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POPULARITY OF MIDWIFE-ASSISTED BIRTHS SOARS AS WOMEN'S HEALTHCARE GOES BACK TO BASICS
Connecticut's Only Birthing Center Opens Satisfying Growing Need for More Personal, Natural, Family-Oriented Birth Experience
A group of Danbury obstetrician-gynecologists and certified nurse-midwives, Women's Health Associates, has responded to a growing demand for more options in prenatal, childbirth and post-partum health care by opening the Connecticut Childbirth and Women's Center in Danbury. This is the only birthing center in the state and the first to operate in Connecticut in more than ten years.
Over the past 20 years, there has been a steady rise in the number of women who want a more personal, natural birth experience than what has been commonly available with physicians in a hospital setting. This desire is reflected in a nearly 1000 per cent increase in the number of certified nurse-midwife (CNM) attended births from 19,686 in 1975 to 195,410 in 1994. By 1995, the number of midwife assisted births rose still further to nearly 229,000. The number of nurse-midwives certified each year has jumped 25 per cent annually since 1991 to keep pace with the growing demand for a "back to basics" approach to pregnancy and childbirth.
Statistics show that the number of women in Connecticut giving birth at home rose 28 percent between 1991 and 1994 despite the overall six percent decline in total births in the state. Interviews with women who had given birth at home indicated that some would have preferred to have the choice of a free-standing birthing center, but none were available. "By establishing our birthing center in Danbury, we are responding to a growing demand among low-risk women not only in Connecticut, but in Westchester, Rockland, Putnam and Dutchess counties in New York as well," explained Cathy Parisi CNM, director of the Connecticut Childbirth & Women's Center (CCWC). "Women in this area, like women all over the country, are clear about what they want in maternity care, and also about what they don't want. We are happy to be filling a need for those who want the kind of experience we offer with midwife-attended births at the Connecticut Childbirth and Women's Center."
What is Fueling the Rising Popularity if Midwifery Care?
Control over their own health care is the reason most women cite for selecting a midwife over the traditional physician/hospital based maternity care routine. Women want to play a more active role in their prenatal care and delivery of their child. They want to give birth in a comfortable environment where pregnancy and childbirth are treated as a natural part of life rather than a nine-month medical condition. A homelike atmosphere is of paramount importance. The Center staff conducted a focus group study at an existing birthing center in Bethelem, Pennsylvania to determine the perceived benefits as described by women who had given birth both in a birthing center and a hospital. One of the women echoed a common sentiment among the group when she said, "I wanted a more natural, home-like setting where birth was viewed as a natural, normal process and where I was treated as a participant, not a patient."
Women who chose midwifery care at a freestanding birth center state they do not want to be subjected to what they perceive as excessive and unnecessary interventions. In the National Birth Center Study completed in 1989, the most definitive study done to date, findings showed that the rate of cesarean sections performed on women who came to a birthing center to deliver was only 4.4 percent. The national average of C-sections performed on low-risk women by obstetrician/gynecologists was 13.6 percent and 15.1 percent for family physicians at that time. The national average for C-sections for all women (both high and low-risk) in 1995 was 20.5 percent and the average C-section rate at Danbury Hospital over the past several years has fluctuated between 19 and 20 percent.
A recent study conducted by the University of Washington also found that midwives' clients received less anesthesia, had a lower rate of episiotomies and induced labor than doctors' patients. Another focus group participant said, "I wanted to be able to relax and know that my wishes would be honored without having to feel I needed to defend my decisions. I also wanted to develop a relationship with my care givers and not feel like I was part of an assembly line."
Relationships are a critical part of women's preference for a midwife-assisted birth at a birthing center. Nurse-midwives become birthing coaches, partners and friends to their clients. The term midwife itself comes from the Old English and means "with woman." Women who give birth at birthing centers overwhelmingly cite the closeness they developed with their midwives as the most satisfying aspect of the birth center experience. Relationships with family and friends are an important part of the support many birthing women want and need. The ability to have unlimited loved ones in attendance during birth at the Center is another critical benefit of the birth center experience.
Stacey Seis, the first woman to give birth at the Connecticut Childbirth and Women's Center, said that after two hospital births she wanted a more personal experience in which her whole family could participate. "Because you have continuity of care with the same person before, during and after the birth, you develop such a close, personal relationship with your midwife. When I go back to the birth center, it feels like I'm going home. I wish every woman could experience what I've experienced."
Safety is another important concern of every expectant mother. Study after study shows that births attended by a midwife have excellent outcomes. In 1991, the infant mortality rate for nurse-midwives was 4.1 per 1,000. The national average for that year was 8.6 percent per 1,000. After conducting a survey of certified nurse-midwives in March 1992, the Department of Health and Human Services concluded, "The quality of midwifery care is equivalent to physicians' care within their area of competence. Further, they are better than physicians at providing services which depend on communication with clients and preventative action."
Although cost is not a determinant for many women who use a birthing center, it is significantly less expensive than a hospital birth. According to the American College of Nurse-Midwives, it can cost up to 30 to 50 percent less to have a baby at a birthing center than in a hospital. The cost at the CCWC of $2,000 includes all necessary care for birth, care of the newborn and a 24-hour post-partum home visit by a registered nurse.
The Connecticut Childbirth & Women's Center is an independent, free-standing birthing facility equipped with birthing rooms for low risk women who want an alternative to home and hospital deliveries. The 2,900 square-foot facility is staffed by three certified nurse-midwives who have completed a rigorous postgraduate program specializing in midwifery. They have passed a national certification examination and met strict criteria and requirements set by state health agencies.
The Connecticut Childbirth and Women's Center provides a continuity of care throughout a woman's lifecycle that is unmatched in more mainstream programs of healthcare. What differentiates the Center from more common forms of obstetrical and gynecological care is its focus on empowering women to take a more active, vital role in their own healthcare. It offers women more choices in managing their health and enables women to have a partnership with their healthcare providers.