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Ralph deAyala and Elyse Cho

Image: Troy Fields

Ralph DeAyala walks in to Elyse Cho’s office bearing good news: The hospital that his obstetrics and gynecology practice is affiliated with, the Memorial Hermann Memorial City Medical Center—right next door—has acquired a trio of state-of-the-art squatting bars, which are popular for midwife-assisted births, to attach to their beds. “Sweet!” says Cho in response, punctuating her excitement with a fist pump.

Cho joined deAyala’s practice in January 2017, becoming the first certified-nurse midwife to receive credentials at Memorial Hermann. Even as attitudes and preferences around giving birth have shifted in recent years, expectant mothers in Houston have mostly been limited to two options: a traditional, hospital birth or an alternative route, typically delivering at home or at a birth center with a midwife and/or doula. But deAyala says it doesn’t have to be that way—and in other parts of the country, it usually isn’t.

“Houston is rare,” he says, careful to note that locally, Texas Children’s Hospital and UTMB also offer limited midwife care. “I practiced for 11 years in the East Tennessee area, and I don’t know of a single OB/GYN with a busy practice who didn’t have one or two nurse-midwives working there.”

Bringing a midwife into a traditional practice benefits everyone involved, Cho and deAyala say. Cho manages her own clients, and she can handle the entire labor and delivery process for low-risk patients, with deAyala available to step in if a complication emerges. She also offers additional face time and support during the doctor’s deliveries.

“She knows a lot more of the granny methods and home-remedy stuff that works—it really does, it’s been working for years,” he says, referencing practices like using essential oils to stimulate contractions and positioning techniques to move the baby into the right spot in the birth canal. “And we don’t get that training in med school, so I learn from her, too.”

Having a midwife in a hospital setting also means that patients with risk factors that would disqualify them from birthing centers have more options within the hospital safety net. It also makes midwife-driven care possible for those who can’t pay out of pocket for the service—most birthing centers don’t accept insurance.

Cho herself originally wanted to be a doctor, only to fall in love with the midwife role while attending a medical conference in high school.

“I was supposed to be following this OB/GYN, but he was like, ‘I don’t have time for a student today, go with the midwife.’ I thought to myself, ‘The midwife? Ugh.’ But it turned out to be the most amazing experience. I was able to labor with a patient all day … It was breathtaking to watch her relationship with the patient.”

Despite their different backgrounds, Cho and deAyala share a collaborative and flexible approach to the birth process. Though they can’t offer every alternative-delivery method at the hospital—water births are currently out—they support patients who want to walk around, eat, take a shower, or use a birthing ball during labor, as long as the situation warrants it. And now there’s the new squatting bars that women can lean on in order to facilitate delivering from a more natural squat stance, rather than the traditional supine position.

“My motto is, you can deliver the baby however you want,” says Cho. “I’ll be there to catch it.”

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