Special Reports

Delivery options numerous for expectant mothers in Whatcom County

Planning to deliver your baby in Bellingham? You have a wide range of choices.

You can give birth in the hospital with a family physician, obstetrician or a certified nurse midwife attending.

You also can deliver at home or in a birthing center with a licensed midwife, certified nurse midwife or a professional midwife by your side.

“The wonderful thing about Bellingham is there are so many options,” says Dr. Chad Thomas, an obstetrician at PeaceHealth St. Joseph Medical Center.

Obstetrician in hospital

One advantage of the traditional hospital model is that if a Caesarean section or other complications arise, you don’t have to switch to another provider.

“If an emergency arises and we have to deliver quickly, we can do that faster in the hospital than if you’re coming in from a birth center or home, due to transfer time,” Thomas says.

And if you want an epidural, which is administered by an anesthesiologist, it is only available in a hospital, whether you’re attended by a doctor or an in-hospital midwife.

St. Joseph hospital offers birthing tubs, comfort measures such as a birth ball, and a day-bed for the father or other support person. Hospital policy is no more than five people in the room during delivery.

Expectant parents need to be flexible, because birth, while a natural process, can hold surprises. For example, new Bellingham parents Tally Rabatin and T.J. Tipton had their hearts set on a natural birth in a birth center for their first child, but their baby had other plans.

“She came four weeks early, which required us to be at the hospital, to my dismay,” Rabatin says. “Luckily, my experience at St. Joe’s birth center was nothing like I had imagined. The nursing staff was supportive of my birth plan, and helped me to labor and deliver our baby naturally. Although it was not how I planned it, it was a great overall experience.”

Family-practice physician in hospital

Family-practice physicians provide obstetric care and births, but generally don’t cover high-risk pregnancies or C-sections.

The advantage is that your baby can continue under the physician’s care indefinitely.

Certified nurse midwives in hospital

St. Joseph hospital offers in-hospital births attended by certified nurse midwives. The hospital has had two midwives on staff for three years, and two more were added in December 2014.

Midwives, like obstetricians, rotate coverage so one is always on duty. Midwives provide excellent care for women with normal, low-risk pregnancies, Thomas says. Costs for in-hospital birth are the same, whether a physician or a midwife is attending.

Midwives can prescribe medication and provide ongoing care. A certified nurse midwife at St. Joseph can care for a woman who is not a candidate for an out-of-hospital birth but who still wants a midwife.

“The midwifery model of care is more holistic,” says Jennifer Cartwright, a certified nurse midwife at PeaceHealth. “We spend more time. We come in earlier (to attend a woman in labor) and stay longer. Midwives provide ongoing labor support through the birth.”

A midwife’s care is more tailored to what the patient is seeking, says Erin Swanda, another certified nurse midwife at PeaceHealth. Midwives are less likely than physicians to break water or augment labor with the drug Pitocin, which induces or speeds up labor

“Birth is often really normal,” Cartwright says. “We are the experts of normal.”

Appointments can take longer because midwives offer the expectant mother more education. Midwives educate women about the physiology of pregnancy and birth, and encourage them to advocate for themselves.

“It helps women trust more,” Cartwright says. “They’re more likely to relax and have a normal birth experience.”

Licensed midwives in birth centers

Midwifery puts the mother, not the doctor, at the center of the birth experience, says Christine Gibbs, co-owner of Bellingham Birth Center with Catriona Munro.

While birth centers can administer medications and oxygen, midwives promote the natural progression of labor. They do not administer epidurals or use Pitocin. Studies show that planned home or birth-center births, attended by a licensed midwife equipped with oxygen and medications, are as safe as hospital births, with fewer interventions.

The center is less than a mile from St. Joseph hospital, but emergency transfers are rare, Munro says, because at-risk pregnancies are usually identified early in pregnancy. The most common reason for a transfer is not distress but a prolonged labor that isn’t progressing.

A birth-center birth costs one-third of an uncomplicated hospital birth, according to Gibbs and Munro. Washington insurance companies cover midwife and birth-center services.

Licensed midwife Ann Tive has practiced in Bellingham since 1990. In June 2014, she and co-owner Jessie Bradley, also a licensed midwife, opened Birthroot Midwives and Birth Center at 1600 Broadway.

“People are becoming more savvy as health-care consumers,” Tive says, “and seeing the benefits: less money, better experience.”

Birth centers simplify childbirth for healthy, normal pregnancies, she says.

An obstetrician is a good choice for high-risk pregnancies, Munro says, but for low-risk pregnancies, “it’s equally safe, and you know your providers here.” Low-risk pregnancies means healthy moms, single babies, head down, not premature and not post-term.

“Natural childbirth with a licensed midwife is an important option for women with normal pregnancies who want a safe birth,” Munro said in an email. “Licensed midwives have a 3 percent Caesarean rate, and an even lower induction rate. More women are seeking this type of care, as they fear unnecessary interventions.”

Since Bellingham Birth Center opened in 2004, out-of-hospital births in Whatcom County have doubled, growing from 6 to 12 percent of all births, based on data collected from birth certificates signed by out-of-hospital midwives and compared to total deliveries in the county. In Washington, out-of-hospital births are 3 percent. Nationwide, they are 2 percent.

Wherever people in the U.S. choose to have their baby, prospects for a happy outcome are good, says Thomas, the PeaceHealth obstetrician.

“In areas of the world where there’s no prenatal care, one in seven women dies in childbirth, and newborns at a rate higher than that,” he says. “Here in America, the risk of dying in childbirth is 1 in 10,000.”