Sometimes labor, especially with a first baby, stretches for hours or even days from start to finish. A nurse-midwife will not rush in with labor-inducing drugs or a cesarean section. In hospital parlance "failure to progress" is the most frequent reason for a cesarean birth; but a nurse-midwife does not automatically classify a slow labor as a faulty one. If labor is not proceeding at textbook pace, a midwife is taught to consider a number of factors: she may gauge the health of the baby through its heartbeat and may take a sample of the fetal scalp blood to make sure enough oxygen is reaching the baby. She also considers the mother's stamina. If all seems fine, she allows nature to take its course.

Audrey, an Ann Arbor physician whose two sons were born in a hospital with nurse-midwives, spent fifty hours in labor with her first son. She stayed home for the first twenty-four hours and feels certain a doctor would have intervened with a cesarean or used forceps to help the baby out--procedures she very much wanted to avoid. In the end, she needed neither, in large part due to the nurse-midwife's approach.

When the baby's heart rate started to go down somewhat, rather than call for a cesarean, the nurse-midwife took a sample of the baby's fetal scalp blood. This showed that the baby was receiving adequate oxygen. She let Audrey proceed at her own pace.

"I pushed for four hours," Audrey said. "Obstetricians don't linger for four hours. They usually set it at two hours. It's not an absolute protocol, but usually if pushing goes on for more than two hours, then they use forceps."

Certainly the labor was exhausting, but in the end, she had a healthy son, a rapid recovery, and none of the procedures she had hoped to avoid.

That willingness to work one-on-one with a woman is a hallmark of nurse-midwives. Nurse-midwife Leslie Stewart now attends home births, but she remembers the contrast between her approach and the doctors' when she worked in a large, busy hospital in southern California. Often, doctors would order a cesarean section for "failure to progress," only to find that all operating rooms were full. Leslie would be asked to work with the woman in the meantime.

Leslie would help the woman out of bed and walk the halls with her, or encourage her to squat. Many times, the labor picked right up, and the woman delivered vaginally. The problem, Leslie said, is that a woman who is lying flat on her back often gets stalled in labor, and then discouraged.