Community Medical Center President to Meet With Missoula Birth Center Supporters

By Sutton R. Stokes, 1-30-09

Area moms have been in mourning since last week’s news that the Missoula Birth Center would close.

In what has become a busy comments thread on last Thursday’s article announcing Community Medical Center’s plans to convert the Birth Center into a primary-care clinic, the prevailing sentiment is represented well by commenter Samantha Hines: “what a waste of such a beautiful building and a wonderful ideal.”

Now, Community Medical Center President Steve Carlson has offered to meet with Birth Center supporters to see which — if any — of their concerns can be addressed in the design of Community’s new Women and Infants Center, scheduled to open in 2010. In a comment left on last week’s article, Carlson provided his phone number (327-4003) and asked for input, writing that “our goal is to develop a program that can accommodate the needs of all patients, including those interested in a more natural experience.”

In other words, Community Medical Center is turning the Birth Center into a more traditionally “medical” space, but is willing to redesign its hospital — or part of it — to resemble the Birth Center.

I’m no expert, but this seems like a complicated way to try to meet the needs of the growing segment of Missoula parents who are interested in natural birth.

I’m also not sure that Community Medical Center can address the largest concerns of women who prefer to deliver in a birthing center rather than a hospital. As I learned in interviews with a half dozen past, present, and potential Birth Center patients over the last two weeks, it’s not just the ambience of a hospital that turns them off. Here are some of the themes Carlson will likely be hearing about, if anyone ever contacts him. (There’s only been one phone call so far.)

Let’s start with the concerns that should be relatively easy for Carlson and Community Medical Center to address.

For example, several women I spoke to hate the separation of mother and infant that routinely happens at many hospitals, even if only briefly. Angela Timm-Miller, who delivered at Community, spoke of the distress this caused her. “When they take your baby from you, it just freaks you out,” she says. “You’ve waited nine months to see it and then you don’t have it with you, and that’s so disappointing.”

Other mothers with hospital birthing experience resented being pressured to stay in the hospital longer than they wanted to. At the Birth Center, mothers typically went home hours after delivering, but mothers who delivered at Community Medical Center said this didn’t feel possible there. “Community made me stay an extra day for things I think I could have checked back in about,” says Oschell.

And, of course, while ambience is not the deciding factor, it does matter. Birth Center patients raved about that facility’s natural light, kitchen, adjacent family waiting area, birthing tubs, private bathrooms, and all of the other features that led one patient to describe her birthing suite as “more like a five-star hotel than a hospital room.” If design elements like these aren’t already being considered for the new Women and Infants Center, I’d have to suggest that Community Medical Center request its money back from whoever is advising it on this project.

Still, none of these steps will do anything about the main dealbreaker for many moms: the new Women and Infant Center will be in a hospital, precisely the place these women hoped to avoid by delivering in a place like the Birth Center.

The reason many expecting mothers want to avoid a hospital setting — no matter how nice — has to do with the issue of control. In a birth center, attended by midwives, mothers feel confident that they will remain in control of their delivery and that their birth plans will be honored; in a hospital, they worry about being under someone else’s control.

Addressing this concern will be trickier than it sounds. For example, consider mothers who choose natural birth in order to avoid using pain medication. They have various reasons: being numb from the waist down makes it more difficult to know when to push, increasing the chances of a difficult or even harmful delivery; drugs can also leave mothers and babies too groggy for successful breast-feeding after delivery.

The problem is that mothers who want to deliver naturally can find it hard to stick to this plan when they find themselves in pain and in an environment where pain medications are available and encouraged, such as in a hospital.

Michelle Burton, who has delivered at both Community Medical Center and the Birth Center, experienced this problem firsthand. “In a hospital, it’s hard to stick to that choice of having a natural birth,” she says. “For me, if there’s an epidural available, I’m going to get it.”

If a mother delivering in a hospital does elect for pain medications, her mobility becomes limited. The drugs are delivered through a drip, so mothers can’t move around during labor, an essential pain-management technique in natural childbirth.

For Gia Randono, who chose to deliver at the Birth Center, concern about movement was a deciding factor. “I didn’t want to deliver in a hospital because it was important to me to be mobile,” she says. (I should point out that it’s not that mothers aren’t allowed to move around during deliveries at Community Medical Center — they are — it’s that being in a hospital tempts some women toward medical options that would then keep them from moving around.)

In other words, many women who choose to deliver at a place like the Birth Center do so precisely because they want to be prevented from having certain hospital-type options during labor and delivery. So no matter what the new Women and Infant Center is like, these women will still see the simple fact that it is in a hospital as a major problem.

One option — if only a compromise — would be for Community Medical Center to commit to taking the steps necessary to achieve birthing-center accreditation for the natural-birth section of the new Women and Infants Center. Kate Bauer, the director of the American Association of Birthing Centers, tells me that accreditation is not just for standalone centers but can be sought for any facility that is sufficiently separate from a hospital’s labor-and-delivery unit — even if the only separation is provided by a door.

For a model, Community could look to Miami Valley Hospital in Ohio, which has an accredited birthing center within its women’s health unit. Bauer points out that taking this kind of step can be very good for a hospital’s reputation in its community and may even increase its non-birth-related business. “If a hospital has a good relationship with a birth center, the birth center can generate other types of clients for the hospital,” says Bauer. “Especially since mothers are often the primary decision makers about their families’ health-care choices.”

Of course, even if Community goes this route, it won’t change the fact that Missoula will be without its beloved Birth Center, a medical facility that filled an important niche in the continuum of health care in this diverse and eclectic city. Barbara Hall, whose November delivery was the 200th at the Birth Center, said something that I quoted in my first Birth Center article and which bears repeating here.

“If I lived in a place where there wasn’t an option like the Birth Center,” says Hall, “I might feel like it was a place where I didn’t belong.”

For more like this, read the rest of the Missoula Notebook.