Louisiana exceeds the national average regarding incidences of labor inductions, epidurals, and cesarean section births. These statistics are disturbing to many pregnant women preparing for birth, yet there is hope for better birth options. This positive shift is due to an increasing number of women who have begun to equate medical management with health risks rather than benefits. Many women now seek out a birth doula – a knowledgeable, experienced companion who stays with them through labor, birth and beyond – to help ensure their plans for a minimal medical-intervention birth. Birthing tubs for labor and birth are much more common now than a decade ago. The presence of in-hospital midwives has increased as well. A general awareness of birth options is steadily growing in the Baton Rouge area.
Nicki Solomito Pugh, a Bradley method instructor for the Baton Rouge area, encounters women seeking personal ways to manage their own births. She says, “I certainly have more students now than when I first started” in 2007. In the past couple years, Baton Rouge has had greater exposure to choices centering around non-medicated births. One major event has been Lafayette’s springtime Preserving Normal Birth workshop, which has been well attended by Baton Rouge Birth professionals since its initial session in 2006.
René Johnson, a Baton Rouge doula practicing since 1980, comments about the recent shift in birth options awareness, saying, “I’ve noticed a marked increase in waterbirths, interest in unmedicated birth, etc. [Around 2005] Birth Help [my doula practice] was invited to teach full day in-service workshops (several per year) for L&D nurses, and we still do several a year.” Johnson has noticed the classes taking affect, saying that “because almost all of their nurses are at least exposed to natural birth philosophy and hands-on techniques, we have seen a shift in attitude at Woman’s Hospital.” Women’s Hospital has even begun allowing women to labor, but not birth, in birthing tubs.
When asked about the changing birth scene in Baton Rouge, Jackie Macaluso, a lactation consultant who has also worked as part of Mother’s Touch Doula services, says, “Definitely water births have increased – we now have three Aquadoula tubs and one inflatable ‘homebirthing’ tub.” She attributes this increase in part to the Certified Nurse Midwives (CNMs) at Ochsner, saying, “They have greatly encouraged the mothers in their care to use these tubs.” Macaluso asserts that “We need more doctors and even more hospitals to embrace the relief moms receive from being submerged in water” during labor.
In April 2010, Ocshner Medical Center – Baton Rouge opened the Family Birthing Center and thus became the only hospital in the area to offer a midwifery program to its patients, thereby providing a number of alternative birthing options. The hospital’s fourth floor is entirely dedicated to mothers and babies and includes: 6 large birthing rooms, 2 nearby operating rooms, and 2 suites with built-in birthing tubs, as well as 14 all-private patient rooms, Level-3 Neonatal Intensive Care Unit (NICU), with a “starlight” ceiling, 4 observation rooms, and family waiting rooms for the Labor and Delivery and NICU areas. The Family Birthing Center is currently staffed by six full-time, board-certified OB/GYN physicians, plus a collaborative midwifery practice with seven certified nurse-midwives. Rooms are twice the size of normal hospital rooms to create a home-like experience for mother and baby. The Family Birthing Center will be staffed by six full-time, board-certified OB/GYN physicians, plus a collaborative midwifery practice with four certified nurse-midwives.
Some women are not drawn in by the home-like experience however; they choose to opt out of the hospital altogether, proclaiming safety and “avoidance of unnecessary medical interventions common in hospital births” as their top reasons for doing so.[i]
Studies show that women birthing at home under care of a midwife have a cesarean rate of less than 5%.[ii] This comparison is not completely fair, since midwives work only with low-risk pregnancies, yet it is interesting to note that the national average for cesarean sections for hospital births was on par with this optimal rate in 1965 (4.5%) when cesareans were first measured.[iii] The rate has since risen to what the 2007 CDC National Vital Statistic Report proclaims as “the highest level ever reported in the United States, 31.8 percent.”[iv] Louisiana is above the national average at 35.9 percent.[v] While ACOG admits that “the cesarean delivery rate has concerned [them] for several decades” they shrug their shoulders, explaining that “there is no scientific way to recommend an ‘ideal’ national cesarean rate as a target goal.” They point instead toward multiple health factors as the culprits of America’s skyrocketing cesarean figures, factors headed by “maternal choice” as well as the rising tide of high-risk pregnancies due to “maternal age, overweight, obesity, [and] diabetes.”
The out-of-hospital birth option for Baton Rouge residents is now more available, yet still minimal. In June 2006, Gentle Choices, A Birth Center opened in Lafayette, offering services to Baton Rouge residents. As for homebirth, Family Centered Birth Services, based in Ponchatoula, thrives while serving the New Orleans and Baton Rouge areas. The big question however is OB backup. Several states, Louisiana included, require women under a homebirth midwife’s care to have check-ups and back-up assistance by an obstetrician.[vi] This puts the ultimate power in the hands of the obstetrician, who is often reluctant to support clients planning a midwife-assisted homebirth especially since the American College of Obstetrics and Gynecology (ACOG) issued a 2006 statement against doing just that.[vii] ACOG “acknowledges a woman’s right to make informed decisions regarding her delivery and to have a choice in choosing her health care provider,” yet that choice often remains a hypothetical non-reality. Solomito Pugh says that while few of her Bradley students choose homebirth, “Who is to say how many moms would birth at home if OB backup and/or cooperation with CPMs were available?”
Currently, out-of-hospital births remain a minute fraction of all deliveries. Yet birthing options are increasing, in hospital and out. Awareness of medical management alternatives is growing. And more women are working with their health care providers to create a more optimal birth experience.
[i] Journal of Midwifery & Women’s Health. “Staying Home to Give Birth: Why Women in the United States Choose Home Births.” Volume 54, Issue 2. March 2009.
[ii] Citizens for Midwifery. “Cesarean Rate Continues to Rise.” [Online] 5 December 2007. http://cfmidwifery.blogspot.com/2007/12/cesarean-rate-continues-to-rise.html.
[iii] Childbirth Connection. “Why Does the US National Cesarean Rate Keep Going Up?” [Online] 2008. http://www.childbirthconnection.org/article.asp?ck=10456
[iv] Center for Disease Control and Prevention. State Profile, Louisiana. [Online] 2007 preliminary data. http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_12.pdf
[v] Center for Disease Control and Prevention. State Profile, Louisiana. [Online] 2007 preliminary data. http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_12.pdf
[vi] Department of Health and Hospitals, Board of Medical Examiners. Louisiana statute. Chapter 53. Licensed Midwives. Subchapter A. Standards of Practice. §5313. Required Tests. [Online] August 1991. http://www.mana.org/laws/laws_la.htm.
[vii] American College of Obstetrics and Gynecologists. ACOG Statement on Home Births. [Online] 02 February 2008.