The natural baby boom: Why some pregnant women are dodging the hospital and saying no to drugs

"Women are doing their research, they’re finding out it’s safer for a low-risk woman to birth outside of the hospital."

What makes a midwife?

Breath of Life is the only nationally accredited birth center in Tampa Bay and the only one staffed by certified nurse-midwives (i.e., advanced registered nurse practitioners who are also certified by the American Midwifery Certification Board). The area’s other centers are staffed by certified professional midwives. The difference in these designations is in the amount of schooling. Certified professional midwives are graduates of a three-year academic midwifery program and are only licensed to practice in 27 states, Florida included. —HK

EDITOR'S NOTE: Following publication of this story, we received a note from Charlie Young, Certified Professional Midwife (CPM), Licensed Midwife (LM) in the state of Florida and owner of Bay area home birth service provider Barefoot Birth, with the following clarification regarding certification standards for midwives:

"In Florida, in order for a midwife to practice legally she must be a Certified Nurse Midwife (CNM) or a Florida Licensed Midwife (LM). While some LMs may ALSO carry their CPM it is not required to practice here and their standards do not equate to that of the Florida Licensure. Florida Licensed Midwives are licensed and regulated by the Department of Health. Licensure is obtained through attendance at a three-year Florida-approved midwifery school as well as several prerequisites and clinical internship. LMs are required to abide by the law and rule set forth by the Dept. of Health which includes the requirement of malpractice insurance, mandatory statistic reporting, and continuing education. These standards are much higher than that of the CPM and as Licensed Midwives we are proud to share that Florida licensure for midwifery is one of the most comprehensive in the U.S. very similar the direct entry model used in England and Ireland. As LMs we have spent a lot of time in the past 18 years educating the public about what it is we do and teaching that the L in LM is for 'Licensed' and not 'Lay.'"

Heidi responds: "I'm sorry if I caused any confusion over the different midwifery licenses and designations in the state of Florida. It was one of the technical areas I attempted to simplify in order to keep things succinct. Thank you for your feedback and clarifications. I hope the story succeeded in letting more pregnant women know they have choices; that not all babies need to be born within the confines of a hospital."

click to enlarge THE FIRST TIME: “It sucked. I’m not going to lie,” says Noelle Talley, pictured here in the throes of her first water birth at Breath of Life. “But I have zero regrets.” - ANGELA SACKETT
Angela Sackett
THE FIRST TIME: “It sucked. I’m not going to lie,” says Noelle Talley, pictured here in the throes of her first water birth at Breath of Life. “But I have zero regrets.”
My first introduction to childbirth came from watching the movie Robin Hood: Prince of Thieves. In it, Morgan Freeman’s character comes to the aid of a laboring woman whose baby is breech. The situation seems dire. Kevin Costner looks on helplessly as the baby’s father, a man who resembles Hagrid from Harry Potter, questions whether Freeman is skilled enough to perform an un-medicated C-section. A nearby peasant hands the suffering woman a stick, tells her to bite down, and then as the camera pans away, she lets out a guttural scream.

Seconds later, the film cuts back to the new mother resting in a hut, cradling her newborn, her face flush with bliss. Even as a prepubescent girl, I knew better than to assume she’d fare well following medieval surgery without anesthesia or sterile supplies. I was born in 1982 via C-section after 36 hours of labor. My mother, who went on to have two more C-sections, was knocked out completely for all three procedures and looks like she’s wincing in the pictures. You know how some kids grow up thinking storks deliver babies? I grew up thinking doctors cut them out of bellies.

That’s not the case, of course; only one-third of American babies are born this way. But the C-section rate in the United States has risen dramatically over the last few decades, in some cases seven-fold. Although most bundles of joy exit through the birth canal, a staggering 32 percent in the U.S. are delivered surgically, making the C-section one of our nation’s most frequent operating-room procedures.

But even as C-section deliveries multiply, more and more women are seeking alternatives — in birthing centers, with midwives and, even when giving birth in a hospital, refusing drugs.

Call the midwife

Medically unnecessary C-sections came under fire in Ricki Lake and Abby Epstein’s 2008 documentary The Business of Being Born. The film, which takes to task the health care industry’s homogenized, overly clinical, intervention-heavy, one-size-fits-all approach to childbirth, did for obstetrics what Supersize Me did for Big Macs. It made viewers question how they treat their bellies.

The fallout from Lake’s film has been palpable in Tampa Bay’s birthing center community over the past 10 years.

“It changed everything,” says Glenda Pearson, executive director of Breath of Life Women’s Health & Birth Center in Largo. “We still get clients coming in saying, ‘I saw that movie and it opened my eyes.’ Even though it delves into home birth, it was about community birth, which is what we’re trying to get people to understand. We’re trying to bring midwifery back to Main Street.”

With so many advancements in prenatal testing and so many state-of-the-art tools at the disposal of obstetricians, midwifery sounds downright antiquated. Yet the practice, which dates back to Greco-Roman antiquity, is enjoying a kind of renaissance thanks to our culture’s information overload and pressure from other developed nations. (In 2014, Britain’s National Institute for Health Care and Excellence issued new guidelines advising women with uncomplicated pregnancies to have their babies at home or at a birth center under the care of a midwife.)

“Social media and the expansion of the internet has helped tremendously,” Pearson says. “Everyone is sharing their experiences. Women are doing their research, they’re finding out it’s safer for a low-risk woman to birth outside of the hospital. I had natural childbirth in a hospital back in the ’80s. I was stuck in a bed on a monitor. I wasn’t allowed to eat or drink, except for ice chips. It was torture.”

click to enlarge NOW HEAR THIS: Nurse and lactation consultant Ashley Homan performs a hearing test on Sarah Davidson’s newborn at a postpartum appointment at Breath of Life. - HEIDI KURPIELA
Heidi Kurpiela
NOW HEAR THIS: Nurse and lactation consultant Ashley Homan performs a hearing test on Sarah Davidson’s newborn at a postpartum appointment at Breath of Life.
Pinellas and Hillsborough counties are home to half a dozen birthing centers, including two that opened just last year: The Birth Center of St. Pete and In Due Season north of New Tampa. For one region to offer so many birth alternatives is remarkable. The entire state of New York, for example, has only two freestanding birth centers.

Says Pearson, “We see same-sex couples, home-schooling mothers having their sixth baby, Scientologists, working women and women in school. We get women who are single and women who are married. It runs the gamut.”

The majority of these patients are getting what they want: natural deliveries, free of drugs and interventions. Breath of Life’s hospital-transferred C-section rate is 7 percent. (The state average is a whopping 42.8 percent.) “If this place had been available to me when I was having babies, I’m certain I would have chose it,” Pearson says.

An affordable alternative

The natural baby boom is in full swing.

Breath of Life celebrated its 10th anniversary in April, coinciding with the birth of its 1,000th baby. It opened with 20 clients and has increased its patient load every year by 20 percent. Labor of Love, a cozy, high-volume practice in Lutz, is fully booked through September and is currently operating on a waitlist.

Jessica Willoughby, midwife and owner of The Birth Center of St. Pete, a small one-woman operation near St. Petersburg’s Crescent Lake neighborhood, delivered 70 babies in 2016 — her first year in business. 

“I didn’t even know what a midwife was,” says Willoughby, who studied anthropology at the University of South Florida before pursuing midwifery. “I thought you had to have an epidural to have a baby. My first year at USF, a doula came in and talked about home birth and water birth and I was like, ‘Oh my god, you can have a baby standing up?’ It was like this secret nobody told me.”

Willoughby’s birth center operates out of an old bungalow, which is de rigueur for a lot of practices. If the average gynecological clinic is cold and impersonal, then the average birthing center is as homey as a bed and breakfast. Breath of Life, which is decidedly more clinical-looking than most centers, still has quaint/chic birthing suites with pretty furnishings, airy curtains, oversized birthing tubs, plush bedding, rocking chairs and sweet-smelling candles.

“People think I live here,” Willoughby says of her practice. “I understand why. It’s definitely set up to look that way.”

With all its boutique-y trimmings, personalized care and low patient-to-midwife ratios, you would think birthing centers would charge more than hospitals for prenatal care and delivery. They don’t. Most facilities accept Medicaid and some private insurance. Breath of Life’s self-pay clients pay around $7,000 for routine care. According to Pearson, local OB offices bill insurance companies about $23,000 for a vaginal hospital delivery. A C-section costs twice as much. “Hey, somebody has got to pay for the obstetrician’s Maserati,” says UK native Ian Rowell, owner of Labor of Love. “In England, maternity wards are staffed by midwives and midwives alone. There is an obstetrician on call should there be a complication, and there is no insurance to cloud up the water.”

click to enlarge Sarah Davidson and Everleigh, born April 30 at Breath of Life. - HEIDI KURPIELA
Heidi Kurpiela
Sarah Davidson and Everleigh, born April 30 at Breath of Life.
Unlike hospitals, which typically admit women for two or three days postpartum, birthing centers let healthy moms and babies fly the coop within hours of delivery. Dunedin science teacher Sarah Davidson left the house to have her first child at 8:30 a.m. and was back home in time to catch the 5 o’clock news. “It was like I put in a day’s work,” she jokes.

This kind of turnaround freaks out a lot of traditional obstetricians and moms-to-be, which is why only 1 percent of women intentionally choose to have their baby outside of a hospital. The majority of women still feel safest with a doctor — that, and some pregnancies are too risky for a home or birth center setting. High blood pressure, twin pregnancies, breech babies and blood-clotting conditions are all grounds for dismissal from most birth centers.

And then there’s the stigma that only religious zealots or New Age-y hippies birth babies in bathtubs without drugs. 

“You’re still part of the grand minority when you choose this model of care,” says Vikki Bennett, nurse-midwife and clinical director at Breath of Life. “There’s this notion in the back of some people’s minds that we walk around in Birkenstocks with unshaven legs; that you’ll be squatting in the reeds out back while we sing to you. They’re always surprised when they get here. We’re not what people expect.”

No pain, no gain?

There’s a tradeoff to all this freedom and control, and that’s pain management. Natural labor is a bitch, and not all moms are down with the martyrdom. Some women regard natural labor the way they regard natural foods — as a fad or another crunchy chapter in the all-organic-all-the-time paleo movement. Celebrities have certainly normalized the alternative. When supermodel Gisele Bündchen described her home water birth as “not at all painful,” mothers the world over scoffed.

“I have friends who had babies naturally and I’ve always made a point of not saying they’re crazy, but in my head I’m like, ‘Are you crazy?’” says St. Petersburg mother of two Monica Kile.

Kile, director of the Osher Lifelong Institute at Eckerd College, had no desire to pursue a Bündchen-style transcendental water birth. 

“I have a pretty optimistic opinion of Western medicine,” says Kile, who as a teenager was in a bad car wreck and spent a couple weeks in the hospital, where she says she received top-notch care. “I was never interested in subjecting myself to pain. I didn’t have any concerns about receiving an epidural. I wouldn’t have had it any other way.”  

Bennett respects this perspective. As a midwife, she has transferred patients to Morton Plant Hospital for epidurals alone. “You’re going to have your best birth experience wherever you’re most comfortable. It’s important to remember that women have been having babies forever and no one is handing a trophy out at the end.”

We all know the trophy is your baby. I have two of these trophies, both of them boys; one is in kindergarten and the other is 18 months. I pushed them both out at Breath of Life in a tub of tepid water with a washcloth gnashed between my teeth. It wasn’t easy, but it was nothing like that scene in Robin Hood.

In the pictures, unlike those of my mother, my face is flush with bliss.

After delivering my second son, I asked my friend, Shannery, who had three kids in a hospital — the third without pain-killers — if she’d ever felt the urge to pull her car off the interstate and have her babies on a rock like the warrior princess I know she is.

“This natural birth shift has definitely put some pressure on women who go the conventional route,” she said. “But I think that’s okay. If I hadn’t felt some pressure from friends who had birthing center experiences, I may not have had a natural birth with my third. I think women are being encouraged to question health care and to question what they’re told and taught about their bodies. In our society, childbirth is not something we grow up learning about. I don’t know, but I think that’s changing for the better.”

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