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Veteran finds his calling in prenatal care, labor and delivery at St. Luke's

Midwife B. Scot Hart visits with his patient Lizzy Hepp at the birthing center at St. Luke's hospital. Tyler Schank / tschank@duluthnews.com1 / 2
Midwife B. Scot Hart said he likes all aspects of his job: working with people, nurses, nurse practitioners and doctors. He likes the science behind his work. Tyler Schank / tschank@duluthnews.com2 / 2

B. Scot Hart already has heard the joke, thank you very much.

"I get the midhusband joke quite often," he said.

As one of two certified nurse midwives on the staff at St. Luke's hospital, and before that among Navajo populations in New Mexico, Hart is familiar with the arched eyebrows and the skeptical comments.

But as a man in a profession mostly associated with women, Hart, 40, said he encounters far more acceptance than resistance.

"There will always be a few people who are uncomfortable with it," the Philadelphia native said last week during an interview in the Birthing Center at St. Luke's, where he has been working for three months. "But for the most part, I've had good success. I would say it's a rarity for that to be an issue."

Certainly, the perception that there are few men working as midwives is accurate. It also has historical precedence. During the time of Hippocrates, "it was thought that midwives in Athens should be required by law to have had children themselves," the journal Men In Nursing reported in a February 2008 article. In the United Kingdom, men were prohibited by law from practicing midwifery until 1983, the article added.

Among 11,826 practicing certified nurse midwives in the U.S. today, 709 — or 0.6 percent — are men, according to the American College of Nurse Midwives.

The profession is not only dominated by women, but by white women, said Hart, who is of mixed race. Nearly 90 percent of certified nurse midwives are white females, according to a 2006 study cited in the Men in Nursing article.

"I think it's becoming more popular among men, but right now the minorities remain a minority by a landslide," Hart said.

'A quiet goofball'

So perhaps it's not surprising that Lizzy Hepp was a little surprised when, after moving to Duluth in July, she learned her new midwife would be male.

But not a problem, said Hepp, 24, who is 27 weeks pregnant with her third child.

"Once I met him and started talking to him, it was just another midwife," Hepp said. "It wasn't any different than a woman. He's very knowledgeable. ... It's no different from a male OB/GYN doctor."

Hepp is not only Hart's patient, she's his colleague, because she works as a medical assistant in obstetrics and gynecology at the hospital. Hart's soft-spoken demeanor, she said, doesn't reveal everything she has come to know about him.

"Oh, he's so goofy," Hepp said. "Right away he was kind of quiet, but once you start talking to him he's a quiet goofball."

Hart isn't like other midwives, or other medical providers she has dealt with, in one respect, said Hepp, who was assisted by a midwife in both of her previous births in the Twin Cities.

"He doesn't rush you," she said. "He goes over everything with you and makes sure ... everything is clear to the patient. ... And I don't think I've experienced that before with a provider."

Moreover, having gone through a high-risk pregnancy and difficult labor with her first child, Hepp said she's confident Hart will keep his cool in an emergency because of his past experience.

That includes two stints in Iraq while serving in field artillery with the U.S. Army and a tour of duty with the Peace Corps in Morocco. During the second Iraq tour, 2007-08, Hart's brigade was involved in rebuilding infrastructure, spending $65 million in the process. That was a sharp contrast to what he had the resources to do while helping Moroccan women employed in sewing rugs improve their products, he said.

"The Army was so well-funded at the time that it was easy to put up a project and manage large projects," he said. "In the Peace Corps, you're begging for $2,000 to fund your project."

Serving tours in both the military and the Peace Corps is another way that Hart has followed an outside-the-mainstream course. According to Peace Corps data, more than 90 of its volunteers over the past year and a half have been military veterans. The current volunteer force is nearly 7,400.

New Mexico to Duluth

Hart felt called to both areas of service, but health care was in his blood, he said. His father is a pediatrician, and his mom, his sister and a grandmother all are nurses. At 31, he entered nursing school, completed this R.N. degree and then added three specialties over three years: health administration, women's health and gender studies, and midwifery. Nurse midwife is an advanced practice certification, the equivalent of nurse practitioner.

His first two years of nursing school drew him to midwifery as a specialty, Hart said.

"I felt like I could make the most difference in prenatal care, labor and delivery," he said. "Because I saw the most disparity between racial and ethnic groups and social classes in labor and obstetrics."

Issues such as drug use, obesity, diabetes, high blood pressure and diet all can affect pregnancy, Hart said, and in those areas he felt he could make a difference in the lives of women preparing to give birth.

One of the Navajo reservations he worked in was a "food blackout" area, Hart said, where pregnant women got their food from convenience stores. He seeks to help women in such situations that aren't conducive to a healthy pregnancy.

At one of those reservations, Hart worked alongside midwife Amanda St. Aubin. A year and a half ago, St. Aubin took a position at St. Luke's. When he was leaving the Indian Health Service after three years, St. Aubin contacted him and said St. Luke's needed an additional midwife.

The only Duluth association he knew of at the time was Duluth Trading Co. commercials, he said.

He has found it to be a good fit so far.

"St. Luke's has got a very good OB practice," Hart said. "And the setup for my partner, Amanda St. Aubin, and I, is good because we see patients in clinic, and then we're able to come in and cover our patients in labor and delivery."

The midwifery he and St. Aubin provide is a relatively small part of pregnancy care at the hospital. Of current patients who are receiving their prenatal care at St. Luke's OB/GYN Associates, 17 percent have chosen to use a midwife, hospital spokeswoman Melissa Burlaga said.

Moms-to-be who choose a midwife's care are interested in a more physiological birth, Hart said, or what's more commonly known as natural childbirth. It means fewer medical interventions, eating and drinking during labor if the women wishes and the ability to move around freely during labor.

It's what Hepp knew she wanted for all three of her pregnancies.

"I feel like midwives are more hands-on with your pregnancy and more hands-on through your labor," she said. "They don't push you; they don't push baby. They just let your body do its thing."

And whether it's a man or a woman providing the service, the title is the same.

"We're still midwives," Hart said, "because it just means 'with-woman.' "