ViviAnne Fischer practices midwifery in her clinic near Pullman, where you can see her connection to the long and complicated history surrounding the practice.

In a green-colored house along a dirt road, at the top of a set of stairs, a large, nondescript black suitcase stands before a crammed bookshelf, her “library” for families. Inside the suitcase is a mix of new, modern medical equipment beside bottles of herbal extracts.

On the other side of the room is an odd-shaped stool at the foot of a bed. The bed is almost cot-like but the wooden frame poking out from beneath the quilt is carved. The quilt itself is bright and cheery, a subtle reminder of the joys of childhood and family.

Fischer positions herself on the stool. Using both her body and her words, she describes how the stool is used by women who want to remain semi-upright during birth. Birthing stools are ancient, she says.They’re designed to help first-time mothers with difficult births.

The Pacific Northwest has a certain reputation for being a little unconventional, so it’s not surprising that alternatives to the typical hospital birth, including midwifery, are higher in comparison to other regions.

Childbirth is one of the leading reasons for hospital visits throughout the country, yet the Centers for Disease Control reports that Washington, Oregon, Idaho, Montana, and Alaska—along with Pennsylvania—have the highest percentage of out-of-hospital births: between 3 and 6 percent in contrast to around 1 percent nationally.

Although midwifery has been around since humanity began, its use in the United States dwindled over the last century as the medical field expanded. It has staged a comeback in the last 10 to 15 years, even as it remains illegal in some southern states.

Anthropologists like Barry Hewlett have been exploring birth practices throughout the world’s cultures. The WSU professor focuses on what he refers to as the “anthropology of childhood.” Hewlett says that what American society refers to as “alternative” birthing practices is, in reality, rather common throughout other cultures.

While each mother may have a distinct reason for choosing a midwife or another form of alternative birthing practice, many providers suggest mothers may choose alternatives because they enjoy increased individual choice that they may not be able to get in hospitals.

In addition, many midwives report that the women seeking such alternatives have done extensive research on natural births and might wish to avoid interventions such as pain medications and C-sections.

Ashley Wilson has assisted many of those women as a certified nurse midwife, or CNM, in urban environments throughout the country. On the East Coast, she was primarily in hospitals or large ob-gyn clinics. In Spokane, Wilson worked through the Community Health Association of Spokane and with individual-owned birth centers. She has also practiced an increased number of home births.

Wilson describes her job as being primarily educating women. Not only about alternative birthing practices, but also about contraceptives and women’s reproductive health. “Healthy sex lives, healthy bodies, healthy women’s psyches,” she says.

As a WSU nursing doctoral student, Molly Altman ’15 PhD researched the care provided by CNMs compared to care provided by traditional hospital birthing staff. She found significant differences between CNMs and ob-gyns in regards to birth interventions and “specifically in regards to mode of birth, epidural anesthesia use, labor induction, labor augmentation, and cervical ripening.”

She describes midwifery as being a more hands-on form of birthing based on the idea of childbirth as a normal life event for many woman, rather than as a “medical problem,” which is how Altman describes the common view of birth in the last 100 years.

In addition, Altman found that the use of CNMs resulted in less resources and decreased costs for both the hospitals and the families. She concludes that births by CNMs are equally as safe as those performed by ob-gyns. She advocates that midwives should be considered as the primary care providers for medically low-risk mothers as this could decrease the burden on the health care system.

Psychologist Ekaterina Burduli (’08, ’11 MS, ’16 PhD) explores birth satisfaction in the United States. She and other researchers worked with women giving birth in hospitals and with women giving birth either at home or in birth centers. Burduli found that women who followed an alternative birthing plan were more satisfied than those who had given birth in a hospital setting.

Elizabeth Soliday, an associate professor of human development at WSU Vancouver, has studied alternative births for years. She describes mothers seeking out-of-hospital births as having an apparent increased faith in their body’s ability to perform natural births. In other words, the women often expressed very little concern regarding the need for interventions such as induced labor, C-sections, medication, or other medical interventions. They feel confident in the midwives’ knowledge and ability if an emergency should arise. In addition, many midwives have connections with local hospitals should an emergency occur.

Furthermore, Soliday says the cultural climate of the region adds to the popularity of alternative births. She says the variety of types of midwives and the availability of credentials for the profession are much more extensive in the Northwest states. Washington has “some of the most progressive birth care policies in the nation,” Soliday says.

In fact, many insurance companies will cover births performed by midwives, according to Soliday.

Despite decreased costs and comparative safety, midwifery and other forms of alternative births still have a long way to go. Midwifery is still seen as a counterculture, even in the Northwest. There is no nationwide standard for midwives as every state decides on licensure.

Back in Pullman, Fischer says midwifery in the state is “light years ahead” of many areas of the United States but “light years behind” the rest of the world. With this in mind, midwifery associations throughout the country are working together to have a set standard for the profession by the year 2020, which may reflect aspects of international standards.

Krystle Lyric Arnold, a senior studying communication, is an intern with Washington State Magazine.