CHAPEL HILL -- When Elizabeth Collini learned she was pregnant two years ago, she already knew she wanted a certified nurse-midwife to deliver her baby.

She was looking for a more personal approach to her pregnancy and delivery.

"From what I was told, an obstetrician would be there for the delivery, but a midwife would also be there for the labor," said Collini, 34, of Chapel Hill. "The midwife option seemed more natural. Not jumping to c-sections and interventions was more appealing."

A friend referred Collini to the UNC Division of Midwifery. She had appointments with each of the practice's four certified nurse-midwives during her pregnancy so she could develop a relationship with whoever would be on-call when the baby arrived.

When Collini went into labor, she headed to the hospital, accompanied by her husband, Morgan, and several family members. Midwife Deb O'Connell checked on her hourly and stayed in the room to answer questions, monitor her condition and speak with the family.

Collini was allowed to eat breakfast and walk around the room as labor progressed, which is common for midwife-attended births. When the pain became unbearable, Collini requested an epidural.

"Some people are concerned with midwives and think they look negatively on using pain medication," she said. "I was not planning on using any, and they had no problem with me changing my mind."

When she'd been in labor so long after her water broke that she risked developing an infection, Collini was induced. O'Connell stayed to comfort and coach her. After 24 hours of labor, Collini delivered Cameron, a healthy baby girl.

"Deb guided me through the whole thing," Collini said. "She worked the baby out without causing pain or residual effects. She was absolutely fantastic."


1 in 10 births

One out of 10 births in North Carolina is attended by a certified nurse-midwife, according to the N.C. State Center for Health Statistics. That's about five times the percentage delivered by them three decades ago when the state's certified nurse-midwives received prescription-writing privileges and North Carolina's first certified nurse-midwife practice was opened in Lumberton, according to the American College of Nurse-Midwives.

In the 30 years since, legislation and increased backing from the state, particularly in education and insurance reimbursement, have altered the practice of midwifery.

In North Carolina, certified nurse-midwives practice at more than 100 locations. They include hospitals, home-birth practices, birth centers, family-planning clinics, health departments and federally funded clinics, according American College of Nurse-Midwives.

In the last 15 years, the number of certified nurse-midwives practicing in North Carolina has increased eight-fold to around 200, according to the college. East Carolina University now offers a graduate program in midwifery.

Still, many women don't understand the services modern midwives can offer.

"I believe there is a voodoo mystique about midwives," said Kathy Higgins, a certified nurse-midwife who started the UNC Division of Midwifery. "There might be a misunderstanding about exactly what we do."


Registered nurses

The American College of Nurse-Midwives sets standards of training for registered nurses to become certified nurse-midwives. All certified nurse-midwives are certified through the college, and each state has its own licensure and practice requirements. North Carolina licenses only certified-nurse-midwives, and nearly three-fourths of them hold master's degrees.

UNC offers the only 24-hour nurse-midwifery practice in the Triangle that delivers in a hospital, meaning women who get prenatal care from a midwife are guaranteed that a midwife will deliver them. The division's five full-time and part-time midwives also collaborate with the hospital's obstetrician-gynecologists to offer regular gynecological care to women throughout their lives, in addition to obstetrics.

The division's cesarean section rate is around 11 percent, compared to the hospital physicians' rate of 25 percent to 30 percent, said Jane Arnold, director of the UNC Division of Midwifery. However, she cautions that the physicians often see high-risk patients, and some women choose to have cesarean sections.

"Western medicine tends to want to intervene, but we let labor take its course unless the mom and baby are in danger," Arnold said.

As mandated by the state, physicians sign off on the medical protocols that certified nurse-midwives use. A downside to midwifery care is that a midwife may not be able to see a high-risk patient or might have to transfer care of a patient to a physician if the patient becomes high-risk or requires a surgical intervention, such as a cesarean.

"Since we do collaborate, a lot of issues can be handled without transferring care," said Chris Munoz, a UNC obstetrician-gynecologist. For example, if a woman develops pre-eclampsia, or dangerously high blood pressure that can lead to organ failure, midwives can induce labor. "If it becomes severe, however, they will transfer care. In those cases, the midwives generally stay and support their patient through the procedure and in the early postpartum period."

The Women's Birth and Wellness Center, one of North Carolina's two freestanding birth centers, is also in Chapel Hill. It offers well-woman care, as well as low-risk maternity care for women who prefer to have their birthing experience out of the hospital.

Like many women who seek midwife care when they become pregnant, Collini said she plans to continue receiving regular care with the midwifery practice and hopes to deliver with it again in the future.