Birth Center Comes to Life Center Will Be First for the State
By Mark L. Hendrickson
Aszani Kunkler, CNM, MSN, has a vivid and tangible history of bringing good things to life. Kunkler has aided in the births of hundreds of children in the Madison area and now is ready to bring something else to life: the Madison Birth Center, which is set to open January 2003.
Kunkler, a graduate of the Frontier School of Midwifery and Family Nursing in Hyden, Kent., is developing the Madison Birth Center with the assistance of her husband, Bill Kunkler, who serves as a business advisor. She says the center will be the first in Wisconsin, and it will provide a very comfortable setting in which low-risk women can safely deliver their babies out of the hospital.
Safe deliveries are at the heart of her mission. Safety is assured for the center's low-risk clients by the constant presence of certified nurse midwives who are experts in risk assessment, but who will go to extraordinary measures to accommodate family preferences in child birthing.
The birth center's philosophy is focused on meeting families' individual preferences and lots of personal attention. "A birth center encourages people to express their spirituality and emotions throughout the birth process. This is a holistic, open approach so people can bring who they are to the experience" she explained.
Features of the birth center include air-jet whirlpools for water births, sturdy queen-sized beds, birth balls and birthing chairs. In addition, no woman will be left unattended while in labor-a certified midwife will be at hand through the entire labor and birth.
Support for new mothers doesn't stop there. The birth center will provide postpartum depression screening and offers support groups and classes. "This is a vulnerable time for new mothers and we strive to develop a sense of community with them. We spend a lot of time educating women and families about what to do in the postpartum period. We have certified lactation counselors to answer their questions about breast feeding," Kunkler said. Nurses and nurse midwives will also make home visits to assess how the new mother and baby are doing and to conduct various newborn-screening tests.
Something Old is New Again
A century ago, babies were born at home. Most often those births, just like those of today, were normal family events. By the middle of the 20th century, however, childbirth had become the exclusive domain of hospitals.
Today, with an increasing eye toward the wise use of resources and cost-effective care, birth centers are becoming more popular. It's a relaxed atmosphere that feels like a bed and breakfast or someone's home. Most birth centers provide plenty of privacy because of their low-volume nature. "We don't have ten women giving birth at the same time. Only one or two women will be in the center giving birth," Kunkler said. She also points out that mothers will have received much of their prenatal care at the birth center and will thus be familiar and comfortable with the staff and environment.
Low volume, privacy, personal attention and cost effectiveness come together in remarkable unity at today's modern birth centers. Charges for normal births are on average 50 percent less than regular hospital births. Even The New England Journal of Medicine concludes that "birth centers offer a savings in cost and minimize the rate of Caesarean section. Few innovations in health service promise lower cost, greater availability and a high degree of satisfaction with a comparable degree of safety."
Choice and Control
"Women are empowered in society today in terms of how they live their lives and the work they do. Yet, when it comes to childbearing, we are very passive. Why is this so? Why don't we look at this incredible transforming process and truly make it our own?" Kunkler asks. Choice and control are at the core of making childbearing truly personal, and birth centers excel in these two important areas. "You want a water birth, we can accommodate that request. If you want to deliver standing up, that's OK too," said Kunkler.
Hospitals, on the other hand, have a structure and method of organization into which childbirth must fit. Nurses there work eight- or 12-hour shifts and a woman in labor receives assistance from whoever is on duty-a new face when shifts change.
Midwifery births are for low-risk women who need much less intervention and much less technology to deliver their babies safely. "Hospitals are set up for high-risk births-if you are high-risk, they are the best place to be. However, low-risk women do not require the technology and level of intervention given to high-risk women," Kunkler explained.
"In birth centers, patience is the key. When you're admitted to a hospital, you have to get delivered and move along. At a birth center, you are not admitted until you are in active labor. We can manage you at home with regular clinic visits. Studies show that birth centers are as safe or safer than hospital care for low-risk women in the hospital. We don't intervene unless there is a need for intervention."
While a birth center is a fine place for low-risk women to deliver, data indicates that seven to 15 percent of clients transfer from a birth center to a hospital while in labor. Most of these transfers are due to slow labor and the need for labor-stimulating medications. About one percent of cases require hospital care for more intense pain control or complications. Kunkler says the Madison Birth Center will be ready for a smooth interface between the birth center and a hospital. In fact, Madison Birth Center clients tour the labor and delivery areas and complete pre-registration with the appropriate hospital so there is no surprise should a transfer be required. Across the country, less than one in 1,000 birth center clients require emergency transfer to a hospital.
Kunkler has worked for many years in the labor and delivery area at St. Marys Hospital Medical Center in Madison. She earned her bachelor's degree in nursing from the UW-Madison School of Nursing and a master's degree in nursing from the Case Western Reserve University School of Nursing in Cleveland, Ohio.
The challenge for Kunkler, who completed the nurse midwifery program in 2000, was to establish the first nationally-certified birth center in the state.
The Business of Birthing
"The Madison area is perfectly suited for a birth center. We have lots of educated, motivated women in this city who want to take charge of their health care. We see ourselves in partnership with our clients. We will work with them and say, 'This is what we see and these are your options. What works for you in your life right now? What are the things you can control and change?' Then we offer options and work closely with people throughout the childbearing process."
Working closely with clients and family members is essential for success. "This is how we keep low-risk women low risk," said Kunkler. "We analyze diet, supplementation, exercise, the entire holistic portrait that makes a human being and pregnancy experience."
While the Madison area is clearly the target market for the birth center, Kunkler says people from throughout south central Wisconsin and northern Illinois will find the center's programs and services valuable. This value encompasses a scope broader that the birth process.
The Madison Birth Center also caters to the lifelong health care needs of women. "We see our relationships with women as being long-term. The typical birth center client will be assertive about what she wants. She will want to be involved in her own health care, and she will want to have someone to listen to her with a discerning ear who is interested in her life and can offer choices about her health care." Women's health care services available at the center include annual physical examinations, health screenings such as pap tests, general gynecology and women's wellness.
REPRINTED FROM:
Nursing Matters
November 2002
Volume 13, Number 11
