A toddler rests an ear on her mother's swollen belly and listens. Today, her baby brother is due to arrive.
Dressed in a maternity tee and leggings, the mother waits as her midwife's assistant listens for a heartbeat.
"Can you hear it?" Charlie Rae Young, the assistant, says to the little girl, a bump-bump sound whispering through equipment static.
The sister-to-be nods. Whether baby Ezra comes today or, as it turns out, a week late as she did, the 2-year-old will witness the physical challenge that is birth. She will be there as Young helps her mother, Ida Mundell, bring a baby into the world at home, without hospital monitors, or painkillers or restrictions that prohibit children in birthing rooms.
For the little girl, the birth of her brother is a mysterious event. For Young, it is life as a midwifery student, learning how to safely help women labor on their own terms.
Birth is more than getting the baby out safely, Young says. It's nurturing the mother's experience from conception to delivery.
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Historically, midwives were revered. Women used them regularly until the mid 20th century, when improvements in modern medicine shifted the consciousness toward hospital birth. In the last two decades, the practice has re-emerged. The number of at-home births delivered by midwives has increased by about 25 percent since 1990, according to a 2010 report from the Centers for Disease Control and Prevention. The number of registered Certified Professional Midwives or CPMs, has risen from 54 to 1,977 since 1995, according to the North American Registry of Midwives.
Since 2006, enrollment has doubled at the Florida School of Traditional Midwifery, the only Midwifery Education Accreditation Council-approved institution in the Southeast. In the past, students were mostly middle-aged women, school officials say. Now, the majority are 20-somethings like Young.
"I didn't think people still had their babies at home," Young says. "But I knew when I started reading, that this was what I wanted to do with my life."
The country's health care crisis and an emerging green movement also have contributed to the renewed popularity of midwifery, school officials and midwives say. Florida midwives charge from $4,500 to $6,500 for prenatal, birth and postpartum care. Hospitals charge thousands more.
Midwives accept Medicaid. But their work is not typically covered through private insurers though some will work with private insurance companies, professionals say.
Despite increasing in popularity, home births still represent only 1 percent of all births, records show.
About four years ago, Young gave birth to her daughter at a hospital. She wanted to do it naturally. Then, medical staff intervened.
Her labor was induced against her wishes, she says. Nurses swarmed the scene but talked at her, not to her. She felt powerless and left angry.
Back at home in Brandon, she went into research mode. She researched maternity care options on the Internet. She read books late at night while nursing her daughter. She discovered women like her, fed up with caesarean sections and sterile hospital beds. Many blogged or wrote about midwifery.
The topics surprised Young: With a midwife, if a woman wants to give birth standing up or in her bed, she can. If she wants to eat and drink between contractions, she can. There are water births, and scented oils, soothing music and children present.
Last December, Young enrolled in the Florida School of Traditional Midwifery. She is one of 22 women in a three-year midwife program. At the school, in Gainesville, she studies everything from psychology and anatomy to herbal remedies and breast-feeding. The rest of the week she works with licensed midwives in Brandon and Lakeland.
In order to graduate, Young must manage 20 births as an assistant to her mentor. This includes prenatal exams, in-home visits and being present on the big day. When a client goes into labor, she rushes to the scene.
Once she completes her training, Young will take the test to become a CPM. In Florida, state law allows CPMs to practice. Midwifery is illegal in 13 states, including Georgia, North Carolina and the District of Columbia, according to the Midwives Alliance of North America, an organization of professional midwives founded in 1982.
In Florida, midwives also must apply for a state license. Certified Nurse Midwives, registered nurses trained in a master's degree program at an accredited institution, can practice at hospitals. Certified Professional Midwives usually work out of private offices or birth centers. Most of their clients deliver at home, midwifery school officials said.
State law allows midwives to work with women who have low-risk pregnancies. Women with certain health concerns, such as high blood pressure or miscarriages, have to see a physician. Midwives also do not administer epidurals or induce labor.
Young and her classmates at the midwifery school know the rules, school officials say. They recognize when their training is inadequate, know how to perform emergency response techniques and cooperate with local hospitals.
Still, obstetricians worry about potential risks.
Dr. Jill Hechtman, an obstetrician-gynecologist and medical director of Exodus Women's Care in Brandon, thinks midwives should practice in a hospital setting.
"What if your baby's heart tones fall, a cord could be wrapped around its neck? A lot of things could happen even with a normal, low-risk pregnancy," Hechtman says. "It could take 20 minutes or more to get to a hospital, and that's 20 minutes that your baby is in trouble."
Professional midwives say emergencies are rare, occurring about 10 percent of the time.
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So far, Young has assisted with 150 births. She says she is happy with her career path. She likes being on call because it means she helps people. She plans to eventually open her own practice, though she knows it won't make her rich. Midwives' salaries are unpredictable and depend upon the number of births they handle. An average single practice assists with two to four births per month charging $2,000 to $4,000 per birth, according to the midwives' accreditation council.
In 2009, Young and a friend, Megan D'Orazio, started Barefoot Birth, a pregnancy support business based out of Young's home in Brandon. Barefoot offers the services of a doula (a woman who offers emotional support, comfort and advice) as well as massage therapy, birth classes and baby photography.
"This life is a huge time commitment, but people are so supportive of what I'm doing," Young says. "The most important thing is that women know they have options."
Sarah Whitman can be reached at (813) 661-2439 or firstname.lastname@example.org.