Settling in for the long-haul
One of our wonderful birth center families after a long, and victorious labor.
Sorry guys, it is always a birth analogy, so prepare yourself.
Sometimes, when you are in labor with steady contractions, working hard to cope with each wave, you start to wonder if it will ever be over. Will this baby ever come out? Maybe you want a cervical check and find out you aren’t as far along as you hoped you would be (bee-tee-dubs, cervical exams won’t ever tell you where you’ve been or where you’re going, but just give us a snapshot of where things are in that moment, but more on that later).
You try a position for a while and it works, until it doesn’t, and then you find a new thing.
And on you go until that blessed moment when we all hear tiny lungs fill with air and cry out for the first time.
But before then, sometimes you want to pack up and go home, press the pause button, give up. But, as all midwives will tell you from their wisdom: the only way through is through.
Now back to us, we have opened, we are licensed, we have obtained our national accreditation via CABC (which is a big deal, ahthankyouverymuch), our facility is beautiful, our providers are awesome, we’ve welcomed close to 200 babies. We’ve FOUGHT for better regulations, better insurance contracts, better rights, better support. We’ve won a lot of those fights and made huge progress.
Hold up, lemme edit that real quick: we are fighting, present-tense. Every time we experience a victory, we realize that there is still so, so much work to be done. It’s like getting through a contraction and realizing that the baby isn’t here yet, and you’re going to have to do it again.
So here’s where we are at: 8cm, starting to feel like we need to push, and about to deliver this 11-pound toddler-baby of long-term sustainability. We’ve realized, just like when you are in labor and reach out for that hand to squeeze and steady, calm eyes to look into, that we need your help.
Right now birth centers everywhere are having a group-realization: we can make a huge dent in the maternal health crisis, but we have one, huge barrier to our success: fair and sustainable insurance contracts.
Here’s the deal: we offer the exact same care for low-risk, uncomplicated birth as a hospital. And we are doing it with significantly better outcomes (our c-section rate is <6% compared to 27%, a ~10% epidural rate compared to the national average of 85%, fewer NICU admits, fewer preterm births, better client satisfaction, etc). Notwithstanding the epic cost-savings that this presents to insurers, they are reimbursing us at a fraction of the rate for uncomplicated, vaginal birth.
So we started pushing back on this and asking why they’re paying us less for the same services with better outcomes. Why are they reimbursing us at unsustainable rates when we are meeting the international standards set by the CDC, the NIH, and the WHO when we’re not doing this as a nation? Nobody has a good answer. So we’re asking them to change. The state insurance commissioner agrees, and has offered us a meeting with each of the 12 insurers with a presence in Oregon. We meet in about three weeks.
We have the data. Man, we have so much data. But we need you. The most compelling information at the end of the day is how you feel about your care. Even if you didn’t choose a birth center, you know how important it is that people have choices.
Will you send us your stories? Tell us what difference having a midwife made to you. Tell us why Astoria and NW Oregon and SW Washington need to have access to a birth center. Tell us what you would do if we didn’t exist. Send pictures! We will compile all of these stories and bring them with us when we go to Salem. We’ll share them on social (please don’t share anything you don’t want publicly known and let us know if you want your initials left out).
You can send these to us via instagram, facebook, your EHR, or email them to hello@astoriabirthcenter.com. Birth centers all over Oregon are doing this so we can show the decision makers what this means to you.
Either way, we’re going to fight for this, and we will deliver this baby. It will result in long-term sustainability and increased access to birth centers everywhere. But we’ll do so much better with your help.
Onward, y’all.
“I always believe women…”
This is not a picture of me. My nails are never that nice.
I was 34 weeks pregnant, living in Seattle, and worried about some symptoms I was having. I’m not going to go into them here, because that’s not the important part of the story. It will suffice that what I was noticing was low-level, but I’d had a complication with my last pregnancy and was worried I was headed for the same thing again. I asked my healthcare provider if what I was noticing was anything to be worried about.
We’ll keep an eye on it. The doctor said.
I shifted my considerable weight on the crinkly-papered exam table and asked (secretly hoping to be reassured but not knowing how to be),
Do you think it could all be in my head?
Yeah, it probably is, the doc responded.
My heart sank. If it was all in my head, how would I know if I was actually having a problem or not? Who would tell me? What if I ignored it and, at some point, it was too late?
I talked it over with a friend. She suggested that I ask for a second opinion from another healthcare provider, a midwife she knew who had a lot of experience with my particular issue. I was hesitant. I didn’t want to be “high maintenance.”
By the way, let me just say here that it is 100% okay to need help, even to need a lot of help. I’m just saying that having needs can feel uncomfortable because of the perceived expectation that I should just be okay and not need things, whatever that even means. Do you feel that, too? Just me? Okay, moving on…
Anyway, I took her advice and made an appointment to be seen for a second opinion. Honestly, it felt a little good somewhere deep inside me, where all my repressed feelings live, to advocate for my own need.
Another day, in a different office, on a different exam table, this time with a midwife, I again described my situation and again asked,
What if it’s all in my head?
The midwife stopped taking notes and met my eyes.
I always believe women.
She said this matter-of-factly. Like, the weather is 62 degrees and partly cloudy. I like salsa verde on my nachos. I always believe women.
And I sat there, in the office of a complete stranger, and started crying some very surprising tears.
I did not realize until that moment of my life how heavy the burden I had been bearing until then actually was. I had never known what it felt like to just be believed. Not to be given the benefit of the doubt, not to have someone just hear me out and make their judgement afterward if I had a strong enough case, not to be “believed” with saccharine sympathy only to be scoffed at behind my back. To be believed because it was obvious that I know myself best. Because I am a woman. Because I am a mother. To have a healthcare provider say this to me was transformative, not just to my healthcare, but to my life.
We ended up talking about that some. I asked her whether she worried about being lied to ever. She said that she wasn’t.
She explained that when women have concerns sometimes they are misarticulated for any number of reasons. Sometimes they don’t know how to describe what is wrong, so it comes out funny. Sometimes they are used to being mistreated, so they say what has worked for them in the past. But never to her knowledge had a woman just made something up who didn’t actually have a problem that needed attention.
It occurred to me that this was true healthcare. I was witnessing a provider in the active role of understanding her patients, understanding the complexity of women, understanding that we all need to be believed.
Ultimately, that’s why I opened a birth center. We need more places where a whole person can be seen. We need spaces and providers who are allowed to care for the entire human, the entire family. Physical, spiritual, emotional, pregnant, postpartum, all of it.
This is, above all else, a place for women to be believed.
It really was a lot like birth
Three days ago one of my birth-friends remarked that the process of opening a birth center is really a lot like birth itself. It started out with an idea, it grew quickly and, near the end, it became an unstoppable and powerful cascade. I will only mention the cravings, weight gain, mood swings, and back pain as conditions incident to the plot here.
I joked back that if this is like birth, that we were in transition - the most intense part of labor, right before birth, when many women say things like “I’m not sure I can do this” right before they go on to actually do it.
That is what I was saying. I’m not sure I can do this.
But we reached deep and worked so, so hard. We cried, sweat, and bled some (yes, actually bled, nevermind that it was due to the inadvertent misuse of construction equipment). And today, the 31st of July at 4pm, we delivered the first fully licensed, freestanding birth center on the Oregon Coast.
Afterwards we cried, laughed, and shared our intense joy with our family, friends, and community.
Meet our pride and joy, Astoria Birth Center. Delivered to you after a labor of love.
Okay, I’ll stop with the birth puns.
No I won’t.
“Laughter” by Amanda Greavette, is featured in our center.
Almost There
Astoria Birth Center is on its way!
July 1, 2020
If we were in labor, we’d be in transition (that last, intense part right before you push a baby into the world).
People are asking when they can come see the new birth center and if it will be ready by the time they are due.
There are still a few things that lie just beyond our control, but we are getting so close. We have our ribbon cutting tentatively planned for July 31st, but we will be able to offer private tours before that time. Sign up for one here.
What everyone is asking:
Where are you at in your process?
We just finished painting, and now we are cleaning up all of our remodeling debris before we unpack all of our super cute furniture and decorate.
We’ve put our ribbon cutting and a safely-distanced open house on the schedule for July 31st.
We should be open for all services in August, but some things depend on powers beyond our control. We will keep you posted!
What kind of care do you offer?
Prenatal, birth, and postpartum care by Certified Nurse-Midwives
Waterbirth (and any other kind of natural birth)
Women's health care (GYN, pap smears, birth control, STD testing and treatment, cancer screenings, etc)
Massage
Acupuncture
Lactation services
Childbirth education
Who can deliver there?
Any pregnant person who has had an initial consultation and who meets the health criteria set forth by the state. (If you have certain complications of pregnancy, or twins, a hospital may be the safest place for you to deliver).
People who plan to have an uncomplicated, unmedicated, vaginal delivery (birth centers do have nitrous oxide, but don't offer narcotics, epidurals, or cesarean births).
People who are due in August or later.
Does insurance cover birth centers?
Yes. We will be accepting all major health plans, including Tricare and OHP. If you have a question about payments or insurance, check with your insurance provider first and then reach out to us! We're happy to help.
Can I take a tour?
In another week or two we will be ready to offer private tours to expectant families. If you'd like to take one of those, free of charge, you can sign up here.
What’s Next:
We’ll keep in touch, share more details about our progress, and give you an idea of what birth in a birth center looks like (spoiler: it’s awesome).