When Rebecca and Zachary Lewis' baby, Noa Sage, was born in September, their experience combined the best of both worlds: home birth and hospital birth. The midwife in attendance was home-birth specialist Susanrachel ("Birdie") Condon of Hudson Valley Midwifery, but the chosen setting was the Family Birth Place at HealthAlliance Hospital Broadway Campus (formerly known as Kingston Hospital), where Pitocin, pain meds, and emergency C-section obstetricians were just an arm's reach away. And it's a good thing they were. Rebecca's labor was a three-day marathon including two days of early labor at home, and a fair share of harrowing moments in the hospital. "I started off in the birthing tub, which was great—I really, really wanted to be in that tub," she says. "But [Noa] just wasn't coming. Her hand was up by her head, and her elbow was sticking out. After five hours in the tub, Birdie said, 'You have to get out of there.' They said I needed Pitocin, which hadn't been the plan—the plan was to have a natural birth, though it didn't exactly pan out that way." Once the Pitocin strengthened her contractions, Rebecca opted for intrathecal pain relief as well, and after an epic four-and-a-half hours of pushing, she was able to deliver Noa vaginally—no small feat for both mother and midwife. Adds Rebecca, "If I was in a different hospital with a different practice, I would've had a C-section for sure."
Support That's All-Encompassing
Having a planned hospital birth with private midwives in attendance is a brand-new option, and a very welcome one, for many of the Hudson Valley's expectant parents. Two local hospitals—HealthAlliance in Kingston and Columbia Memorial in Hudson—have recently extended privileges to independent midwives who practice autonomously, rather than under the authority of physicians. While many midwives work in a hospital setting, most must adhere to the style and schedule of a highly medicalized and corporatized birth culture. Private midwives, on the other hand, are free to practice a more traditional midwifery model—a holistic, woman-centered model that considers birth to be a natural process and that minimizes medical interventions as much as possible. Most private midwife practices have about a 5 percent Caesarean rate, compared to a staggering 32.2 percent rate of Caesarean births nationwide. And when a C-section is really necessary, midwives have a backup physician on call to perform the surgery and birth.
Private midwifery in a hospital setting affords women and families more choices—and choices are exactly what they want, according to Susan Rannestad of Hudson Valley Midwifery, who has been practicing locally (primarily as a home-birth midwife, but now at Kingston Hospital too) for over 27 years. "The future of medical practices is the corporation- and conglomerate-owned business; however, women want their maternity care to be more independent and holistic," she says. "They want to know who's going to be with them at the birth. They want to choose the style and setting." Rannestad adds that midwifery is individualized to the mother, who can select what's right for her family; it also gives women an active level of participation in their care, providing them with education and counseling. At the same time, midwifery today has room to include all the technological advancements of modern maternity. "Midwifery can encompass the same medical care that women want—early diagnosis and testing, prenatal care, sonograms, or not—integrating health and education for a better outcome."
Home Sweet Hospital Birth
Women choose to deliver in a hospital or at home for various reasons—and for the Lewises, who recently moved from New Paltz to Germantown, there was a lot of family pressure to deliver in a hospital. "I come from a family of doctors, so the thinking is pretty conservative," says Rebecca, a social worker. She and Zachary (a real estate developer whose latest project is a new food hall in uptown Kingston) also have two big dogs at home, and they didn't know how the pooches would react to the commotion of labor and birth. So when they heard about a team of home-birth midwives that recently got privileges at Kingston, going with them was the obvious choice. "I met them and thought, they're awesome," says Rebecca of Rannestad, Birdie, and their partner Whitney Hall. They told her she could stay at home for a good part of the labor, and when that time arrived, one of the midwives came to her house to check her progress—something that would never happen with a conventional medical practice. After Noa was born, the midwives paid several more home visits; they also remained available by phone or text. "A big part of why I chose them is all the postpartum care. My daughter had trouble latching on, and they wanted to make sure she was gaining weight."
The combination of home visits and a hospital birth is not always standard practice among midwives; many see their prenatal and postpartum clients only at the office. But for Hudson Valley Midwifery, it was a strategic choice. "When we decided to add hospital births [to our practice], we wanted to give the same style of care that we gave to our home-birth mothers," says Rannestad. After years of delivering in private homes, Rannestad feels a bit like a fish out of water in the hospital. "I'm not used to having nurses do things, and the nurses aren't used to having a provider who does things. If I want a glove, I get up and get a glove. I get lubricating jelly and put it on. They're like, what's she doing? I clean up—they think I'm a nut because of that. They also say our births are so sweet and calm and loving."
What's difficult for Rannestad is seeing things happen in the hospital that interrupt the baby's natural cycle in the first hours of life. "I feel that babies were born to be in the arms of people who love them, not in a little plastic box two feet away from its mother," she says. Yet she embraces Kingston for taking steps to become Baby-Friendly—a designation that recognizes and rewards birthing facilities that offer an optimal level of care through breastfeeding support and mother-baby bonding. "The commitment to that at HealthAlliance is top-notch. They are really committed to being Baby-Friendly and making a safe place in Ulster County to give birth."
True Care, True Community Service
Another team that practices at Kingston, Capital Region Midwifery (CRM), offers care that combines a hospital experience with traditional midwifery in a different kind of way. "We're experts in the hospital," says Liz Pickett, who with her partner Megan O'Connor opened CRM's Kingston branch earlier this year (CRM also has offices in Troy, Latham, and Clifton Park). "We're more comfortable in a hospital setting because we feel like there's more help if something goes south. Babies need to be resuscitated, moms have postpartum hemorrhages, and as much as you can take care of those things in a home setting, it's much nicer to know that if you need a staff blood transfusion you don't have to transfer to a hospital. The services that you need are right there." Focusing exclusively on hospital births also lets Pickett and O'Connor reach a demographic of people with fewer resources. "I want to serve the underserved," says Pickett, whose group offers free breastfeeding and education classes and takes just about every kind of insurance, including Medicaid.
For Pickett—who worked as a perinatal educator for local social-service agencies before becoming a midwife—getting privileges at Kingston was like coming home. Earlier in her midwife career she worked for a large, doctor-run practice at one of the region's largest, busiest hospitals. "I couldn't practice real midwifery care there at all," she says. "They had a tub room but the nurses never wanted us to use it, because they charted patients so much that they wanted us to stay near the computers. So water birth and hydrotherapy, these things that midwives do, we couldn't really offer that." Fear of liability meant that the nurses were constantly hooking up laboring women to fetal monitors and administering IV hep-locks, even when they weren't necessary—hindering the freedom of movement craved by laboring mothers. "Everybody was on the monitor all the time, perfectly healthy women with healthy pregnancies," Pickett recalls. "Once I walked into the labor room of a woman who was totally fine, contracting every seven minutes and not in a lot of pain, but she was sitting in bed with an IV hep-lock for no reason."
At Kingston, the vibe is completely different. "The hospital is so welcoming, it's such a different feel there," says Pickett. "If we want intermittent monitoring, we don't have a physician telling us we can't do that." Her mothers have been free to labor unimpeded, and yes, to birth in the tub if they choose. And if mama and baby are doing well, they can go home after 12 hours, just like in a birth center. "Our patients have been 100 percent happy," she notes. "Every one of them has raved about the place."
A Whole Approach to Health
Midwives are the traditional doyennes of birth—so many people don't realize that they offer gynecological services too. "We do annual exams, infection checks, birth control, IUD insertions, you name it," says Pickett of the women's care her group provides at all stages of life. Before, when she worked in a corporate-run practice, her time with patients was limited. "It wasn't patient-driven; it was numbers-driven," she says. "The providers were judged by their productivity." Now, instead of spending seven minutes with a patient, she'll take an hour with them.
Rannestad, too, gives her time liberally. "I joke that people wait eight minutes in the waiting room and then spend an hour with me, instead of waiting an hour and spending eight minutes with me." Her group, she notes, has exciting plans: They're working to expand their new Kingston office into what would become the Hudson Valley's only freestanding, midwife-run birth center. (Currently, New York has just two freestanding birth centers—one in Brooklyn and one in Buffalo, over eight hours away from each other.) Stay tuned as plans develop, hopefully unfolding in the next two to four years. In the meantime, Hudson Valley Midwifery offers yoga and meditation classes, mommy-baby groups, and a small boutique.
For parents like Rebecca, it's the care and attention of the midwife model that makes all the difference during some of life's biggest moments. "The birth was a lot for me," she says. "I think if I didn't have them, I'd be at a higher risk for postpartum [depression] for sure. The emotional support, the support with breastfeeding—just having them there, it all helped. It was comforting to know that they were just a text away. And still are."
RESOURCES
Capital Region Midwifery Capitalregionmidwifery.com
HealthAlliance of the Hudson Valley Hahv.org
Hudson Valley Midwifery Hudsonvalleymidwifery.com
