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Roots Childbirth Blog
Friday, 05 February 2016 00:00

Birth Center?

     Birth Center?

 

     Did you hear the news? Hendersonville now has a Birth Center! As a Sumner County native and long-time advocate for healthy and safe birthing options in Middle Tennessee, I was so excited when I heard this was coming. So, when they cut the ribbon and opened the doors for the first time, I had to go check it out for myself. I mean, the setting that a woman chooses to deliver in can affect outcome almost as much the provider she chooses to manage her care. I was beyond excited that Hendersonville was now going to be able to offer this unique setting to women in Sumner County and the surrounding area.  

 

     For anyone who may be wondering what the differences are between the hospital and a birth center, I’ll defer to an expert in the field. According to Dr. William Sears, MD, author of, “The Pregnancy Book,” (among many others), the difference between a hospital and a birth center has little to do with what the room actually looks like, but instead the birthing philosophy. He states, “Birth centers are predominantly a woman-run show, midwives are on staff to attend all normal, low-risk deliveries and Obstetricians are readily available for consultation, back-up and transfer of care.” He goes on to explain that birth centers manage pregnancy and birth as natural processes, utilize technology when necessary but don’t over utilize it to the point it can create unnecessary risks. He goes on to cite a study by the New England Journal of Medicine, stating that the outcome rates for successful vaginal deliveries are much higher than the hospital setting (especially for first time mothers and women attempting to have vaginal births after cesareans or “VBACs”) and that the neonatal death rates were also way below average.

 

 

     Some of the other defining characterizations that Dr. Sears and many other birth professionals consistently (nationally and internationally) use to describe birth centers as utilizing are: labor tubs, non-hospital beds for delivery, midwifery and doula support throughout prenatal care and labor, drug-free options for comfort and pain relief, evidence based care including eating/drinking during labor and being able to move freely (without restrictive interventions such as routine IVs and continuous monitoring), being able to deliver in any position that is comfortable to the mother and providing breastfeeding information and support that coincides with the “Breastfeeding Health Initiative 10 Steps.” These common characterizations for birth center care also coincide with many of the guidelines in the “10 Steps to Optimal Mother-Baby Maternity Services,” being implemented world-wide by UNICEF and the International MotherBaby Childbirth Initiative. You can read more about the International Mother Baby Childbirth Initiative here: http://www.imbci.org/

 

     So, back to me. Knowing all of the above about birth centers and being very familiar with new Baby+Co birth center downtown and all of its stunning ammenities and flexible options for birthing families (Baby+Co birthing suite pictured above), and knowing how desperate Sumner County has been to have something like this in our area my entire life, I cannot put into words how excited I was to get to touch and feel this place! To look at the rooms, see the tubs, touch the beds, ask questions to the staff, meet the midwives and doulas, and just share space with this place that was surely going to decrease c-section rates, increase breastfeeding success rates, improve outcomes and give woman an encouraging new option for birth in my community. I was so excited! I listened as members of the local government gave their speeches. I heard the $18.5 million dollar price tag and drifted off from reality as I imagined these beautiful suites and blissful birthing spaces that must be awaiting my eyes (I mean, the average birth center nationally costs about $1 million, so this place must be absolutely phenomenal!! ). So finally, after all the local government, administration and staff had their turn to talk, it was finally our turn. We were finally going in. I found myself among 3 colleagues and we toured the facility together, all of us eager to see what was on the other side of those doors.

 

     Well…. It was very pretty. The floors weren’t sticky, the furniture was new and the vinyl couches pull out into sleeper units for dad. All nice improvements for sure. And here are some other facts. No midwives are on staff. The same Obstetricians will be attending births in the new facility as were attending births in the previous facility. No doula support program has been implemented although the staff did seem open to doulas attending births. The beds were still hospital beds that elevate at the head and foot and can be broken down for delivery (like in all major hospitals). Laboring women will now enter through the ER regardless of the time of day. Like their sister TriStar hospital in Nashville (Centennial, who also has a stand alone Women’s Center), they are hoping this will make for a smoother admittance procedure by giving all women the same instructions for arrival. There are no labor tubs. There are walk-in showers but those can only be utilized by patients who do not require continuous monitoring. Over half of the patients who labor at Hendersonville are continuously monitored (according to one of the head nurses, Cindy Corley) either because of their particular provider’s protocols (a few require this of all their patients) or because of that patient’s risk category (mothers being given a trial of labor after cesarean are in this group and are required to have continuous monitoring and IV fluids although, again, the evidence per Cochrane reviews does not support these interventions increasing healthy outcomes for mother or baby and has actually shown that they have the ability to decrease the rates for successful vaginal deliveries). So unfortunately, many patients signing up to use the new birth center in hopes for hydrotherapy may be disappointed. “It is a question that should be discussed with their care provider early on,” advises Corley.

 

     Chief Nursing Officer, Lisa Gann, who was giving a tour of one of the new 14 labor rooms (less that what they could accommodate previously) was also very excited about the new baby isolettes in all the rooms. She said, “now we can weigh, warm and provide oxygen to the baby right in the room, whereas before, we had to take all the babies to the nursery,” (a practice that has been outdated for serval years in most hospitals, especially those seeking compliance to the Mother-Baby Friendly Initiative mentioned earlier). In fact, all recognized maternal-child organizations worldwide (including the American Academy of Pediatrics and the American College of Obstetrics and Gynecology) recommend 1-2 hours of uninterrupted skin-to-skin contact between mother and baby after delivery and except for a few extreme circumstances, do not recommend EVER removing baby from mother’s room during the entirety of the hospital stay. There are a host of physiological, emotional and psychological reasons for this, and “rooming in,” and “skin-to-skin contact” is considered routine care now in many hospitals nationwide and in all birth centers (or at least the ones who operate under the general understood definition we discussed above).

 

     So, Birth Center? Not even close. Same hospital, new entrance, prettier furniture and bigger showers (for dad mostly, like the pull out sleeper).  “We wanted it to feel like a hotel suite,” Vice President of Human Resources Matt Gilday said. Well, I say that goal was met.

 

     But here’s the BIG STORY! The one that got missed in most of the headlines. The one that didn’t make the hashtag. Breaking News: Sumner County now has a NICU! Guys, this is huge. Before now, babies who were born before 32 weeks or that had an emergent issue had to be transported to Nashville. Women’s Services Director and prenatal nurse, Jan Alexander spoke in the opening ceremonies about her own personal premature story and how difficult it was for her new family to commute and afford the expenses (even food) that came with having a baby in the NICU. She vowed to bring these services to Sumner County one day and today is when she has fulfilled that promise. The “Birth Center” at Hendersonville Hospital now has a Level 2 Neonatal Special Care Unit that houses 6 PRIVATE NICU rooms with a sleeper couch in each room so that families can have privacy and don’t have to leave their babies. That’s a big big deal!! And honestly, THAT should be the headline.

 

     When asked about the new birth center and the facilities during the open house ceremony, one of the OBGYNS on staff, Dr. Tanya Dannemann, said, “The main benefit is the NICU. Now pre-term babies or babies with medical problems have a place to stay and be taken care of close to home. Before, the babies were transferred to one of the hospitals in Nashville or the mother was transferred if we anticipated a premature birth.” Yes, I agree. THAT’S the real benefit here. That’s the big change and that’s the part we should be talking about.

 

So what is a Level 2 NICU? According the American Academy of Pediatrics, the NICU levels break down as follows:

 

Level1: Basic Care Newborn Nursery

Evaluation and postnatal care of healthy newborn infants greater than 34 weeks

 

Level2: Special Care Newborn Nursery

Specialized care (including mechanical ventilation for periods less than 24 hours), IV therapy, TPN and central lines of infants greater than 32 weeks

 

Level 3: Neonatal Intensive Care Nursery

Comprehensive care for newborns of any age at the highest skill set level possible. Comprehensive on-site access to subspecialty consultants; Performance and interpretation of advanced imaging tests, including computed tomography, magnetic resonance imaging and cardiac echocardiography on an urgent basis. Performance of major surgery on site including surgical repair of serious congenital cardiac malformations that require cardiopulmonary bypass.

 

     So now, Sumner County families will be able to benefit from the Level 2 neonatal care that Hendersonville Hospital has to offer and avoid being transferred to Hendersonville’s sister hospital (Centennial) downtown to receive this level of care. Very sick or premature babies will still be required to be transferred to Vanderbilt, but this is a huge step in the right direction.

 

So what did my colleagues taking the tour with me think?

 

"I was so excited when I saw Sumner County was taking on a new birth center. I was thinking doula services, labor tubs, and a comfortable atmosphere. Sumner County has upgraded Tri Star Medical Group to bigger rooms and beautiful floors.  It most definitely is a beautiful upgraded labor and delivery wing. I am however thankful for the new level 2 NICU that we have! We are making baby steps!”

~Elizabeth Hobdy Jones, BA (Childbirth Educator and HBAC mom)

 

“I think the name is deceiving. When I think birth center, I think of a calm atmosphere, intermittent and portable monitoring, labor tubs and big showers. Unfortunately, The “Birth Center” at Hendersonville Medical Center doesn't live up to that expectation. It's basically the hospital's labor and delivery with a facelift. The building is beautiful and houses brand new state of the art equipment. So if you're looking for a posh new labor and delivery unit this is the place for you. The level 2 NICU is a wonderful asset for Sumner County families. I love that parents are able to room in with their baby 24/7! I think this new unit shows how behind Middle Tennessee is in maternal/newborn care. There seems to be talk that this unit is not complete and there are plans for more changes in the future. My hope is these plan include aspects of a true birth center.”

~ Kaytlin Gregory, RN, BSN (Labor & Deliver Nurse, Childbirth Educator)

 

"HMC's new wing is not, alas, a true birth center, an option Sumner County lacks. The new L&D rooms are instead typical, if nicely appointed, hospital rooms without any development of the expanded services one expects to see in a birth center. The real headline is the opening of the NICU with its thoughtful amenities to encourage bonding between the exhausted and the fragile. While happy, of course, to see these additions to the hospital's repertoire, we wish they had a song to play for mothers-to-be interested in dancing to a new tune."

~ Lindsey Seger, President, ICAN (and Childbirth Educator)

 

     So, although, based on the information presented in the tour of these new facilities (no change in restrictive policies, no utilization of the midwifery model, no onsite doula support, limited hydrotherapy options, limited drug-free options for pain and comfort, routine separation of mother and baby, etc), the staff may still benefit from more education on the benefits of the 10 steps in the Mother Baby Friendly Initiative, I am pleased to know that these new rooms will now, at the very least, afford them the opportunity to provide more mother-baby friendly care if they do indeed decide to offer that type of care in the future.

 

And I am beyond thrilled that Sumner County finally has a NICU. Although only a level 2, it is still a wonderful start and a fantastic addition to the preterm and emergent neonatal needs in Sumner County.

To read more about the new facilities and to see pictures visit the links below or follow the hash tag #ATriStarIsBorn.

http://tristarhendersonville.com/about/newsroom/tristar-hendersonville-celebrate-birth-center-grand-opening-and-ribbon-cutting

http://www.tennessean.com/story/news/local/sumner/2016/01/07/first-birth-center-opens-hmc/78448870/

MMH

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