Birth Center Provides Homelike Atmosphere : Nurse-Midwives Assist Women in Low-Risk Category

Jose Olivar held wife Nancy’s hand tightly, whispering, “Breathe deep. You’re all right.” They perched on the end of their white wicker chairs, husband seeming to feel his wife’s pain through their clenched hands, until the contraction was over. When the pain abated, Nancy Olivar smiled as if nothing had happened.

The soft pastel pillows, old-fashioned brass bed, cloth-covered picture frames and bright atmosphere of the room was in contrast to the sterile hospital ward where the Olivars had their first child, Elizabeth, three years ago.

After that experience, during which Nancy Olivar said she was “out of control of the situation,” the Orange couple decided to have their baby in “a more relaxing atmosphere,” she said. They met nurse-midwife Lorraine Sanner at their church, and she told them about the New Life Birth Center in Anaheim. It was there that Sanner delivered the couple’s second child, Abraham Josiah, April 21.

The year-old center--which director Lori Leo says is the only such facility in Orange County--offers a homelike atmosphere to women who fall in the low-risk category for birth complications. It employs two nurse-midwives--registered nurses with special training in obstetrics--who, center officials claim, provide the personalized care that is lacking in traditional hospital deliveries. Director Leo said she gets clients from as far away as San Diego and Los Angeles counties.

New Life, which delivers about 10 babies a month, was opened in response to an increasing demand for births that could be in familiar surroundings like home deliveries but that would provide a certain margin of safety, Leo said. She added that the availability of emergency equipment such as respirators, required prenatal classes and the use of nurse-midwives--more highly trained than traditional midwives--makes a center delivery safer than home births.

Under Fire From Critics

Like other independent or non-hospital birth centers across the country, New Life is under fire from critics who acknowledge it performs a needed service but say it does so at great risk because it is not housed in a hospital. Dr. Kirk Keegan, associate director of the Division of Maternal and Fetal Medicine at UCI Medical Center, said non-hospital deliveries in general are dangerous even with low-risk patients such as New Life’s.

Leo, who founded the center, maintains that New Life does not take unnecessary risks because it cannot afford to. No insurance company will provide malpractice coverage for the center itself, although both midwives at New Life have malpractice insurance from the American Nurses Assn. However, the association has informed them it will not renew their policies this year because of skyrocketing lawsuit awards in malpractice cases, Leo said. She added that the American College of Nurse-Midwives is attempting to establish its own insurance company through a bill pending in Congress.

Birth center officials don’t accept patients whose habits may endanger the course of their pregnancy, said birth assistant Kristi Petrikas, who helps the midwives with delivery. Such habits include smoking, drinking alcohol, overeating and drug abuse, Leo said. The center also does not accept women under 18 or over 40, or those with diabetes, heart problems, kidney disease or overall bad health, she added. Those with previous Caesarean deliveries, more than five children, or previous difficult births also are turned away, Leo said.

In addition to screening out high-risk women, New Life also requires patients to have a preliminary check-up with a backup physician, Dr. Mohin Ali, a specialist in obstetrics and gynecology with hospital privileges at Los Alamitos Medical Center. Ali, who has worked with New Life since its inception and also handles patients of home-delivery midwives, said he confirms that the mother is at low risk for birth complications.

If complications do arise during the birth, the patient is rushed to Los Alamitos or La Palma Intercommunity Hospital, where Ali or another obstetrician is available to help with delivery, Leo said.

Because the center workers believe in natural birth, no drugs are used to stimulate labor or to relieve pain unless the mother has to go to the hospital, but Leo said medication is kept on hand for cardiac arrests or seizures.

Los Alamitos Medical Center officials give New Life high marks. “I think they’re doing a terrific job,” said Marjorie Pile, a registered nurse and coordinator of the hospital’s ABC delivery room.

The ABC room provides a homelike atmosphere within the hospital, but physicians perform deliveries. This program may be an alternative to those who fail to meet the criteria for delivery at New Life, Pile said.

“There are always going to be problems, even in a hospital,” Pile said. “I would rather see (patients) have good midwives and a backup system (such as New Life’s) than leave it to chance (by having a less safe home delivery).”

Ali also supported the center’s work. “I’m satisfied that they don’t take any unnecessary risks,” he said. “The midwives are in constant communication with me.”

He said New Life midwives will refer clients to him if they develop such conditions as diabetes or high blood pressure during pregnancy or, during labor, if the client must have a breech delivery.

However, obstetric specialists at other hospitals expressed concern about New Life’s practice. “I think a midwife can give very adequate care for a normal delivery,” said Vicki Lombardo, director of women’s and children’s services at Martin Luther Hospital in Anaheim. “The problem arises from not knowing when it changes from normal to high-risk delivery.”

Lombardo explained that she has witnessed instances in which the mother would be endangered if she had to be rushed from a birth center to a hospital. “I see conditions change very rapidly. . . . Is one baby’s life worth that (type of delivery)?”

Want Personalized Care

However, she added, “I understand the public wants more personalized care and a non-technical environment.

“I would like to see the medical community meet those needs, but in a safer way (than an independent birth center).”

Keegan, of the UCI Medical Center, said that while he is not familiar with New Life, “my personal belief is that no mother should deliver in any place without immediate access to staff that can handle emergency situations.”

“Ten to 25% of low-risk women become high-risk during labor,” Keegan said. And “the most critical time for a baby is the first five minutes of life.”

Keegan said a safer alternative being developed at UCI is the use of nurse-midwives within the hospital. UCI now has one nurse-midwife who works at the hospital and is planning a midwife center. “In 1986, patients should deliver in the hospital” because of the immediate availability of emergency equipment and services, Keegan said.

But former New Life clients are quick to come to the center’s defense.

Mary Gannon, who was a registered nurse in Canada before moving to Fullerton, said she was relieved to find a birth center in Orange County because there was none in Canada. She had her first child at a Canadian hospital and said she would never have another hospital birth if possible. Her baby girl, Erin, was born at the center in January.

“It’s a 100% difference just in attitude,” she said. “It’s a real family atmosphere, and you can request the staff members you want. My husband felt a lot more involved.”

Gannon did say, however, that she would probably never have a home midwife delivery “unless I lived next door to a hospital.

New Life offers classes in the LaMaze birth technique, nutrition, general prenatal care, helping siblings adjust to the new baby and dressing professionally during pregnancy. Like hospitals, the center also offers marriage and family counseling and gynecological services, Leo said. Cost for classes and delivery combined is often less than the cost of a traditional hospital delivery and obstetric care, Leo said. New Life clients pay $1,800 for delivery, which does not include LaMaze classes, lab tests, the preliminary visit with an obstetrician, or hospital services if the mother must be taken to Los Alamitos for delivery, she added. Additional non-emergency services can bring the cost to more than $2,100. Traditional hospital deliveries in Orange County can cost considerably more for the birth and hospital stay alone, Leo said.

Leo said she has found that most of the center’s clients come to New Life because of the available services, not the cost.