Why have you decided to spearhead the opening of a local freestanding Birth Center?

I have been involved in homebirth, as a midwife apprentice and assistant, and hospital birth as a doula for over 12 years in Santa Barbara. I am acutely aware of the concerns of women as they plan their births. Over and over again I speak with couples who want the intimate environment and midwifery care that is offered by a homebirth but for various reasons are not planning one- perhaps their family is not fully supportive of the idea, or their living situation does not feel conducive to birthing at home, they have roommates or live far from the hospital, or they just aren’t totally comfortable with the idea. These families are asking for the option of a birth center- to birth in a home-like setting, with consistent midwifery care, close to the hospital, with the possibility of financial assistance.

A birth center is designed from the ground up as a place that supports normal, spontaneous physiologic birth- the freedom to move about without being attached to a monitor, the opportunity to walk outside in nature, to have the option of using birthing tubs, to have as much family present as desired, to be in a room that feels like home, to not be held to any schedule and to have all newborn exams done right there at the bedside- no separation of mother and baby at all.  Monitoring of the baby’s heart rate is done carefully and consistently but in a very unobtrusive manner, by handheld doppler, wherever the mother happens to be. No routine interventions such as mandatory IV starts or any certain position for pushing and birth are required.

The hospital is wonderful when an increased level of medical care is needed- we are so grateful for the excellent care they provide in those situations. But many women are understandably concerned about their chances of having a normal birth in a high-tech environment. A birth center is a missing link in perinatal services in Santa Barbara- and by link I do mean that a birth center exists as part of a continuum of services available. There will always be women who want to birth at home, and there will always be women who will need to birth in a hospital due to underlying medical conditions and high-risk pregnancies. A birth center has transport protocols that allow a smooth and seamless transfer of care for a woman who needs an increased level of medical care in labor and the immediate postpartum.

How does the Birth Center’s prenatal care differ from the care provided of an OB or a homebirth midwife?

The prenatal care at the birth center will be essentially the same as in a homebirth practice: hour-long prenatal visits with the midwife, which consist of the same clinical components as an OB visit, with a lot of extra time for talking and questions.

Much of our discussion during prenatals has to do with nutrition, emotional well-being, family dynamics, questions about pregnancy and birth, connecting families with community resources, and preparation for the postpartum period.

What resources will be accessible through the Birth Center for expecting families?

First of all, it is part of our mission that midwifery care and the birth center option be made available to all women who want it, provided they have a low-risk pregnancy. It is our goal that through fundraising we will be able to offer subsidy to women who need financial assistance in order to birth at the Birth Center.

The Santa Barbara Birth Center will serve a complementary function as a Birth Resource Center- a place where anyone can come to learn more about healthy pregnancy, birth and postpartum options. We will have a lending library of books and DVDs, gathering space for classes, free and low-cost lectures, and film screenings.

It is our hope that the SB Birth Center really feels as though it belongs to the community- that whether or not a woman wants or is able to plan to birth there, she feels comfortable and welcome to come participate in other ways. We want it to be a safe, warm, familiar place for any woman who is seeking community support during the childbearing years.

We will have readily accessible printed material from other SB resources such as First 5, CALM, TAPP (teenage pregnancy and parenting program), Fatherhood Coalition, La Leche League, Neighborhood Clinics, WEB, The Central Coast Doula Association, Mamatoto, PEP, etc. We will offer comprehensive lists of community resources such as childbirth educators, doulas, prenatal/postpartum yoga classes, lactation consultants, breastfeeding resources, homebirth midwives, massage therapists, chiropractors, acupuncturists, pediatricians, and so on. There will also be monthly clients gatherings where everyone who is planning a birthcenter birth can come and meet up for a potluck, for discussion and support and community-building. New parents can come share their birth stories.

What will the Birth Center offer as pain coping methods to women in labor?

So much of coping with the pain of labor has to do with hormone levels- high oxytocin and endorphins, and low adrenaline. A woman accomplishes this by birthing in a familiar, safe place with people she knows well and trusts to take care of her. It means that she has control over the temperature and lighting, has freedom to assume any position she wants, is not unduly interrupted, can eat and drink freely, and can make use of warm water. One of the most powerful tools available is the use of a labor tub. There will be a deep tub in every room that is big enough for both the woman and her partner. We will not offer any anesthesia or narcotics.

Will the Birth Center be able to offer a VBAC (vaginal birth after cesarean) option?

At this time we cannot plan to offer a VBAC option. It is my hope that in the future, on a case-by-case basis, it will something we could offer. We would need the support of at least one pro-VBAC obstetrician, and of the hospital, in order to do this.

What kind of emergencies will the Birth Center be equipped to handle and what will be the transport protocol?

Just as we do for homebirth, the midwives at the birth center will be equipped to resuscitate the newborn and the mother with Ambu-bag and oxygen, to control hemorrhage by use of various drugs, and to use IV fluids for hydration, volume expansion, delivery of intrapartum antibiotics and postpartum pitocin.  We closely monitor the well-being of both mother and baby during labor, birth and postpartum. If it becomes necessary to transport to the hospital we will do so in a conservatively timely manner, with clear communication with the L&D staff before and during transport . Ideally we will have a number of obstetricians who will be available for our clients at any time.

Will the Birth Center accept insurance?

At this time there is very little point in us contracting with insurance- the reimbursement is so poor that our client load would have to be huge to justify the decreased income.  Clients will be responsible for complete payment of the birth fee by the eighth month of pregnancy, and if they have a PPO, will most likely get a good portion of that cost reimbursed after the birth. We will have various tiers for the subsidies, and as long as we have the donated funds we will be able to offset the cost to some extent for many people.We are also looking into what it will take for us to be MediCal providers.

What will the cost be for expecting women/families to birth at the center?

Currently we are figuring $6800 per birth- that breaks down to a $4000 midwife fee (split between at least three midwives and covering all prenatal care, on call time, birth services and postpartum care) and a $2800 facility fee which goes to the cost of running the birth center. We want this to be available to anyone- I feel confident saying that if our operating costs are covered, we are going to do our very best to never turn someone away for lack of funds.