UT: Economy leading more women to midwives
The Deseret News reports…
The slumping economy is becoming a factor in where some Utah women decide to give birth.
Licensed home-based midwives say they’ve seen a slight increase in business in part because their service tends to be less expensive than giving birth in a hospital.
“The fact (that) people are having a lot of financial troubles is causing people to look for alternatives,” said Suzanne Smith, a midwife who said she is taking more calls from people who are uninsured or have high deductibles.
Consulting appointments are also up at BellaNatal, a one-room birth suite in Orem run by Smith.
At the Birth and Family Place, a birth center in Holladay, the number of women touring the center who say they’re attracted by the price has risen to about one-third, according to medical director Rebecca McInnis.
“I don’t think it’s been that high before,” McInnis said.
A hospital-based birth can cost about $8,300, including about $6,000 on average for the hospital charge, according to 2006 estimates by the state health department. Deliveries at home or at a birthing center can be substantially less expensive.
Still, midwives said, cost is rarely the only factor in deciding to give birth at home or at a center. It typically only makes sense for women with low-risk pregnancies and for those willing to forgo epidurals and Caesarean sections. Women have to weigh the risks and benefits of giving birth outside of a hospital, they said.
“You really should be where you feel safe, where you feel good,” Smith said. “Nobody’s going to go to the cheapest place when it comes to the life of their baby.”
Paula Williams of Provo said she wanted to give birth at home with her second child. She said she was dissatisfied with the hospital birth of her first child. Cost was also a factor in considering the birth of her second. Williams, who doesn’t have insurance, delivered her son in a bathtub at her parents’ house in November and was glad she did.
“It was a lot better experience. I got to do it my way,” she said. “I will be doing it again, not just because of the money.”
TX: Birthing center reaches out for help
From the Brownsville Herald:
WESLACO - Holy Family Birth Center has been helping women have babies in a low-stress environment for 25 years, but now the center needs help so it doesn’t have to close its doors.
The center was founded in 1983 by Sister Angela Murdaugh, along with Sisters Mary Thompson, Damien Francois and Ann Wojtowicz.
The original grant for the center was given by the Meadows Foundation, under the umbrella of Catholic Charities in the Diocese of Brownsville.
The center grew to include six birthing suites, a clinic, a classroom, a chapel, medical storage rooms and housing for the staff, volunteers, students and visitors.
Nancy Sandrock, director of the center, is a certified nurse midwife.
She was asked to come to the center last year to keep it from closing because there had been no certified nurse midwives (registered nurses with extra training) for several months.
The donated buildings are located on land at 5819 N. FM 88 that belongs to the Catholic Diocese of Brownsville.
But, despite its name, Holy Family only receives moral support from the diocese; the Roman Catholic Church cannot afford to fund the project, she said.
Although Holy Family is faith-based, the nuns who founded it are now either dead or retired, Sandrock said.
Today there is a shortage of nuns, so there is a paid staff, in addition to volunteers who help women who come to the center and their families, she said.
Having a baby at Holy Family is a different experience than at a hospital, where expectant mothers may be afraid and uncomfortable in a cold, clinical setting, Sandrock said.
Teaching woman to be assertive and to realize they have choices about the birthing experience is one of the center’s goals, she said.
Unlike at most hospitals, they have a choice of having the baby in a warm water bath, which is a very natural experience, or in a bed if they prefer, she said.
The babies are not taken away from the mother at birth and kept in another room for six hours or more, as is done in some hospitals, she said. The baby stays with the mother, she said.
Mothers receive instruction in breast-feeding and care of their newborn and may be attended by a doula, which is a woman who attends to the mother all through the process, she said.
But everything costs money and that is in short supply for the center, Sandrock said.
“We may have to close,” she said. “We take people, regardless of how much money they make. … If you call around town, (other facilities) want $1,000 to walk in the door and who has $1,000 sitting around?”
But, even at Holy Family, low-income families are required to fill out paperwork to apply for Medicaid or CHIP reimbursement because there are many expenses, including staff, supplies, utility bills, equipment and repairs, Sandrock said.
CHIP is the state-run Childrens Health Insurance Program.
Some families may not be eligible for Medicaid or CHIP funding, “but they have to make the effort to apply,” Sandrock said.
Some doctors, hospitals or clinics encourage low-income women to go to Holy Family for pre-natal care, she said.
If the family is not eligible for a program, they will be put on a payment plan, based on what they can afford, Sandrock said.
Holy Family Birth Center does much more than just help women give birth, Sandrock said. Education about childbirth, prenatal care and infant care are all part of the program.
Volunteers and students nurses are trained at the center, she said.
If there are problems with the pregnancy, the mother and child can be taken to Knapp Medical Center in Weslaco, she said.
Dr. Elizabeth Krishnan worked hard to get hospital admitting privileges for the her, said Sandrock, who has a master’s degree in addition to being a registered nurse with training as a midwife.
In addition to money, the center could use donations of baby clothing, baby supplies, packaged baby food, building materials or even gift cards from Home Depot, she said.
Her husband James Sandrock uses his carpentry skills and interest in recycling to make repairs, often with reclaimed building materials, she said.
James and some of the nurses boarded up the buildings before Hurricane Dolly and he has been making repairs since the storm, she said. He also helps maintain the center’s computers.
CA: One-third of births at Palomar Medical Center attended by midwives
From SignOnSanDiego.com:
ESCONDIDO – Tatiana Sanchez was 8 centimeters dilated and having rapid contractions as midwife Kelly Walsh coached her along.
“Largo y duramente! Largo y duramente!” Walsh said, urging Sanchez to push her baby out with strong, sustained attempts.
“Wait for the contraction,” a nurse added. “There you go, more like that.”
Walsh is one of 15 certified nurse-midwives on staff at Palomar Medical Center in Escondido. More than merely coaches, midwives serve as a mother’s gentle, knowledgeable guide from pregnancy to birth. Midwives offer prenatal care in one of five Neighborhood Healthcare clinics, attend the birth and provide postpartum care.
A midwife is on staff in the hospital’s birth center 24 hours a day, usually in 12-hour shifts. At times, a woman’s first birth can take up to 12 hours, Walsh said.
“We have some incredibly stressful days,” she said. “Last Monday I didn’t sit down for more than five minutes. I think I had five deliveries that day.”
Candace Curley, regional representative for the San Diego chapter of the American College of Nurse-Midwives, said there are 75 certified nurse-midwives practicing in San Diego County, about 40 to 45 of whom attend births. The county has one male nurse-midwife, based at Camp Pendleton, Curley said.
About 1,400 of the 4,200 births at Palomar Medical Center last year were attended by midwives instead of physicians. Midwives typically see those with little or no health insurance.
“The people that the midwives see are Medi-Cal patients,” Walsh said. “I know at other hospitals the midwives can see a private insurance patient.” Midwives typically make 65 percent as much as obstetricians, about $75,000 to $100,000 per year, or $55 to $60 an hour, Curley said.
Escondido resident Nadia Ventura said the midwife attending her delivery Oct. 6 was just as good as a doctor.
“She helped me, told me everything would go good and would be easy,” said Ventura, 27, clutching her newborn son, Isaac Sanchez. “She would say, ‘Don’t give up, don’t give up, everything will be all right.’
“I think it’s almost the same thing (as an obstetrician),” Ventura said. “A midwife is skilled. If there is a problem she can check with the doctor. … I feel confident with her.”
Nurse-midwives must have a bachelor’s degree in nursing, then obtain a two-year certificate in midwifery. Most midwives at Palomar Medical Center, including Walsh, have master’s degrees.
Sarah Starling, a midwife-in-training at Palomar Medical Center, delivered a baby Oct. 6 with Walsh’s guidance.
“I have a lot of respect for the midwives that I’ve seen and worked with,” said Starling, a labor and delivery nurse.
The hospital started using midwives in 1996. Susan Bass, a nursing professor at San Diego State University, has worked as a midwife at Palomar Medical Center for five years. She started there as a nurse’s aide in the 1970s after obtaining her license as a registered nurse through Palomar College.
Bass said she had longed to be a midwife since her daughter’s birth in the ’70s.
“It was back in the time when midwives were looked at very differently … as home birth midwives,” Bass said. “We refer to them a lot of times as the Birkenstocks midwife – the long dresses, long hair, much more earthy.”
Though the educational requirements are more stringent for today’s midwives, Bass said public perception hasn’t necessarily kept up with the profession.
“When you say midwife, they sort of think, ‘Oh, somebody’s going to do these deliveries at home,’ ” Bass said. “It’s still thought of as counterculture.”
Most midwives suggest natural, healthy birth options, Walsh said.
“For the most part we would prefer to use the (least) intervention possible – pain medication or internal fetal monitoring,” she said. “If you’re stuck in bed, your pain is probably going to be more intense, but if you can get out of bed and move around a little bit, the pain might not be that bad. … What can we do instead of just jumping to a Caesarean section?”
Midwives are trained to look for complications, such as toxemia, in which case an obstetrician or other attending physician would be called in to take over.
Like obstetricians, midwives know to let pain-induced insults and expletives roll off their backs.
“It would be so easy to just kind of get upset at the experience and be annoyed with her,” Walsh said. “Instead, we really work with her and provide compassion and reassure her that it’s a normal process and she’s doing a great job.”
When the pain is gone and women are left in charge of a new life, their transformation is remarkable, Bass said.
Giving birth can have a profound effect on a woman who has suffered physical or sexual abuse, Bass said.
“Labor and birth can be a really healing process, because now (their) body is working the way it’s supposed to be working,” Bass said. “That’s one of the most rewarding things … to see how it empowers them.”
Happy Midwives Week!
October 5 - 11 is National Midwifery Week in the US– but let’s not stop there, let’s celebrate midwives around the world! My celebration kicked off with the early morning water birth of a healthy baby boy!
You can read more about National Midwifery Week at the American College of Nurse-Midwives website.
KS: A rising birth place
From Hutchinson News:
YODER - In the middle of the night, when the clip-clop of horses’ hooves is heard turning into the driveway at 2913 E. Red Rock Road, it can only mean one thing: A baby will soon arrive in the world.
In this Amish community, the driveway leads to a gray brick building that blends in with the other homes on the edge of town.
A simple sign identifies the house as Yoder’s Birth and Women’s Health Center. It’s here, over the past four years, where 93 babies have been born in one of two rooms that look more like comfortable bed-and-breakfast retreats than hospital rooms, complete with private deep Jacuzzi baths for mothers who choose to soak during labor.
Nationally, the trend toward birthing centers and the use of midwives continues to grow.
According to the American Association of Birthing Centers, there were 125 birthing centers in 1984; that number grew to 178 by 2006.
Additionally, the American College of Nurse Midwifes reported that more than 10 percent of the more than 4 million U.S. births were attended by certified midwives.
In Kansas, the trend toward the use of midwives was recognized as early as 1997, when the Kansas Department of Health and Environment issued a report on birthing trends.
The report indicated that from 1995 to 1998 doctors attended 2 percent fewer births, while midwives attended 1.3 percent more births.
At Yoder, babies come into the world with the smell of cake baking in the oven and the help of Lois Yoder and Angel Schmutz, both certified nurse-midwives.
The center is only one of three in Kansas; the others are in Kansas City and Topeka.
Ten Amish and Mennonite churches in Reno County dreamed the center into reality, and a board of directors from the churches oversees the facility. It was built with the help of a “frolic,” an Amish term for an all-volunteer, all-day gathering in which barns are raised or other big projects are completed.
One-third of the families served are Amish, two-thirds are from surrounding communities and some expectant mothers drive two hours to the center.
“They come because they want a more natural birth and a say in their health care,” Schmutz said. “We believe labor and pregnancy is a family matter. We provide the education and let them make decisions and support them in it.”
The service is not only for obstetrics, but also for well woman exams.
Only low-risk pregnancies, however, are accepted. Narcotics and IVs are available, but few request them, and every safety precaution is taken. “We are always watching and monitoring variations of normal,” Yoder said.
So far, they have detected problems early enough to transport a mother by car, either to the Lyons hospital, where the center has privileges to deliver the baby, or to Wichita.
The entire cost from prenatal care to birth is about $4,000, Schmutz said.
Maria Grace Yoder was one of the center’s most recent arrivals, coming from a different branch of the Yoder family than Lois. Maria was born Sept. 23, about 10 minutes after her parents, John and Renita Yoder, Arlington, arrived at the center.
“It’s not unusual to have quick deliveries here,” said Lois Yoder. While in labor, the midwives are in contact with the mother by phone, but sometimes most of the labor is done at home.
During prenatal visits, the mothers-to-be chart their own weight gain and are trained to check their urine for protein levels. Fathers are very involved, so evening office visits are scheduled to make it more convenient for them to attend.
John Yoder cut the umbilical cord at Maria’s birth, just as he did two years ago when their son, Jeremy, was born at the center. He declined, however, to catch his daughter as she entered the world.
“It happened so fast,” John Yoder said of the birth.
So fast the midwives had to delay their traditional cake baking, which when completed is given to each family that uses the center.”I appreciate the care they give. It’s professional. They really care. We aren’t rushed through, but are treated like a person. That’s important,” John Yoder said.
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Podcast 1: Midwives
Podcast 2: Birth Places
Podcast 3: Thinking About Home Birth
Podcast 4: The Birth Kit
Podcast 5: Interview with Ricki Lake