An Idea is Born
Madison Birth Center takes on health care reform - from the beginning
By Robert Chappell, Madison Magazine
Henry Malueg was born five years ago in a New York hospital. Everything went pretty much according to plan - 10 fingers, 10 toes, happy mom, happy dad.
Perhaps that should read "relatively happy mom." Amy Malueg was happy her new bouncing baby boy was healthy, but felt the whole maternity experience left something to be desired.
"You pretty much have people telling you what to do and how you're going to do it," she says. "There's no sense of ownership in your own birth."
She said the maternity classes and appointments didn't help. "We had taken classes at the hospital and I didn't learn anything," Amy says. "When I had Henry, the appointment was, the doctor would come in and say, 'Yep, looks like you're still pregnant. What do you need from me? Nothing? OK.'"
While not every hospital birthing experience is so cold and impersonal, Amy and husband Chris, who now live in Lake Mills, wanted something different when they learned of the impending arrival of baby number two. "I said to my husband, 'I want to have a home birth, but not at my home.'"
The couple decided to stop in at a storefront business they'd driven by a number of times - the Madison Birth Center in Middleton Hills. "Everyone was so friendly, I immediately trusted them," Amy says.
The new baby, Eva, was one of about 50 born last year at Madison Birth Center. Founder Aszani Kunkler says the Center hopes to assist in 70 to 80 births in 2005 and peak at 120 to 150 thereafter.
MBC is one of just two free-standing birth centers in the state, and the only one with national accreditation through the Commission for the Accreditation of Birth Centers. Kunkler decided years ago that she wanted to translate her UW nursing degree into a business like MBC, and enrolled in the Frontier School for Midwifery and Family Nursing in Kentucky in 1998. She earned her certificate as a nurse-midwife in 2000 along with a master's degree from Case Western Reserve University. The program there leads specifically to ventures like MBC - market research and a business plan are part of the curriculum.
After returning to Madison in 2000, she commuted to Chicago to work as a midwife while she laid the groundwork for her business, which opened in February 2003. "I would say we're a toddling business," she quips.
Kunkler views her job not as alternative health care, but as a return to tradition. "Physicians have only been involved in births for the last 80 or 90 years," she notes.
And her clientele isn't what you'd call the alternative medicine crowd. "They are everything from crunchy granola hippies to Christian conservative home-schooling people and everything in between," she says. "Professional people, stay-at-home moms. We've had women as young as 16 and as old as 44 have a baby here."
They're not all from the same economic situation, either. While one might expect the center to attract upper-middle-class types, Kunkler says all kinds of people are attracted to the center, at least in part for the cost, which she estimates at $5,000 to $8,000 less than the cost for birth in a hospital.
Hospital births are more expensive for a couple of reasons. For one thing, Kunkler says, "You're taking a low-risk population and putting them with certified nurse midwives. I didn't go to school for 12 years. I don't have $400,000 to pay back. I'm not doing surgery." Further, hospital birthing units build the church for Easter Sunday - they have equipment and personnel on hand to handle every manner of emergency, even though 90 percent of their patients don't require it. The four midwives at MBC, on the other hand, are what Kunkler calls "experts in normal."
That's not to say MBC is less safe, though, she says. "We know low-risk women are as safe or safer in this environment than they are in a hospital," she says. "We get lots of warning [before something goes wrong]. We transfer people to the hospital if we feel they need to be there. That's part of the consent form that we sign."
Yet MBC's varied customers do have a lot in common, Kunkler says. "They're looking for more control over their birthing experience. They're looking for a collaborative relationship with somebody where they feel they have input in decision making. They don't always get that [at a hospital]."
Those intangibles come in a number of forms, she says, including a more homelike, less clinical, environment where prenatal appointments last a full hour. "It's a difference of saying, 'Are you eating well? Good,' and saying 'We want a three-day diet history from you,'" she says. "We look at stress levels and exercise and the whole picture. And we get to know them. They get to know us. When they come in here, they really feel safe."
Kunkler says MBC has contracts with WPS and The Alliance, and many independent insurance companies cover their services. MBC also takes Medicaid, even though it pays pennies on the dollar.
"As a health care provider, it's tough. We have people coming to us and they're working and they don't have any money and they don't have any insurance. That's part of why I decided to take Medicaid," she says. "I think the health care system has a long way to go. We're one of the only industrialized countries that doesn't see health care as a basic human right. When you see how many people are uninsured, especially children and women, we ought to be ashamed. I think this kind of care should be available to everybody."
REPRINTED FROM:
Madison Magazine
December, 2004
Robert Chappell is associate editor of Madison Magazine.
