A Look at Midwifery:
Back to Natural Birth
Debby Tewes is Asian
Wisconzine's Contributing
Writer in the Milwaukee area
As she was preparing to further her education after high school, Islam looked into midwifery as an occupation, but
was discouraged because it had an a-legal status in Wisconsin. She opted to attend the University of Wisconsin-
Madison to pursue a degree in international relations.

Yet Islam was still interested in maternal health and chose to complete her senior year in Kenya, Africa and
completed an internship working on maternal health issues in rural areas.

“The year in Kenya was probably the best and hardest year of my life,” Islam said. “I was doing a lot of group,
prenatal education on issues of malaria, domestic violence, alcoholism, malnutrition, anemia and pregnancy and
water quality and breast feeding. We did a lot of group prenatal education. I also worked with traditional birth
Tehmina Islam is Wisconsin’s  first
person of color to be a certified
professional midwife.
By Jonathan Gramling

For the Baby Boom generation and beyond, it may seem that it has
always been hospitals where babies were born, that it is only “natural”
that a woman goes to a hospital to give birth. After all, 99 percent of births
in the United States are in hospitals. But at the beginning of the 20th
century, the vast majority of births were done at home under the care
of a general practice physician or a midwife.

As a high school student in Madison, Tehmina Islam first witnessed a
birth when her friend, also a 16-year-old high school student, asked her to
be in attendance at her child’s birth.

“Watching her in the hospital, I was so amazed by the strength with which
she birthed her child, but I was also really in awe with the poor treatment
that she received as a teen mom in the hospital,” said Islam, the first
person of color to become a certified professional midwife in Wisconsin.
“After that, I really thought a lot about birth and knew that my skill
set belonged in providing care for women and pregnant women and
laboring women.”
attendants in the community of Kisumu and lived with a host family there. I would
work with the traditional birth attendants to make home visits to a lot of the moms
who had recently had children or were about to and try to provide prenatal and
postpartum care for them.”

By the time that she came back from Kenya, Islam had decided to become a
certified professional midwife (CPM), which had now become certifiable and
regulated by the Wis. Dept. of Regulation and Licensing. Islam would have to
undergo a rigorous training before she could become licensed.

“I started volunteering as a doula, which is a woman for labor support through an
organization called Small Miracles, which provides doulas for low-income women,
teen moms and women on BadgerCare,” Islam said. “And through doula care, I
learned about a midwifery school in Chicago out of the National College of
Midwifery and started attending classes with a fellow midwife for two years. As part
of your training, you go to school and then you complete an apprenticeship. My
apprenticeship lasted four years. I apprenticed with local home midwives
in Madison and Milwaukee. I also did a six-month internship at the Madison Birth
Center. I got a really nice breadth of apprenticeships.”

Islam apprenticed with CPMs as well as certified nurse midwives (CNM) who are registered nurses with a certification
in midwifery. She also received training in neonatal resuscitation and adult CPR. Last fall, Islam received her
certification and license and established Access Midwifery LLC and works out of her home just off of Williamson Street.

As a midwife, Islam works with women who are experiencing low-risk pregnancies to have a natural childbirth in their
home setting. If the pregnancy remains low-risk, the woman gives birth at home without a doctor or nurse present and
without the administration of drugs like Pitocin, a labor-inducing drug.

“The midwife’s model of care really advocates for holistic care and looking at a woman during her pregnancy and birth
as a holistic aspect, looking at her psycho-social health, her physical health and her mental well-being,” Islam said. “It
is care that minimizes technological interventions and really allows a space for women to follow their bodies and birth
the way they feel most comfortable and most supported. It’s also vigilant care where you are monitoring that pregnancy
and making sure that home birth is safe when you have low-risk women having home births. It monitors the pregnancy
to see when that risk increase and become a high risk pregnancy. At that point, you refer to obstetrical care or hospital-
provided care. I think that’s also a part of midwifery care, to be vigilant about what is low risk and really maintain that
boundary so that home birth stays safe.”

Central to the practice of midwifery is the development of a trusting relationship between midwife and the pregnant
woman who remains in control of her pregnancy.

“I don’t automatically assume that she will listen to what I have to say because of my credentials,” Islam said. “I hope
that she will listen to the recommendations that I make because I have invested in a relationship of trust and integrity.”

Midwifery is natural childbirth that has the relationship between the midwife and the mother as the center of the birthing
process. Each visit, which lasts an hour, involved only the midwife and the mother. Over the course of the nine-month
pregnancy, a relationship based on trust and communication that is imperative for a positive birthing experience, is
formed.

“During your prenatal visit — they last an hour or more — it’s really just one-on-one care,” Islam emphasized. “They’re
getting an hour visit where we talk about nutrition, supplements and how they are doing and how their body is handling
the pregnancy. We measure the baby with a measuring tape. And we palpate to know the baby’s position. We listen to
the baby’s heart tones, which is a good sign of the fetal health. And we really try to incorporate the mom and the family
into the care as much as possible. So we show her how to feel her own body and allow her to listen to the heart tones
as well. Sometimes we use a Doppler, which is an ultrasound to listen to the baby, or use a fetus scope, which is more
of a traditional tool to listen to the baby’s heart rate.”

When one says it is natural, they mean natural. There are no drugs involved.

“A lot of our clients will really educate themselves about natural childbirth and about ways to cope with it and really
mentally prepare for the hard work that is labor,” Islam said. “Pain medications don’t often cross your mind when you
are in the throes of labor because you have prepared yourself to manage as best as you can. And that is also why you
have a good support team, why you’ve called a midwife and why you have involved your partner hopefully in your care so
that you do have people you can rely upon to get through it. It is natural childbirth and that natural childbirth really allows
the avenue for all of your hormones to be at their peak so that when you birth that child, you are having bonding
hormones. You’re having oxytocin flow through your body and flow through your baby and that
really allows bonding to take place between mother and child.”

With natural childbirth, it is the mother who is in control although there are rules and guidelines that must be followed.
For instance a birth at home can only occur during the 37th to 42md week of pregnancy. If labor begins before or after
that time, the mother must deliver in a hospital where she can access a certified nurse midwife or the traditional
hospital birthing procedure. But at home, it is the partnership between the midwife and mother that creates a positive
birth experience.

“She may call to let me know that she is experiencing some contractions or that her water might have broken or she is
starting to see her mucus plug come out,” Islam said about the beginning of the birthing process. “So she might start to
feel the signs of labor slowly come on. We may stay in touch by phone. I might make a home visit and check in and then
she calls me when she is ready for her midwife to be there. That might be in the middle of labor. That might be towards
the end of labor. That might be early in labor.

“But I provide continuous support and monitor her health. I take her vitals. I monitor the baby’s health and listen to the
baby’s vitals and heart rate. I rarely do vaginal exams. I only do that at the mom’s request or if there would be a need for
it. But a lot of midwifery care is sitting on your hands and really just being vigilant and watchful and supportive. You only
intervene when there is a need, but not intervening because you are trying to create an intervention. I might intervene
because there is some stalling of labor, but I wouldn’t do a vaginal exam just to know how she is doing every two hours.
I ask her to let me know how she is doing and do a vaginal exam if her
outward signs of labor are not showing that she is making progress. So we follow a lot of outside cues as well in
addition to monitoring her vitals and internal exams and things. It is pain-medication free. We offer the option of having a
water birth. So we bring a big warm tub that we can fill up with warm water and she can either labor in there to help with
the pain or she can birth her baby there as well in the water. But we try to use natural remedies like massage, warmth,
water and position changes. We use some herbs and homeopathic remedies to help with the stalling of labor or mood.
But yes, it is natural childbirth.

“We stay until she has birthed her baby. I don’t ever say that I delivered the baby because the mom really does all of that
work. I just attend the birth as midwife. And we stay a couple of hours postpartum. We make sure that her bleeding has
decreased or is stable. We monitor her vitals postpartum. We make sure that the baby had been breastfed. We make
sure that we do a dull newborn exam on the baby before we leave to make sure that his or her vitals are stable and
mom and baby are comfortable. And then we leave and return in 24 hours. We do a newborn and mom check at 24
hours and then we return at three days, at two weeks and at six weeks.”

During this whole period while she is being attentive to mother and child, Islam is following strict guidelines that dictate
what happens if any complications arise. If certain thresholds are met, it is off to the hospital for more intensive medical
care.

Islam is the first person of color to be licensed in the state of Wisconsin as a midwife. And she feels it is important for
more women of color to get involved in natural childbirth as midwives and as mothers.

“It is especially important to me because midwifery care has good birth outcomes and in Dane County, if you are a Black
woman, you have a four times greater likelihood of having your infant die than a white woman when you are pregnant,”
Islam said. “I think that midwifery care could potentially be a solution to decreasing infant mortality and I think it is more
individualized, has more continuity of care and has therefore the potential to have better outcomes for higher risk
women or women of color who just through racism face a greater likelihood of having their infant die. And so, partially it
is that I am a woman of color and I want to see more women like out there. And partially, midwifery care shows good
outcomes and I think women of color deserve that chance of having a good birth outcome, which isn’t the case right
now.”

Islam emphasized that natural childbirth isn’t for everyone. And although the services of a midwife can cost
$1,500-$3,500 — Islam charges a sliding scale fee — it shouldn’t be done just as a way to save money although
economics continuously play a bigger role in health care. It should be done for the benefits.

“Every woman has the right to choose a home birth and midwifery care,” Islam said. “In my humble opinion, I think that if
a home birth and hiring a midwife is where you feel safest and most secure and most comfortable, if that model of care
offers so many advantages, then people should be able to avail themselves of it. There was a study in 2005 that recently
compared low-risk women in the hospital to low-risk women at home. The cohort group was over 5,000 women in the
United States. The women who had their babies at home had a lower c-section rate, a lower epidural use rate, a lower
rate of episiotomies, a lower rate of medical interventions in general and a lower rate or pre-term births and low birth
weight babies. So the outcomes are good in home birth. In that same study, the neonatal and maternal mortality risks
were the same. So the risks were the same to baby and mother, but the benefits exceed when done at home.”

Natural may just be the way to go.

For more information about midwifery, Tehmina Islam may be contacted at
accessmidwiferywi@gmail.com or 251-0776.