By Ron VandenBoom
Dr. Frank Miller, an OB/GYN at Northern Montana Hospital,
said many advancements have been made over the years to make
the birthing process better for the expectant mother, but
he's quick to acknowledge that a few problems exist today
that didn't 50 years ago.
One of the problems is substance abuse.
"It's really here," Miller said, adding that he believes
Havre has a higher level of abuse than other comparable
communities in Montana.
The issue is important because drugs are capable of passing
through the placenta and can impact the development of the
Miller said the most abused substance he sees in his
practice is tobacco.
The result of tobacco use can cause babies with a lower
than normal birth weight and also, according to Miller,
impact the development of the brain and cause permanent
"Once the brain cells are formed, he said, you don't grow
Dr. Mike Nolan, a family practitioner, said he, in recent
years, believes the number of cases where substance abuse is
a factor are fewer because education about the dangers drugs
have on the fetus has improved.
Nolan attributes TV commercials and other forms of
education for the change, adding that it is a social change
and not necessarily one inspired by the medical community.
Socially transmitted diseases or STDs, are also something
Miller said he has seen more frequently in recent years. But
he is also quick to note that some of today's better known
diseases, such as AIDS, were not known 50 years ago.
Here too Nolan agrees with Miller's analysis, but also
believes better education has recently reduced the number of
expectant mothers afflicted with STDs.
Perhaps first on Miller's list of modern day problems,
however, is the issue of lay midwives.
Lay midwives are woman who have little or no formal medical
training that offer to go into the home to assist in the
home delivery of babies.
While still a rarity in the Havre area, lay midwives
present, according to Miller, "a recipe for disaster."
Miller said he is unaware of any qualified nurses or
physicians serving as midwives, but he emphasizes the fact
that hospitals, with all of their facilities, are the safest
environment for having a baby.
"Hospitals have things you just can't put into a saddle
bag," he said.
Miller is also upset that the Montana Legislature has
chosen to legitimized midwives.
"It's not only legal, but the legislature, in its infinite
wisdom, has seen fit to provide licensing for people that
have zero formalized medical education," he said.
agrees with Miller emphasizing that many unexpected things
can go wrong during a delivery and it's critical to have the
necessary equipment close at hand at those times.
"In the home there's a big lag between where it happens and
medical care," he said.
Nolan said he knows of no instances locally where a baby
has died because they were not in a hospital when an
emergency occurred, but he said he does know that "there
have been some real catastrophes happen that could have been
Assisting on those rare occasions when emergencies do occur
is something Miller said is called the OB MAP.
MAP is a buzzword for Multi Disciplinary Mapping, or in
layman's terms, a prearranged plan of action for how
departments will handle certain patients or emergencies they
NMH and the Obstetrics Unit at the hospital have worked
diligently to come up with a workable MAP.
"So we're all on the same page," Miller said. "So we're
more uniform and consistent."
Woman today will experience a safe and more family oriented
environment then was known several generations ago.
Stays in the hospital have been reduced from three or four
days to as little as 24 hours in the case of a normal
The level of choice, types and degree of pain relief, and
accessibility to f