Welcome to Karin Larson's world, where she welcomes babies into the world in the Twin Cities.

"We are really the experts in the normal birthing process," said Larson, MSN, CNM, RN. As the senior certified nurse-midwife among eight at Fairview Riverside Women's Clinic in Minneapolis, she has seen major milestones in midwifery, both as a profession and a consumer service. It has not been without struggles, though.

"There's a lot of support things that both nursing and nurse-midwifery do, but when you're the nurse-midwife, you're the manager. You manage the labor," Larson said. She has testified in legislatures about the hows and whys of nurse-midwifery and worked to overcome the public perception and physician attitude that nurses with a two-year graduate degree can't possibly provide the same-often complex-care as an obstetrician who has invested eight years in medical school and a residency.

But they can, and do. Larson, 53, has managed more than 2,000 births.

"In Minnesota, we got prescriptive privileges and third-party reimbursement. We got advanced practice nurse status a few years ago," she said. She also helped get midwifery recognized by the Colorado Legislature.

"A few years ago, the American College of Nurse-Midwives set a goal of 10,000 midwives by the year 2000 and they did achieve it, which was huge," she said. "There are nurse-midwives practicing in every state."

Larson admits she lost her objectivity about midwifery in graduate school at the University of Utah. "I was kind of a young whippersnapper," she said of her first two years in nursing, working the night shift on a labor and delivery unit in California. "I decided I wanted to do more."

Time and "a very patient-centered, family-centered philosophy" are among her assets. Midwives, like obstetricians, are under the gun to increase productivity. But Larson and her colleagues are able to give a client more than the 7½ minutes that a doctor may have for them. "That's pretty grim when a woman has specific issues," she said. "We have more time and I don't know that we're going to back down on that. We spend the time and really work to have an understanding of what's going on."

The payoff comes at delivery when a nurse doesn't have to educate a physician about the family's needs and desires. During a course of months, the midwife learns both the physiology, management and psychosocial aspects of a woman's pregnancy.

The goal always is "a safe and satisfying birth experience," which means working within a health care system that allows for consultation, collaboration, referral and sometimes joint management. Larson's practice group also includes seven obstetricians.

Prenatal consultations and education occur in the clinic; deliveries are in an affiliated hospital with "all the bells and whistles" should a delivery present a problem. "If we have a patient whose baby is getting into trouble, we can immediately call for help and get the appropriate care. We're well-connected … very skilled at getting people to the care they need," Larson said.

The practice has delivered 4,000 to 5,000 babies a year for about 15 years, in no small measure because of satisfied families. "Thank heaven for word of mouth," Larson said, because it's a never-ending challenge to persuade medical services administrators to include the names of certified nurse-midwives in health care provider books. "It's commonplace to have physicians only. It's one of the ongoing struggles," she said.

During the last year, Larson has partnered with a former client who suffered severe postpartum depression to add another dimension to patient services. At the time, Larson was dealing with the end of a 31-year marriage.

"Between [the patient's] postpartum depression and my newfound understanding of depression, we started a support group for pregnant women with anxiety and depression," Larson said. "Our passion is that if you can have women get treated, perhaps get on medication during the pregnancy, they will not have to bottom out postpartum. There's a lot of suffering that goes on postpartum."

She said her most memorable midwifery patients have been those who have lost a child in pregnancy and then "I was there for a healthy baby the next time. That's always tremendously special, especially when you've lived with them through the difficult times."

Of course, there are equally joyous, but more fun memories, too. She recalls a woman who went to a new fondue restaurant and left her party just before dessert to give birth. Larson joked that the new mother deserved the final course and the next thing she knew, "the restaurant packed up the fondue and brought it down for the staff and the rest of the family."

And a New Year's Day birth turned one of her patients into a momentary TV celebrity in 2001. "I delivered a baby … at 01:01 on 01-01-01," Larson said. "That was kind of fun."

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