http://www.greatfallstribune.com/apps/pbcs.dll/article?AID=2009902240366
By ERIN MADISON • Tribune Staff Writer • February 24, 2009
Kim Miller wasn’t too keen on the idea of delivering her baby in the hospital.
“I’m not sick,” said Miller, who always has felt hospitals are for people who are ill.
Instead Kim and her husband Jeff are planning to have their first child, who is due in June, at the Family Birth Center in Great Falls with midwife Traci Palagi delivering.
“I just feel birth is a natural thing,” Miller said.
Rather than the hustle and bustle of a hospital, the Millers will have the Family Birth Center, located just off Exit 0, to themselves. They’re welcome to have family and friends there, but the Millers want it just to be the two of them, Palagi and her assistants, and eventually their new baby. To celebrate after the birth, the couple plans to have a champagne cake from Hempl’s Bakery on hand, Jeff’s favorite dessert.
The Millers like the flexibility a birth center offers.
“Women in Great Falls have every option available to them,” said Palagi, who practices in Great Falls and Helena. “I don’t know if they know that.”
They can give birth in the hospital with a doctor, do a hospital birth with a midwife, have a home birth or give birth in a birth center.
“It’s pretty much whatever they feel most comfortable with,” she said.
Women do better through labor and delivery when they are somewhere they feel comfortable. For some people that’s a hospital. For others, it might be their living room.
Holistic Care
Midwives work with expectant mothers all through their pregnancies.
The prenatal care is similar to what women receive with an obstetrician. They have about the same schedule for appointments and run most of the same tests a doctor would.
But the visits are much longer, Palagi said. She spends an hour or more at each appointment.
“We spend so much time and really get to know our patients,” she said.
“It’s just so much more personal than a doctor’s office,” Miller said.
MaryAnn Brown, direct entry midwife, checks patients’ blood pressure, weight, urine, does a blood panel, tests for common bacteria and screens for maternal diabetes during prenatal visits. She also educates patients about childbirth, talks about family dynamics and lifestyle changes, such as diet and exercise.
Because midwives spend so much time with their patients, they will know long ahead of time if there are any risk factors, said Elaine Becker, certified nurse midwife who owns the Family Birth Center. In those cases, they transfer the patient to an obstetrician-gynecologist or other doctor.
“Way before they labor, they’re transferred to somebody who can take care of them,” Becker said.
Low-risk births
Midwives don’t accept women who are considered high-risk or who have complications, Palagi said.
If an unexpected problem arises during labor and delivery, Becker has a plan in place to have the patient transferred to Benefis Health System.
Nationally, about 12 percent of patients who begin labor at a birth center are transferred to a hospital, according to the American Association of Birth Centers. But only about 2 percent of patients go to the hospital as emergency transports.
“There’s a time and a place for hospitals,” Becker said. “The vast majority of pregnant women do not need that level of care.”
Adria Strable had her first two children at Benefis with Becker as the midwife.
She had her third child, Courtney Belle, at the Family Birth Center in December.
The Family Birth Center is decorated much like a house and feels more like a home than a doctor’s office. It has two birth rooms with large beds and private bathrooms. There’s also an exam room.
At first Strable was a little concerned with the idea of not delivering at the hospital, but she and her husband Greg were put at ease when Becker told them it took only eight minutes from the time she dialed 9-1-1 to when Adria would arrive at the hospital. Plus, Strable was very confident with Becker.
In the end, the Strables were very happy with their experience at the birth center.
The atmosphere there was totally different than at the hospital, Adria Strable said.
Strable had Becker’s undivided attention at the birth center, she said.
After Courtney was born, Becker didn’t ever take her out of the room and she even let the couple’s two older daughters help bathe the baby.
“This was a lot more personal attention,” Greg Strable said.
Different techniques
MaryAnn Brown, direct entry midwife, doesn’t offer any pain medication during labor. Midwives believe that it can be harmful to the baby, she said.
Instead, she helps her patients develop relaxation techniques and also will rub their backs and use other methods to make them more comfortable during childbirth.
Adria Strable didn’t ever wish she could use pain medicine during her delivery. Instead, she listened to music and focused on something other than the pain.
Part of the difference in having a home birth or a birth center birth is that women aren’t hooked up to a monitor or intravenous fluids (IV), Palagi said. Instead, they can walk around and be in whatever position is most comfortable for them, whether it’s sitting, standing, lying down or on their hands and knees.
If women listen to their body during labor, they’ll know what position they need to be in to make the delivery easier, Palagi said.
Instead of having women hooked up to a monitor during labor, most midwives use a hand-held Doppler ultrasound device to monitor the baby’s heartbeat.
The Family Birth Center has large, deep bathtubs where women can soak during labor, which helps some women cope with the pain.
Palagi and Brown both offer water births where women give birth in a shallow pool of warm water. Some midwives believe water births are gentler for the baby, but Palagi feels it’s just a matter of the mother’s comfort.
Home births
When Palagi does a home birth, women can deliver wherever they feel comfortable. Sometimes that’s in the bathtub or bedroom or sometimes things happen so quickly that women will deliver wherever they happen to be.
Whenever Becker delivers a baby, she tries to have the mom reach down and pull the baby directly to her chest.
In the case of a home birth, Brown has her patients purchase a package of disposable supplies, which helps keep the mess contained.
“In a half an hour I can make it look like there wasn’t a birth,” Brown said.
After the delivery, Palagi stays with the mother and baby for about four hours.
“That’s the busiest part of my job because now there are two people,” she said.
Palagi makes sure the mom’s bleeding is normal and that the baby’s vitals are normal. Then she helps get breastfeeding started.
Brown sees her patients at least three times postpartum. She checks in on how nursing is going, how the mom’s energy level is and how she’s recovering.
Problems with mainstream care
One of the main theories of midwifery is that pregnancy is a natural, normal process, Becker said.
That’s something that many midwives feel that mainstream medicine has moved away from.
“Nationally the C-section rate is skyrocketing,” Becker said.
A high Caesarean section rate is a sign that something isn’t working as well as it should, she said.
The United States rates 41st for maternal mortality in the world, Brown said.
The countries that rate the best for infant mortality use a midwifery model of care, Becker said.
In addition to rising C-section rates, the cost of health care, including labor and delivery is ballooning.
On average in Montana, a vaginal birth without complications along with a normal newborn stay at the hospital costs about $6,000, according to Montana Informed Patient. That doesn’t include prenatal and postpartum care.
Palagi charges about $2,500 for labor and delivery, prenatal and postpartum care for a home birth.
Insurance typically covers midwives. Both Palagi and Becker have patients pay them upfront and submit bills to their insurance companies for reimbursement.
When the Millers contacted their insurance company about midwifery coverage, the insurance company was very supportive, Kim Miller said.
Overall, Adria Strable was pleased with the care she received from Becker at the Family Birth Center.
“I would do it again in a heartbeat,” she said.
And she probably will get the opportunity. The Strables are already making plans for baby No. 4.
Tags : Homebirth MN