Angela Love is a midwife in Vero Beach. In most countries she would be considered a valued medical professional.
But in the U.S., midwifery still carries somewhat of a stigma as an old-fashioned way of doing things. Love would like to change that perception.
Her practice, Midwife Love, operates from an office on 43rd Avenue. And business is booming.
She has attended 180 births since she opened her own practice in 2010 – and more than 700 in her career. She offers free pregnancy tests, and works with well-mother support groups such as La Leche League, an international breastfeeding information and support organization.
Her birth success rates are high and patients are borderline devotional.
The inclusion of midwives in the business of pregnancy is part of a cultural debate about whether childbirth is a natural, physiological occurrence that women are innately equipped to handle, or a surgical and medical procedure requiring teams of physicians and operating rooms.
But today's midwives are medical professionals trying to bridge that gap.
Love is a licensed advanced registered nurse practitioner with a specialty as a certified nurse midwife, and has OB/GYN clinical and hospital experience.
Her approach is dedicated to assisting mothers from first pre-natal visit through natural, home birth and post-partum care.
Teaching
During Love's hour-long pre-natal appointments, she forms a personal bond with her patients. Their conversations include such topics as breathing, exercises and newborn care.
"There's a lot of teaching in the visits," Love says.
In 2014, Vada Mossavat was new to Vero Beach and without a regular physician. She went to Love for general gynecological services and was so impressed that she thought, "If I ever have a child I want this woman to deliver my baby." And she did.
"Angie helps you become a mother, not just give birth," says Mossavat.
Love arrives for a home birth fully equipped, bringing oxygen, medications, IV supplies and resuscitation equipment.
Another way
She also assists with "vaginal births after C-section" – known as VBAC.
The most feared potential complication for mothers who have previously undergone C-sections are uterine scar ruptures, a serious medical event that endangers mother and baby. But Love believes that the appropriate candidate can do well with VBAC, as opposed to automatic repeat C-sections.
Indian River Medical Center does not do VBAC. The Newsweekly contacted IRMC staff OB/GYN Dr. James Presley about this article, but his office chose not to comment.
Ashley Kosack, 25, came to Love during her second pregnancy, after a 2011 C-section at St. Lucie Medical Center made her determined to have a natural birth the next time.
Recovery from a C-section had been traumatic for her. She spent four days in the hospital after surgery and couldn't fully participate in the early days of her daughter's care. A friend recommended Love and their first meeting sealed the deal.
Kosack had found the doctor's office experience stiff and impersonal, and thought a midwife was perfect for her.
During pre-natal visits she'd share her progress. "Angela was just as excited as I was," she says.
Through months of pre-natal training with Love, Kosack prepared for her first experience with natural childbirth. After a long, exhausting night, Colby was born weighing nine and a half pounds. There were no problems with her cesarean scar throughout pregnancy or during the birth.
High rates
The National Institute of Health found that nearly 90 percent of mothers who have C-sections have them again.
Nevertheless, the study concludes that, "Our findings do not support the widely held belief that neonatal mortality risk is significantly lower compared to VBAC delivery."
And according to the Mayo Clinic's website, between 60 and 80 percent of women have successful vaginal births after a cesarean.
Nationally, the cesarean rate is approximately 32.8 percent according to the Center for Disease Control.
The World Health Organization recommends rates between 10 and 15 percent.
Florida has one of the highest C-section rates in the country. In 2013 it was 38.94 percent, according to cesarianrates.com, which compiles state health department and hospital association data.
The rate at Indian River Medical Center is nearly 33 percent.
South Miami Hospital and Kendal Regional Medical in Miami have 61 and 63 percent C-section rates, respectively.
Discouraging
It was those high numbers in Miami that inspired Love to embrace her life's work.
She always knew she wanted to be a nurse. As a gifted high school student who excelled in math, she was offered a full tuition scholarship to Messiah College, a private Christian College in Mechanicsburg, Pa.
After receiving her nursing degree she chose obstetrics, because, "it was happy," she says. "Smiling moms, beautiful new babies."
She moved to Miami, "to be in a multi-cultural environment."
But as an RN in labor and delivery units at Miami hospitals she was surprised and even distressed by disturbing break room conversations.
Doctors cited hot dates or tee-times as reasons to induce labor or persuade a patient that a C-section was necessary.
Love hadn't previously considered becoming a midwife or doing home-births, but after five disillusioning years, she "couldn't be a party to it anymore," and made a change.
During graduate school she had spent summers at a birth center.
"At first it was like a social science study," she says. But she discovered a whole new experience. "Women (in labor) were walking around, they were eating and drinking, and in and out of tubs, which makes for an easy transition for the baby."
Love had found her calling. And she has had to send only ll percent of her patients to a hospital for delivery, where 8 percent have had a C-section.
Avoiding problems
Her wholistic approach focuses on teaching women ways to avoid issues that require medical attention. For instance, she teaches massage techniques and pushing methods to help avoid tearing. She has never had a patient go through an episiotomy, an incision to enlarge the birth canal.
Financial considerations, as well as inconvenience, can also dictate C-sections, according to Love. Doctors and hospitals receive higher fees for C-sections than for natural births. A study by Truven Health Analytics cites natural birth costs at around $16,000 and cesareans are approximately $26,000.
At Midwife Love the total cost is $5,000, which includes all lab work, pre-natal visits, the birth, and six weeks of postpartum care for mother and baby. They accept insurance and Medicaid.
More natural
Love points out another distinction between natural home birth and hospital delivery. At hospitals, women are "leashed to a machine for continuous monitoring. Love has found, "Intermittent is better.".
The American College of Obstetricians and Gynecologists agrees. Their website states that there is no benefit in continuous monitoring for low-risk women, and that it restricts mobility and limits comfort positions.
"Continuous monitoring," according to the ACOG, "has also been associated with an increase in other interventions, such as forceps, vacuum extractors, and cesarean section, without evidence of benefit to the baby."
For natural birth, Love uses no pain relief medications. At hospitals, mothers in labor routinely receive narcotics including Demerol (a form of morphine), which can cause side effects such as nausea.
For babies, potential problems are more serious. Narcotics cross the placenta during labor and may cause central nervous system and respiratory depression, as well as altered neurological behavior and many other adverse effects, according to the American Pregnancy Association.
Mossavat experienced a painful labor.
"You want the pain to stop," she says. "If I'd been at a hospital, I would have asked for something for the pain. It's like a Snickers – if it's there you'll eat it, even though you probably shouldn't."
Other solutions
Love has delivered both of Jennifer Smith's children: 15-month-old Milan and newborn Taleia.
Smith wanted to give birth at home, even though friends tried to talk her out of it. "What if something goes wrong?" was the repeated question.
But Smith says, "As soon as I met Angie I felt connected."
Her son Milan came with long labor. "We tried everything, the pool, doing lunges, I was exhausted."
Finally a "rebozo" technique worked. This Mexican midwife tradition uses a scarf around the belly to gently vibrate the abdomen, relaxing tight ligaments and adjusting the baby's position.
It seems to have been just what Milan needed. Shortly after the second rebozo maneuver, "Milan descended and Jenny immediately started feeling more pressure," Love said.
When he came out, his hand was against his cheek, and Love speculates his elbow may have caught on the walls of the uterus, stopping him from entering the birth canal sooner.
His birth was a true family affair. Smith's husband Tomas, mother-in-law, sister, mother, a doula (a birth coach) and Love were all in attendance, taking pictures while Smith gave birth squatting on her knees.
Midwife Love is doing so well that Love (who chose that name and changed it legally) is considering adding another midwife to her practice.
She organizes an annual Babies, Bellies & Brunch reunion at South County Park. It's a well-attended event for current and former patients, their families and babies, lots of babies.
"She's created a whole community," says Mossavat. "She's a catalyst for good, healthy things. I can't say enough good things about her and about what she's doing."
Angela Love will continue helping women committed to the alternative of having their babies at home naturally, and possibly change some opinions about midwives in the local medical community – one baby at a time.
"Child birth," Love says, "is the last frontier of feminism."
But in the U.S., midwifery still carries somewhat of a stigma as an old-fashioned way of doing things. Love would like to change that perception.
Her practice, Midwife Love, operates from an office on 43rd Avenue. And business is booming.
She has attended 180 births since she opened her own practice in 2010 – and more than 700 in her career. She offers free pregnancy tests, and works with well-mother support groups such as La Leche League, an international breastfeeding information and support organization.
Her birth success rates are high and patients are borderline devotional.
The inclusion of midwives in the business of pregnancy is part of a cultural debate about whether childbirth is a natural, physiological occurrence that women are innately equipped to handle, or a surgical and medical procedure requiring teams of physicians and operating rooms.
But today's midwives are medical professionals trying to bridge that gap.
Love is a licensed advanced registered nurse practitioner with a specialty as a certified nurse midwife, and has OB/GYN clinical and hospital experience.
Her approach is dedicated to assisting mothers from first pre-natal visit through natural, home birth and post-partum care.
Teaching
During Love's hour-long pre-natal appointments, she forms a personal bond with her patients. Their conversations include such topics as breathing, exercises and newborn care.
"There's a lot of teaching in the visits," Love says.
In 2014, Vada Mossavat was new to Vero Beach and without a regular physician. She went to Love for general gynecological services and was so impressed that she thought, "If I ever have a child I want this woman to deliver my baby." And she did.
"Angie helps you become a mother, not just give birth," says Mossavat.
Love arrives for a home birth fully equipped, bringing oxygen, medications, IV supplies and resuscitation equipment.
Another way
She also assists with "vaginal births after C-section" – known as VBAC.
The most feared potential complication for mothers who have previously undergone C-sections are uterine scar ruptures, a serious medical event that endangers mother and baby. But Love believes that the appropriate candidate can do well with VBAC, as opposed to automatic repeat C-sections.
Indian River Medical Center does not do VBAC. The Newsweekly contacted IRMC staff OB/GYN Dr. James Presley about this article, but his office chose not to comment.
Ashley Kosack, 25, came to Love during her second pregnancy, after a 2011 C-section at St. Lucie Medical Center made her determined to have a natural birth the next time.
Recovery from a C-section had been traumatic for her. She spent four days in the hospital after surgery and couldn't fully participate in the early days of her daughter's care. A friend recommended Love and their first meeting sealed the deal.
Kosack had found the doctor's office experience stiff and impersonal, and thought a midwife was perfect for her.
During pre-natal visits she'd share her progress. "Angela was just as excited as I was," she says.
Through months of pre-natal training with Love, Kosack prepared for her first experience with natural childbirth. After a long, exhausting night, Colby was born weighing nine and a half pounds. There were no problems with her cesarean scar throughout pregnancy or during the birth.
High rates
The National Institute of Health found that nearly 90 percent of mothers who have C-sections have them again.
Nevertheless, the study concludes that, "Our findings do not support the widely held belief that neonatal mortality risk is significantly lower compared to VBAC delivery."
And according to the Mayo Clinic's website, between 60 and 80 percent of women have successful vaginal births after a cesarean.
Nationally, the cesarean rate is approximately 32.8 percent according to the Center for Disease Control.
The World Health Organization recommends rates between 10 and 15 percent.
Florida has one of the highest C-section rates in the country. In 2013 it was 38.94 percent, according to cesarianrates.com, which compiles state health department and hospital association data.
The rate at Indian River Medical Center is nearly 33 percent.
South Miami Hospital and Kendal Regional Medical in Miami have 61 and 63 percent C-section rates, respectively.
Discouraging
It was those high numbers in Miami that inspired Love to embrace her life's work.
She always knew she wanted to be a nurse. As a gifted high school student who excelled in math, she was offered a full tuition scholarship to Messiah College, a private Christian College in Mechanicsburg, Pa.
After receiving her nursing degree she chose obstetrics, because, "it was happy," she says. "Smiling moms, beautiful new babies."
She moved to Miami, "to be in a multi-cultural environment."
But as an RN in labor and delivery units at Miami hospitals she was surprised and even distressed by disturbing break room conversations.
Doctors cited hot dates or tee-times as reasons to induce labor or persuade a patient that a C-section was necessary.
Love hadn't previously considered becoming a midwife or doing home-births, but after five disillusioning years, she "couldn't be a party to it anymore," and made a change.
During graduate school she had spent summers at a birth center.
"At first it was like a social science study," she says. But she discovered a whole new experience. "Women (in labor) were walking around, they were eating and drinking, and in and out of tubs, which makes for an easy transition for the baby."
Love had found her calling. And she has had to send only ll percent of her patients to a hospital for delivery, where 8 percent have had a C-section.
Avoiding problems
Her wholistic approach focuses on teaching women ways to avoid issues that require medical attention. For instance, she teaches massage techniques and pushing methods to help avoid tearing. She has never had a patient go through an episiotomy, an incision to enlarge the birth canal.
Financial considerations, as well as inconvenience, can also dictate C-sections, according to Love. Doctors and hospitals receive higher fees for C-sections than for natural births. A study by Truven Health Analytics cites natural birth costs at around $16,000 and cesareans are approximately $26,000.
At Midwife Love the total cost is $5,000, which includes all lab work, pre-natal visits, the birth, and six weeks of postpartum care for mother and baby. They accept insurance and Medicaid.
More natural
Love points out another distinction between natural home birth and hospital delivery. At hospitals, women are "leashed to a machine for continuous monitoring. Love has found, "Intermittent is better.".
The American College of Obstetricians and Gynecologists agrees. Their website states that there is no benefit in continuous monitoring for low-risk women, and that it restricts mobility and limits comfort positions.
"Continuous monitoring," according to the ACOG, "has also been associated with an increase in other interventions, such as forceps, vacuum extractors, and cesarean section, without evidence of benefit to the baby."
For natural birth, Love uses no pain relief medications. At hospitals, mothers in labor routinely receive narcotics including Demerol (a form of morphine), which can cause side effects such as nausea.
For babies, potential problems are more serious. Narcotics cross the placenta during labor and may cause central nervous system and respiratory depression, as well as altered neurological behavior and many other adverse effects, according to the American Pregnancy Association.
Mossavat experienced a painful labor.
"You want the pain to stop," she says. "If I'd been at a hospital, I would have asked for something for the pain. It's like a Snickers – if it's there you'll eat it, even though you probably shouldn't."
Other solutions
Love has delivered both of Jennifer Smith's children: 15-month-old Milan and newborn Taleia.
Smith wanted to give birth at home, even though friends tried to talk her out of it. "What if something goes wrong?" was the repeated question.
But Smith says, "As soon as I met Angie I felt connected."
Her son Milan came with long labor. "We tried everything, the pool, doing lunges, I was exhausted."
Finally a "rebozo" technique worked. This Mexican midwife tradition uses a scarf around the belly to gently vibrate the abdomen, relaxing tight ligaments and adjusting the baby's position.
It seems to have been just what Milan needed. Shortly after the second rebozo maneuver, "Milan descended and Jenny immediately started feeling more pressure," Love said.
When he came out, his hand was against his cheek, and Love speculates his elbow may have caught on the walls of the uterus, stopping him from entering the birth canal sooner.
His birth was a true family affair. Smith's husband Tomas, mother-in-law, sister, mother, a doula (a birth coach) and Love were all in attendance, taking pictures while Smith gave birth squatting on her knees.
Midwife Love is doing so well that Love (who chose that name and changed it legally) is considering adding another midwife to her practice.
She organizes an annual Babies, Bellies & Brunch reunion at South County Park. It's a well-attended event for current and former patients, their families and babies, lots of babies.
"She's created a whole community," says Mossavat. "She's a catalyst for good, healthy things. I can't say enough good things about her and about what she's doing."
Angela Love will continue helping women committed to the alternative of having their babies at home naturally, and possibly change some opinions about midwives in the local medical community – one baby at a time.
"Child birth," Love says, "is the last frontier of feminism."
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