Nationwide, the number of midwives and the number of births they attend is booming.
According to a 1982 survey conducted by the American College of Nurse-Midwives, a professional organization with certification powers, some 3,000 nurse-midwives conducted approximately 72,000 births, a 115 percent increase in five years.
In all its forms, the college says midwifery now accounts for about 2 percent of all U.S. deliveries, a far cry from the days when virtually all children came into the world at a midwife's hands, but still an increase over a few years ago, when the art was threatened and midwife births were counted in the tenths of a percent.
The root of this resurgence, midwives say, is twofold: they offer proven and safe care, usually for less money than a hospital delivery, and they hold to a philosophy that shies away from what many see as overly aggressive medical procedures.
These aggressive prodecures -- such as inducing labor with drugs and the use of forceps -- the midwives say, routinely take place in too many hospital delivery rooms and are a direct reason for the increase in cesarean sections performed nationwide.
"We approach childbirth with the attitude that it's not a surgical event, it's natural," says Carol Leonard, vice president of a New Hampshire-based organization called the Midwives' Alliance of North America.
It's the rise in medical aggressiveness in delivery rooms, as well as the middle class' interest in alternative health care, that is the basis of midwifery's growing popularity, its advocates say.
But midwifery has had to struggle, and although many midwives are nurses who practice in large medical group practices or in health maintenance organizations and hospitals, many have struck out on their own to deliver babies at home or in free-standing birthing centers.
In 1982, the Maternity Center, located in a 20-year-old family home on a narrow Bethesda side street, became the first free-standing birthing center in the metropolitan area.
By combining antique-filled bedrooms with modern medical equipment such as oxygen, electric suction and a fetal monitor, says founder nurse-midwife Janet Epstein-Baden, the Maternity Center can offer a compromise between the laid-back atmosphere of a home and the high-tech sterility of a delivery room.
"There are people who want to have their babies out of the hospital, and they deserve the same kind of good-quality medical care as people who want to go to the hosital. Our concern was to provide a safe environment for them," she says, pointing out that the center is within 10 minutes of a hospital and has several consulting physicians willing to back up the midwives in an emergency.
But with the rise of free-standing birthing centers came opposition from the established medical community.
"As a working policy, we oppose free-standing birth centers," says Laurie Hall, a spokesman for the American College of Obstetricians and Gynecologists.
The physicians' concerns, she says, center on safety.
"A hospital setting provides the safest environment for a mother. We feel if you have to be transported, and it takes 10 minutes -- you might not have 10 minutes."
Despite the reservations of some physicians, couples like Pat and Ken Terrell of Vienna are attracted to midwife-attended births in places like the the Bethesda center.
Pat Terrell, who felt intimidated by her obstetrician, says, "I wanted to take a more active role, to be treated as a person with some intelligence."
The couple investigated midwifery and found it to be as safe as birth in a hospital.
The statistics show such births are safe. Studies found that both independent and certified midwives provide care that equals the safety records of physicians. Malpractice litigation rates also are lower.
The low complication rate, however, is related to the fact that nurse-midwives handle only low-risk births, referring to obstetricians women with complications such as a breech baby, twins, high blood pressure or a need for a cesarean delivery.
That fact is welcomed by the midwives. "When it comes to the normal, healthy family, nurse-midwives give the same medical care," Epstein-Baden says. "The difference is, I think, that we spend more time with families. We're more interested in what goes on in the periphery of the family as well as just the woman."
The Terrells also discovered that their health insurance would cover part of center's $1,500 fee.
But few large insurance companies cover the deliveries. "They won't touch us with a 10-foot pole," says Sue Bartlett, a New Hampshire midwife.
The Terrells believe, however, that some things can't be measured in dollars. An hour after their daughter was born, Ken Terrell says, he was walking down the center's hallway when his parents arrived. "I handed my dad the baby and said, 'I'm going to go make some spaghetti.' He was flabbergasted. He wasn't even in the room when I was born."