SAN JOSE -- When Alisa Burmeister got pregnant five years ago with her son, Gideon, she wasn't thinking about giving birth to a Silicon Valley startup that aimed to make childbirth less expensive and safer for babies and moms.
She simply wanted a certified nurse midwife to deliver Gideon -- with a doctor on standby in case of emergency. And she wanted assurance the delivery would be natural, with no C-section and with pain control like showers and massages instead of drugs.
The 35-year-old Campbell teacher's second son is due in two weeks -- and once again, midwife Maria Greulich will be at her bedside for the delivery with the same simple goal: Let nature take its course.
The back-to-basics philosophy -- fueled by a $1 million investment from the wives of Google and Yahoo co-founders -- is behind a pilot project to team midwives with doctors to drive down the alarmingly high rate of cesarean-section deliveries and early induced births.
Medical experts say too many low-risk expectant mothers and their physicians are opting for C-sections -- out of convenience. Until the early 1990s, the surgical procedure was used only to ensure the health of pregnant women and their unborn babies.
"The philosophy is to trust the body's ability to do that process, and we are the overseer," said midwife Lin Lee, who joined Greulich and Dr. James Byrne to help start Lucina Maternity Foundation, a nonprofit named for the Roman goddess of childbirth who safeguarded the lives of women in labor.
Lee was a midwife for biotech CEO Anne Wojcicki, the estranged wife of Google co-founder Sergey Brin, and Angela Buenning Filo, Yahoo co-founder David Filo's wife.
"That does not mean some people don't want medication or an epidural," Lee said. "We will support you in whatever you choose to do."
Up to half of the Lucina Maternity Foundation's $1 million seed money allowed Lee and Greulich in early 2012 to start their own Cupertino midwifery center, called Bay Area Maternity.
Meanwhile, C-section delivery rates in the U.S. have risen from 4.5 percent in 1965 to 33 percent today. In California, the rates are similar. The World Health Organization recommends a rate less than 15 percent.
But several Bay Area hospitals are already on board. In 1975, San Francisco General Hospital began a program to pair midwives with doctors that is considered one of the best in the United States. UC San Francisco, Oakland's Highland Hospital and Alta Bates Summit Medical Center in Berkeley also have versions. Several Northern California Kaiser hospitals also use a collaborative model, as do some Sutter Health hospitals and their affiliates.
Greulich got her start as a midwife in the late 1980s under Dr. Tony Damore, who helped pioneer the team approach in the South Bay, though it never spread.
"Having midwives working in collaboration with physicians where everyone is using their appropriate skills and the appropriate time is better for the mother and baby -- and is more cost-effective," said Tina Johnson, director of professional practice and health policy at the American College of Nurse-Midwives, which represents 11,192 certified nurse midwives. "And that's in line with the Affordable Care Act."
The new federal health care law, better known as Obamacare, aims to cut unnecessary medical costs. But reducing the number of C-sections is a sensitive issue for obstetricians and gynecologists, who are facing increased scrutiny by the federal government, business consortium and even physician groups.
C-sections generate more revenue for hospitals than vaginal births -- about $7,000 extra per procedure. Some doctors acknowledge that they do them because they reduce their exposure to malpractice lawsuits resulting from complicated vaginal births.
But even the American Congress of Obstetricians and Gynecologists has concluded that C-sections are frequently unnecessary and in March issued new guidelines to help doctors reduce C-section rates and allow a prolonged labor.
Studies show C-section births often put women's health in jeopardy because they sometimes lead to hemorrhaging and infection, among other problems. And since most women who have a C-section with their first baby end up having repeat C-section deliveries for subsequent babies, the health risks keep mounting.
Like most midwives, Lee and Greulich focus on low-risk maternity cases -- mothers who are healthy, not those with complicated medical or pregnancy issues. Still, they have always partnered with ob-gyns, who are on-call as a backup. But some private-practice doctors say that involving two medical professionals to deliver babies isn't an efficient use of their time. And doctors say some malpractice insurance carriers balk about the birthing handoff between midwives and doctors.
Lane Rado, 29, left her ob-gyn in Sunnyvale to have her baby three weeks ago with the midwives at the Bay Area Maternity center. While Rado, also a Campbell resident, liked her doctor, she felt their relationship emphasized "standard procedures" that involved intervention, not the kind of natural birth experience she envisioned.
Under an agreement with Lucina Maternity, the two midwives have five years to repay their loan to the foundation, which will then loan that money to other midwives interested in starting a business.
The rest of the funding is helping to launch a midwife-doctor program at Santa Clara County's Valley Medical Center, where Byrne, who heads the Lucina Maternity Foundation, also leads VMC's ob-gyn program.
"It is a standard of care used in almost all of the other industrialized nations of the world -- which, not surprisingly, have far better outcomes," Byrne said.
Certified nurse midwives
U.S.: About 40,000
Nine of California's 58 counties do not have any ob-gyns
Source: American Midwifery Certification Board; California Nurse Midwives Association; American Congress of Obstetricians and Gynecologists
RISE IN C-SECTION BIRTHS
In 2011, one in three women who gave birth in the United States did so by cesarean delivery, a 60 percent increase since 1996.
The overall C-section rate in the U.S. is 32.8 percent, while in California it is 33.2 percent. The World Health Organization recommends that it not exceed 15 percent.
Source: American Congress of Obstetricians and Gynecologists, U.S. Centers for Disease Control and Prevention