The idea of a birth center started early. I didn’t see it. But it was there.
I grew up with a mother who managed a medical clinic and a father who worked as an EMT. I remember cleaning exam rooms and stopping for accidents on the side of the highway. As a high school student, I also became a certified EMT like my dad. My first experience with birth was in the back of an ambulance with a new mother just one year younger than me. I came home that night and told my mom I wanted to be a midwife. Soon after, I joined the military and headed off to basic training and college where I earned my degree in Human Development and Family Studies and Health Science. My experiences in those early years allowed me to be with families in their most pivotal moments. I was given the opportunity to see our healthcare system at every level and take notes about what works and what doesn’t work. You know what works? Collaboration.
The day I discovered birth centers.
Fast forward to 2010. I had recently given birth to my first son. While chatting with some new friends at La Leche League (after fumbling clumsily through breast latches and diaper changes), we started casually talking about birth options in South Dakota. This was a new idea to me because I was under the impression that the hospital was my only option for birth. I didn’t even know home birth and birth centers existed and I didn’t fully grasp the idea until my second son was born two years later. I listened closely that evening while the other women explained that birth centers are offering care to families across the country. We talked about some of the reasons a family might choose a birth center over a traditional hospital birth:
A family might be seeking to have more involvement during pregnancy and birth.
A woman might be interested in experiencing an unmedicated birth while remaining in an environment which can efficiently offer medical interventions or transfer, if necessary.
A family carries the philosophy that pregnancy is a normal part of the lifespan which includes expected physical, emotional, and social changes.
A family seeks to be informed and self-reliant regarding their health.
A family seeks a safe, lower cost alternative to traditional hospital services.
- A family seeks to reduce their risk for induction and cesarean birth.
- A women wishes to breastfeed with access to immediate and ongoing support.
Birth centers are guided by the principles of prevention, sensitivity, safety, appropriate medical intervention, and cost effectiveness and are supporting families across the globe. They offer regular well-woman care and pregnancy, birth, and postpartum care for healthy women experiencing low-risk pregnancies. The hallmark of an effective maternity healthcare model is one that works efficiently and collaboratively with other health services, including home birth midwives, birth centers, and hospitals while offering sustainable care at a manageable cost for families. Birth centers have consistently shown charges 50% less than hospitals for uncomplicated births. They do this by providing “high touch” rather than “high tech” care, offering wellness education and prevention programs, initiating fewer routine medical interventions, collaborating with community and specialty services instead of duplicating services, and following established policies and procedures for screening and transfer to acute care services. Families can expect attentive, skilled care from a team of Certified Nurse-Midwives (CNM) and Certified Professional Midwives (CPM), nurses, educators, and community outreach professionals. A birth center is just one element of the full system of care that thrives on collaboration and continuity with other local health services.
With my hazy, new-mom brain I was only able to retain about half of the conversation that evening, but I do remember that I felt a little duped. I wish I had known ALL of the options available to me so I could make the right decision for me. Looking back? I probably would have still chosen to birth at the hospital. It was the right choice for my family at that point on our journey. But today, my decision might look a bit different.
That’s the thing.
Actually, that’s the whole point. Families make decisions that are right for them for where they are on their journey. We all make choices that reflect our values and experiences and at no point should we be imposing our own values on anyone else. I’ve seen women thrive in the structure of a hospital setting. I’ve witnessed extremely calm and peaceful births in women’s homes. I’ve watched these worlds come together beautifully in birth centers. When we have more options, everyone can feel supported because there’s a comprehensive, collaborative system of care.
Let’s go back.
If we look at the history of birth, we can get a better sense for how birth center care evolved and, specifically, how it came to be in South Dakota. Prior to the 19th century, women largely birthed in their homes with female birth attendants. Midwives were first licensed in New York in 1716 and were the primary caregivers during birth. The beliefs regarding birth care began to gradually shift to a more medical model of birth in the late 18th century. In the 20th century, medical care in the United States was greatly improved with new developments in surgical and anesthesia techniques, improved sanitation, blood transfusions, and antibiotics. The number of medical schools doubled and health insurance became more accessible.
As an unintended consequence of these improvements, birth became a medical event . Mothers were heavily sedated during birth and newborns were taken to the nursery. Breastfeeding on demand was discouraged. The incidences of infant mortality and low birth weight babies began to rise and are still higher today than in other developed countries. Costs showed a steep increase and continue to rise. Many invasive medical procedures and policies were widely accepted and implemented without adequate study, some of which are still routine in many places today (ie. routine episiotomy and continuous fetal monitoring). In 1981, the Maternity Care Association (MCA) of New York developed the Cooperative Birth Center Network (CBCN) to fund the first national birth center study. The study was published in the American Journal of Public Health and became the guidance for the first regulations for licensed birth centers in 1983. The American Association of Birth Centers (AABC) was formally created and prepared the first national standards for the accreditation of freestanding birth centers. In 1989, the National Birth Center Study was published in the New England Journal of Medicine, concluding that “few innovations in health service promise lower cost, greater availability, and a high degree of satisfaction with a comparable degree of safety.” The second National Birth Center Study was published in 2013 and showed similar outcomes related to the safety and cost effectiveness of birth center care. Birth Center pioneers tell the history of birth centers in this video.
Meanwhile, in South Dakota, a Certified Nurse Midwife (CNM) was offering home birth services to families in the Black Hills and identified the need to offer services to some women in one centralized location, a birth center. South Dakota Birth Matters, worked hard to educate our legislators and ultimately pass legislation which regulated and licensed birth centers in South Dakota. ARSD 44:69 was passed in 2012, allowing for the development of South Dakota’s first and only freestanding birth center in Spearfish, SD in 2013. That birth center is no longer in operation, but it opened the doors for a new kind of birth experience for families in South Dakota.
After I became a certified birth doula and lactation counselor in 2014, I quickly discovered that families in Sioux Falls were seeking the type of birth experience that only a birth center could provide. We hosted townhall meetings where passionate men and women shared their ideas for design, services, events, and classes. They told us they want the midwives to be able to focus their time and energy on the families, and not on operations of the center. They said it’s important that the center provide a community atmosphere where families can come together for things like potlucks and yoga and parenting classes. We talked about ways to integrate community programs from organizations like Dress for Success. In 2015 we registered as Nourish Birth Collective, LLC so that we could offer formal, collaborative birth services as we moved forward with the development of the birth center. Through Nourish, we developed the Village Facebook group and provided referral services for mental health, breastfeeding, chiropractic, and doula services. I attended the American Association of Birth Center (AABC) birth center workshop in Annapolis, MD in Fall 2015 and was provided the tools to prepare the foundation for a successful birth center. I spent the next year learning, networking, developing an advisory team, and preparing a comprehensive business plan. One of the things that was expressed to us in those early town hall meetings is that this center needs to be sustainable and safe. Families in South Dakota have waited too long for adequate birth options and it’s appropriate to offer a service that is reliable and safe.
How can you help?
- Continue educating people about the birth center model of care.
- Tell your insurance companies and medical providers that birth center care is important to you.
This brings us to Ovo. Families have been asking for a freestanding birth center for years and it’s time they had a physical place to come together for their health and their community. Ovo is dedicated to developing South Dakota’s first freestanding, accredited birth center. This is an intensive process that involves advisory meetings, networking, financial projections, renovations, policy writing, hiring, and a whole lot more. I spent the last year touring birth centers in Maryland, Colorado, Minnesota, Wisconsin, and Texas. I met the leadership teams and learned about everything from policies to clinic layout to staffing. I’ve included just a few of the 900 photos from those trips in a gallery below. We’ve created a loving, local Facebook group called The Nest which is just a nice place for families to come together and ask about potty training tips and date night ideas. We’d love to have you join us in The Nest.
I think back to the day I held that new mothers’ in the back of that ambulance. I didn’t know it at the time, but I was already a doula and I’m excited to bring a new type of birth support to South Dakota. It’s time.
Lisa Groon is a certified birth doula and lactation counselor and feels passionately about the concept of building a community to support families during the incredibly challenging and rewarding journey of parenting. Lisa loves to laugh and you’ll inevitably be greeted with a big hug and a little sass. She enjoys staying busy and spends much of her time chasing her two adorable little boys with her exhausted husband Jason.
American Association of Birth Centers. Accessed March 08, 2017. Available at: http://www.birthcenters.org/.
HealthyPeople.gov. Healthy people 2020: Maternal, infant and child health. Available at: http://healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=26. MICH 7.1 “Reduce cesarean births.”
Midwifery Today. Accessed March 08, 2017. Available at: https://www.midwiferytoday.com/articles/timeline.asp.
Rooks JP, Weatherby NL, Ernst EK, et al. Outcomes of care in birth centers. The national birth center study. The New England Journal of Medicine. 1989;321:1804-1811. Available at: http://www.ncbi.nlm.nih.gov/pubmed/2687692.
Stapleton SR, Osborne C, Illuzzi J. Outcomes of care in birth centers: Demonstration of a durable model. Journal of Midwifery and Women’s Health. 2013. Available at: http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12003/full.