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ByTracySeipel Mercury-News SAN JOSE When Alisa Burmeister got pregnant five years ago with her son, Gideon, she wasn't think- ing 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 de- livery would be natural, with no C-section and with pain control like showers and massages instead of drugs. The 35-year-old Camp- bell teacher's second son is due in two weeks — and once again, midwife Maria Greulich will be at her bed- side for the delivery with the same simple goal: let nature take its course. The back-to-basics phi- losophy — fueled by a $1 million investment from the wives of Google and Yahoo co-founders — is be- hind a pilot project to team midwives with doctors to drive down the alarmingly high rate of Caesarean de- liveries and early induced births. Medical experts say too many low-risk expectant mothers and their physi- cians are opting for C-sec- tions — 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 mid- wife Lin Lee, who joined Greulich and Dr. James Byrne to help start Lucina Maternity Foundation, a nonprofit named for the Ro- man goddess of childbirth. 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 medica- tion or an epidural," Lee said. "We will support you in whatever you choose to do." Up to half of the Lucina Foundation's $1 million seed money allowed Lee and Greulich in early 2012 to start their own Cuper- tino midwifery center, Bay Area Maternity. Meanwhile, Caesarean 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 Fran- cisco General Hospital be- gan a program to pair mid- wives with doctors that is considered one of the best in the United States. UC San Francisco, Oakland's Highland Hospital and Alta Bates Summit Med- ical Center in Berkeley also have versions. Several Northern California Kaiser hospitals also use a collab- orative 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 work- ing in collaboration with physicians where every- one is using their appro- priate skills and the appro- priate 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 Amer- ican College of Nurse-Mid- wives, which represents 11,192 certified nurse mid- wives. "And that's in line with the Affordable Care Act." The new federal health care law, better known as Obamacare, aims to cut un- necessary medical costs. But reducing the number of Caesareans is a sensi- tive issue for obstetricians and gynecologists, who are facing increased scrutiny by the federal government, business and even physi- cian groups. C-sections generate more revenue for hospitals — about $7,000 extra per procedure. Some doctors acknowledge that they do them because they reduce their exposure to malprac- tice lawsuits resulting from complicated vaginal births. But even the Ameri- can Congress of Obstetri- cians and Gynecologists has concluded that C-sec- tions are frequently un- necessary and in March is- sued new guidelines to help doctors reduce Caesarean rates and allow a prolonged labor. Studies show Caesar- ean births often put wom- en's health in jeopardy be- cause they sometimes lead to hemorrhaging and in- fection, among other prob- lems. And since most women who have a Caesar- ean with their first baby end up having repeat Cae- sarean deliveries for sub- sequent 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 is- sues. Still, they have al- ways partnered with ob- gyns, who are on-call as a backup. But some private- practice doctors say that involving two medical pro- fessionals to deliver babies isn't an efficient use of their time. BABIES Mi dw iv es fuel move to go a ll n at ur al "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." — Tina Johnson, director of professional practice and health policy at the American College of Nurse-Midwives By Eraldo Peres The Associated Press ARARAS, BRAZIL This is a village where the people melt away. Tucked into the sunbaked rolling hills of Brazil's mid- west, Araras is home to what is thought to be the largest single group of people suf- fering from a rare inherited skin disease known as xe- roderma pigmentosum, or "XP." Those with the disease are extremely sensitive to ultraviolet rays from sun- light and highly suscepti- ble to skin cancers. It robs victims of the ability to re- pair the damage caused by the sun. That's a particularly vex- ing burden in Araras, a trop- ical farming community where outdoor work is vital for survival. "I was always exposed to the sun — working, plant- ing and harvesting rice and caring for the cows," said Djalma Antonio Jardim, 38. "As the years passed my con- dition got worse." Agriculture is no longer a real option for Jardim. He survives on a small govern- ment pension and meager earnings from an ice cream parlor he runs. XP shows early signs that it has taken hold of its vic- tims. Jardim said he was just 9 when a large number of freckles and small lumps started appearing on his face, the tell-tale signs that experts say signal XP is present in children and call for measures to protect them against the sun. Such precaution wasn't taken for Jardim, who now wears a large straw hat in an effort to protect his face. But it's helped little. He has un- dergone more than 50 sur- geries to remove skin tu- mors. In an effort to camou- flage how the disease has eaten away the skin on his lips, nose, cheeks and eyes, Jardim wears a rudimen- tary orange-tinted mask, its stenciled-in right eyebrow not matching his bushy real one that remains. Beyond skin damage and cancers, about one in five XP patients may also suffer from deafness, spastic muscles, poor coordination or devel- opmental delays, according to the U.S.-based National Cancer Institute. More than 20 people in this community of about 800 have XP. That's an incidence rate of about one in 40 people — far higher than the one in 1 million people in the United States who have it. For years, nobody could tell Jardim or the others what was afflicting them. "The doctors I went to said I had a blood disor- der. Others said I had a skin problem. But none said I had a genetic disease," Jardim said. "It was only in 2010 that my disease was properly di- agnosed." Experts say Araras has such a high incidence rate because the village was founded by only a few fam- ilies and several were carri- ers of the disease, so it was passed to future genera- tions as villagers intermar- ried. For instance, both of Jardim's parents were carri- ers of the defective gene that causes the disease, largely ensuring he would have it. Both mother and father must carry the gene for the disor- der to show up in their chil- dren, according to an ar- ticle posted by dermatolo- gist Sulamita Costa Wirth Chaibub and geneticist Ra- fael Souto on the website of the Associacao Mariavito- ria, a Brasilia-based organi- zation that helps people with rare diseases. They wrote that the geo- graphic isolation of Araras made marriages between cousins common, greatly in- creasing the incidence of the disease. The best way to con- trol the disease's symptoms is to avoid sunlight and to use sunscreen, hats and sun- glasses when going outside, they added. Gleice Francisca Mach- ado, a village teacher whose 11-year-old son, Alison, has XP, has studied its history in the area and says she found cases of people hav- ing the disease going back 100 years. She has started an association that edu- cates locals about XP and tries to get parents to take extra care for their children, even if they may not have outward signs of the illness themselves. "The sun is our biggest enemy and those affected must change day for night in order live longer," Machado said. "Unfortunately, that is not possible." Associated Press writer Stan Lehman in Sao Paulo contrib- uted to this report. WORLD Rare disease afflicts Brazilian village ERALDOPERES—THEASSOCIATEDPRESS Joao Goncalves da Silva, 80, who suffers from a rare inherited skin disease known as xeroderma pigmentosum, or "XP," takes off his hat March 14in the kitchen of his home in the Araras community of Brazil's Goias state. Dr. Sulamita Chaibub assists Djalma Antonio Jardim on April 9, who has xeroderma pigmentosum at the Hospital Geral de Goias in Goiania, Brazil. Both of Jardim's parents were carriers of the gene that causes the disease, largely ensuring that he would have it. Xeroderma pigmentosum worsens as those afflicted work their fields The Associated Press NEW YORK Health officials have confirmed a second U.S. case of a mysterious vi- rus that has sickened hun- dreds in the Middle East. The latest case is not an American — he is a resi- dent of Saudi Arabia, visit- ing Florida, who is now in an Orlando hospital. He was diagnosed with MERS, or Middle East Re- spiratory Syndrome, Sunday night. It is a respiratory ill- ness that begins with flu-like fever and cough but can lead to shortness of breath, pneu- monia and death. Fortunately, the U.C. cases so far have not been se- vere. The first case, a man in Indiana, was released from a hospital late last week. And this latest patient is doing well, officials said. The two cases are not linked, said officials with the Centers for Disease Con- trol and Prevention, during a news conference Monday. "The risk to the public remains very low," said the CDC's Dr. Anne Schuchat. CDC officials repeated that cases are not unex- pected. MERS is a respiratory ill- ness that begins with flu-like fever and cough but can lead to shortness of breath, pneu- monia and death. Most cases have been in Saudi Arabia or elsewhere in the Middle East. But earlier this month a first U.S. case was diagnosed in a man who traveled from Saudi Arabia to Indiana. That man, an American, was a health-care worker at a hospital in Saudi Arabia's capital city who flew to the United States on April 24 on a plane that originated in Riyadh, stopped in London and then landed in Chicago. After landing in the United States, the man took a bus to Munster, Indiana where he became sick and went to a hospital on April 28. He improved and was re- leased from a Munster hospi- tal on Friday. Tests of people who were around the man have all proved negative, health officials have said. Health officials now must track down fellow travelers who were around the new- est case, and this time it will be more challenging: There were more flights involved. This man also was a health-care worker; he worked in a hospital where MERS cases were being treated, the CDC said. He traveled on May 1 on flights from Jeddah, Saudi Arabia, first to London, then to Bos- ton, then to Atlanta, and fi- nally to Orlando. He went to a hospital on May 8 and was placed in isolation. Health officials did not im- mediately release additional detail about his travels or his week in Florida, except to say he remained in the Or- lando area to see family. MERS belongs to the coronavirus family that in- cludes the common cold and SARS, or severe acute re- spiratory syndrome, which caused some 800 deaths globally in 2003. 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