Thursday, August 28, 2008
There really are three reasons that need to get hammered out as to why this just doesn't make sense for anyone to do it. I am copying a letter posted on the utahfriendsofmidwives yahoogroups.
Many of you are already aware of this, but I wanted to post to make sure
Those of us involved in birthing centers in the state are working to change the laws so that more birthing centers can serve the birthing public. I discovered just how bad our birthing center laws are more than five years ago when I first started working seriously on the idea of opening one. It didn't take long to figure out it was impossible.
There are three main barriers that need to be removed:
Barrier #1: Construction Requirements
Current law requires birthing centers to be built like hospitals. It costs $200 just to get the over 800-page book of special requirements, and it's completely unnecessary. Where other states (and national birth center standards organizations) advocate ordinary commercial or residential construction standards for birthing centers, Utah goes way overboard. It requires things like 5-foot-wide hallways and extra plumbing and a million other things that together make establishing a birthing center economically non-viable. Birth centers are low profit-margin businesses, and a birth center owner would never be able to make enough off the business to cover the start up construction costs as things stand now.
Barrier #2: Provider Restrictions
Current law only allows certified nurse-midwives and physicians to deliver in birthing centers. Naturally, these laws were written before licensure of LDEMs, so no slight was intended. Nevertheless, the consequences of this restriction are devastating. We all know there are no physicians who want to deliver in birthing centers. And there are precious few CNMs who want to (but we love you!). The providers, as a group, who are most aligned with the out-of-hospital birth model are LDEMs (well, all DEMs, but it's not likely to be possible to get acceptance of unlicensed DEMs as birth center providers). If a birthing center can't find providers to deliver there, they can't operate. Again with the fiscal non-viability. So in order to have a big enough pool of willing providers to staff birthing centers, we need to broaden it to include LDEMs (and others, such as naturopathic physicians if we can find 'em).
Barrier #3: Hospital/Doctor Agreements
Current law requires birthing centers to have agreements with hospitals to receive transferring patients. While on the surface this sounds like a good idea, it is the single most potent killer of birthing centers. Hospitals make a full 20% of their income off their labor and delivery units. It is easily the most profitable sector of their business. Hospitals have no interest whatsoever in seeing birthing centers flourish, since they represent direct competition for their most important customers. Since a birthing center can't exist without an agreement with at least one hospital, all the hospitals have to do to prevent birthing centers from existing is refuse to enter into agreements. Which they do. Everyone who has tried to open a birthing center has run into this brick wall. And it's worse. Even if a hospital does sign an agreement with a birthing center, they can withdraw at any time and immediately put the birthing center out of business because it can no long operate legally. So I ask you...what business person would invest money in such a risky venture, where your competition can prevent you from existing or wipe you out with the stroke (or non-stroke) of a pen? No one.
It's no accident that there are almost no birthing centers in Utah. The barriers are too great. I was able to find a way around these barriers when I opened BellaNatal Birthing Suites, but very few seem willing to follow my path. And my path does have what I consider to be needless restrictions...such as the inability to have insurance cover. So, Holly, Heather and I, along with Becky McInnis and Susan Rugg from Birth and Family Place, and a few others (Krista Black and LDEM/CNM Cyndi Johnson) who are interested in making birthing centers available to Utah's families have come together to try to change things.
Fortunately, the laws regarding birthing centers are not in statute, they are in rule. That means we can change them without going to the legislature. The agency responsible is the Health Facilities Committee under the auspices of Health Facility Licensing, Certification and Resident Assessment (think of it as the facility equivalent to DOPL). We have met with the whole committee, and thrillingly, they have assigned a sub-committee to study this issue and see what changes should be made. We have met with the sub-committee once, and, well, it was a bit firey, to say the least. We have a long road ahead of us, but I have great confidence that we can succeed.
I believe in birthing choices. I know many of you love homebirth. I love homebirth. But I also know there are many families out there who, for whatever reason, won't choose homebirth. I want them to have other options besides standard hospital birth and a 30% c-section rate. I support choices for Utah's midwives, too. Why shouldn't LDEMs be able to choose birthing centers as their venue for providing care to mothers and babies?
I'd like to know what you all think about this new project. Do you support it?
Would you be willing to help?
Suzanne Smith, LDEM
I arrived a little late but this is what my account and feelings for the day look like.....
I walked in to a guy (a Hospital Administer) saying it only takes one normal birth to change in an instant and then you have a mess, and we (hospitals) in Utah have a really good job of cleaning up and saving the day in that situation, making it as safe as possible.
I flipped.... I told him that was inaccurate information that non of the Davis county hospitals are staffed by OB 24-7 and they don't have emergency anesthesia readily available after 5. So that was inaccurate to say the least! What I didn't say is, women who choose to give birth in a birth center setting aren't afraid of not having that immediately available and are willing to take the chance as little as it may be. None of us ever said birth was without risk. But so is swimming, or walking on the beach a sneaker wave could take you. Life isn't safe and they don't get it they get sued because they guarantee that which is NOT in their control! GRRR
It was amazing the representative for Utah Hospitals (lawyer/lobbyist) said, basically, I'm paraphrasing... NO WAY, if you want in on the money then your going to have to pay the same expenses that we do. Gee now. That would mean we would have to charge their prices, too.
They brought up the fact that surgical centers that charge less for their surgery fees than a hospitals, have been popping up and they don't want that but the public does and they can't stop it. Hospitals are feeling the crunch. (They actually brought this up!)
Birth is a financial money maker for hospitals and not only do they not want to give up their 1%, they are afraid that women will go to theses in flocks. In fact, the same guy said, what we don't want is a franchise of these opening up all over the state. They must know that women want this option.
The guy asked what are we really doing this for? (sarcasm-No one can be actually spending their time for the good of women.)Then asked, "Where are the people that want this where are they?". We offered to have you show up. He then retracted and took that back, saying, "Oh no, we've played that game before." (Yes, and they lose at it.)
Women do you hear it? They are controlling your choices to fatten their pocketbooks. Who's safety and concern is really being watched, I don't think it is the woman's or the baby's when it comes to these fat cat lobbyists!
Hope that you will join us at the next meeting....NOVEMBER 6, 9am -11am Room #336
Monday, August 25, 2008
I have had many interesting comments in the last little while in regards to me "going natural".
"You are brave." Is one of the most common. I'm not sure how to respond. What exactly does that mean? I don't feel "brave". I have a hard time explaining it. Many really don't understand where I am coming from, what I am thinking.
Do I like pain? Am I trying to be tough? Do I just want to stick it to the companies that make pitocin? Hardly! (except for maybe that last one.)
There is so much to birth. More than machines can monitor. More than medicine can control. It is an experience of emotions. It is an experience of challenge. It is an experience of succumbing. It is an experience of power! It is an experience of intimacy. It is an experience of bonding. It is an experience of beauty! It is an experience of strength! It is an experience of great accomplishment! It is an experience of a life time. It is an experience from God. Who would not want to experience all of that?
Thursday, August 21, 2008
When I had my first baby 8 years ago, I instantly bonded. He was the most beautiful thing I had ever laid eyes on (except my husband, of course. he he) The thought of ever paying a babysitter to watch him was absurd to me. They should pay me to hold him!
But through different birth and newborn experiences, and heart break, that changed. I was unsure how this postpartum would unfold. I knew a newborn would be a lot of work. I knew my other children would go through their jealous phase. I knew I would miss sleep. I knew my body would have to heal. I knew we would have to figure out nursing together. But all those concerns have dissolved. I am truly loving this newborn! I can't stop kissing and snuggling him. He is so sweet! I love his squeaks and grunts. I love his smell. I love his softness. I love his little diapers. I love him needing my milk. I love his little features. I love his newborn cry. I love the white fuzz on his head. I love his sleepy eyes. I love it! I had forgotten that part.
Wednesday, August 13, 2008
I'm not sure where in time I should start with this birth story. This was an emotional pregnancy for me. I had fears to work through. I cried many nights. I prayed many nights. I wanted to do everything right. I wanted the very best. My husband seemed to know right away. It took me more time, but with his encouraging words and support we came to the same place.
When I woke up early Tuesday morning, August 12, about 5:30 a.m., my hips and lower back were killing me! I was so stiff and it was work to get out of bed. After using the bathroom and feeling the lower back contractions consistently - I knew today was the day. At 8:00 a.m. I called my doula and midwife. I gave them the heads up that I was in early labor. With the contractions in my lower back, I knew the baby was posterior. I tried the knee-chest position to see if it would help the baby rotate. I felt him move. The contractions were now low in front, right where they should be. But then they slowed down, way down. For most of the day they had sizzeled. I got discouraged. I wondered if things would pick up again. I decided to try to rest and take advantage of the break. I would go for a long walk later when it cooled off.
At around 4:30 p.m. my husband left to pick up some barbecue chicken pizza. Yum. By the time he came back, the contractions had picked up the pace and intensity again. I had called the midwife and doula. They were on their way. I ate some pizza and we fed the kids. My husband walked the kids to the neighbors house to play.
The contractions continued steadily. They slowly increased in intensity. I had nice breaks between them. I was coping and breathing through them well. I felt very aware through this labor. I wasn't overwhelmed. I was calm. Those around me were calm. The mood was right.
As time went on the contractions were stronger. I got in the tub. Brian sat on the edge and pushed down on my lower back through the contractions. That felt good to me. At times he would rest his head on my shoulders as he rubbed. I liked having him close and involved. He would quietly encourage me, tell me I was doing great, and kiss my head.
The time was getting close for the baby to come. I could feel him coming down. I felt very aware of where he was as he moved down. I never felt an uncontrollable urge to push. I felt like I could if I wanted or I could breathe him down and out. I did a bit of both. I noticed that I would have a longer, stronger contraction and then a shorter, less intense one. That seemed to be the pattern. I had long breaks between. It was easier to cope and remain focused and aware.
Right before the baby emerged the bag of waters ruptured. Side note: my husband thought that looked pretty cool in the water, like a jet. Then the baby came. 7:25 p.m. The midwife caught him and Brian reached down with one hand and helped him up a bit. He was supporting my back and that was as close as he could get to catching. He said later, "I'm not a good catch." when asked if he caught the baby. I beg to differ! There was such joy and peace and calm in the room as the baby was placed on my chest. No commotion. No noise. No strangers. No fear. Just happiness, love, and excitement.
Brian called the neighbor and she began walking the kids home. Brad said he ran and jumped on his bike. He got home a good 10 minutes before the others. He was standing outside of the bathroom trying to peek a view in the reflection of the mirror. We let him in. He was all smiles. He snipped through the umbilical cord with the scissors, but only cut half of it. He didn't want to cut the rest, so Brian did. They took the baby out to meet the other two siblings while I birthed the placenta and rinsed off. I came out and got in bed and nursed the baby. He latched right on! What a relief it was to me when he nursed so vigorously. A sign of good health! After he nursed they took him and did all the newborn "stuff". They weighed him, measured him, listened to him, and looked him over thoroughly. All was well! He looked great!
The midwife checked me and I tore a tiny bit. While she stitched me, Brian and the kids were in the other room with the new baby. When I was done they brought him back to me for more nursing. We offered a family prayer. Brad said it. Brian asked him to remember to thank Heavenly Father for the safe arrival of Rylan. Brad never mentioned the baby. He thanked Heavely Father for the fun day and prayed he'd have fun tomorrow. Then Brian and my doula, Twyla, put the kids to bed. Brian helped Twyla and Chris, the midwife, pack their things to their cars. After some tender hugs and thank yous, they left.
It was just Brian and I with our new baby. It was a special and spiritual time together before going to sleep for the night in our own bed, in our own home with our children all asleep down the hall from us. Everyone was safe, happy, and together. It was a perfect day.
Monday, August 11, 2008
"Get out of the house!
When the project launched in 1999, it was one thing to convince rural-dwellers about the benefits of giving birth in hospital rather than at home, and quite another thing to get them out of their homes, into the hospitals and receiving the treatment they needed and deserved.
As well as raising awareness of the greater safety of hospital deliveries - which was achieved through the use of local media, community champions and group learning activities - it also introduced new schemes to ensure that obstetric services were, in the first place, actually affordable."I certainly understand that these women may need more resources and education, but making sure they all get out of their homes and into the hospital is not exactly the way to go. Why can't they educate midwives and lean on the hospitals for emergency care only.
"Under the project, local health centres received a substantial investment to make them places that people would want to visit. A flurry of building and renovating followed, which saw rooms being heated for the first time, new toilets installed, and patients' concerns about privacy incorporated into designs. Up-to-date equipment, selected with local needs or demands in mind, was also introduced. "
And wouldn't you know money would be involved to get the hospitals to take on these new patients.
What do you think? Is this the way to improve births. The government had a big role in this program. Do we want the government in our free country taking this kind of role here?