Premier Birth Center Fact #1 – How “the Kims” met

Over the next few days, we’re going to focus on sharing some facts about Premier Birth Center we hope you’ll find interesting and fun. Keep following the blog posts to learn more about us!

Premier Birth Center Fact #1: How “the Kims” Met

Premier Birth Center Midwives Kim Pekin, CPM and Kimberly Haines, CPMKim Pekin and Kimberly Haines have just recently paired up to serve families through Premier Birth Center, but they’ve known each other for quite some time. In fact, Kimberly Haines was the first client Kim Pekin cared for on her very first day of visits as a student midwife. Kimberly was a postpartum mama at the time, so Kim got to meet her at her postpartum visit on March 20, 2008. Fast forward 8 years, and now they’re working side-by-side helping moms and babies here at Premier Birth Center!

After that day, Kim Pekin went on to finish her training and establish her practice in Virginia, while Kimberly was a stay-at-home mom for a while and then finished her midwifery training in Florida before returning to Virginia to practice. They both worked as home birth midwives and birth center midwives, and both saw the benefits of each choice for the families they served.

Kimberly and Kim’s paths converged again last summer, and now here they are at Premier Birth Center!

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Whose birth is it anyway?

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Why does it seem that so much about birth has to do with who controls what? For many people who choose to give birth outside the box, some of the most irritating things about the hospital environment have to do with control. The hospital seems to have a great need to control every aspect of the birth and hospital stay of the mother and baby. They have rules about just about everything!

  • There are rules about the birth tub — IF there’s a tub, you can stay in it for labor, but typically not for the birth, and sometimes not at all if your membranes have ruptured (depending on the hospital).
  • There are rules about the hours that your loved ones can be with you — partner 24/7, grandparents can stay until midnight, children until 8pm, etc.
  • Rules about bathing your baby — the baby is considered a biohazard, so most hospitals require the baby must be bathed ___ hours after the birth.
  • Rules about whether your baby can go home in the car seat you brought with you — don’t even get me started about the car seat test!
  • Rules about whether you can even take your baby home from the hospital — can’t take the baby home if you don’t have a car seat. Not a bad rule, but a rule nonetheless.
  • Rules about doulas — some hospitals don’t even allow them!
  • Rules about what you can eat and drink — pretty much nothing, although your labor partner should eat and drink frequently to keep his strength up. (Hmmm… who’s the one laboring here?)
  • Rules about the Vitamin K and Erythromycin ointment — they look at you like you just grew a third eye if you even question it.
  • Rules about how many people can be in the room — usually no more than 3 plus the laboring woman (depending on the hospital, some are more lenient) and usually only 1 if the birth is a cesarean birth. But, there can be as many hospital staff members as the hospital wants.
  • Rules about having to have an IV — must have it unless your doctor “allows” you to opt for a hep-lock instead.

Yeesh! All of those rules! How does the presence of these rules affect a laboring woman? My thought is that just having someone else calling the shots on things you may or may not care much about, hands your power over to that person or institution for the things you do very deeply care about. The woman gives up her power and her responsibility to think for herself because the institution has a rule for every decision she would normally have to make for herself. Giving up this power and responsibility for the most basic decisions about food, comfort, companionship, and her baby’s treatment puts her in a position of relinquishing control of the bigger decisions by default. She’s already accepted the hospital and doctor as the decision makers for her basic needs, so how could she have the gumption to question the more complex decisions they make for her? Birth becomes something that is done to her, rather than by her.

When listening to women talk about their hospital births, how often do you hear something like this: “I’m not sure why, but they did ____ to me. I’m sure they had their reasons.” Or, perhaps, something like this: “The doctor allowed me to _____.” Something like that would just not fly in midwifery care! In midwifery, the woman takes part in just about every decision made. She becomes informed about the options available, she learns about the objective evidence regarding the risks vs. benefits of those choices, hears her provider’s perspective about her own clinical experience, considers that information along with her own goals and preferences, and then makes a decision about her care based upon this informed choice process. This participative style of decision making is the cornerstone of midwifery care.

Are there rules for out-of-hospital birth with midwives? Sure, of course there are. Each midwife has her own practice guidelines, and there is a community standard of care, but midwives support the mother’s informed choices, even if those choices are not exactly the choices we would make for ourselves. Skip the eye ointment and the vitamin K? If you’re informed about the risks and benefits and feel like that’s the best choice for your family, yes, of course. Eat and drink in labor? Absolutely. In fact, most midwives insist upon it. Get in the water after membranes have ruptured? Sure, why not? Have your loved ones with you 24/7? Absolutely. We wouldn’t have it any other way, provided that’s what you want. Skip the bath? It’s your baby, why not? If someone is worried about disease, they can wash themselves after they touch the baby! Car seat? Yes, but we’re not going to do the car seat test! Ultrasounds? If you want them, you can get them, but that’s up to you. Want to catch your own baby? Go for it, but if you want your midwife to do it, she’d be happy to do so.

The point is that you have as much control as you want to have. You have choices in your birth. Your midwife might guide you, and she might point you to information to help you make decisions about your care, but having a midwife means you have the control to make the choices you believe are best. It’s your birth. You own your choices, which means you own your birth.

My 1966 Baby Book

On the eve of my 50th birthday, I just re-read my baby book. Yep, I know, when was the last time you did that? I figured, hey, I’m going to turn 50 tomorrow, so I thought I’d look at my baby book for a trip down memory lane. A few years ago, I wrote a blog post about my baby book when I was organizing my photo albums. I thought tonight would be a good night to revisit that post and update it with some pictures and a little commentary.

 

Mom-and-Grandpa

My beautiful Mom and my Grandpa two days before I was born.

So, this baby book was quite a treasure trove. There was, of course, a lot of really great stuff in there about my growth and development as a toddler, which was a lot of fun to read. It was great to see my mom as a young mother, noting the same things I noted about my own kids’ babyhoods. I can just see her in her psychedelic 1960’s outfits, with her Sophia Loren eye makeup and bouffant hairdo, chasing little me around trying to get me to eat my pureed peas.

 

My-Firsts

I love this! All of my “firsts” documented!

My mom deserves all of the glory for raising me to be the person I am today. She did a lot, and with very little support from anyone. She was a very young mother, only 19 when I was born. My parents divorced when I was very young, and my mother raised me on her own. How she did it, I’ll never know. She worked two, sometimes three jobs to keep us fed and clothed and keep a roof over our heads. Financially, we were very poor, but we never lacked for fun or love. Mom always made sure of that. She did her absolute best for me, and it is because of that I have always worked to do more, to give more, to be more.

Doing her best for me began with doing her best for my birth. I was born in 1966, back at a time when most moms were knocked out for birth. The natural childbirth movement was just starting to gather momentum back then. Dr. Bradley had just published Husband Coached Childbirth the year before, but I don’t think my mom had read it before my birth. She did, however, read Grantly Dick-Read’s Childbirth Without Fear.

I was born at Forbes Air Force Base hospital in Topeka, Kansas. Here’s a picture of it. From what I understand, the hospital no longer exists, and I think the Air Force Base is no longer there either.

Forbes-Hospital

My dad wasn’t allowed in the room with my mom. My mother, having read Childbirth Without Fear, decided she wanted a natural childbirth. I, like many first babies, was late. According to my mom’s calculations, I was 3 weeks late. She ended up being induced. Despite the induction, mom insisted on having no pain medication. She says she remembers the pain was like waves, and she would just visualize ocean waves during the contractions to get through it. She remembers a very nice nurse who was very comforting and maternal towards her during her labor. When mom started to push, the doctor had the nurse strap a face mask to her leg. It had trilene gas, a popular anesthetic at the time. The nurse said it would be there for her if she needed it, and she could just grab it and inhale if the pain became too much to bear. At the moment of crowning, when mom was startled by the intensity of that moment, she grabbed the mask and inhaled, not knowing it wasn’t going to get any more difficult than it was right then, and she was knocked out. When she came to, she remembers hearing me cry, and she thought I was a cat meowing.

Baby-Kim

Baby Kim Rae Armstrong. Born May 26, 1966. 7# 4 oz., 19 1/2″ long.

When mom tells the story of my birth, she gets really angry, and rightly so. She made it all the way to the end and then took the drugs because she didn’t know she was at the end. She never had any more children, so she missed her one chance to experience the moment of the birth of her child. As a woman who has experienced that moment for all 5 of my children, I really feel like my mom got ripped off.

I always thought that story was so sad, but I was so proud of my mom for trying hard for a natural birth back in those days. She was the only woman in the maternity ward who chose to breastfeed too. My mom was such a rebel. At the young age of 19, she knew already just how important natural birth and breastfeeding are. I am forever thankful for her choices and so proud of her for taking that path.

So, I was reading my baby book today and thinking about all that my mother went through when I was born, all of the challenges she faced. The baby book she had for me was part baby book/album and part baby care guide. It was really interesting to read what they had to say about birth, breastfeeding, and baby care. Here are some snippets I found particularly telling about the mindset surrounding birthing back in 1966:

Hospital Routines:

“If you believe you are going into labor, do not eat any food until you speak with your doctor. Anesthetics are best tolerated on an empty stomach.”

“After the doctor has examined you, he usually orders the nurse to give you an enema.”

” ‘Natural Childbirth’ is a term that has been accepted by those mothers wishing to experience the birth of their babies without the aid of analgesia and anesthesia. Even those mothers, however, are frequently given a local anesthesia.”

“When you recover from your anesthesia and delivery, you will, of course, be tired and so you may fall off into a natural sleep for three to four hours. Following this rest … your first interest will be your baby and the nurse will bring him into your room as soon as you ask to see him.”

“(Rooming in) requires special nursing routines and special regulations concerning visitors that most hospitals do not customarily allow.”

Feeding:

“Most hospitals thoughtfully give the mother a bottle containing enough formula for 24 hours on her day of discharge from the hospital. This takes the pressure off the first day at home and makes the preparation of the first formula a pleasure rather than a hasty chore. You will be given a copy of the formula the baby has been receiving, and with the demonstration of formula preparation which you observed the day prior to discharge fresh in your mind, you will find that formula making is much easier than you may have anticipated.”

“All normal newborns receive a 2 1/2% sugar water solution twelve hours after birth and at intervals during the following twelve hours. 24 hours after birth, the baby is put to the mother’s breast for three to five minutes every four hours for one day. Feeding time is then gradually increased to the normal period of 20 minutes.”

Infant Identification:

Baby-identification

“Some hospitals expose the infant to enough ultra-violet light to sunburn his name on his skin. Others place a large piece of adhesive on the infant’s back upon which his mother’s name is recorded.”

Seriously? WOW. I knew it was bad then, but wow. My mom traversed some pretty high obstacles just to even breastfeed back then. I saw in my baby book that she remained in the hospital until June 1st, which was 6 days after I was born. I can’t imagine not seeing my baby until 4 hours after the birth, nor can I imagine only being “allowed” to breastfeed my baby 24 hours after the birth, and then for only 3-5 minutes every 4 hours. Can you believe the stuff about the sugar water and not nursing for the first 24 hours??? The sunburn thing is absolutely barbaric!

My baby book was a real eye-opener in so many ways. It gave me a whole new respect for my mother’s courage and determination in the face of a very well-established system of obstetrical care. I find it absolutely amazing that she was able to do as much as she did. In fact, I find it pretty amazing that anyone breastfed or had natural births back then. It is pretty mind-boggling to think of what a radical shift in philosophy the natural childbirth movement was back then. It makes my current efforts seem tame by comparison. Now, when people call me a radical or a rebel, I’ll wear that label with pride and a little smile because I know I’m not nearly the rebel my mom’s generation was. I aspire to be that kind of rebel.

Mom

One of my most favorite pictures of my mom, taken in the hospital shortly after I was born. She was a 19 year old new mother and just radiant. Probably working on the very baby book I’m writing about here.

 

Insurance vs. Samaritan Ministries and other Christian health care cost sharing plans; what’s right for you?

Premier Birth CenterMidwives are often asked which health insurance plans have the best coverage for home births or birth center births. Everyone’s financial picture is different, and we can’t give you advice about which insurance plan you should choose. In these times of great change in health insurance, conservative plans rise to the top as a very progressive idea, especially for out-of-hospital births. Christian health care cost sharing plans like Samaritan Ministries and Christian Care Ministry (Medi-Share) are an idea we encourage families to consider when they look at options for paying for their health care expenses. Premier Birth Center supports Samaritan Ministries by not requiring any pre-payment or out-of-pocket expense for Samaritan members. 

 

Commercial Insurance

Most people have commercial insurance, such as Blue Cross/Blue Shield (Anthem, CareFirst), Aetna, Cigna, United Healthcare, etc. These plans are often subsidized by their employer or by the government (through “Obamacare”). ObamacareMonthly payments (premiums) generally vary according to the size of your deductible and co-payment. HMO plans tend to have lower premiums than PPO plans, but when you have an HMO, you are limited to using the providers within the insurance company’s plan. PPO plans usually have in-network and out-of-network benefits, although some plans do not have out-of-network benefits at all. Some plans allow for an in-network exception. Some plans will pay for all kinds of midwives, some exclude certain credentials. Some will pay for a birth center birth, but will not pay for a home birth.

With commercial insurance, you generally have a deductible, co-payments, and co-insurance. The deductible can be different for in-network vs. out-of-network claims. So, let’s say you have a $2000 out-of-network deductible with a 70/30 co-pay. You will need to pay the $2000 before your insurance will pay anything at all. Once you have met your deductible, your insurance will pay 70% of what they consider to be the “usual and customary” amount for the codes your provider submits on their claims to your insurance, and you are responsible for the other 30%. So, if there are $6000 in usual and customary expenses after the deductible, you will need to pay 30% of that $6000, or $1800, in addition to the $2000 deductible, for a grand total of $3800 out of pocket expense.

There are many variables, and even when we think a plan will pay well, we sometimes are surprised be a claim being denied after the birth. There really is no way to know for sure whether a plan will pay and how much they will pay, so we often will tell people to plan for the maximum out of pocket (no reimbursement at all), just in case there is a surprise. It is better to be prepared for that and then be pleasantly surprised if your insurance pays well, but most of the time people are very disappointed by how poorly their supposedly “awesome” commercial insurance reimburses for their home birth or birth center birth.

Doesn’t a hospital birth cost less than a birth center or home birth?

Medical CostsOften, people look at their commercial insurance and think a hospital birth will cost them less than a birth center or home birth. Sometimes, this is true. But, if they have a deductible and co-pay, they may be surprised to find that their hospital bill will end up costing about the same or even more. Using a $1500 in-network deductible and an 80/20 co-pay as an example, if you had a $15,000-$25,000 hospital birth, you could easily end up with a bill for $4000-$5000.

Christian Health Care Cost Sharing Plans

Medi-ShareThese plans are not health insurance, although they do “count” as coverage for the Affordable Care Act. As Christian Care Ministry says, they are a “healthcare sharing ministry where members share each other’s medical expenses.” Members pay a monthly “share” instead of a premium.

Samaritan MinistriesEach health care sharing plan has slight differences in the way that their programs are run. For Samaritan Ministries, if a member has a qualified medical need, that need is published to the membership. Members will send their shares directly to the person in need, often with a note of encouragement, expressing their plan to keep the family in their prayers. Members have reported feeling very uplifted and supported by the personal and spiritual connection with other Samaritan members.

The monthly share for these plans is quite low compared to commercial insurance. Samaritan Ministries‘ monthly share for a family is $405 (as of May 2016). Christian Care Ministries‘ monthly share varies according to family size, date of birth, and Annual Household Portion (out of pocket cost per year before needs are published for sharing).

The plans have guidelines for their programs available on their websites. These guidelines detail what is and is not considered to be a publishable need, as well as what the qualifications are for membership. Generally, members are required to be Christians and live a Biblical lifestyle.

Samaritan rewards families who choose midwifery care. They waive the initial unpublishable $300 need amount for homebirth and VBAC because “they lower overall maternity costs,” and they also will pay up to $500 for doula services. They will pay in advance of the birth if the maternity care provider discounts the fee for paying in advance.

The big question: What if I transfer?

Good question. We can’t answer that question fully for every person, but in our experience, Samaritan Ministries has handled this very well. The ministry will help negotiate lower fees with the hospital and the remaining hospital bills are handled like other publishable needs.

If you would like more information about Samaritan Ministries or Christian Care Ministry, we encourage you to explore their websites to see if these plans might work for you. Your midwife can also answer questions about her experience with these plans, as well. Call Premier Birth Center at 540-709-1737 for more information about health insurance and Christian healthcare sharing plans.

Home birth with midwives is not a trend. Hospital birth with doctors was a trend that lasted 70-80 years before women began returning to what they know truly works.

A Traditional Hospital Birth is an Oxymoron

Home birth with midwives is not a trend. Hospital birth with doctors was a trend that lasted 70-80 years before women began returning to what they know truly works.

When I ask someone whether they’ve considered having their baby at home or at a birth center, I often hear them respond with something like, “I decided to have a traditional birth in the hospital.” This generally makes me smile, because giving birth in a hospital is hardly the traditional way to give birth! Traditionally, women have been the healers in communities. Women have traditionally held the wisdom of the healing power of herbs, and carried the rich oral history of birth and healing from generation to generation. Traditionally, older women taught younger women how to care for their own families and neighbors, thus training the next generation of community healers. Women tended to the sick and the dying, as well as to the birthing women in their communities. The experimental way to give birth is this relatively new idea of giving birth in the hospital with doctors. It has been only recently that healing became the more male-oriented profession of medicine.

Nigerian Midwife Assisted Birth

Note the upright position adopted by Nigerian women. U.E. Egwatuatu.

Midwives have been helping women give birth since before recorded history, and most of the people alive today were born into the hands of midwives. Just a little over a century ago, in 1900, midwives attended half of the births in the US, and only about 5% of births happened in hospitals. By 1939, about half of women gave birth in hospitals, virtually all with twilight sleep. By 1960, 97% of births happened in hospitals. Why the dramatic change? Was it because hospital birth was safer?

No. In fact, when doctors first began attending births, and births began their shift to the hospitals, outcomes for mothers and babies worsened significantly for a while. The experiment was a horrible failure! Part of this decline in safety was due to a lack of care taken in prevention of the transmission of infections. Doctors would go from doing autopsies straight to catching babies, without even washing their hands. It was no wonder that infection became rampant. Once the connection was made between hygiene and infection control, outcomes began to improve. Men in obstetricsOne big reason births moved to the hospital was women’s desire for pain control. It was an attractive option for those who could afford it, which made hospital birth a show of affluence and status, as well as a desirable choice for women who were afraid of the pain of childbirth. The use of “twilight sleep,” where women were given amnesic medications during labor and knocked out for the birth, became a popular option. Doctors would have to use forceps to help the babies be born, because the mothers were unconscious and unable to push the babies out themselves. Of course, these deliveries were risky, causing a lot of damage both to mothers and babies.

Now, we have generations of people in the United States who have only known hospital births for their family members. Looking at my own extended family, I believe I may have only one living relative (other than my own children) who was born at home, and she will be 104 years old this year. Most people’s reference point for birth is that it is a medical procedure. In the media, we see hyped up shows like “Maternity Ward” and “A Baby Story” that show highly interventive, medicalized, often scary births. Most people see that as traditional, normal, and oddly somehow safer than an out-of-hospital birth, rather than what midwives know as the truth of birth: birth with midwives is traditional, normal, and safe, emergencies are rare, and birth almost always works or there wouldn’t be so many people on the planet. Midwives, and more specifically midwives who attend out-of-hospital births, are the birth practitioners who are guardians of traditional, natural, physiologic birth. We’re the only health care providers who ever see births that are truly natural.

Hospitals have made huge improvements over the years in trying to make birth more family-centered, but even the most natural-minded hospital-based practices don’t come close to a home birth or freestanding birth center experience. When was the last time you heard of a hospital birth where a woman with no IV (or saline lock) gave birth attended by the midwife she’d seen for all of her prenatal visits, birthed her baby in a quiet, dimly-lit room, and caught her own baby in a birth pool in whatever position she wanted to be in? We home birth and birth center midwives see that kind of stuff all the time. Fortunately, as people become more educated about midwifery and about the benefits of the midwifery model of care, the tide is beginning to turn. People are increasingly seeking the help of midwives for their babies’ births, and are returning to traditional care. Modern day midwives are increasing in numbers, especially in out of hospital settings. The Internet, films like The Business of Being Born and Orgasmic Birth, as well as help from organizations like The Big Push for Midwives, MANA, and NARM have all helped to increase awareness of birth options for families. The links below are full of historical information about midwifery, traditional birth, and about continuing struggles for the freedom to choose where and with whom a woman may give birth. Something to think about the next time says they want a traditional hospital birth.