Birthing Centers Gain Popularity : Childbirth: In an age of high-tech medicine, these low-tech, non-hospital facilities for low-risk mothers are multiplying. Critics say they cannot deal quickly with possible emergencies.

Twenty-nine-year-old Debbie Winterroth didn’t want the drugs, the clinical procedures, or the possibility of a Cesarean section that went with having her baby in a hospital.

So instead, when her labor began, she visited a La Habra birthing center.

There, in a room painted blue and decorated with cumulous clouds, Winterroth labored on a large, ruffled bed. Coaching her through the delivery was Dr. Howard E. Marchbanks, a grandfatherly general practitioner who has been delivering babies for more than 40 years.

Minutes after the birth, Winterroth’s husband, Jeffrey, bathed his wife and new son, Seth, in a nearby tub. And two hours after the delivery, the Winterroth family went home.

This is an age of high-tech medicine, but around the country, low-tech birthing centers--out-of-hospital facilities for low-risk mothers--are on the rise.

Still, while these alternative childbirth centers are gaining supporters--even a respected academic hospital is planning to open one--they remain controversial. Critics argue that childbirth can be fraught with life-endangering complications that require immediate medical attention that the birth centers cannot provide.

To their proponents, birth centers seem the ideal way to have a baby--offering a natural delivery and highly personal care, often in a setting that resembles a home.

The idea, said Kitty Ernst, executive director of the National Assn. of Childbearing Centers, is “to make birth a better experience for the women. . . . The people doing birthing centers believe pregnancy is normal until proven otherwise.”

The centers are also relatively cheap. According to the Hospital Insurance Assn. of America, a typical hospital birth in 1989 cost $4,334, including physician charges, whereas a one-day stay in a birth center was $2,111.

And the numbers of the centers are growing. The National Assn. of Childbearing Centers counts 135 of them nationwide and 35 more under way. In Orange County there are three, and UC Irvine Medical Center is planning a fourth, a 14-bed facility staffed by nurse-midwives that would handle 1,700 births in its first year, perhaps 3,000 by the second, making it one of the largest birth centers in the country.

But are the centers safe?

Until recently, many obstetricians said no. Since 1982, the prestigious American College of Obstetrics and Gynecology has held fast to a policy opposing them.

Explained ACOG spokeswoman Kate Rudden: “Close to 20% of pregnant women turn high risk during labor and delivery.” If they are in birth centers, they must be moved--and quickly--to a hospital for an emergency Cesarean section.

Adding to the controversy, two Southern California birth centers recently drew negative publicity.

In December, obstetrician Milos Klvana was convicted of second-degree murder after the deaths of nine babies at his centers in Valencia and Temple City.

And in early January, the Medical Board of California opened an investigation concerning an Anaheim birth center doctor who used anesthesia to deliver the year’s first baby, then displayed her just after midnight on New Year’s Eve at a religious service at Melodyland, near the birth center. Dr. Charles W. Turner Jr. contends that he did nothing wrong. But leading obstetricians said it is dangerous to use anesthesia outside a hospital and risky to take a newborn from the center.

Still, birth center proponents called the Klvana case an aberration. And commenting on the Turner case, they argue that most centers--including all 110 members of the national association--expressly forbid such high-risk procedures as anesthesia.

Buttressing their contention that birth centers are safe is a landmark study published in the Dec. 28 issue of the New England Journal of Medicine.

In a two-year review of 11,814 deliveries at 84 birth centers, researchers found few complications, few emergency transfers, a low infant mortality rate and no maternal deaths. In all, they announced, “birth centers offer a safe and acceptable alternative to hospital confinement” for carefully screened women, particularly those who have already had children.

Around the country, birth center administrators and other supporters believe the report will increase their ranks.

“With the very positive article in the New England Journal, you will see more of this,” said Health Insurance Assn. spokeswoman Patricia Schoeni. “And it definitely is cheaper” than hospital care.

Dr. Thomas Garite, UCI Medical Center’s chairman of obstetrics and gynecology, agreed. “Birthing centers are going to be the reality for our health-care system,” he said.

UCI’s motive in starting a birth center is a little different from most operators, however. Rather than responding to women seeking natural childbirth, officials of the financially strapped hospital are trying to relieve severe overcrowding in the maternity ward with the low-cost center.

And because they expect nearly all the patients to be indigent, they are requesting $2 million in state tobacco tax funds--earmarked for medical services--to enable them to make capital improvements and open by next year. They are also negotiating with Medi-Cal for a favorable reimbursement rate. (So far, they estimate a one-day birth center delivery would cost $970, compared to $1,200 for a typical two-day hospital delivery).

But because this is to be a low-budget project, Garite warned, it will not offer the plush, homey atmosphere of many birthing centers, Garite warned.

“You’re not going to find Jacuzzis or excess space or fancy paintings on the walls,” he said. “This gives you bare bones.” Still, Garite promised quality care--careful monitoring, prenatal care and possibly post-delivery visits at home for poor women, many of whom have had trouble finding any obstetrical care in Orange County.

One concern is whether UCI’s center will be perceived as a “poor people’s delivery center.” Chauncey Alexander, chairman of United Way’s Health Care Task Force, raised that issue, suggesting that to avert this, the project should include a community advisory board with representation from women’s groups.

Garite bristles at criticism that he is creating a second level of medical care. “There is a different level of care for poor people,” he said. “There’s non-existent care for poor people. And that’s why we’re developing the birthing center. . . . This is an improvement.”

In the history of birthing centers, some have served poor women (centers in Brownsville and Harlingen, Tex., for instance) but the nation’s first urban birthing center began in 1975 for a well-heeled crowd--middle- and upper-class New Yorkers.

Nurse-midwife Ruth Watson Lubic bucked opposition from local obstetricians and pediatricians to open in a Manhattan townhouse.

At the time, Lubic said, young people were opting for home births. The parents-to-be would read up on childbirth, “the father would catch the baby, and many times it would work out.”

But sometimes it wouldn’t. And so Lubic created a homelike alternative where mother and child could be professionally monitored. The Maternity Center Assn., which she directs, bought a townhouse, installed double beds, rocking chairs and bassinets in the two birth rooms, built a playroom for visiting children and hired nurse-midwives.

Lubic describes her center, which handles about 250 births a year, as “low-tech high-touch.”

Lubic helped spawn a movement. By 1981 there were 14 birth centers across the country and they formed a network, the National Assn. of Childbearing Centers, to share information and set standards for care.

Despite some setbacks, that network has grown. During the mid-80s, some centers couldn’t find insurance and closed. But now, the association’s Ernst said, centers and nurse-midwives can get policies again and the network is growing fast.

In Orange County, Dr. Marchbanks started the first birth center 15 years ago in Orange, moved to Brea, and nine years ago settled in La Habra. Some in the medical community haven’t liked the center, he acknowledged, but “mostly they ignore me.”

A general practitioner who learned how to perform home births at the University of Kansas medical school, Marchbanks still performs an occasional home delivery. But he prefers that his patients come to him “so I (won’t) have to drive so much.”

And though he sometimes delivers babies at a La Mirada hospital, “I’ve always felt babies born outside the hospital were safer,” he said matter-of-factly. “Hospitals are where sick people go.”

Marchbanks says he has never lost a baby or a mother in his birth center. And he estimates that he delivers babies from 180 women a year with a complication rate of “less than 1%.”

But he works hard to screen out high-risk patients. “We don’t want anybody with twins or toxemia or high blood pressure or obesity,” he said. His is a low-risk place where mothers are encouraged to “be up and walking around--not fettered down with an IV and a fetal monitor” during labor.

After the delivery, Marchbanks likes to see his patients again and provide care for their infants. Though he has considered taking the exam to become a board-certified obstetrician, Marchbanks said he really does not want that specialty. “I wouldn’t be able to take care of the babies if I did that,” he said. “I like taking care of the babies.”

Dr. Charles Wesley Turner, who runs the Covenant Birthing Center located just behind Melodyland, also likes babies--especially bringing them into the world.

“It’s not just catching a baby,” the Anaheim general practitioner said. “It’s the miracle of life. I like helping the miracle happen.”

A devoutly religious man, Turner said the name for his birth center describes the covenant he made with the Lord when he opened in November, 1988. “I said, ‘Lord, you give me a place to do deliveries and as long as I can walk and work, I’ll deliver them.’ ” And so far he has, at the rate of about 30 babies a month.

Like Marchbanks’ birth center, Turner’s has homey touches. But although his patients labor in beds with flowery bedspreads and nestle there later with their babies, their births occur on a traditional delivery table, with the woman’s legs firmly clasped in stirrups. Close at hand in the brightly lit room are intravenous solutions, oxygen tanks, a fetal monitor, a defibrillator and an anesthesia machine.

“I believe in a good old-fashioned delivery table,” Turner said. “I don’t have ‘em in bed” because it’s hard to see the woman clearly.

Turner also uses forceps and administers “saddle block” anesthesia in his birth center. Many birth center proponents and local obstetricians wince at that, saying both practices are dangerous outside of a hospital. But Turner disagrees, noting that he’s given saddle blocks for years and “never had a serious complication.”

The only complications he’s had lately, he complained, are bad press.

In Santa Ana, nurse-midwife Elaine Barnes does not believe anesthesia or IVs belong in a birth center. “This is not a hospital,” she said firmly.

Barnes’ 2-year-old Maranatha Alternative Delivery Center is in a 75-year-old home with lace curtains and cradles in the birthing rooms. Large bulletin boards beside the stairs display hundreds of baby pictures from satisfied clients.

Barnes, who received her midwifery training in England, provides prenatal and postpartum care, coaching during delivery, and classes in childbirth and parenting. During labor, she encourages her clients to walk through the two-story house and out into her back yard garden.

All she wants, Barnes said, is to give them “a happy birthing experience.”