,200 babies a year delivered at Gundersen, said Belling-Dunn, who also partly credited Gundersen physicians with the midwife program’s honor.

“Receiving this award would not be possible without the continued support and collaboration of our physician colleagues,” she said.

Midwives can delivery most babies, having to hand off duties only in more complicated cases or when a cesarean section becomes necessary, Belling-Dunn said.

Midwives also practice at Mayo Clinic Health System-Franciscan Healthcare, which has seven midwives on staff and where midwives deliver just over half of the babies, according to a spokesman.

The 40-year-old Belling-Dunn, whose three girls — ages 15, 10 and 8 — also were born with the assistance of midwives, said she her goal was to become a midwife since she began her career as a labor and delivery nurse in the Twin Cities.

She began as a birth doula, which she said provides the smoothest path toward becoming a certified nurse midwife.

“The coolest part is when you get to know the family,” Belling-Dunn said.

“If a woman has an idea of what she believes would be her optimal experience — such as if she is passionate about a water birth — we work with her. It can be so empowering,” she said.

“It’s such an honor to be there and give support,” Belling-Dunn said.

The practice of midwifery has surged again in recent decades with pushback against physician dominance and increasingly strict education and licensing requirements for midwives.

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