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After calming protests from some staff members, midwives have received permission to deliver babies at American Fork Hospital.

One child has already been delivered by La Rita Evans, the certified nurse midwife who will supervise the group that will work at American Fork.Evans is a registered nurse who has been bringing babies into the world in hospital settings for 13 years. She has contracted with two doctors at the hospital to work with the midwives when they become involved in problem deliveries.

The arrangement benefits the midwives, because it allows patients the safety net of physician care, and the doctors get a retainer fee whether they help with the delivery or not. Evans and Dr. E. William Parker, one of the doctors contracted to work with her, refused to say how much of a patient's $950 delivery fee is used for the retainer. Mothers who have problem deliveries do not have to pay extra unless they are admitted to the hospital for procedures like Caesarean sections. In that case, they pay the midwife's fee and a bill by the doctor.

Some American Fork Hospital doctors who are not involved in the contract with the midwives were concerned about having them work in the hospital because they think it's not as safe and, Parker said, because they are worried about losing business themselves.

"The doctors want to maintain their little turf," he said.

Nevertheless, all of the obstetricians on staff at American Fork have agreed to assist the midwives if the contracted doctors are not available during an emergency.

The hospital has established guidelines to help define when doctors should become involved. The standards are more strict than those at Orem Community Hospital and less so than the standards at Utah Valley Regional Medical Center. But Parker said he believes the guidelines are mostly there to appease concerned doctors.

For instance, American Fork will require a doctor to complete a hands-on examination whenever labor deviates from the norm, such as when it continues for an unusually long time. But Parker said it will be mostly ceremonial.

"In reality, what I will do is pass through in the room and say, `hello, we're going to start some (medication),' and walk out to satisfy the hospital," Parker said. "I have never been ill at ease at all with the standard of La Rita's practice. She's providing about 95 percent of the care to her patients. With a midwife, she is at the bed with the patient during the entire labor. There are a number of people who feel that's a distinct advantage."

Evans said some women will choose a midwife whether they can find one who works in a hospital or not, because some people want a woman doctor and Utah County has no female obstetricians.

Parker said it is important to make certified midwives available at hospitals so women will not be tempted to turn to lay midwives, who don't necessarily have any medical training and don't work in a hospital.