Unassisted: Home Birth in Nebraska, Part One

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February 6, 2012 - 6:00pm

Editor's note: This report is part one in a two-part series. Tune in Wednesday, Feb. 8 during Morning Edition and All Things Considered to hear part two.

Methodist Women's Hospital, which opened in 2010, sits just off the interstate in Elkhorn. The modern, two-building facility is a "one-stop shop" for women's health. Women-centered facilities are not a new concept in the health care industry, but turning back to a more home-like and natural birth experience is. Sue Korth, vice president of the hospital, took a KVNO News reporter on a recent tour of the hospital's new labor and delivery rooms. Korth said they are as "home-like" as they can get.

"When we did construction, the construction staff called this the baby garage,'" Korth said as she opened up closet doors revealing a baby warmer, anesthesia carts and other delivery equipment. Most equipment is hidden throughout the room behind doors, drawers and paintings to keep them out of view of the patient and her guests. Soft music played in the rooms, which looked more like hotel suites than delivery rooms.

Photo courtesy of WomanKind Midwifery

WomanKind Midwifery is located in Spearfish, S.D., near the South Dakota-Wyoming border, but owner Jeanne Prentice said women drive from as far as Lincoln, Neb. to see her - more than 600 miles.

Photo courtesy of WomanKind Midwifery

Jeanne Prentice of South Dakota-based WomanKind Midwifery said some women are "desperate" to have a different type of natural birth than what's offered at most hospitals.

Photo courtesy of Methodist Women's Hospital

A delivery room at Women's Methodist Hospital, which opened in 2010 in Elkhorn, Neb.

An open room even had a jacuzzi tub. Korth said some moms feel more comfortable laboring in water.

She added that a lot more women are asking for natural birth plans lately, meaning births with limited medical interferences such as epidurals, labor-inducing medications and/or cesarean sections. After the tour, Korth was asked about the most natural of birth plans: the home birth.

"We feel like we've done a very good job as getting as close to that as we possibly can," she said. "I think this is just the absolute safest place to be."

But there are some Nebraska couples who feel a hospital will never replace the comfort of home - like "Katie" and "John," an Omaha couple who asked their names be changed to protect their identities.

"I'm terrified of hospitals," Katie said with a laugh. And she knows hospitals: Katie works at one in Omaha and her husband, John, is a paramedic.

"It's just an uncomfortable environment, I think," she said. "From the bed you're in, to the room that you're in, to multiple people coming in and out, in and out, not necessarily telling you what they're doing or what's going on -- they're just doing it. It's just so impersonal I'm just afraid of that."

The couple is not expecting just yet, but is looking at their options. They prefer an assisted home birth with a certified nurse midwife, or CNM, but they will face some difficult choices in their planning, as the birth experience they want is an illegal one. Nebraska is one of two states where an assisted home birth attended by a CNM is prohibited. Alabama is the other.

Katie fears the professional and personal implications of having a home birth.

"I would fear for my job if I had a home birth," she said. "It is scary, the thought of doing it, not just my job, but with my family and society and the view of what that means."

John said he's also unsure of the professional implications he could face. He hasn't told any of his paramedic instructors about their plans; only one trusted co-worker.

John's professional experience may allow him to legally deliver a baby himself, either as a father or as a paramedic. If they do decide on a home birth, he said, he would have an ambulance on standby.

"There's that gray area," he said. "I could easily say She went into labor! We had no choice but to deliver at home!' and no one would think anything else, you know?"

If Katie decides on a home birth, it would be difficult to find a CNM willing to help. The penalties for an attending midwife can range from license revocation to jail time.

That has some Nebraska women coming to Jeanne Prentice. Prentice is the owner of the WomanKind Midwifery, located in the town of Spearfish, South Dakota, minutes from the South Dakota-Wyoming border, and nearly 600 miles from Omaha.

She never delivers in Nebraska, but said Nebraska mothers from as far southeast as Lincoln drive hours, or even days, to see her. She said these women are "desperate" to have a different type of natural birth.

Speaking from her office in Spearfish, Jeanne said, "They want a different experience, they don't want to be induced, they don't want an epidural, they don't want to be flat on their back with a monitor. They want something different. They want that personal care. And they can't get it in their home state."

Prentice said the atmosphere that compels women to drive hundreds of miles can never be replicated in a hospital setting. Hospitals are meant to treat disease, she said, something she sternly added pregnancy is not. And as for the new home-like atmospheres, Prentice isn't buying it. She feels hospitals are quick to perform interventions, sometimes unnecessarily, breaking the tranquility of an otherwise quiet room.

"You can put nice Pergo floor in and you can hide your equipment, but the minute things look a little or feel a little scary to you, you drag that stuff out," she said.

Not all certified nurse midwives feel the same about attending home births. Prentice had strong words about those who support the current statute, which outlaws assisted home births in Nebraska.

"Shame on them! Shame on them, that they would rather see women deliver unattended than allow another nurse midwife to provide that care," she said. "I'm disgusted."

But back in Elkhorn, Marilyn Lowe is one of four CNMs who make up Methodist's new Midwifery Department. She said a natural birth doesn't have to take place outside of a hospital. After a full day of seeing patients, Lowe talked about her views in her office.

"Birth is a philosophy," she said. "And it can be as natural in a hospital as it can be in a home. Our goal is to help that woman accomplish what she wants to accomplish."

And that doesn't apply just to natural births. "We also have patients who want epidurals," Lowe added. "But if somebody wants a natural birth, that is our goal, to help them accomplish that with as little intervention, but yet knowing if we need that intervention, it's available."

Safety for the mother and baby, Lowe said, is best found in a hospital setting.

"I've been an O.B. since 1978," she said. "I've seen a lot of things happen very quickly, that we had to act on. We had maybe eight to ten minutes. If you're outside an institution, eight to ten minutes is your travel time. To me, it's a safety factor."

But for Katie and John, not having the option of an attended home birth leaves them feeling unsafe and frustrated. Katie is perplexed at the notion that they can deliver themselves, but not with a trained professional.

"For me, I want to have a home birth, but I don't want to just be by myself at home popping out a kid," she said. "What if something goes wrong?"

"My biggest frustration is that I can have a home birth, me and my husband can have our kid at home, but we can't have somebody who's trained to be there with us."



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