Is Birthing
taking a Bath?
Like babies, great ideas are born every day.
One recently birthed idea, much touted by nurse midwives and other medical
professionals in SLO County, is to create a birth center that will offer
pregnant women an alternative to hospital birth.
The proposed center, Birthaven, has a board of directors made up of nurses,
nurse midwives, and other professionals who are working out staffing,
licensing, and budgetary needs for the operation.
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PROUD
MOM
For Dawn Feuerberg,
the second mother to have a water birth
at General Hospital, the water birth tub
was a saving grace. She said her daughter
Amalia was born smiling. |
Birthaven, its supporters say, would close a gap left when General Hospital
shut down last July and county women abruptly lost certain health care
services—such as water births in a licensed facility, or birthing
classes taught in Spanish. Further, at a time in which C-sections in the
United States have reached an all-time high of 26.1 percent, the center
would offer women a place to give birth in which such interventions are
minimal. The center would also relieve some of the overcrowding at Sierra
Vista and French Hospital labor and delivery units caused by General’s
closure.
The problem is, Birthhaven is having trouble finding its own place of
birth in the county. Birthaven directors were faced with a recent setback
in their hopes to occupy space on the second floor of General Hospital.
They say they initially received encouragement from county supervisors
that the birth center could rent the space for a nominal annual fee of
$1—and then were later told the center would need to pay rent of
$10,000 a month. (See sidebar, “The $119,999 question.”)
Birthaven needs initial start-up funds of about $200,000 and it could
open its doors “almost immediately,” its directors say; its
staff is ready to go. If space were donated, this amount would be less.
The center would need the equivalent of a three-bedroom house within a
five-minute drive to a hospital.
“This is about offering women choices,” says Linda Seeley,
a certified nurse midwife who is one of Birthaven’s directors. A
veteran who has delivered more than 3,000 babies in the 22 years she’s
worked in the county, Seeley argues that the homelike setting of a birthing
center can be optimal for women delivering in low-risk pregnancies.
“Birth is one of the most important experiences a human can go
through,” Seeley says. “In a hospital, birth is treated like
an emergency waiting to happen. We’ve turned this into a very technology-focused
experience in which the mother is pretty disconnected from what’s
going on.
“A baby is born in an almost hyperalert state of life—most
sensitive, most receptive to influences,” Seeley adds. “It’s
important that a baby be brought into a place of love and trust and safety
right from the very beginning.”
“Pregnancy is not an illness. Hospitals are designed to care for
the sick,” says Kate Bauer, director of the National Association
of Childbearing Centers (NACC), a national organization that sets standards
for birth center licensing. About 85 percent of women can anticipate a
normal pregnancy and birth, according to Bauer, and are potentially good
candidates to have babies at a birthing center.
Basically, birth centers are staffed by nurse midwives, and offer, in
addition to birthing services, prenatal and follow-up care to women considered
low-risk pregnancies. Centers also offer well-woman gynecological care
to women in their childbearing years and other services. For instance,
Birthaven plans to offer services including mother’s groups, prenatal
classes in English and Spanish, and support groups for postpartum depression.
There are 165 birthing centers in the country, and nine in California.
|
PROUD
MOM
For Dawn Feuerberg,
the second mother to have a water birth
at General Hospital, the water birth tub
was a saving grace. She said her daughter
Amalia was born smiling. |
Each center is backed by at least one obstetrician. At a birth center,
the emphasis is on “natural” childbirth: The centers do not
offer labor-inducing drugs, such as Pitosin, or painkillers, such as an
epidural. No C-sections are performed there. Women in labor who encounter
complications are transferred to hospitals; the transfer rate for birth
centers is about 15 percent, Bauer says.
What birth centers do offer is a homelike environment: bedrooms, jacuzzis,
a kitchen, space for family members or friends whom the laboring woman
wants to accompany her. Each woman in labor has one midwife designated
to care for her throughout the labor and one registered nurse—a
total of two licensed personnel dedicated to the laboring woman at all
times.
“It’s one-on-one birthing,” says Vita Miller, a former
supervisory nurse at General Hospital and another of Birthaven’s
directors. “In the hospital, a labor nurse may have up to four ladies
in labor; the nurse often has to watch all four on a monitor. What an
enormous difference when you have this one-on-one attention.”
Despite the closer attention, cost for a birthing center birth is far
below that of a hospital: about $2,800 to $3,500, compared to hospital
costs that can be upward of $10,000. Most major insurers cover births
at a birth center, according to Bauer.
Birth centers’ low-tech approach to labor gives rise to concern
about safety in some circles.
“The difficulty is determining who the low-risk person is going
to be all the way through her labor,” says Dr. Barbara Clutter,
M.D. (Of three local obstetricians contacted, Clutter was the only one
who responded to the New Times’ questions about the proposed birth
center.)
“You can have a woman who looks like a totally low-risk pregnancy
but comes up with problems at the end,” Clutter adds. “That’s
why many OB/GYNs don’t like to do home births.”
At the same time, Clutter acknowledges that a home birth or non-hospital
birth is the preferred choice for some women. As part of its safety net,
a birthing center should have equipment to resuscitate a baby, and should
be within a five-minute drive of a hospital, Clutter says.
Birthaven directors agree about the need for caution and five-minute
proximity to a hospital.
“Things do happen … birth is not without risk,” says
Seeley. “But if you’re really scrupulous about selecting your
clients, and monitoring them throughout the pregnancy, and there are no
medical interventions that are done during labor, then you minimize the
risk of complications.”
The last major study done on birthing centers, published in 1989 in the
New England Journal of Medicine, tracked 11,814 women at 84 birth centers
and found the birth centers to have comparable safety rates to low-risk
in-hospital births. What wasn’t comparable were the C-section rates:
at the time, only 4.4 percent of women ultimately transferred from birthing
centers had C-sections, while women initially admitted to hospitals had
a 24 percent C-section rate.
Now, according to reports released last June by the Centers for Disease
Control, the nation’s C-section delivery rate in 2002 was 26.1 percent,
the highest level ever reported in the United States. The C-section delivery
rate had declined during the late 1980s through the mid 1990s, the report
found, but has been on the rise since 1996.
“Our bodies are made to give birth naturally,” says Janet
Murphy, a Cal Poly lecturer who teaches infant and child development courses.
“Now the idea is that we can’t do it without intervention.”
Murphy, who has had all three of her children by natural childbirth,
says this process is “most beneficial to mothers and babies. You’re
just so alert and awake right after the birth, and the bonding process
is so positive … neither you or the baby is inhibited by any drugs
or medications.”
For advice on setting up the safest possible birth center, Birthhaven
has engaged the support of San Diego’s Best Start, which is California’s
oldest and largest birth center. Established in 1984, Best Start has seen
3,000 births. Its transfer rate to hospitals of women with complications
during labor is 14 percent. Its mortality rate for mothers and babies:
zero, according to Best Start CEO Silvana Poletti.
Poletti and other Best Start staff spent three days last year in San
Luis Obispo, meeting with the Birthaven group, hospital administrators,
and other health care providers. Based on the client numbers for local
midwives, there seems to be a demand in the county for a birth center.
“Birthaven would do well here,” Poletti says.
That’s part of the legacy of General Hospital. Its labor and delivery
unit had the local reputation of offering the most family-oriented birthing
environment. Further, the hospital had been designated by the World Health
Organization and United Nations Children’s Fund as a Baby Friendly
Hospital. Currently, only 38 hospitals in the country have applied for
and met the Baby Friendly criteria for breastfeeding support and follow-up
health care. The hospital also housed the Breastfeeding Clinic, which
offered daily lactation consulting to new mothers in the hospital—as
well as free lactation consulting to any woman in the county.
Jennifer Stover, an independent childbirth educator and practicing doula,
says she has seen high demand among her clients for services a birthing
center would provide. (Doulas are something of a professional childbirth
coach whose support services are extended to a family before, during,
and after birth.)
Since General Hospital closed, several of Stover’s clients have
rented tubs and brought them to French Hospital for labor. Five years
ago, before General offered water births, one of Stover’s clients
was so adamant about having a water birth in a licensed facility that
she planned to travel to the nearest birthing center—in Ventura—to
deliver her baby in a birthing tub. The woman ended up delivering en route,
with her husband pulling off the road and “catching” the baby
in the car near Refugio Beach.
The demand for birth alternatives historically was met by General Hospital,
Stover says.
“In this county, General Hospital always spearheaded innovation
towards more natural, more family-oriented birthing,” says Stover.
“The first hospital in the area to heavily promote breastfeeding
and to have a lactation consultant was General. The first to allow rooming
in by the father was General. The first to have a birthing chair—something
other than being on a delivery table with your feet in stirrups—General,”
Stover says. “This was capped off with allowing water births to
happen.” General began offering water births in 2002.
Water birth is akin to taking a warm bath during labor and birth. Proponents
say it eases the woman’s perception of pain, buoys her and allows
her to move more easily, and allows the baby to be born from a warm environment
to a warm environment—no sudden shock of cold air. Detractors warn
that the process poses risks of drowning the baby during birth or having
the baby contract an infection through tub water.
At General, laboring women took microbial showers before getting into
the tub to decrease any risk of infection, says Laurie Stern, R.N., former
OB manager at General Hospital and another of Birthaven’s directors.
Further, the concern about a baby drowning “is a moot point,”
Stern says. “The baby doesn’t breathe until he comes in contact
with the air.”
For Dawn Feuerberg, the second mother to have a water birth at General
Hospital, the tub was a saving grace.
“The surges [contractions] were about 10 times more intense when
I had to get out of the tub to be checked,” Feuerberg says. “I
was kneeling over—couldn’t even lie down. It was a day-and-night
difference when I got back in the tub. I don’t know what I would
have done without it.” Feuerberg’s husband Matthew Fleming
was able to be with her in the tub during the labor; their daughter Amalia
was born smiling.
Feuerberg chose a water birth in the hospital because she was apprehensive
about having a child in her home in Morro Bay, which she felt was too
far from a hospital. Further, she liked the convenience of having someone
else take care of the surroundings. “If you’re at home, afterwards
you’ve got the mess to clean up. Being able to have a water birth
at General was just a blessing.”
Since General Hospital closed, women no longer have the option of water
births unless they have a home birth. French has allowed some women to
labor in a birthing tub, but the woman has to climb out before she has
the baby. Couples interested in water births must privately rent, set
up, and clean their own tubs.
“I’m grateful to French, but I wanted my birth to be some
place more like a home, a natural environment,” says Maika Clarke,
who rented a water-birth tub for her labor. “Look, a hospital is
a great resource if you’re comfortable with it—I’m more
comfortable with one three blocks away. A hospital is a very medicalized
environment. Even if you’re trying to have a natural birth, you
feel like they’re waiting for something to go wrong.”
Actually, Clarke’s vision for a birthing center is not that far
off from the vision Birthaven’s board of directors has.
“It could be such a nice space,” Clarke says. “A beautiful
garden to walk in while you’re laboring. A comfortable bed and linens
and your own clothes instead of a hospital gown. A kitchen, so your birthing
team can get something to eat. A birthing tub.”
In fact, based on what Clarke saw in the hospital’s crowded delivery
unit, “one little birthing center isn’t going to make a dent
in what the county needs,” she says. “We could use several,
in all areas of the county—Cambria, North County, SLO… .”
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Contributing writer Lisa Coffman can be reached at
[email protected].
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