Unassisted: Home Birth in Nebraska, Part One
December 29th, 2011
Omaha, NE- Birth is big business to a healthcare industry that welcomes over four million babies in the United States each year. Hospitals are reinventing themselves to create an atmosphere catering to a womanâ€™s evolving needs. However, some Nebraska women want to take their business out of the hospital altogether, but find their choice may not be a legally viable option.
Methodist Womenâ€™s Hospital, which opened in 2010, sits just off the interstate in Elkhorn. The modern, two-building facility is a â€œone-stop shopâ€ for womenâ€™s health. Women-centered facilities are not a new concept in the health care industry, but resorting back to a more home-like and natural birth experience is. Vice President of Methodist Womenâ€™s Hospital, Sue Korth, took me on a tour of the hospitalâ€™s new labor and delivery rooms. Korth said they are as â€œhome-likeâ€ as they can get.
â€œWhen we did construction, the construction staff called this the â€œbaby garage,” said Korth 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 out of view from the patient and their guests. Soft music played above as we walked through rooms that looked more like a hotel suite, rather than a delivery room.
Korth took me to an open room with a jacuzzi tub. She said moms feel more comfortable laboring in water.
Korth said a lot more women are asking for natural birth plans lately, meaning births with limited medical interferences such as epidurals, labor inducing medications, and cesarean sections. After our tour, I asked Korth about the most natural of birth plans: the home birth.
“We feel like weâ€™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.â€
But, there are some Nebraska couples who feel a hospital will never replace the comfort of home. I spoke with “Katie” and “John”, an Omaha couple who asked we change their names to protect their identities.
â€œIâ€™m terrified of hospitals,” laughed Katie. And she knows hospitals, Katie works at one in Omaha and her husband, John, is a paramedic.
â€œIt’s just an uncomfortable environment, I think,” she said. “From the bed youâ€™re in, to the room that youâ€™re in, to multiple people coming in and out, in and out, not necessarily telling you what theyâ€™re doing or whatâ€™s going onâ€”theyâ€™re just doing it. Itâ€™s just so impersonal…Iâ€™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, but they will face some difficult choices in their planning. The birth experience they want is also an illegal one. Nebraska is one of two states where an assisted home birth attended by a Certified Nurse Midwife is prohibited. Alabama is the second.
Katie fears the professional and personal implications of having a home birth.
â€œI would fear for my job if I had a home birth,” she said. “But 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.â€
John said heâ€™s also unsure of the professional implications he could face. He hasnâ€™t told any of his paramedic instructors about their plans, but only one co-worker because he said he trusts her.
Johnâ€™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.
â€œThereâ€™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?â€
If Katie decides on a home birth, it would be difficult to find a Certified Nurse Midwife 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 says Nebraska mothers from as far southeast as Lincoln drive hours, or days, to see her. She said these women are â€œdesperateâ€ to have a different type of natural birth.
Speaking from her office in Spearfish, Jeanne said, â€œThey want a different experience, they donâ€™t want to be induced, they donâ€™t want an epidural, they donâ€™t want to be flat on their back with a monitor. They want something different. They want that personal care. And they canâ€™t get it in their home state.â€
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.
â€œYou 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,â€ she said.
Not all Certified Nurse Midwives feel the same about attending home births. Prentice had strong words about midwives who support the current statute which outlaws assisted home births in Nebraska.
â€œShame on them! Shame on them, that they would rather see women deliver unattended than allow another nurse midwife to provide that care,” she said. “Iâ€™m disgusted.â€
Back in Elkhorn, Certified Nurse Midwife, Marilyn Lowe is one of four CNMs who make up Methodistâ€™s new Midwifery Department. Lowe says a natural birth doesnâ€™t have to take place outside of a hospital. After a full day of seeing patients, Lowe spoke with me after hours in her office.
â€œBirth is a philosophy,” Lowe 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.”
“We also have patients who want epidurals,” she said. “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, itâ€™s available.â€
Safety for the mother and baby, Lowe said, is best found in a hospital setting.
â€œIâ€™ve been an O.B. since 1978,” she said. “Iâ€™ve seen a lot of things happen very quickly, that … we had to act on we had, maybe, eight to ten minutes. If youâ€™re outside an institution, eight to ten minutes is your travel time. To me, itâ€™s a safety factor.â€
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.
â€œFor me I want to have a home birth, but I donâ€™t wanna 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 canâ€™t have somebody whoâ€™s trained to be there with us.â€