Expectant mothers who want an alternative to a hospital birth will get one this fall with the planned opening of Buffalo’s first birthing center.
It will be only the third free-standing birthing center in New York State when it opens in November, offering nurse-midwifery services for low-risk pregnancies based on natural childbirth.
The birthing center also is likely to be the only one in the United States combined with an abortion clinic, as it is a project of Buffalo Womenservices, 2500 Main St.
Birthing centers are gaining in popularity in the United States. Advocates say they could cut the rate of cesarean sections and save money.
But not all doctors embrace the concept, and a center attached to an abortion clinic is a combination bound to surprise some people and upset others.
“It’s absolutely ludicrous that those who specialize in taking life claim they are qualified to help women give birth,” said Stasia Zoladz Vogel, president of the Buffalo Regional Right to Life Committee.
Still, the idea arouses interest, even among those who oppose abortion.
“We should welcome any place that cultivates the life-affirming choice of birth. This is about choosing life, and that is positive,” said Karen Swallow Prior, a former Buffalo resident who was involved in anti-abortion activism here.
To those behind the facility, the location of the birthing center makes sense for philosophical and practical reasons.
“I see a connection between respecting a woman’s right to decide to end a pregnancy and her right to determine how she has her baby,” said Dr. Katharine Morrison, the obstetrician-gynecologist who has owned Buffalo Womenservices since 2005.
Birthing centers provide a homelike setting, but advocates say the experience is about more than the look of the room.
“Hospitals offer a lot of machines and pain medications,” Morrison said. “Everyone is treated as though they are high-risk. The idea of a birthing center is to offer a lot of care. We give a woman more options.”
Labor is not induced, and birthing centers use alternative methods to control pain instead of drugs. Women are encouraged to move around, to eat and drink what they want during labor, and to invite whomever they want to the birth. Birthing centers also are less expensive than hospitals.
Morrison is financing a $250,000 renovation at the Buffalo Womenservices clinic to accommodate the birthing center, which will take up about one-third of the building’s lower floor. It also will be owned and operated by Terri Fregoe, executive director of Womenservices, and Eileen Stewart, a certified nurse midwife who attends about 100 home births a year in collaboration with Morrison.
Midwifery assumes most pregnancies and births are normal processes that result in healthy babies.
Some hospitals may offer elements of the home birth or birthing center experience. However, Stewart said the focus in hospitals is on diagnosing and treating complications of pregnancy, and there is a presumption with all patients that something may go wrong. As a result, she contends, many women get interventions they don’t need or want.
Birthing centers are not for everyone, Stewart and Morrison stressed.
It’s an option aimed at expectant mothers with uncomplicated pregnancies and healthy lifestyles. If the need arises, the expectant mothers are transferred to a hospital, a requirement of state law. But patients will be followed by the birthing center staff, Morrison said.
Fewer births in Erie County
The center is opening as hospitals here compete for fewer pregnant patients. The number of births in Erie County fell from 11,280 in 2000 to 9,772 in 2010, according to the National Center for Health Statistics.
Morrison and her partners made the case, in seeking approval for the birthing center, that it might attract a portion of the small number of women interested in home birth but in a setting with greater safety and proximity to a hospital. But they acknowledge that the center, which can handle up to about 100 patients a year, is likely to appeal to women who want an alternative to a hospital.
The Womenservices birthing center follows four years of planning by Morrison and her colleagues, and it reflects their views about women and pregnancy.
“It’s no mystery that I am the person to do this,” Morrison said. “To me, it is about choice. Women have a right to say no to the interventions they get in the hospital.”
About 61 percent of abortions are obtained by women who have children, according to the Guttmacher Institute, a national organization that compiles abortion statistics. Morrison, who also runs an obstetrics practice at the abortion facility, made the case that women who obtain abortions are not a distinct group from those who give birth to babies.
“Both of these experiences – abortion and birth – can exist in a woman’s reproductive life,” she said. “Many mothers have had abortions or will have one.”
A ‘strange’ arrangement
To Swallow Prior, the idea of a birthing center in the same building as an abortion clinic initially seemed “strange,” but the more she thought about it, the more her doubts subsided.
“I asked myself, what’s the downside? I don’t see one. There is a lot more to be gained than lost from this arrangement,” said Swallow Prior, who now serves as chairwoman of the Liberty University Department of English and Modern Languages and writes frequently about abortion-related issues.
To Vogel, however, offering abortion and birthing services in the same building is a terrible idea.
“For anyone to entrust the birth of their child to a business that specializes in ending the life of infants in the womb is foolhardy at best and dangerous at worst,” she said.
Kate Bauer, executive director of the American Association of Birth Centers in Perkiomenville, Pa., said she believes a facility offering both abortions and a birthing center will be “one of a kind” in the nation.
“But it fits, because it’s all about women taking charge of their health care and having options,” she said.
Morrison and Stewart expressed confidence that the mixture of services will work for some women. As for the potential for controversy, Morrison said, “I’m used to it.”
Warming up to the concept
Although the birthing center concept has yet to be fully embraced by the public or other physicians, attitudes appear to have softened.
In their most recent policy statements on home births, the American Academy of Pediatrics and American College of Obstetrics and Gynecology, which had historically opposed out-of-hospital births, characterized both hospitals and birth centers as the safest settings for birth.
Currently, 248 birthing centers operate in 37 states and the District of Columbia, up from 170 in 2004, according to the birth center association. In addition, the annual number of birthing center births has grown in recent years and stood at 14,206 in 2011, the most recent statistic from the federal Centers for Disease Control and Prevention.
But births in birthing centers remain a tiny fraction of the nation’s total annual births of about 3.9 million.
Some research does suggest birthing centers provide safe care.
A study of 15,574 women at 79 birthing centers showed that women who receive care at birthing centers incur lower medical costs and are much less likely to have cesarean births.
The study, which was conducted by the American Association of Birth Centers and published this year, also found that of the women who planned to give birth at a birthing center, 84 percent ended up giving birth at the birthing center. Emergency transfer occurred in 1.9 percent of the cases.
No moms died in the study. The authors said the stillbirth and newborn death rates were comparable to what other researchers have reported when they studied low-risk women.
But the study did not include a hospital comparison group, so they could not tell whether there is a statistical difference in deaths between planned birthing center and hospital births.
Advocates also tout birthing centers as a cost-effective alternative to expensive hospital stays for normal births.
The average facility charge for a vaginal birth in a birth center was $2,277 in 2010, compared with $10,166 for a vaginal birth with no complications in a hospital, according to the birth center association.
‘It’s a very litigious job’
Still, doubts persist.
“I’m not opposed to birthing centers. There is a low-risk population for which they would be suitable. But I urge people to be cautious,” said Dr. Julie Gavin, president of the Buffalo Gynecologic and Obstetric Society.
“You never know what is going to go wrong in a birth. There are unanticipated events, and you need to make decisions in minutes,” she said.
Gavin said significant concerns by obstetricians over the potential for malpractice lawsuits make physicians reluctant to deliver babies anywhere but at a hospital, where there is equipment to diagnose, resuscitate and operate, if needed.
“It’s a very litigious job,” she said. “You can get sued years after a child is born.”