Behind the Scenes at a Birthing Center

The birth of every baby is special, but on March 9, 2003, my son and I made history. My delivery was unremarkable, and my son's middle-of-the-night birth had few witnesses. But when Adam came into the world at the Madison Birth Center, he became the first baby born at a free-standing birth center in Wisconsin.

It was a first for me as well. My two previous births had taken place in hospitals. Then I saw a newspaper headline that changed our lives: "Birth Center Comes to Life." I was five months pregnant. The rest, as they say, is history.

These days, a lot of hospital maternity units call themselves birth centers, adding homey touches such as curtains and framed pictures to regular hospital rooms. But decor is only a small part of what separates a birth center from a hospital ward.

Some centers are, quite literally, not connected to a hospital at all. Their goal is to offer you an environment with all of the comforts of home -- a regular bed, soft lighting, privacy -- where you can give birth in whatever way works best for you. Most have cozy birthing rooms, kitchens, family areas, and whirlpool baths where laboring women and their families can relax.

But what truly sets birth centers apart is the philosophy of care. They're run by midwives, who believe that birth is a normal, natural event, and that women's bodies are perfectly equipped to handle childbirth. This philosophy also supports natural childbirth. Narcotic pain relief is an option, but an epidural isn't. If you need one, you must transfer to a nearby hospital.

This approach definitely appealed to me. My first birth was a maze of medical interventions; it took two weeks to recover from that one day of labor. My second was a big improvement -- only a little narcotic pain relief -- but it was still in a hospital. As a third-time mom, I knew I needed emotional help and reassurance, not drugs, to navigate the choppy waters of childbirth. And as a registered nurse, I understood the birth process, as well as the benefits and drawbacks of using such a center.

The new center sounded ideal, except for the fact that it was an hour's drive from our home. I e-mailed for information anyway, and I'm glad that I did.

When the owner, certified nurse-midwife Aszani Kunkler, called to introduce herself to me, I was immediately impressed with her warmth and knowledge. She asked about my past births and current pregnancy. Because birth centers are for low-risk women, she would have been unable to accept me as a client if I'd had a complicated pregnancy or previous c-section.

A week later, my husband, Marc, and I met Aszani in person and toured the center. We asked lots of questions: I was concerned about the kind of labor support I'd receive, and my husband, naturally, was concerned about the bottom line.

Unlike hospitals, the birth center charges one set fee that covers:

• all prenatal care and classes
• the birth itself
• newborn care
• follow-up visits

Typically the overall cost is about 50 percent less than a hospital birth. Some insurance companies cover birth-center care; others don't.

She also outlined the center's program of care. Prenatal visits last an hour and include personalized education. Marc and I needed to take a complications class as well as an early home care class, where we'd learn skills such as how to check both Mom's and baby's vital signs and when to call the midwife.

On delivery day, two midwives would support me throughout labor and birth. And after he made his appearance, my baby would rest in the arms of his new family. When everyone was stable, the family would go home, usually not more than 12 hours after birth -- and I'd receive a home visit from a midwife at 24 and 36 hours after birth to perform newborn screenings and offer support, be it emotional or physical.

After our visit, my husband and I agreed that the birth center was exactly what we'd been looking for -- a place where I could trust that my instincts would be honored and supported.

But I had some concerns. I wished the center were closer to our home, and I was worried about the 12-hour discharge policy. I knew I would need plenty of rest after the birth and wasn't sure how I'd get any with a 2-year-old and 4-year-old running around at home. In order to make a birth- center delivery work, I'd need lots of help and support from my family.

I was lucky -- I talked to my mother and some other family members and was delighted to hear that they supported my decision and offered to help.

With the help issue out of the way, Marc and I considered how far away the center was and decided that distance wasn't a deterrent. My previous labors were not fast, and the chance to labor in such a supportive environment was well worth the drive.

But there were other things to consider beyond help and convenience. I believe that birth is a natural process, but many medical professionals believe it's a risky business best suited for a hospital. I didn't want to put my baby or myself at risk, so I did some digging and found that all the research supported the safety of birth centers:

• A study of 12,000 birth-center births published in the New England Journal of Medicine demonstrated no maternal deaths, a greatly reduced c-section rate, and good infant outcomes.
• Birth-center staff are certified in lifesaving techniques for mother and baby, and emergency equipment and medication are always on hand.
• If necessary, my baby or I could quickly be transferred by ambulance to a hospital with a neonatal intensive care unit; in fact, I was closer to high-level care at the birth center than at my local hospital.

So with just seven weeks to go before delivery, I transferred to the Madison Birth Center. From that moment, I saw that the birth center was very different from what I was used to. Prenatal visits included all the usual checks, but I weighed myself and did my own urine dip, using special sticks to check for protein or sugar. Together, Aszani and I discussed everything from family and pregnancy to ways to cope with birth. It was wonderful to have such rapport with a healthcare provider.

Marc and I arrived at the center in labor at 10:45 p.m. on March 8. It was a soothing, welcome sight; soft lighting and music filled its rooms, and we were able to choose the room in which we wanted to give birth. All of them were beautiful, adorned in muted earth colors, with queen-size beds, and luxurious sheets and pillows, as well as whirlpool tubs.

Aszani checked me and confirmed that I was indeed in labor. Then she tucked us into bed. Twenty minutes later, my water broke and my contractions intensified. But I was relaxed; everyone around me believed in my body's ability to give birth without medication or medical interventions.

I found I was able to concentrate on one contraction at a time. Aszani monitored the baby's heartbeat with a handheld Doppler. She and Mary, another midwife, murmured words of support, and I surrendered to the forces flowing through me.

When the contractions got really intense, I entered the tub. Then I felt the baby coming down. "Go ahead and push," Aszani said. "Just go with your body." I was momentarily confused. I was used to hospital births, where a doctor declares you effaced and dilated and instructs you to push. But I felt my baby, and my body was telling me that it was time. (Since this was my third child, the last stage of labor progressed pretty quickly.) Minutes later, my son was born. Aszani caught him and brought him up onto my chest.

I felt incredibly empowered! By relying on my body's wisdom, I'd brought my baby into the world. Our son, Adam, was healthy, alert, and breastfeeding like a pro. We all rested in bed throughout the night, monitored frequently by staff. And just 10 hours later, we headed for home.

While I'd worried about the early discharge, I found I loved being home, surrounded by my family. I tucked my older kids in at bedtime. I slept in my own bed with Adam snuggled up beside me. Every eight hours, I recorded my vital signs and Adam's, as well as when he nursed and how many diapers he wet.

Aszani visited us on Day 2 and 4. She checked me and the baby and performed all the newborn screening tests in the comfort of our own home. Before she left on her final visit, we hugged.

Aszani and the Madison Birth Center staff had given me more than a great birth and a healthy baby. I'm now a passionate advocate for midwifery and birth-center care. I've embraced a more natural style of living. And I'm a better mother. My experience taught me to trust myself and my intuition -- priceless gifts for any parent.

Jennifer L.W. Fink is a mother of three in Mayville, Wisconsin.

Originally published in American Baby magazine, April 2005.