Choice of 3 specialties, 13 caregivers

Since Our Bodies, Our Selves hit the bookstores in the early 1970s, women have redefined the birthing process in America.
Their empowerment is reflected in the myriad of choices women make about how to bring their babies into the world, starting with selection of their caregiver--a caregiver who is not necessarily a physician, a physician who is not necessarily an obstetrician.
In Santa Cruz County, there are three choices of professionals for prenatal care, childbirth and care following the delivery—an obstetrician, a nurse-midwife and a family physician. All three care for women from youth through old age and are committed to supporting the wishes of mothers-to-be, open lines of communication, providing education and giving high quality care. Each, however, has a special niche.

OB/GYNs Specialize in High Risk Pregnancies

The five obstetricians in the Santa Cruz Medical Clinic are Janna Doherty, M.D., Dawn Lawson, M.D., Marsha Muir, M.D., Howard Salvay, M.D. and Susan Schaefer, M.D.
An obstetrician/gynecologist (OB/GYN) is a physician who has completed four years of residency training in diseases of the female reproductive system. They are specialists in women’s medicine, which includes but is not limited to prenatal care and delivery. “We see ourselves as more specialized for women with high risk pregnancies and births,” said Dr. Doherty “We’re comfortable managing the medical complications of pregnant women with diabetes, high blood pressure and asthma, for example, or older childbearing women.”
In addition to normal vaginal births, obstetricians perform cesarean sections, operative vaginal deliveries and vaginal births after a previous cesarean section (VBAC) or with mothers at high risk for medical complications during vaginal birth. They also do ultrasounds in early pregnancy and screening ultrasounds for abnormalities.
The OB/GYNs back up family practice physicians and nurse-midwives in case an emergency arises during delivery by a healthy, low risk mother who has not selected an obstetrician for care.
“It is part of our OB/GYN group’s philosophy to work with family physicians and midwives,” said Dr. Doherty, who delivered 1,000 babies during her internship and residency at a Kaiser facility. “They add a different dimension to our practice and we feel very comfortable in backing them up. We like to function together as a team.”

Nurse-Midwives Focus More on Emotional Needs

Three nurse-midwives share offices with the Clinic’s OB/GYNs. They are Karen Laing, CNM, Sherrie St. Clair, CNM and Kris Ayer, CNM, whose total of 76 years’ experience delivering babies is evolving into caring for a second generation of mothers.
Like the Clinic’s OB/GYNs and family physicians, they deliver babies in a hospital, usually at Sutter Maternity and Surgery Center (SMSC). In fact, one-third of the babies born at SMSC are delivered by nurse-midwives.
They do not deliver babies at home. “SMSC provides a very homelike, relaxed birth experience with a nursing staff who is very supportive of families. It’s a wonderful facility with all the medical back up we might need that we wouldn’t have during a home birth,” Ayer said.
“We come to the hospital when mothers are in active labor, helping in whatever ways are necessary. The physical part of our labor support might be giving back rubs, focusing breathing and helping the women labor in a nice, big bathtub,” Ayer explained. “We deliver the baby when it’s a normal birth or support the mother’s partner if they’re interested in catching the baby and putting the baby on mom’s belly.”
If the birth turns into a cesarean section, the nurse-midwives are right there as surgical assistants.
“We have more of a peer relationship with mothers because we aren’t physicians,” Ayer said. “Women feel distinctions between themselves and physicians that they don’t feel with us. If they desire it, we often develop close personal relationships with our patients and their families.”

Family Practice Pysicians Attuned to Family Dynamics

The Santa Cruz Medical Clinic is somewhat unusual for offering birthing services by family practice physicians who in many counties were driven out of obstetrics years ago by the high cost of malpractice insurance.
The five family physicians who include obstetrics in their practices are Laura James-Beckham, M.D., Denise Devereaux, M.D., Kathryn Harvey, M.D., Lonna Larsh, M.D. and Tracy Maclay, M.D. Family Practice physicians specialize in primary care for all ages.
Like nurse-midwives, family physicians care for healthy, low-risk mothers; are backed up by OB/GYN specialists; spend a lot of time with mothers through labor and transition; and deliver babies.
“Family physicians are very interested in family dynamics and all that influences each family member’s health and psychological well being,” Dr. Devereaux said. ”Delivering babies seems really natural because you’re involved in extending a family and having babies is a huge part of being a family.”
“Many women like to continue seeing someone they already know and trust, someone who treats the family,” she explained. “And we usually care for the baby, too. It’s fun to watch them grow.”
These five female physicians share a similar philosophy and tend to deliver their own patients when the time comes, whether or not they are on call.
“Most of the time, women know their bodies and what to do,” Dr. Devereaux said. “We’re there to make sure the woman and baby are safe and to support women in what they want for their births.”

All Santa Cruz Medical Clinic OB/GYNs are board certified by the American College of Obstetrics and Gynecology, and the Family Practice physicians who deliver babies are board certified by the American Board of Family Practice.
The three nurse-midwives are registered nurses with advanced education and training in midwifery and women’s health. They are also licensed OB/GYN practitioners and certified by the American College of Nurse-Midwives.

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