Gindi, who had recently moved to Washington, had had a Caesarean section with her first child in 2008 at a Baltimore hospital where she felt pressured to give up her effort to deliver naturally. She was determined to feel more in control for the second. She wanted a provider who supported her desire to try again for a vaginal birth, and the birth center fit the bill.
Because professional guidelines say that a vaginal birth after Caesarean, or VBAC, should be attempted only in places where surgical intervention is “immediately available,” Gindi could not have her baby at the birth center. It has no physicians and is staffed by certified nurse-midwives, a type of advanced-practice registered nurse with expertise in low-risk pregnancies. But its agreement with Washington Hospital Center meant that Gindi could still have the birth center experience by doing her pre- and postnatal care at the birth center and then delivering at the hospital under the management of birth center midwives. Doctors would be called in only if problems developed.
“Maybe they were going to have to recommend a C-section all over again, but I could tell this was the kind of place where . . . they were going to listen to me,” she said.
How did it work out? After 30 hours of contractions and labor at home, Gindi and her husband met birth center midwife Dorothy Lee at the hospital for delivery. And about five hours after that, with Lee’s guidance and with doctors largely out of sight, Gindi delivered a healthy baby girl vaginally in May.
“If there was ever any second-guessing of what the midwife was doing, it certainly didn’t happen in front of me,” Gindi recalls. “It was a pretty amazing experience. I feel really, really lucky.”
The relationship between the birth center and the hospital began in 2000, when Ruth Lubic, a midwife and MacArthur “genius grant” recipient, set up the center near Benning Road in a part of Northeast Washington where infant and maternal mortality were high. Birth center patients have better maternal and child health outcomes than the District and national averages, says general director Cynthia Flynn. In 2010, for example, the center’s preterm delivery rate was 2.2 percent and its low birth weight rate was 3.8 percent. These rates for Washington overall in 2009 exceeded 14 and 10 percent, respectively, according to preliminary data from the Centers for Disease Control and Prevention.
Accredited free-standing birth centers are safe for labor, delivery and the immediate postpartum period, according to the American Medical Association and the American College of Obstetricians and Gynecologists, or ACOG. But some women, such as Gindi, are not eligible to deliver at the birth center. A previous Caesarean, anemia, a multiple pregnancy and substance abuse are all factors that make a woman “risk out” of delivering there, says Judith Krones, a midwife at the center and co-chair of the Washington chapter of the American College of Nurse-Midwives.