Birthing Center a Refuge From Hospitals’ Clinical Atmosphere : Health: Simi midwife Rasmia Tebo says, ‘The woman delivers herself. . . .We’re just helping.’ But some are wary.

During her first visit to the obstetrician, Linda Bruce noticed the words high risk written on her medical chart.

It wasn’t that the petite Simi Valley hairdresser smoked, had high blood pressure or didn’t exercise. The reason was simply that she was pregnant over the age of 35.

And when Bruce pressed her doctor for assurances that her delivery would be without drugs or medical intervention, he told her, “We don’t know how that’s going to go.”

Worried that the high-risk label would make her a candidate for a Cesarean section, Bruce, 38, looked for an alternative to a physician-attended hospital birth.

It didn’t take her long to find Rasmia Tebo.

In fact, she had only to look across the parking lot.

There, at the busy intersection of Madera Road and Royal Avenue, in the same shopping center as Bruce’s hair salon, Tebo operates Ventura County’s only independent birthing center.

She is also Simi Valley’s only nurse midwife, and one of only a handful of certified midwives practicing in the county. Two nurse midwives practice in Ventura but work with physicians who attend births with them in hospitals.

Born and trained in Israel, Tebo opened her Simi Valley clinic, the Natural Birthing Service, in 1991. Since then, she has delivered 135 to 150 babies a year, half in private homes, the rest in the clinic, which is not affiliated with a hospital.

Birthing centers were originally developed to serve rural communities and began appearing in urban areas in the mid-1970s. But according to the Pennsylvania-based National Assn. of Childbearing Centers, a growing number now serve suburban areas.

The centers provide maternity care for women at low risk of complications. They are typically run by midwives who refer high-risk patients to obstetricians. Some are run by physicians or by midwives closely supervised by physicians.

Most of the 135 birthing centers in the United States are concentrated along the East and West coasts. Another 100 are slated to open during the next year, said Kate Ernst, executive director of the association.

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To her patients, Tebo, 40, and her clinic offer a refuge from the clinical environment of a hospital and from physicians who typically devote only 15 or 20 minutes to each patient.

Tebo, by contrast, may spend an hour talking with a single patient about stress, diet, exercise and what to expect during labor and delivery.

Summing up the philosophy of the ancient practice of midwifery, Tebo said, “The woman delivers herself. She births herself. We’re just helping.”

But while Tebo’s patients support her approach wholeheartedly, many in the medical establishment oppose the concept of birthing centers that are not attached to a hospital.

“I think that midwives play an important role in providing prenatal care,” said Dr. David Kasting, chief of pediatrics at Ventura County Medical Center “But I feel they should be under the supervision of an obstetrician and attached to a medical facility where they can access support and help when they run into complications.”

No state or federal agencies inspect or license birthing centers, although nurse midwives must complete advanced training in obstetrics and gynecology through master’s or certificate programs. Such programs are offered by the University of California’s San Francisco and Irvine campuses, among other schools.

Dr. Alan E. Shumacher, a retired neonatologist and a member of the California Medical Board, said he believes such facilities are potentially dangerous for both mothers and their babies. Complications during birth cannot always be predicted, he said.

“When something becomes high-risk, you don’t often have the luxury of time to start planning and making arrangements for transportation to a hospital that’s able to care for their problems,” he said.

At Tebo’s clinic, patients who have a problem are referred to Dr. Alex Abbassi, a Woodland Hills-based obstetrician. If there is a problem during delivery Abbassi meets Tebo and the patient at a hospital.

Concerns such as Shumacher’s are nothing new to those involved with midwifery.

In an era of managed care and increasing competition for patients, some midwives say tension between them and obstetricians has increased.

Others say the two groups simply have a different philosophy about pregnancy and childbirth.

“In the birthing center, we view birth as normal until proven otherwise,” said Kimberly Pool, a spokeswoman for the American College of Midwives which represents 5,000 certified midwives. “Whereas, the American Medical Assn. looks at birth as a catastrophe waiting to happen.”

At Tebo’s clinic--an airy suite of rooms decorated with pastels and hundreds of pictures of newborns--patients range in age from 14 to 46.

Some are professionals who have waited until their 30s and 40s to have children. Among Tebo’s patients have been two medical doctors, a professor at UCLA and a yoga teacher in Malibu.

But others are younger, less educated and less affluent. They are interested in finding care that costs less than a private doctor and a hospital. Tebo accepts Medi-Cal and is covered by some private insurance plans.

According to the National Assn. for Childbearing Centers, a delivery at a birthing center in 1993 cost an average of $3,300. By contrast, a hospital delivery, including a 24-hour stay, costs about $4,800. A two-day stay raises the cost to about $6,000.

Despite her presence in Simi Valley for four years, Tebo still draws most of her patients from Thousand Oaks and the San Fernando Valley. Some drive even longer distances. “People who want these services are willing to go a long way,” she said.

Aurora Alvarez, 34, had already delivered two of her children at home and one at a birthing center before coming to Tebo during her fourth pregnancy.

Alvarez, who lives in San Bernardino, had planned to move to Camarillo by the time she gave birth. But when those plans fell through, she and her husband drove the 2 1/2 hours round trip to Simi Valley for checkups and stayed in a nearby motel two days before her son was born in February.

Alvarez, who takes only homeopathic remedies, said she likes the freedom a midwife affords.

“You couldn’t pay me to go high-tech,” she said. “They take all your rights away. With a midwife, I’ve got every option open to me. It’s my body, it’s my baby, and a midwife respects that.”

For her fourth delivery, Alvarez decided to give birth underwater, in the Jacuzzi-like tub at Tebo’s clinic.

“I had already done everything I could think of to make the birth as easy as possible for the baby, and having it underwater seemed like taking it one step further,” she said.

After her labor began, Alvarez said her water broke as she was having a contraction on her bed at the clinic. She barely had time to get into the tub before her son was born.

“I never pushed,” she said. “This little guy just kind of swam out. My husband said he was doing the backstroke.”

Tebo encourages many of her patients to sit in the temperature-controlled tub during labor because it relieves some of the pressure during the contractions. Often, women who had not planned to give birth in the tub decide to stay in the water because it is more comfortable.

According to Tebo, about 3% of her patients are transferred to the hospital because of complications during labor or delivery. Tebo said she uses a fetal monitor, though not continuously, to check on the baby’s heart rate. If a problem arises, the hospital is only a few miles away.

But the real risk reduction, Tebo said, comes during prenatal visits.

Through regular exams and lab tests on blood and urine, Tebo said she can screen out women susceptible to risks, who should be cared for by physicians.

But for women in good health, Tebo said pregnancy should not be treated as a sickness. Before accepting a new patient, Tebo first schedules a consultation and encourages them to ask questions.

“I never try to convince them,” she said. “I tell them, ‘If you are more comfortable in a hospital, go to a hospital.’ ”

Certified nurse midwives must first become registered nurses and then complete one to two years of additional training in obstetrics and gynecology.

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They must then pass an exam to become licensed by the state of California.

“We’re not dealing with second-rate health-care providers,” said Pool of the American College of Nurse Midwives. “These are people who are highly educated and experienced professionals.”

Tebo was trained as a nurse and midwife in Israel. She worked from 1970 to 1984 at a hospital run by midwives and from 1984 to 1986 at Hadassah Hospital in Jerusalem.

After traveling through the United States for a year, Tebo settled in Simi Valley, in part, because the climate was similar to the Mediterranean. And when she discovered there were no other midwives in the area, she took the midwifery exam in 1991 and opened the clinic.

“This is what I’ve been doing all my life,” she said.