Friday, August 04, 2006

Delivering a new place to begin in Roanoke

A local group hopes to open a birth center in the Roanoke area.


As a resident specializing in family practice, Dr. Kim Dulaney has delivered babies at Carilion Roanoke Community Hospital.

"I've had a lot of happy births at Community," Dulaney said.

But for her own two children, Dulaney chose to deliver at a birth center in Norfolk two and a half years ago and at home in Franklin County earlier this year.

"Sometimes, sure, you need it, and it's a good thing we have it," Dulaney said about giving birth in hospitals. "But it shouldn't be the standard of care for everybody."

Dulaney, who is 30, is part of an effort to establish a free-standing birth center in the Roanoke Valley. She has joined the board of directors of a local faith-based, nonprofit organization called the New Life Birth Center. Karen Winstead, a certified nurse midwife from Rocky Mount, is leading the effort to establish the center.

If the women are successful in their efforts, the center could provide another option for pregnant women. The organizers hope to hire two obstetrician/gynecologists and two nurse midwives to start out and help women give birth to about 300 babies within three years of opening. They want to serve women within an hour's drive of the center.

Winstead, who works as a labor and delivery nurse at Carilion Franklin Memorial Hospital, said she decided to go to school to become a midwife after watching German Baptist women who gave birth in the hospital use very little medication and deal with pain through more natural methods.

"We just hope to empower women to care for themselves and their families," Winstead said.

The difference between hospitals and birth centers is that hospitals work with a medical model of care, while birth centers follow a midwifery model of care, Winstead said.

The center would offer all the services typically available through obstetrician/gynecologists, such as ultrasound testing. Women would give birth at the birth center. But the obstetrician/gynecologists employed there would also seek privileges at area hospitals in case more medical interventions were needed, Dulaney said.

The group is looking for a site somewhere between Carilion's Roanoke hospitals and Lewis-Gale Medical Center in Salem. They hope to open by the fall of 2007, and plan to accept insurance and Medicaid and seek accreditation from the Commission for the Accreditation of Birth Centers.

But they do face an uphill battle in opening the center. The group approached local hospitals, but the hospitals declined to partner with them because of their own comprehensive obstetrical programs.

And the organizers also need to raise about $750,000 to pay staff and cover malpractice insurance and operating costs for the first two years, Winstead said.

With the organization's nonprofit status, Winstead said they plan to apply for faith-based grants from both the federal government and private organizations to cover the bulk of the startup costs. They are also hoping to partner with other community organizations, she said.

Currently, Virginia has two birth centers: one in Alexandria, the other in Norfolk. There are about 178 birth centers in the United States, according to Kate Bauer, executive director of the American Association of Birth Centers.

Alice Bailes, co-director of BirthCare and Women's Health in Alexandria, said she sees women from every income level, educational background and faith at her center: from home schooling families to Washington political types. The center opened in 1992 and averages about 20 to 25 births per month, she said.

The type of women who deliver their children at birth centers depends on the composition of the community the birth center is in, Bauer said.

"You have all these women coming together in one practice," Bauer said.

In about 15 percent of the cases, a woman in labor at a birth center is transferred to a local hospital, Bauer said. The most common reason for transference is failure to progress in delivery, she said.

"A good dialogue between the family and the midwife and the consultation that's available in the hospital is very important," Bailes said.

Some birth centers are staffed by midwives. In Virginia, however, nurse midwives must operate in cooperation with a doctor. Local hospitals in the Roanoke Valley are not interested in partnering with the New Life Birth Center at this point.

"Some doctors are receptive, others are totally against it," Winstead said.

Melina Perdue, senior vice president for women's and children's health for Carilion Health System, said Carilion had been approached but had not been formally asked to partner with the proposed birth center.

She pointed out that Carilion is moving obstetrical services from Community Hospital to a new tower that is being added to the top of Carilion Roanoke Memorial Hospital.

Carilion has invested in building a pediatric intensive care unit, new mother and baby unit, new labor and delivery unit, and a new neonatal intensive care unit. It is also increasing the number of available beds.

Between Carilion and Lewis-Gale Medical Center, there are plenty of obstetrical beds available locally, Perdue said.

According to statistics from the Virginia Department of Health, there were 3,700 to 4,000 live births each year between 2001 and 2004 in Planning District Five -- which comprises Roanoke, Salem, Covington, and Roanoke, Botetourt, Craig and Alleghany counties.

Donna Sams, director of women's services for Community Hospital, said that as the perinatal referral center for Southwest Virginia, the hospital sees many high-risk births that need medical interventions.

She also said, however, that some patients do want "low-tech" births.

"The patients usually put birth plans in writing, and we make every effort to honor them," she said.

Perdue also said she knew of a birth center in Occoquan that was not able to stay open because of the financial toll of paying malpractice insurance.

But if birth centers are well-run, they are a nice option for some families, Perdue said.

"I absolutely think if it was built, people would use it," Perdue said.

Nancy May, a spokeswoman for Lewis-Gale Medical Center, said the hospital had been approached about the birth center project, but didn't anticipate getting involved with it because the hospital has its own comprehensive maternity care center.

Women who have normal vaginal births can have family present and can be involved in the care of the newborn, May said. The advantage of giving birth in a hospital is that emergency services are also immediately available, should women need them, she said.

Both Carilion and Lewis-Gale offer childbirth classes, accommodations for families and lactation consultants. Lewis-Gale also offers a postpartum follow-up program.

Dulaney said part of the reason she got involved in the project is her own experience. She said as a family practitioner, she doesn't get to spend a lot of time with her patients.

"As a doctor, you're just very busy," Dulaney said. "You have 15 minutes, and you have to talk about a whole lot of things."

At the hospital, the first prenatal visit is usually a half-hour. Each visit after that is typically 15 minutes, Dulaney said.

Carilion's OB-GYN clinic is very busy, and patients don't always get to see the same doctor, Dulaney said. A patient would probably only be referred to a nutritionist at the clinic if they were high-risk and had diabetes or hypertension, she said.

In contrast, Dulaney said in her experience, midwives spent 45 minutes to an hour with her at each visit and talked about nutrition and other factors in her life.

At the birth center, women would be able to eat and drink during labor, wear their own clothes, and labor in a tub. The aim is to make the experience as home-like as possible, Winstead said. Midwives would also be able to help women with prenatal and postnatal care during home visits.

Dulaney said she also believes that birth can be transformative and that how it happens is important.

"I try to tell patients that birth is something to enjoy and they look at me like I'm a little nuts," Dulaney said.

Dulaney also said that what drew her to the birth center was the lower rate of medical interventions, such as Caesarean sections. She acknowledged, however, that hospitals see more high-risk pregnancies.

"There are some women who definitely need to be seen by a specialist and definitely need to be in a hospital to deliver," Dulaney said.

Winstead said she knows women from the area who have traveled to North Carolina so they could deliver in a birth center. She said women she's talked to don't know that other options are available for giving birth.

Once women educate themselves, she hopes they'll learn to ask more questions about health care in general.

"We need to teach women how to take care of themselves and take care of their kids," Winstead said. "If we can teach women to ask the right questions, they'll ask them for the rest of their lives."

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