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	pregnancy & birth homebirth

Making Midwifery Accessible To The Poor

Alivio Medical Center, in Chicago's South Side "Little Village" neighborhood, has one of the most innovative midwifery programs in the US Alivio serves a large low-income, low-literacy, Mexican American and immigrant community (93 percent of clients are Medicaid patients). The midwifery program was the brainchild of Ceal Bacom, CNM, and direct-entry midwife Mary Sommers.

"The vision of Alivio is to be a model where obstetricians, nurse midwives, direct-entry midwives, doulas, lactation consultants, and community women work together," Sommers explains. "Homebirth and hospital birth are both honored and equally viable places to give birth with the support of everybody on that team."

The entire staff is bilingual and includes two obstetricians (available for high-risk pregnancies), 12 certified nurse-midwives, three direct-entry midwives/midwife assistants, and eight doulas. Alivio won the American College of Nurse Midwives Kitty Ernst Award in 1998 and the Safe Motherhood Initiative-USA Model Award in 1999 and 2000.

Executive Director Carmen Velasquez established Alivio as a community health center in 1989 and added midwifery services in 1993. According to Sommers, Alivio's model can and should be replicated throughout the US, simply by midwives, both direct-entry and certified nurse-midwives, linking their services to those of established and licensed community health centers.

Alivio's achievements include:

• Attending about 1,200 births yearly, of which about 150 are homebirths.
• 5,000 home visits for breastfeeding support.
• Cesarean section rate of 6 percent.
• Vaginal birth after cesarean (VBAC) success rate of 80 percent.
• Episiotomy rate less than 1 percent.
• Use of medication in birth less than 14 percent.
• Reciprocal training program with midwives from Casa, the first professional midwifery program in Mexico, located in San Miguel de Allende.
• Doula, breastfeeding, and peer counselor training programs for community women.
• Nearly 53 percent full-time breastfeeding mothers, up from 5 to 6 percent at the inception of the program.
• Successful teen program for prenatal through postpartum care.
• Positive reciprocal relationship with affiliate hospital Mercy Medical.