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Birthing center controversy: What do women really want?

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Proposed center in Elizabethtown receives wellspring of support from moms seeking more choices

By Marty Finley

Kentucky’s lack of delivery alternatives led Christy Kendall late last year to a cabin in rural Tennessee.

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Kendall, who lives in Louisville, reached out to former high school classmates with children, asking for tips on books to read, documentaries to watch and other insights on pregnancy. Many cautioned her to calm down, but Kendall said she was driven by the desire to control her own pregnancy and enjoy the process her body was designed for. Her mother gave birth naturally several times and instilled a respect for midwifery in her daughter.

“Birth is such a natural experience and I think a lot of women are missing out,” she said.

Mary Carol Akers, a certified nurse midwife, takes the stand Wednesday in Frankfort to argue there is a need for a freestanding birth center in Kentucky. Her testimony comes on the third and final day of a certificate-of-need hearing for the proposed Visitation Birth & Family Wellness Center she is seeking approval to build on Ring Road in Elizabethtown.

In doing so, Akers will have a stable of mothers from around the state and the country in her corner.

Kendall is one of those supporters who believe another option is needed beyond the confines of a hospital or one’s own home.

She joined other mothers as they shared their birth stories with The News-Enterprise in the wake of the debate over the center’s establishment.

Kendall said she knows birth centers are not an option for every pregnancy, as only low-risk mothers are qualified to be taken on as patients, but mothers who want quiet and peaceful pregnancies away from the environment of drugs, injury and sickness should have a choice in the state.

First consulting with Clark Memorial Hospital’s birth center in southern Indiana, Kendall traveled more than three hours to the Farm Midwifery Center in Summertown, Tenn., a birth center that has provided prenatal, labor and delivery services for more than 40 years, according to its official website.

Her husband initially was taken aback by her decision, but the couple made the lengthy drive for prenatal visits and built an intimate relationship with the midwives at the center.

“My midwife knew my body better than my husband,” she said.

While giving birth in a secluded cabin may seem strange to some, Kendall said it was a relaxing experience for her as the midwives allowed her to lead her own labor, standing by for support and guidance when needed.

“I never thought I would just know what to do,” she said.

Because her son, Joe Jr., was a larger baby at around 10 pounds, the center’s midwives had to maneuver his shoulders and head during the delivery. But Kendall said she cherished the center’s care and management of the situation. Even when Joe Jr. stopped breathing post-delivery, Kendall said she never panicked because she fully trusted that her midwife — because of her experience and training — would keep mother  and baby safe. Now more than 3 months old, her son playfully laughed in his mother’s arms during their visit to Hardin County.

“Midwives, they’re not in it for the money,” she said. “You’ve got to love it.”

If Akers receives the certificate of need from the state and successfully land a license for the center, Kendall said she gladly would drive from Jefferson County to Elizabethtown to give birth to any future children. The thought was echoed by fellow Louisville resident Brittany Wolf, who has given birth twice and is carrying a child for a family as a surrogate mother.

Wolf sought out Clark Memorial Hospital in Jeffersonville, Ind., for its midwife services during her second pregnancy after having a less-than-ideal experience in a hospital setting during the birth of her son. 

Opposition to the birth center has scrutinized the business model for the center, which expects to attract a large number of home births from surrounding counties and the majority of its clients from Jefferson County. In both cases, attorneys have argued the model is unrealistic and irrational because labor and delivery services primarily are local in nature.

Wolf plans to return to Clark as a surrogate but said she would have sought out a birth center in Elizabethtown had it been available. She had limited interaction with the nurses who drifted in and out of her room during her first pregnancy,  she said, but the experience was much different with midwives, who were supportive, patient and open to her birth plan — allowing her immediate skin-to-skin contact with her baby after birth.

She hopes the center is approved and is successful so the idea can gain traction in her own hometown.

“Louisville needs to get on top of this,” Wolf said. “They’re slacking.”

 

Hospitals valued but alternatives needed.

Dr. Barbara Carr delayed starting a family with her husband until she finished medical school, her residency and deployment as a member of the U.S. Army.

Now an emergency physician at Fort Knox’s Ireland Army Community Hospital and mother of 19-month-old Eleanor, she said the debate between supporters and area hospitals, such as Hardin Memorial, over the need for the center is a multi-faceted discussion that is perceived by some as a black-and-white feud of ideas.

“On both sides of this debate, I don’t think anyone would argue that what we all want most are healthy moms and healthy babies,” Carr said.

She gave birth to her daughter in a natural setting at Clark Memorial after questioning some of the interventions used in hospitals and touring other facilities. Most hospitals she approached said they were open to birth plans but Carr said the perception she took away from the meetings was any approach outside of the normal medical methodology was considered eccentric or alternative.

“I didn’t have a 10-page birth plan,” she said. “It was very simple: Let me walk, let me eat, let me drink.”

Her only two regrets from her birthing experience were being forced to use services out of state and her inability to deliver in a tub, she said.

She recalled one instance in her professional career where a caesarean section was advised when it was unnecessary. The mother was not coping well with labor, but the child was not in distress, Carr said. A midwife monitoring the situation stepped in, removed everyone from the room and offered guidance to the struggling mom, Carr said.

In its opposition to the birth center, HMH officials argue local obstetricians are not comfortable entering agreements with the center because of a potential delay in emergency care and a lack of familiarity with birth center patients.

Carr said HMH should not be labeled as the “mean hospital group” fighting the center because they are a needed contributor to the community and offer much-needed and valuable services to patients.

On the other hand, she said there should be other options for mothers who are not high risk and prefer a quieter experience.

“I work at a hospital,” Carr said. “I think hospitals are wonderful. When you’re sick or injured, they’re the place to be. (But) if you’re healthy, the baby is healthy and you’re low risk, it may not be the best option.”

 

From hospital to home.

Howevalley couple Amanda and Tristan Raymond used a hospital for the delivery of their first child, Vivien,  now 2. Amanda described the experience as “awful.”

She labored for hours and said her obstetrician and the hospital staff were more hands on than she desired. The staff discouraged drinking liquids, she said, for fear she may vomit and choke if a C-section was required.

“I felt so defeated that I asked for an epidural,” she said.

Unbeknown to the hospital staff, Amanda was allergic to the anesthesia and her heart rate plummeted. Shortly after, her daughter’s heart rate followed suit.

“It was a nightmare,” she said. 

There were no long-term complications from the birth, but her daughter did have some post-delivery health problems, she said. Afterward, they knew they wanted to explore other options, and their planning ultimately resulted in a home birth for their second child.

During the birth of their son, Ira, the couple sought a professional midwife, spending more than $2,000 out-of-pocket for her services because professional midwifery services are not covered under their insurance. In contrast, the availability of a birth center would allow insurance coverage and place them closer to the hospital, they said. The couple was miles removed from the nearest hospital during the home birth.

Obstetricians often move quickly between patients, Amanda said, but the midwife made her feel like she was the only patient. They spent hours together during consultations. The midwife also ran many of the same tests as obstetricians and routinely checked their son’s heartbeat, ensuring the child was safe and growing at a healthy and normal rate.

Tristan said he was more comfortable during the home birth because he was able to assist his wife. While in the hospital, he felt banished to a corner, helpless as he watched his wife’s misery play out.

From her personal interactions with midwives, Amanda believes there are gross misperceptions about the education, experience and skill involved in midwifery. They are trained professionals, she said, not drifters off the street.

“Our midwife feels like family to us,” she said. “It felt like she loved us and cared about our child as much as we did.”

Amanda said the availability of midwife  services gave them the “most beautiful memory we’ve ever had” and said a freestanding birth center is past due in Kentucky.

“It’s 2013,” she said. “People should have a choice.”

 

When interventions can’t be avoided.

Hodgenville resident Erin Thompson had all intentions of giving birth naturally 11 years ago this month when carrying her son, but his decelerating heart rate and the stress of a long and intense labor required a C-section.

“Mother nature said no,” she said of her birth plan.

Thompson has since given birth two more times at HMH and all three times she came away with a positive experience because the doctors and nurses communicated the risks and the need for each procedure and were willing to listen to her concerns, she said.

Thompson said she believes mothers often are not aware of their rights as patients and their ability to refuse certain procedures, such as intravenous therapy. Likewise, she believes natural birth can be attained in a hospital setting if a mother properly communicate her desires to doctors.

“As long as there’s no risk, your birth plan can be followed,” she said.

Thompson underwent three C-sections but said she has no regrets about her inability to give birth naturally. When asked about her views on a freestanding birth center in Elizabethtown, she voiced support for natural birth but said she was concerned about the center’s plan of action if “something goes south” and an emergency transfer is necessary.

In those circumstances, minutes are valuable and delays can be costly, she said.

“You’re putting the mother and the child at risk then,” she said.

Marty Finleycan bereached at (270) 505-1762 or mfinley@thenewsenterprise.com.

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