Joan Green offers West Marin midwifery with heart

01/19/2012

Nearly 30 years ago, while fasting alone in the deserts of New Mexico, Joan Green had an epiphany. Educated in biology but long uncertain about how to create a fulfilling career, she realized what she wanted most was to help bring people into the world.

Today, the 57-year-old midwife continues to enjoy the fruits of her—and others’—labor, which show up everywhere. “I love the fact that I can go for a neighborhood walk and point to a lot of houses and say, ‘I had a baby there,’ or ‘Oh, I had one over there,’” she said.

Green is trained and certified through the state to provide home care to women during pregnancy, labor, birth and the postpartum period. As a midwife, she has certain medical skills, such as the ability to resuscitate a breathless child or recognize when a mother is losing too much blood. She also offers emotional guidance to mothers and couples prior to and after birth.

In the age of modern medicine, childbirth has evolved into a highly sterile and scientific process. Midwifery—both in and out of hospital—is used in just 7 to 9 percent of all births in the United States, according to the Center for Disease Control and Prevention (CDC). Homebirth accounts for just 1 percent of all U.S. births.

But Green believes the alternative is better for families. “It’s a huge benefit for the baby because in a standard hospital birth the baby is usually immediately removed from the mother and placed under bright, artificial lights,” she said. “[Home birth] offers just a softer, much more organic transition for the baby, one that ensures that the incredible biological bonding between a mother and child is not interrupted.”

A 2007 CDC report determined similar mortality rates for low-risk hospital births and planned home births.

Many parents are attracted by midwifery’s holistic approach. “I was born at home, my brother was born at home; it’s just something I was more comfortable with,” said Terra Livingston, who, with guidance from Green, gave birth to her son at her Inverness home in 2010. “Really it was about wanting to be in more control and not wanting drugs.”

Of her experience with Green, Livingston added: “It was awesome.”

Homebirth can also afford fathers a greater role throughout pregnancy and during labor. “I love dads to be involved,” Green said. “So one of my roles is letting them get to know me, and then a lot of times if a mom needs something like a certain touch or massage I’ll encourage the dad to do that, just nudge them along.”

Cost is also a factor. A typical low-risk birth in a hospital costs approximately $20,000, Green said. Her fee, in comparison, is just $4,000. The downside is that health insurance companies are less prone to cover midwife services, though Green said most of her clients get about 50 percent of their fees covered.

And higher hospital costs don’t necessarily equate to more attention. “An average obstetrician visit is about five minutes,” said Green, who spends over a dozen hour-long consultations with her clients during and after their pregnancy.

One of Green’s biggest health concerns with in-hospital births is the increasing tendency towards Cesarean births, or C-sections. The procedure, which removes children surgically via an incision in the mother’s abdomen, was originally intended for high-risk or problematic births, but a growing number of pregnant women are today having it administered voluntarily. According to the CDC, the rate of C-sections performed in the U.S. has risen to approximately 32 percent, a 48 percent increase since 1996.

“My main concern is that a C-section is major abdominal surgery,” Green said. “Having a baby is already a lot of work for the body and to add surgery on top of that can be really dangerous. Plus it interrupts bonding with the baby, involves drugs, and the long-term complications”—such as adhesions, hernias, infections, blood loss and even maternal death—“are vast and unknown.”

Home births, like all births, come with some risk. According to Green, the worst is blood loss, which she says is especially rare in West Marin, where women tend to have healthier diets. She is also trained to spot problems early on. “Most complications don’t arise out of nowhere,” she said. “There are always red flags, and if we see something we’ll go immediately to the hospital.”

Green was born in Oklahoma, the daughter of two schoolteachers. She grew up in Texas and went on to study biology at the University of California, Berkeley and the University of Texas, El Paso. After college she wandered from job to job in the Southwest, working as a substitute teacher and later in real estate.

After her desert awakening, Green returned to El Paso, where she began studying midwifery, which was legally recognized by relatively few states at the time, Texas being one. Her program was intensive; she recalls taking part in some 150 births during one seven-month period.

Green eventually relocated to the San Geronimo Valley and started her own practice, called Heart Wisdom Midwifery. Since then, she’s witnessed a marked shift in the public’s perception of her profession. “When I started out we were just battling to get recognition; we were a bit more hippie back then,” she said. “Now, midwifery has really become a recognized profession.”

Green’s practice is relatively small. On average she oversees two to three births per month, always with the presence of a second trained midwife. Recently, she acquired her first apprentice, who will work with her for the next three or so years before beginning her own practice.

Green notes that though the hours can be long and the financial rewards slim, she can’t imagine herself doing anything else. “I like looking at my life and thinking I was lucky enough to find something I really love,” Green said, “because it’s definitely not fame and glory that a midwife is going to get.”