CORRECTION: Previous versions of this article misspelled Dorneeta Harper's name. Correction made on Saturday, Oct. 11, 2014.
CARY -- When the first newborns are delivered here in December, North Carolina’s newest freestanding birthing center will test the local baby market at a time when some say the holistic way of childbirth is poised to gain wider acceptance.
At Baby+Company, midwives will substitute for doctors, water-birth pools for painkillers, and pillar candles for the blinking lights of electronic machines.
With the ambiance of a bed-and-breakfast, the center presents itself as a relaxed alternative to a hospital maternity ward, where moms-to-be typically have to change into a hospital gown, get an IV port stuck in the arm, and are hooked up to electronic monitors.
“It’s supposed to be something natural and beautiful,” said Dorneeta Harper, 34, who is planning her first childbirth. “When I do it, I want it to be as perfect as possible.”
The harmonious aura resonates beyond mom and baby. WakeMed Cary hospital is a business partner, rather than a competitor; as a minority owner of the Baby+Co. facility, WakeMed has a financial stake in the success of the Cary birthing center.
In addition, WakeMed Cary hospital, where 2,260 babies were born last year, is the designated destination for birthing center moms whose labor doesn’t go as planned. The hospital is just down the street and visible from the window of the Baby+Co. facility.
“It’s lovely to have, but it wasn’t necessary,” Baby+Co. founder Cara Osborne said of WakeMed’s investment. “The more important part is the relationship being really cooperative and that they are able to see the birth center as a part of their system.”
Harper, a coordinator for adult education at Nash Community College, was among the 150 families who visited the center last week during an open house and site tour. She’s not yet pregnant but says she is “expecting to be expecting.”
The spalike facility features low-emission paint, a plush bed to accommodate an entire family, and a vending nook with nutritional supplements and breastfeeding aids.
The new facility joins already established centers in Chapel Hill and Statesville, and like those centers it appeals to women who feel conventional medicine approaches pregnancy as if it were a disease.
“In a hospital a mom is quarantined off in a hospital bed with rails, and you’ve got all this stuff stuck to you,” Osborne said. “Our goal is to have a healthy, happy mom and baby.”
Resurgence of interest
Birth centers are seeing renewed interest across the country. The American Association of Birthing Centers lists 288 in 40 states and Washington D.C., nearly doubling the number of centers in the past five years.
North Carolina has seen birthing centers come and go over three decades – as interest in natural births has ebbed and flowed. The state’s first, Waters of Life Family Health Center, opened in 1982 in Buncombe County and closed three years later.
Baby+Co. has just one other facility, in Arkansas, which opened last year, and is planning to open another near Denver, Colo. It chose Cary because of WakeMed’s corporate endorsement and the Triangle’s growing population. Wake County accounted for 10 percent of all births in the state in 2012 with 12,309 babies born that year.
The Cary facility will have capacity of 380 births a year in its three birthing suites. Baby+Co. is also looking to expand to Charlotte, Wilmington and Greenville, Osborne said.
Triangle Physicians for Women, a nearby OB/GYN practice, will supervise Baby+Co.’s midwives. North Carolina law requires that midwives be overseen by doctors. Otherwise, North Carolina does not certify or license birthing centers, as other states do.
Risk factors considered
To win a birth slot at the Baby+Co. site, women will have to pass the center’s risk assessment standards that could exclude more than 1 in 4 applicants. Risk factors include a previous C-section delivery, obesity, diabetes, hypertension and other chronic conditions. About a third of births in North Carolina were delivered by C-section in 2012.
The moms also have to agree to be transported to the hospital if the midwife decides the birth is not going well. About 12 percent of birthing center moms nationally end up in hospitals because of difficult labor, and 2 percent of births develop into medical emergencies.
“It’s a natural process that doesn’t always go smoothly,” said Ann Collins, an obstetrician/gynecologist who delivers babies at Rex Hospital in Raleigh. “There will always be a small number of complications. No one wants to talk about that because it’s supposed to be a happy time.”
A less publicized benefit of a birthing center is that it costs much less than a hospital. A typical vaginal birth in a hospital can run a $18,329 tab, according to a 2013 study of birth costs by Truven Health Analytics. That compares to about $6,400 for a birth center visit – facility services and professional services combined – according to the American Association of Birth Centers’ Perinatal Data Registry.
Birth centers are cheaper because moms typically don’t stay overnight, and the centers don’t bill parents for painkillers, staff doctors and sophisticated equipment, such as an adjustable hospital bed.
With growing focus on controlling health care costs, birth centers start to look like a bargain. A recent paper in the Medicare and Medicaid Research Review concluded that Medicaid, the single biggest payer for maternity services in this country, could save $11.6 million per 10,000 births a year by switching to birth centers.
“Policymakers should consider a larger role for midwives and birth centers in maternity care for low-risk Medicaid pregnant women,” the study states. “In addition to potentially improving care for low-income women, birth center care may reduce costs compared to usual care.”
Moving hospital services off-site is a common strategy to stem runaway health care costs, and birth centers are a natural extension of that process. A similar shift has taken place with other low-risk procedures, such as dialysis, chemotherapy and knee surgeries, now performed at freestanding clinics and facilities.
“More hospitals are thinking about how to expand to outpatient services,” said Pam Silberman, Clinical Professor of Health Policy and Management at the UNC Gillings School of Global Public Health.
“The writing on the wall is to reduce the highest-cost procedures,” Silberman said. “Down the road there’s going to be less inpatient care, so you have to think about other ways you can offer service and maintain a source of revenue.”
For women who prefer an all-natural birth, the other options are home births, or a hospital stay with specific instructions not to administer painkillers. That was the strategy of Maria Phillips, a Cary stay-at-home mom who gave two natural births in England, until she heard about Baby+Co.
“I was coming in with a very strict birth plan,” Phillips said. “I didn’t want anyone to touch me, basically, just let me labor. And let me eat, because I am going to eat.”
Home births have not gained wide acceptance in North Carolina, however, with only 645 reported in 2013, including 39 in Wake County, 17 in Durham County and 10 in Johnston County.
Just mentioning home births elicited a visceral “Ugh” from Shannon Morgan, a 35-year old Apex mom. Her first child took less than three hours to deliver at Duke Regional Hospital in 2011 and she’d like a repeat performance at a birthing center.
Morgan, who has a master’s in nursing and works as a nurse practitioner, said delivering in a hospital was a miserable experience. She recalled the constant monitoring by nurses, round-the-clock hallway noise and other disruptions that prevented her from getting her rest.
Morgan embraces the non-invasive birth option as not only more pleasant but potentially less risky.
“If you’re going to do it all-naturally, then that in and of itself should put you at less risk for needing advanced medical services,” Morgan said. “You’re not doing pain medicine that makes your baby dopey so that they’re not going to breathe.”