Other than shepherds, prophets and demons, not many occupations are named in Genesis, the first book of the Bible. One mentioned twice is midwife. And except for a few shepherds up in the hills, some self-anointed prophets and senior demons, it’s the only one of these still going strong today.

In fact, the role of the woman (and the occasional man) who assists in births has received increasing acceptance the last four decades from OB-GYNs, the physician gatekeepers of pregnancy care who for many years looked down their noses at these earnest ladies.

Today’s midwife, however, is not the apron-wearing granny-farmwife of rural lore, and hasn’t been for a long time.

Watching all this with a satisfaction that runneth over is Carmela Cavero, an energetic, size Xsmall petite, 79-year-old retired nurse living in Tierrasanta. For decades, she worked to upgrade the science of midwifery and its public perception.

Carmela is the daughter of a Peruvian physician-father and an Irish mother. She graduated from Cornell University in nursing in 1955, but after four years in public health decided to become a midwife. She then earned a master’s degree in nursing from Columbia University in 1960, and also a certificate in nurse-midwifery.

Her internist father looked askance at her choice of careers. “That’s one of the oldest professions,” he would remind her. “Do you know what the oldest is?”

She says her father finally came around when she became president of the American College of Nurse-Midwives in 1971.

Looking back, she says, “One had to be very passionate about it, because it wasn’t that easy. It wasn’t acceptable. It was misunderstood. There weren’t that many jobs for nurse-midwives. We were swimming upstream in the culture.”

Though long accepted in Europe, in the U.S. the recognition of midwifery languished during the first decades of the last century due to resistance from the medical establishment. The effect was to deprive midwives of proper training, though the need for their services grew along with the numbers of poor women.

“When I started out, when we would be making small talk at a party, people would say, ‘Oh, and what do you do?’ and I’d say, ‘I’m a midwife.’ They’d say, ‘What? Isn’t that illegal?’ ”

Her entry into midwifery coincided with a shortage of physicians in the ’60s and ’70s, and the rise of the women’s movement. Feminists encouraged the use of midwifes because of concern that poorer women were receiving inadequate and even dangerous pregnancy care, from prenatal to birthing to postnatal.

Carmela says the women’s movement also became concerned that the childbearing experience had become too “medicalized.”

“Decisions were being made by physicians and not by couples themselves. For example, the overuse of painkillers, the immediate separation of mothers and babies after birth, and the denial of family participation in the process, especially fathers.”

She is asked why the medical establishment itself didn’t address these concerns.

“It had to do with the education and belief system. Doctors are concerned with the treatment and cure of disease. Pregnancy, however, is a natural event. The focus of the midwife is on health, not illness.”

She believes there is today an increase in home births because of a desire for greater family intimacy and a fear of hospital-borne infections.

Midwives make house calls.

(The dictum midwives follow is to participate in normal births, which almost all are. However, if trouble is foreseen, they are to immediately call in a physician. And if a physician should ask to be involved, not to argue.)

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Hard slogging though it can be, need and education change social perceptions. Carmela had a great, satisfying moment during a conference last year of the nurse-midwives organization.

“The message I heard then is that midwives are being asked for input at the governmental level on setting maternity care policy. I thought, ‘Wow! We’ve come a long way.’ ”

The organization now has more than 6,300 members, most with master’s or doctoral degrees.

Carmela says the science of child-birthing can overshadow its art. For example, she developed a deft “touch” of being able to reposition a baby whose shoulders can’t pass the mother’s pelvis during delivery. She would patiently maneuver the shoulders to enable the baby to pass through the birth canal. “Sometimes,” she says, “a doctor who encountered that situation would, in midbirth, tell his nurse, ‘Call Carmela’ ” to perform the delicate procedure.

In 1973, she ventured to South Carolina for three years at the invitation of the Medical University of South Carolina to establish a nurse-midwifery program to upgrade maternity care, especially in rural areas. At that time, many births were attended by “granny midwives,” the mostly black women who served their sisters who often were denied care in the hospitals of a state still struggling to rid itself of segregation.

Carmela says she was well received by those midwives who — human nature being what it is — might have resented outsiders telling them what they were doing wrong.

“No,” she says, “they weren’t like that. I loved the granny midwives. I was in awe of what beautiful people they were and how proud they were of what they did.”

She also served as a midwifery consultant in Colombia and Guatemala.

Carmela didn’t have to go far to encounter cultural differences in birthing. In Fresno, she attended to Hmong women who would squat on the floor during labor, most of them delivering in silence.

Carmela says that of more than 2,000 births, she has never delivered a baby that was not alive, but that doesn’t mean the shadow of tragedy was unfamiliar to her.

“In 1971, in Springfield, Ohio, I was called to a community hospital to attend to a teenager. There were no physicians, nobody. When I examined the girl, the baby’s head was not in the birth canal and was preceded by the water bag, a bulging, tense bag of fluid. The danger was that when the bag ruptured, the cord could come right down with it. There wasn’t really time to do much of anything because she was starting to deliver.”

She explained that if the cord slipped down in front of the head, it could become compressed and cut off circulation to the baby, thus one of the surest ways for a baby to die.

“That was a moment when I was praying really hard. I decided to pinprick the bag and let it leak down slowly. Sure enough, the head came right down. It was born and everything was fine.

“It was a very close call.”

Have you had children of your own?

“No, I didn’t have that experience. Instead, I had 2,000 experiences that I shared.”

Fifteen years ago, newly retired, she was called to a neighbor’s house in Tierrasanta to deliver a last-minute baby boy. She was rewarded with a box of candy, but that neighborly gesture was in addition to her real reward, the same satisfaction she got from her first-ever delivery, and every one thereafter.

Her final delivery happened three years ago when she delivered a healthy baby girl to her step-granddaughter.

And Ted Williams also hit a home run in his last at-bat.



Fred Dickey’s home page is freddickey.net His email is freddickey@roadrunner.com



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