Birthing babies

It’s as different from a doctor’s waiting room as you can get: cozy chairs, plush purple pillows and a massage table as well as an exam table.

The Chico office of Paradise Midwifery Services is located in a house in a residential neighborhood. There’s not even a sign out front. Inside, there’s a lending library of pregnancy-related books, as well as back issues of Mothering magazine—the most progressive of them all. Free clothes are set out for those who need them, and there is a table to hold fliers for hypnobirthing classes, nutrition information and herbal belly oil.

“People get to come here, and they don’t feel like it’s a doctor’s office,” said Dena Moes, a certified nurse midwife (CNM) there. And, CNM and co-owner Janice Kalman grinned, “We call everyone back the same day.”

Kalman and Cheryl Struve started the business in November 1995, and it wasn’t easy. “We went from bank to bank to bank, and no one would give us a loan,” said Kalman, who also teaches at Chico State University. Finally, they approached a local business owner, who extended a loan that they quickly paid back.

Seven years later, the practice is thriving.

And the patients are not the granola-chomping, “childbirth is fun” crowd one might expect. Today, about 9 percent of births are attended by a midwife, and most of those take place in hospitals, reports the American College of Nurse-Midwives.

“We have the spectrum” of clients, said Moes. They range from teen mothers to professionals to conservative Christians to incarcerated women. Kalman said, “I think that’s a beautiful thing about our practice. It’s so integrated. We’ll have a teacher and an inmate, and they’re all comfortably chatting in the waiting room because they’re all going to be mothers.” No one is turned away, Kalman said. Most of those with private insurance find they’re covered.

Besides prenatal care, Paradise Midwifery Services offers family planning and gynecological care. The midwives help deliver 10 to 20 babies a month. It’s been on the higher end lately, and they speculate it’s some kind of post-Sept. 11 baby boom. The fourth midwife in the practice is Ellie Orbeton, who earlier this year came down from Susanville, where she had been a midwife for 12 years.

Moes pointed out that 80 percent of all births nationwide are normal. “Emergencies almost never happen.” The infant-mortality and caesarean rates are lower when a midwife is present.

Even so, doctors are waiting in the wings, so to speak, in case labor doesn’t progress well. Paradise Midwifery Services’ consulting physician is Dr. Ronald Ainsworth, whom the women describe fondly as both knowledgeable and patient. Being allied with a doctor is required for the midwives to have hospital privileges.

If a mother needs an epidural or pain medication to get through delivery, that’s fine, too. “Pain is a given; suffering is optional,” Kalman likes to say. Adds Moes: “We’re not there to tell them how to run their lives or birth their babies. We’re here to serve women, not to push some agenda.” The midwives try to limit the use of a fetal monitor, so the laboring mother can move around. The mothers are encouraged to deliver in positions such as standing up, if they’d like. Labor is seldom induced, and episiotomies are rarely performed.

Another difference is you won’t see midwives crowded around the woman yelling, “Push, push!” “I try to let the woman spontaneously push,” Moes said. In many of the photos of deliveries chronicled in an album at the Chico office, there isn’t even any blood, because there was no tearing.

“I think our practice is women-centered. We try to follow the wishes of the patient,” Kalman said. “People get the best of both worlds.”

Kalman herself had a baby girl five months ago. She intended to have her at home, but when the baby seemed to be in distress, they went to the hospital and she ended up with a caesarean section. “I understood that that was necessary, but I was a little bit sad,” Kalman revealed. Moes had her baby at home three years ago.

The midwives would love to focus exclusively on caring for mothers, but politics and bureaucracy are a part of the business.

Kalman and Struve even found themselves lobbying in Sacramento in favor of a law giving midwives the power to pursue reimbursement from HMOs, which had refused to contract with their practices. Too much time is spent on the phone dealing with insurers. And when an insurer drops an area from coverage, as Sierra Valley IPA briefly did in Paradise, or Medicare lowers its reimbursement rates, it hits a small practice even harder, Kalman said.

Moes, who came to Butte County from Santa Cruz in January, doesn’t have to worry about a big factor that’s been blamed for pushing some midwives out of the business: the ever-increasing cost of malpractice insurance. Paradise Midwifery Services’ owners pay the insurance for the practice, and as employees Moes and Orbeton are covered, too. When Orbeton used to pay for her own insurance, it ran her $9,000 a year.

The midwives don’t make as much money as labor and delivery nurses, they said. But Moes said she felt a “calling” to the profession, so it was out of her hands.

Midwifery was the norm before the mainstream medical community got hold of it in the early part of the 20th century. Doctors argued that physicians needed to get more experience delivering babies, so they led a push against midwives. Thwarted by laws and a shift in public opinion, midwifery became less popular.

“Women have had a lot of loneliness in their births,” Kalman said. “It seems like we’ve lost our folklore.” But Kalman was quick to point out that in the Chico area “the medical community is very supportive.” There are several midwives working in Butte County, and Kalman said they don’t feel like they’re competing with one another, since all are good and there are plenty of patients to go around. The Paradise Midwifery Services CNMs rotate schedules so someone can be with a patient throughout much of her labor. While their office on Buschmann Road in Paradise is home base, each midwife works in Chico at least one day a week.

All deliver at Feather River Hospital, which they say has a homier birthing center than Enloe Medical Center does. Besides huge, private birthing rooms complete with patios, the Birth Day Place has a tub for laboring women. “It’s the Hilton of hospitals to birth at,” Orbeton said.

Pepper Knox, whose third child, a girl, is due in a month, has used a midwife each time. Her last baby weighed 11 pounds, and she was able to deliver him without medication.

“Doctors are more clinical, versus personal," she said. "You do feel like a woman [understands because she] has the same body."