Personalized Care
With over 17 years' experience in labor and delivery, Aszani Kunkler, RN, CNM, MSN has assisted at the births of hundred of babies. But early this year, she helped birth her biggest baby yet - the Madison Birth Center, Wisconsin's first and only freestanding birth center. Although the first American birth center opened over twenty-five years ago in New York City, birth centers are still a relative rarity in the United States.1 Currently, there are about 150 birth centers nationwide. Only a handful of these are located in the Midwest. As an alternative birthing option, birth centers provide another choice for childbearing families. Personalized care that empowers women is a hallmark of the Madison Birth Center, which operates according to the midwifery model of care. The Center offers a complete array of maternity care, well-women care, and parenting and childbirth classes, as well as community education and support.
A Different Perspective
Today, most women in the United States receive maternity care under the medical model. They labor in hospitals, and medical interventions as a part of labor and delivery are expected and accepted. In contrast, the midwifery model of care believes that pregnancy and childbirth are normal and natural, and that women's bodies know best how to deliver babies. Midwifery care is holistic, addressing clients' physical, emotional, spiritual, psychological, and social responses to pregnancy and birth. As experts in normal pregnancy and birth, midwives carefully monitor their clients for complications, and refer to OB/GYNs as needed. Midwives actively support their clients during labor and delivery, utilizing natural comforting techniques. Medical intervention is used only when clearly necessary. After birth, breastfeeding and postpartum support are emphasized.
Numerous studies have demonstrated the safety and cost-efficiency of midwifery care and out-of-hospital birth. In general, midwives have lower rates of maternal, infant, and neonatal mortality. Studies show that midwives' patients are less likely to have medical intervention in the course of labor and delivery, and more likely to deliver naturally.
From Dream to Reality
A desire to promote and practice the midwifery model of care lead Kunkler, a graduate of the Frontier School of Midwifery and Family Nursing, to open the Madison Birth Center. "I've wanted to do this for a long time," said Kunkler, who previously worked as a doula, labor and delivery RN, childbirth educator, and lactation consultant. With her husband, Bill, an accountant, Kunkler wrote a business plan and worked to bring the Center to life. It wasn't easy, though. Despite the many studies supporting midwifery care, the public and medical establishment have not always accepted nurse midwives. Kunkler said she had to be politically astute and willing to market her services. "We have to establish our credibility," she allowed. "But that is one of our goals - to educate people about childbirth in general and midwifery in specific." A recent change in Wisconsin state law also facilitated the opening of the birth center. In April, the Nurse Midwifery Practice Act was amended to allow nurse midwives to practice "in collaboration with a qualified physician," instead of "under direct supervision." The Act also updated the scope of practice for CNMs.
With everything falling into place, Kunkler located a site in a commercial building in Middleton. She also hired a team of experienced professionals. Today, the midwifery team includes Kunkler, Mary Sommers, a certified professional midwife with twenty years' experience in out-of-hospital birth, and Elizabeth Humphries, CNM, MSN. Nurses and lactation consultants complete the staff. Clients come from a 100-mile radius. The first birth was in January. Because the Center was not yet completed, the client delivered at St. Mary's Hospital, Madison. The first birth center birth was my own son, Adam Joseph Fink, born March 9, 2003.
Personalized Pregnancy Care
At the Birth Center, pregnancy and birth are celebrated. The team of midwives cares for women in an environment that respects women's intellect and intuition. Prenatal care is holistic and personal, and women develop a relationship with their care provider. This relationship allows women to labor freely when the time comes, confident that they will be supported and respected. An acupuncturist is also available onsite to help treat common challenges of pregnancy, including morning sickness, sciatica, and breech presentation. This personal, holistic approach is appreciated. "I never before had anyone sit down with me for an hour and half and ask, 'How are you feeling?'" said client Jodi Streicher-Bremer. To prepare for birth, first-time Moms and their partners are required to take a childbirth class. The Center offers Birthing From Within and natural childbirth classes; refresher courses are available for experienced parents. All Birth Center clients are required to take a Complications class and Early Homecare Class. Sibling classes are offered as well. Other classes include yoga, hypnobirthing, an early pregnancy class, and breastfeeding classes. Physically, the Center features two birthing rooms decorated in soothing earth tones. Each has a queen-sized bed, whirlpool tub, and rocking chair. A nearby family room, complete with television and a mini-kitchenette, is also available. Laboring women wear their own clothing and are encouraged to eat, drink, and move around freely. They give birth in whatever position seems most comfortable, and family and friends are welcome. Water birth is an option. Two midwives attend each birth, supporting the laboring woman and monitoring both mother and baby. If needed, St. Mary's Hospital is only seven miles away. Families are discharged within 12 hours after birth, if stable. But Birth Center care doesn't end there. Staff members make home visits at 24 and 72 hours, more often if necessary. Breastfeeding support is emphasized. Office visits are offered at two and six weeks postpartum, and many clients continue to be involved in birth center activities after birth. "We are so connected to that place," said Streicher-Bremer. "It's sort of like family."
Well-Woman Care
The Madison Birth Center also offers annual physicals, Pap smears and breast exams, screening tests, primary care visits, family planning, and menopause management. Again, the care is holistic and personalized. Cultural, ethnic, and religious differences are respected. The emphasis is on prevention as midwives educate and empower women to take charge of their own health.
Community Outreach
One of the Center's goals is to the educate public about childbirth and midwifery. To that end, all classes are open to the general public. The Birth Center also hosts numerous supports groups, including new family meetings, La Leche League, mothers' meetings, and breastfeeding groups. The Center also hopes to educate and inspire healthcare professionals. In May, they hosted a student night, for student nurses interested in birth. And in June, the Center sponsored talks by renowned midwife Ina May Gaskin.
The Future
Currently the Center is in the midst of obtaining national accreditation. The Center also hopes to become the first Mother-Friendly Institute in the Midwest. By their third year of operation, Kunkler envisions that the Center will manage about 150 deliveries per year. Home and hospital births might someday be another option for Birth Center clients. Meanwhile, Kunkler and her colleagues work to improve women's health, one woman at a time. "We really feel like we are returning birth to the consumer," said Kunkler. "We offer info and choices, so they can make the call." The Madison Birth Center is located at 6720 Frank Lloyd Wright Avenue, Middleton, WI. For more information, visit www.madisonbirthcenter.com or call 608-821-0123.
This article was published in an edited form in the October 27, 2003 issue of ADVANCE for Nurses magazine www.advanceweb.com
