Kent resident Tina Marie Lechner, 36, is one very determined woman. Four years ago, she and her husband, Andrew Lechner, decided it was time to start a family. Tina knew exactly how she wanted things to go. The plan: at least two children. Natural births with midwives. Close friends and family in attendance. A serene, relaxing environment. Soothing music. No medical interventions. No monitors beeping. And, of course, healthy babies.
Today, the Lechners are the proud parents of two beautiful, healthy boys: Liam, age 4, and Ryker, 3 months old. But things didn’t go exactly as Tina had planned.
First, there were challenges to getting pregnant. Tina has polycystic ovary syndrome (PCOS), a leading cause of infertility in women. She underwent treatment at Seattle Reproductive Medicine, and both of her sons were conceived via intrauterine insemination (IUI).
Next, she checked with her local hospital about using a midwife, but was told her body mass index (BMI) was too high, which could cause complications during pregnancy. Tina didn’t understand; she was healthy, and confident she could deliver a healthy baby. Terribly disappointed, the Lechners continued searching for options and were delighted when they found Puget Sound Midwives & Birth Center in Kirkland.
Although Tina developed gestational diabetes during her first pregnancy, she was closely monitored and was able to keep her health under control so that she could safely deliver at the birth center. “Liam was born there, with me on a birthing stool, with the help of a midwife, my husband sitting behind me, helping with every push,” Tina says. “With lights dimmed and music playing, I slow-danced with friends and family through the pain of contractions.” Her family found the birth center so relaxing that while she was pushing, they were eating pizza and her father was calling around looking for a used car to buy. To Tina, the scene was “beautiful beyond words.”
The Lechners hoped to reunite with their “birth center family” for the birth of their second child. “Only this time, my baby had a different birth plan,” Tina says. “Late in the pregnancy, my amniotic fluid level jumped well above normal limits and my baby was swimming around in every direction but the proper one. I had just become high risk, I was scared, 37 weeks along, and had to find an OB.”
Tina’s midwives helped her with the transition to an obstetrician (OB) who understood her desire for a natural birth. She delivered Ryker vaginally, but labor was induced and, many hours later, Tina finally accepted pain medication. There were complications. “Ryker came out not breathing properly,” Tina says. “Looking back, I am grateful I was allowed to have my second child vaginally, grateful that the midwives found me a doctor who didn’t require a C-section, and so thankful for the nurses and doctors at the hospital who helped Ryker.”
Tina’s story demonstrates the many birth options women are fortunate to have in Washington state and illustrates the continuum of care that’s available here. It also touches on issues in the heated dialogue about birth that is taking place in our country today.
Although most babies in the U.S. are born in hospitals and delivered by OBs, headlines declaring that home births are on the rise, the issuance of home-birth guidelines by the American Academy of Pediatrics and reports that more U.S. babies than ever are being delivered by midwives are causing women to rethink their options. A landmark national study published in the January/February 2013 issue of Journal of Midwifery & Women’s Health has captured our attention, finding that birth centers provide top-notch care, could cut the number of unnecessary C-sections and save billions in health care costs. The study was conducted by independent researchers and included an analysis of outcomes from more than 15,000 women in 79 midwifery-led birth centers in 33 states from 2007 to 2010.
A report, recently reissued by Consumer Reports, called “What to Reject When You’re Expecting,” raises concerns about the number of births induced and the number of C-sections performed (one of every three babies born). It outlines 10 unnecessary procedures that you should consider avoiding during your pregnancy. John Santa M.D., director of Consumer Reports’ health ratings center said in his opening letter that this report “received the largest social media response of any health article in Consumer Reports history.”
Even before the news hit, Washington state was already introducing changes. Last year the Washington State Medical Association launched a statewide campaign called “Know Your Choices—Ask Your Doctor,” to spark conversations between patients and their doctors about the need for frequently ordered tests and procedures. Groups including the Puget Sound Health Alliance and the Washington State Hospital Association, support this initiative.
In Washington, prospective parents are demonstrating increasing preferences for more natural, patient- and family-centered births. In response, hospitals have been adding—more so in the past few years than ever before—new warm, comforting birth suites and including midwives as an option. At Swedish’s Ballard Birth Center, prospective mothers can choose an ob-gyn, family physician or midwife to deliver their baby. At Northwest Hospital & Medical Center’s Midwives Clinic, the tagline is “Your Birth, Your Way.” Overlake Hospital Medical Center in Bellevue has private birthing rooms with jetted tubs, birth balls and recliners—all geared to make the birth process more comfortable and less clinical. At EvergreenHealth in Kirkland, new babies room with their mothers. Valley Medical Center has recently added midwives. And at Group Health Cooperative—where most women see midwives rather than OBs, unless there are complications or health risks—members can choose to deliver in a hospital or at home.
These changes, and the increasing wealth of options, including the use of ob-gyns, family-practice physicians with obstetric services, midwives, hospitals, birth centers and home delivery, are very positive for women in Washington. But the state is also facing some new challenges, according to Jane Uhlir, M.D., who is executive director of Women & Infants and of The Gossman Center for Advanced Simulation at Swedish Medical Center as well as a board-certified ob-gyn. What concerns Uhlir these days is that “the U.S. is getting more unhealthy—with more obesity, diabetes and high blood pressure—which means more mothers are unhealthy, increasing the number of complicated pregnancies and newborns with health problems. There are also a lot of people without good health insurance and good health care because of the economy,” Uhlir says. “We see those people when they are sicker than we wish they were.”
To combat these trends, says Uhlir, Swedish has initiated a huge educational effort directed toward the public about healthy pregnancies and deliveries and has added new facilities, such as The Lytle Center for Pregnancy & Newborns (see sidebar, page 23). “Hopefully, we’ll be able to see them earlier and refer them to the right place for timely care,” Uhlir says.
Working mom Carol Salerno, M.D., a board-certified ob-gyn, has been at Meridian Women’s Health for 10 years and is also one of the physicians who provides back-up for the midwives who practice at Northwest Hospital. She is impressed with advances that have been made in the technologies for genetic screening and prenatal genetic testing. “In the past, fetal testing for anomalies like Down’s Syndrome had to be done by amniocentesis, which was invasive and risky,” says Salerno. Now patients can do the Counsyl panel in the first trimester, a noninvasive blood test that is a comprehensive carrier screen for genetic diseases, testing the mom’s DNA.
These tests are especially important now that women are delaying childbirth—a notable trend in the Seattle area. Salerno also says another fairly new process is proving to be an important technological breakthrough. Freezing oocytes (eggs) benefits women at risk of infertility because of cancer treatments. “Previously, only sperm could be stored for long periods of time,” says Salerno. “Now, oocyte preservation is possible through freezing.”
A pregnancy may start out as low risk, but the situation can change, as it did in Tina Lechner’s situation. If complications develop, says Chalmers, patients are transferred to an OB for care and delivery in a hospital, often with their midwife present. Most transfers that occur during labor are non-emergency transfers of patients whose labor has stalled or who become uncomfortable with the level of pain they are experiencing. “It’s rare to have an emergency transfer,” Chalmers says.
“The midwives work closely with us and they remain with their patients, even assisting with C-sections,” says Salerno, “to provide continuity of care.”
With the increased use of midwives comes an increased interest in freestanding birth centers. Like Tina Lechner, many women have discovered the allure of birth in a cozy facility with soft lighting, soothing music, serene décor and plenty of room for friends and family. Between 2001 and 2011, there was a 63 percent increase in births at these centers in Washington.
Home births have been gaining in popularity, too. Many women who choose a birth center for their first pregnancy opt for a home birth with their next child. But it’s not for everyone: Both mothers and practitioners have strong feelings about the risks and rewards. Moms often describe it as “magical” and cherish the experience. Others, including Seattle Mama Doc blogger Wendy Sue Swanson, M.D., a highly respected pediatrician, have reservations. In her case, the fear is based on personal experience. She had two hospital births that required C-sections and “all sorts of interventions,” including a bedside resuscitation.
For those who care for women through pregnancy, labor and delivery, it’s not just a job; it’s a calling. Salerno loves meeting new patients and couples, developing long-term relationships, watching them grow their families—traveling that road with them. “I’m a mom myself,” she says. “I’ve taken the same journey.” ✚