Phyllis Gallina says that when she gave birth to her first child, Nicholas, she came out of the delivery room convinced there had to be an alternative to stirrups, shots and enormous hospital bills.
Last June, three years later, the 30-year-old Vienna homemaker delivered her next child under markedly different conditions at the Washington area's only "maternity center," an ordinary-looking house in a Bethesda subdivision near Montgomery Mall. The center, which had opened for business the day before, offers a compromise for parents who want the intimacy of a home birth and some of the benefits of a hospital.
One of about 120 such facilities across the country that have sprung up since the mid-1970s, the center is a place where women can deliver in a home-like setting, but with fetal monitors, oxygen and electric suction supplies within reach. Managed by four certified nurse-midwives whose experience includes the safe delivery of about 1,500 babies, the center is at 6506 Bells Mill Rd., eight miles from Shady Grove Hospital and several minutes from a substation of the Bethesda-Chevy Chase Rescue Squad.
The midwives at the center are registered nurses and graduates of the Georgetown University School of Midwifery, which offers a nine-month course that includes delivery experience.
Because Maryland has no legal requirements for birthing centers, the women did not need a license to open the center -- only a zoning change from residential to business for the birthing house.
Neither Virginia nor the District has regulations governing birthing centers, although Virginia is developing rules on the subject.
"To me the center offers the best of both worlds," said Gallina. "It's actually a two-story home made to serve as a clinic, with a vegetable garden in the back yard and three upstairs birthing rooms that remind me of my own bedroom. The extra medical equipment is there, but it is discreetly stored in closets."
Two dozen women have delivered at the center since it opened June 1, including one who traveled 180 miles from West Virginia. Forty more expectant mothers are currently enrolled to have babies there, said nurse-midwife Marion McCartney.
The births are drug-free, doctor-free (although physicians are on call in emergencies) and devoid of high-tech gadgetry, she said, which keeps fees low. Phillip Gallina, for instance, came into the world for $1,200, including prenatal and post-partum care, while the hospital and doctor's fees for his older brother totaled $2,800, their mother said. The midwives said the $1,200 fee they charge is standard for a normal delivery, in which help from a nearby hospital or from a physician is not necessary.
Sometimes, however, help is needed. In five cases this summer, women and their babies had to be taken to hospitals because of complications, but all are healthy, according to the center's midwives.
Couples who have their children at the center share a desire to dictate the terms of delivery, McCartney said.
"If you think our clients are aging flower children who tried 'est' and are looking for a new experience, forget it," she said. "We're catering to consumer-savvy professionals who believe pregnant women should be treated like healthy adults, not subservient patients."
McCartney and the other midwives, Janet Epstein, Barbara Vaughey and Charlyn Santiago, say they have presided over some highly personalized births.
It's not at all unusual, for instance, if babies' first cries are drowned out by the spontaneous applause of fathers, grandparents and siblings who have assembled to watch the delivery, the midwives said. Champagne and Gatorade are served upon request. Women can shower between contractions, wear their own clothes, and check out as soon as their vital signs and those of their infants have stabilized -- often within eight hours of the birth.
The midwives stress, however, that their services are not suitable for all deliveries. Women who want to deliver at the Bethesda center but who have had a previous cesarean section delivery or medical problems such as diabetes or hypertension are not accepted--a policy the midwives say reduces delivery-room risk.
Nationally, the midwives say, unforeseen complications may force as many as one in five women who come to birthing centers to complete their labor at nearby hospitals. But they say true crises are relatively rare in deliveries.
The rate of infant deaths for maternity centers is about half the national average, according to a 1980 sampling of 11 centers reported in the British medical journal Lancet. For every 1,000 births in the United States, about eight infants die within the first 28 days of life nationwide; maternity centers average only about four deaths, the journal said.
"Patient screening ensures that center deliveries are short on risk," observeed one veteran obstetrician in Bethesda, Dr. James Brew, who is one of 10 back-up physicians for the center. Many of his colleagues would disagree, however.
Dr. Ervin Nichols, spokesman for the American College of Obstetricians and Gynecologists, says the organization believes that "the place to have a baby is in the hospital -- period. Maternity centers are better equipped than homes, but they can't compare with hospitals. And in a crisis the hospital setting is critical.
"Our primary consideration is for the safety of the newborn," he said. "From 1 to 4 percent of all women in labor develop complications, and in that situation the staff resources and equipment in a hospital are imperative."
Nichols said the infant mortality rate "is the lowest it's ever been in the history of the country, and that's a direct reflection of the shift from home births to hospital births that has taken place over the past 50 years."
He added: "We're supportive of midwifery in appropriate conditions, and by that we mean the hospital."
Three of the midwives -- McCartney, Epstein and Vaughey -- delivered babies in a two-year pilot program at the Washington Hospital Center, starting in 1979, but they eventually lost the privilege, even though obstetricians at the hospital acknowledged that there had been no complications with the procedures. Officials told the women the decision to end the program reflected physicians' opposition in general to the practice of home deliveries, which the midwives were continuing to attend.
While doctors traditionally have been wary of midwives operating outside hospitals, midwives maintain that physicians really are objecting to seeing their patients -- and fees -- go elsewhere.
But Dr. Jed Gold, an obstetrician in private practice in Chevy Chase and Laurel, said he is "very concerned about what can go wrong in birth centers. Tell me, what can one midwife do if an emergency cesarean section is required because of total fetal distress?"
"Our record of 1,500 safe births demonstrates it is fairly safe to have a baby outside of a hospital through a service such as ours," McCartney said. "Given that set of statistics, it's up to parents -- not doctors -- to decide where and how they want to deliver."