KRISTA SEYMOUR
Observer-Dispatch

BARNEVELD -- In a quiet log house, Sherry Joslyn-Ruffrage watches her infant boy yawn and wriggle his face into sleepy expressions.

George Robert Ruffrage is the family's third child. This time, the family used the assistance of a midwife at Rome Memorial Hospital, which is one change the hospital is making to lower its Caesarean section rate.

"The midwife was like part of the family," Joslyn-Ruffrage said. "It was the first time I'd had a woman to work with, and I just felt that she was easy to talk to. I liked her from the get-go."

Just two years ago, Rome Memorial had one of the region's highest C-section rates. Now, steps such as use of midwives have led to a decline in that rate at the hospital from 22 percent of births in 2001 to 18 percent last year.

"We've gone from one of the highest rates in the area to one of the lowest, and we're really happy about that," said Cassie Evans-Winter, the hospital's public relations director, adding that the hospital is still focusing on lowering the rate.

Rome Memorial Hospital took a cue from the American College of Obstetrics and Gynecology, which set a national goal of 15 percent for 2000 -- a goal that has yet to be met.

"They began talking about national realistic goals," said Dr. Ankur Desai, a physician at Rome Memorial. "Most national conventions began discussing what could be done about elective Caesareans."

Experts want to lower c-section rates because having surgery is more complicated and requires a longer recuperation time than vaginal births. But the rates may be creeping up because the ob-gyn group recently started discouraging vaginal births after Caesareans, or VBACs.

Although the chances are small, doctors say uterine scar rupture can occur with a VBAC.

The national C-section rate hovers around 24 percent. Last year, many Mohawk Valley hospitals had a higher percentage.

Community Memorial Hospital in Hamilton had an overall rate for last year of 32 percent, the highest in the region. Little Falls Hospital had an overall rate of 27.4 percent, with Faxton-St. Luke's Healthcare slightly higher at 28.5 percent.

Although its rate is higher than average, Community Memorial says it hasn't put an emphasis on changing practices regarding C-sections.

"We're always trying to keep our rates down," said Patricia Strong, nurse manager at Community Memorial, adding that the birthing classes and techniques offered at the hospital help prepare women to give birth naturally.

Working through labor

Rome Maternity Nurse Manager Cathy Destito, a 27-year veteran in the field, has seen dramatic changes that have made her appreciative of the new philosophies and techniques that help laboring mothers feel more comfortable.

She believes that the growing national trend of accepting midwives in hospitals as a part of the maternity ward staff is integral to helping labor and delivery change from being strictly medical to becoming as natural as possible.

She said the historically medical focus of labor and delivery has resulted in many women choosing to have a c-section instead of working through the labor naturally.

Midwives also generally encourage women to have VBACs.

Joslyn-Ruffrage had a c-section with her first child, Keith, now 13, who was in breech position, which required the procedure. But she gave birth vaginally to her other children, including Heather, now 7, and George.

Joslyn-Ruffrage said she had support from her midwife in her decision.

"I was mostly worried about getting to the hospital on time, and not so much rupturing the scar," Joslyn-Ruffrage said. Her entire labor, from the first contraction to birth, lasted a mere four hours.

Four midwives currently work through Rome Memorial. One midwife works through St. Luke's, and there are none at Little Falls Hospital or Community Memorial Hospital.

Joslyn-Ruffrage worked with Nancy Peek, a midwife at Dr. Paul Temple's office. Peek was a nurse before completing two years of midwifery training at SUNY Stony Brook on Long Island.

"As a midwife, I'm responsible for the birth, the mother and the baby," she said, adding that as a nurse she acted more as an assistant to the physician, but now they work as a team.

"In the medical model, a doctor sees a problem and fixes it. In midwifery, we see how we can fix the whole woman. We look at the bigger picture," she said.

Peek said one reason the midwifery model has been slow to take off is because it can be viewed as a threat to the authority of the physicians. But when Rome Memorial accepted midwives in its labor and delivery rooms, the physicians readily welcomed them.

"We really need the midwives in order to have a life outside of being a physician," said Dr. Lauren Giustra, who is originally from New York City. "We really appreciate them."

Giustra said a lot has changed in the birthing process with the addition of midwives. Doctors are trained to do things strictly by the book, she said, and if a woman is not progressing with labor, a doctor is taught to perform a c-section after a certain amount of time.

"A nurse or midwife may look and say, 'wait, let's give this patient another hour to see if she progresses,'" Giustra said. "My philosophy has changed that way."

Different techniques

Destito believes the practices mainstream hospitals are now beginning to use have been common among midwives for years; it has just taken time for physicians to begin to accept the holistic, proactive philosophy.

"Lamaze was the first attempt to make women more proactive," Destito said. "She didn't just lay there and tolerate it any more, and it got the dads involved. They began to work as a team."

Rome Memorial Hospital has also introduced equipment to help mothers keep moving and relaxed. The tools include the birthing ball -- essentially a large exercise ball -- and the birthing stool -- which is a covered metal frame without a seat.

The mother can sit on the stool with legs to each side, which helps relax the pelvic muscles. The birthing ball allows the mother to straddle in a comfortable position while being able to sway and gently bounce, which also relaxes the muscles as labor increases.

"When a woman is more proactive, she relaxes, and that speeds up the labor. It empowers them," Destito said.

2002 CAESAREAN RATES

ROME MEMORIAL HOSPITAL, Rome
Overall: 18 percent. Total births: 574.

COMMUNITY MEMORIAL HOSPITAL, Hamilton
Overall: 32 percent. Total births: Less than 200.

LITTLE FALLS HOSPITAL Little Falls
Overall: 27.4 percent. Total births: 217.

ST. LUKE'S Utica
Overall: 28.5 percent. Total births: 1,933.

Source: Area hospitals