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  • University of Maryland Medicine provides more information on the midwife profession in its online medical encyclopedia.
Midwife Waxes Wistful at Malpractice Rates That Doom Her Practice

Midwife Eileen Ehudin-Pagano with patient Nadia Young (Photo courtesy of Ken Lopez)
Midwife Eileen Ehudin-Pagano at the Baltimore Birth Center with patient Nadia Young. (Photo courtesy of Ken Lopez)

By Sara Clarke
Capital News Service
Friday, April 30, 2004

BALTIMORE - Everyone who knows midwife Eileen Ehudin-Pagano mentions her determination. But ironically, after 27 years of practice, she's giving up.

Ehudin-Pagano, 56, and her business partner Ann Sober opened their free-standing Baltimore Birth Center in 1981 in an orthodox Jewish neighborhood. Since then, they've escorted more than 3,000 babies into the world with a type of care much different from a typical hospital setting.

In May, the center will close, as have several others trapped between declining health plan reimbursement rates and increasing costs for medical malpractice insurance.

Last year, premiums jumped from $5,000 per midwife to $9,000, said Sober. With an average salary of $73,900, Baltimore midwives are paying more than 12 percent of their earnings toward malpractice insurance.

So far, a group of four midwives in Frederick has shut down, a practice in Georgetown has closed, and the Eastern Shore has lost a couple of midwives, said Jenifer O. Fahey, legislative liaison for Maryland Chapter of the American College of Nurse-Midwives.

It's a huge loss in options for women, said Laura Glassow, who will deliver her second child at the center after finding there are no certified nurse-midwives in the area who still do at-home births. "Hospitals are bright, cold and scheduled. It's not women oriented, it's doctor oriented."

Ehudin-Pagano, who became a certified nurse-midwife in 1977, chose to be a midwife to fill a void in women's health care. It was her chance to restore women's confidence in natural childbirth.

"There weren't enough midwives practicing, and it wasn't an anti-hospital or anti-doctor thing, we just wanted to provide more options," said Ehudin-Pagano, who friends and family describe as a dynamo.

"She gets more done in a day than most people get done in a month," said Roslyn Zinner, Ehudin-Pagano's sister.

Raised in a close-knit, middle-class Jewish home in Northwest Baltimore, Ehudin-Pagano is the oldest of three girls. She started early in health care, volunteering as a candy striper and studying nursing at Union Memorial Hospital School of Nursing in Baltimore. She also attended University of Maryland Baltimore County and Towson University.

As a visiting nurse and childbirth instructor for former Baltimore obstetrician Dr. Arnold Michael, she acquired a mentor who supported her and Sober as they planned the birth center.

Twenty-four years after becoming a midwife, she was in school again -- this time middle-aged and with five children -- to get certified as a family nurse practitioner, allowing her to provide more comprehensive care to patients of all ages and genders.

Her famous determination kicked in as she plowed through 42 credits in 10 months, with all As.

"I'd just made up my mind that this was what I was going to do, and that's how I've always functioned," she said. "I don't know how to do anything any other way."

Zinner said her sister is a role model. While studying at Downstate Medical Center in Brooklyn, N.Y., Ehudin-Pagano commuted home to Baltimore on weekends.

"Going back and forth to New York, that's the sort of thing she'd be able to pull off," laughed Zinner. "And she still sends birthday cards out on time."

So determined was she, that Ehudin-Pagano brought her three children to the center each day with a baby-sitter, taking breaks from appointments to feed them.

But her driven nature disappears around patients, said Zinner.

"Experiencing her as a clinician was very different from seeing her as a sister day to day, running and doing things," said Zinner, whose youngest child was delivered by her sister. "Seeing her as a patient, she was calm, quiet, she had a completely different aura. She was able to turn her energy off with patients and pay attention to their needs."

Her personality is neither warm and mushy, nor clinical, said patient Peninah Katy, who had five children at the birth center, two delivered by Ehudin-Pagano.

"She is very knowledgeable, and very comforting," said Katy. "She gives you a very secure feeling, that she's been there, and seen it all, and that whatever happens, she can handle it."

What Ehudin-Pagano enjoys best is being at a delivery.

"What's more exciting than to participate in the birth of a new life?" she said. "I guess for midwives that's the icing on the cake, that's the high, the endorphins, it's very exciting."

Still, long-standing patient relationships are high on the list.

"I just spoke with a woman today that I've been caring for for 21 years," said Ehudin-Pagano. "So that's really exciting, to be with someone as they move through the life cycle . . . to sort of grow old with them."

The center's midwives specialize in gynecological care for their 'special ladies,' women with physical and mental disabilities who often aren't well-received by the health care community.

"People think, 'Ugh, who wants to care for that person?' Maybe they don't look so nice, or act so nice, but here, we've really made a lot of special accommodations," said Ehudin-Pagano.

Many low-risk patients come to the center to avoid the cumbersome medical intervention of hospitals. At the birth center, they can move around during labor, unfettered by IVs or monitors. Family and friends can attend, waiting in the comfortable living rooms or eating together in the center's kitchen. Women can go home the same night. Their newborn never leaves their sight.

"We see our role as the overseer, to make sure that everything's safe, because birth is a natural process," said Ehudin-Pagano.

"Women have been giving birth without epidurals and IVs since Adam and Eve," she added. "It's just like (the quote) in the movie Gone With the Wind. 'I don't know nothin' about birthin' babies.' Well, most of the time, babies just know what to do and come on their own. It's only when something goes wrong that you really use your skills."

As the birth center prepares to close, Ehudin-Pagano is pursuing a job as a family nurse practitioner, for once getting just a 9-to-5 job, and not having to worry about patients calling with labor pains in the middle of the night.

Ehudin-Pagano says she's ready for the switch - almost.

"I will certainly miss the joy of being with families at their births . . . I'll certainly miss that."

Copyright 2004 University of Maryland Philip Merrill College of Journalism


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