taking a Bath?
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.
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.
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… .” ³
Contributing writer Lisa Coffman can be reached at