Kristine Devens always wanted to work with mothers and their babies, and even planned to become a doctor in obstetrics and gynecology, but after having her own children, she pursued another path, the path of a home-delivery midwife.
While pursuing a nursing degree, on her way to becoming a physician, Devens took time off to have her now 7-year-old child, and her experience was less than ideal.
“I did everything wrong essentially, cause I had no idea what I was doing. I had,” she paused. “Not good experiences. So then I knew going through that, that I wanted to make this better for other people. This cannot be the way God designed us; he did not design it so we needed to be cut open.”
She started work as a doula, a supportive but nonmedical advising person for the birth parents. However, she was still working in a hospital, and realized that that was the problem.
“I’m watching the things that would happen in the hospital, knowing what the evidence says about doing different things, like what does normal birth look like? And then going to the hospital and wondering why they’re doing that, they’re not even allowing normal birth to happen,” Devens said.
Deciding she had to do more, Devens pursued her education as a professionally licensed midwife, getting the same training as many nurses, with rigorous testing and training requirements. Although many midwives do deliveries in hospitals, Devens opted to focus on home settings.
After more than two years of an apprenticeship under a long time midwife, Devens took over her own practice, Ignite Midwifery & Wellness, with offices in Sauk Centre and Long Prairie.
“Midwives are experts on normal and healthy pregnancy, births and postpartum care,” she said.
Most OBs and maternal care professionals never see a labor from start to finish, Devens said, and usually only intervene if there’s a problem or for the actual delivery.
“So midwives are a lot more hands-on start to finish,” she said.
The level of individualized care is one reason why people choose midwives and home births, Devens said. Other people have personal reasons or come to Devens by world of mouth.
“Some people have had traumatic experiences at the hospital, like I did,” she said, “Otherwise, lots of people, either their mom had home births, their sister, their friend or there was somebody they knew who had a home birth and had an amazing experience.”
The word of mouth draws many people to her office. She has delivered about 200 babies in her time training and working as a midwife, all home births all ending with healthy babies and mothers.
One of many reasons to choose a home birth with a licensed midwife is the success in natural births with fewer interventions than at the hospital, she said.
“Midwives have much better rates as well for less C-sections actually, less neonatal deaths, and more babies breastfeeding by the time they are 6 weeks old. All because our care is different,” she said.
As a midwife, Devens said she focuses more time on prenatal visits and educating mothers about what a normal pregnancy looks like. She said she’s had mothers who have had several babies in the hospital and then opt for a home birth, expressing near astonishment at the information Devens shares with them, things they didn’t know about their body, Devens said.
“I think too, doctors, you’re lucky if you get three to five minutes with them in the office and they’re out the door. Where our visits are a half hour and to an hour long so we get to have a lot more conversation and information sharing,” she said.
Another factor in her birthing success, Devens said, is that most people are more comfortable in their homes than a hospital setting, reducing stress and creating an environment for a healthy natural birth. She said that home birth is attributed to short labors, cutting hospital labor times in half. Devens said the environment also allows for a relaxed, intimate and individualized birth setting.
“We can keep people home where they’re comfortable and feel loved and safe then their body is able to do what it is supposed to do without interventions. It’s kind of amazing every time just how well it goes,” she said.
However, Devens acknowledged that home birth is not for everyone. For example any mother extremely fearful of birth may feel more comfortable in a hospital setting. Also, mothers who are high risk or have foreseen complications are not candidates for home birth, Devens said.
“Yes things can happen just like anywhere but usually we rule out the things that are going to cause the most amount of issues during prenatal care,” she said.
Midwives do all the standard prenatal care a person would have in a hospital setting, blood work, labs, scans and more are reviewed at length and Devens said she will also consult with physicians and other medical professionals. If there’s any sign that a mother may not be able to safely deliver at home, Devens transfers them to care at a hospital.
According to data gathered by the National Center for Biotechnology Informations (NCBI), U.S. National Library of Medicine from 2004 to 2017, the number of home births increased by 77% in that time period, while birth center births more than doubled.
The data also revealed that planned home births attended by a registered midwife were associated with very low rates of perinatal death and reduced rates of obstetric interventions compared to hospital setting.
In 49 states and Washington D.C., NCBI reported about 85% of home births were planned home births. In 2017, 2.1% of planned home births were pre-term, compared to 11.8% of hospital births. And about 1.3% of planned home births were low birth weight, compared to 8.4% of hospital births.
Fear of an emergency or complications is a common reason why mothers choose a hospital birth, Devens said, but then she mentioned the high rate of C-Sections and maternal mortality in hospital births.
When she hears stories about complications that arose and made a C-Section “necessary” Devens said she questions what led up to that point.
“I’ve really never heard the answer anything different than, ‘Well they induced me because it was almost my due date,’” she said.
“So here they were on Pitocin, maybe they had an epidural, they have had this medication to try to get their cervix to open. So basically the common thing is that there were inventions that were happening that in most cases actually cause the events to cascade in a way that they ended up having that emergency,”
If mothers were allowed to birth naturally and weren’t induced for labor, Devens said the rate of C-Sections would likely substantially decrease.
“We need C-Sections and we need inductions sometimes but they are way overused, we don’t need them near as much as we use them,” she said.
In 2018, the Centers for Disease Control (CDC) reported 3.8 million childbirths in the United States, with 2.6 million vaginal births and 1.2 million by C-Section, about 31.9% of all deliveries were by C-Section.
C-Sections can lead to a slew of complications like increased bleeding, collapsed uterus and unplanned hysterectomies, removal of the uterus, according to NCBI,
One of the biggest reasons for C-Section, Devens said, is a mother’s failure to progress in her labor after being admitted to the hospital, sometimes after a mother was induced for time convenience, as doctors in hospitals generally have less time to spend with patients, she said.
“We don’t see that very often at home because once again you’ve got someone who’s much more relaxed so we don’t see it drag out forever and ever we’re able to support the process. We’re not messing with the hormones and just letting the body do what its supposed to do naturally,” she said.
The U.S. has one of the highest rates of C-Sections in the world, according to the World Health Organization (WHO), and also happens to have the least number of midwives. WHO ranks the U.S. at 55 for maternal mortality rates, just behind Russia. Meaning just 54 countries in the world have higher maternal death rates than the U.S.,
The CDC reported a maternal mortality rate of 17.4 deaths per 100,000 births in 2018 — meaning 658 women died. The maternal death rate for women of color was more than double that of white women. The figure includes deaths during pregnancy, at birth or within 42 days of birth, but according to the CDC, 24% of maternal deaths happen six or more weeks after birth.
A report from 2018, by the Department of Health and Human Services sector at the CDC noted higher rates of mortality in mothers who had C-Sections versus a natural birth.
“It’s ridiculous I can tell you that the biggest reason for maternal death is postpartum hemorrhage and one of the problems is there so focused on the baby’s well-being that I feel like they don’t do a good job at staying on top of what’s going on with mom and they don’t listen to mom,” Devens said.
Her practice handles postpartum differently from hospitals as well, she said. They try to allow for natural delivery of the placenta and don’t rely on medications alone to control any bleeding. The faster the uterus returns to a normal post birth state, the better, she said. One way to promote that is by encouraging breastfeeding soon after the birth.
“People are starting to wake up and wonder, ‘What are the midwives doing because why don’t they have the same problems?’ Inducing too many people,” she said. “That’s the number one issue.”
When a mom is induced it forces the uterus to contract before it’s ready, likely leading to a longer labor and an agitated uterus after delivery. The medication forcing this proves, Devens said, disrupts a new mothers natural hormone balance and can make the body work harder than normal and even lead to bleeding.
While home births are on the rise, there aren’t enough midwives to go around, Devens said she hopes as more people learn about it, they’ll be encouraged to pursue it as a career.