Birth Choices in Ithaca — A Shifting Landscape

By Lauren Korfine and Jeanette McCulloch

Pregnancy is a time of possibility and learning, of growth and questions, and the contemplation of new life. It is also a time when most of us interact with care providers more frequently than any other time in our lives until that point.

For many women, the first time they think about the kind of care they hope to have during pregnancy and childbirth is when they become pregnant themselves. The learning curve is steep as women discover the many decisions to make, some of them right at the outset.

Navigating the various decisions can feel overwhelming. Or, having a lack of choices (which, for various socioeconomic and cultural reasons, is the case for many women) can bring its own set of pressures to the birth.

When a full range of birth options is available in a community, women should have the option to select:

• The type of care provider they want to work with (midwife, obstetrician, family physician);

• Where they will give birth (home, hospital, freestanding birth center);

• Who will be with them during the birth (spouse/partner, family members, doula, friend);

• Whether to take prenatal classes (childbirth education, yoga, exercise, parenting, breastfeeding, etc.); and

• Whether to complement their maternity care with other types of care (massage, acupuncture, chiropractic, etc.).

The maternity care system in our country right now presents many challenges to women seeking optimal care for themselves and their babies. Nationally, one in three babies are born by Cesarean section, more than twice what the World Health Organization has determined is safe. There are tremendous racial disparities in outcomes, such that (among other things) African-American women and their babies die at a much higher rate than Caucasian women and babies. Routine use of obstetrical interventions is at an all-time high, resulting in high-cost maternity care, but not better outcomes for US babies — our country still ranks 27th in infant mortality (where a low ranking means fewer babies are dying). Ithaca is not immune to these trends.

A community that offers optimal maternity care for women and babies is one that has a wide range of options available. These options would include:

• Obstetricians with skills in medical management of birth for the women who need or choose it;

• Midwives who attend women planning home births;

• A freestanding birth center staffed by midwives or low-intervention doctors;

• Obstetricians and family physicians who practice low-intervention obstetrics in the hospital; and

• Independent midwives attending birth in the hospital

When these options are fully represented in a community, women can match their needs and preferences for maternity care with providers who offer this type of care. When providers and consumers are well-matched, everyone gets better care.

There is significant community support for a wide range of birth options in Ithaca. When a statewide effort to change the law to allow midwives to practice without a written agreement from a physician was underway, hundreds of Ithacans came out in support of expanded birth options here — they signed letters and called state representatives to support the legislation; some even went to Albany to speak directly with senators and assemblypersons. This effort helped improve access to midwifery care for women all over New York. Locally, it allowed the midwives who serve a growing population of women choosing home birth to continue providing those services. A survey of 300 women in Ithaca found that the vast majority of women support a freestanding birth center in our community, even if they would not choose to give birth there themselves.

The history of birth choices in Ithaca and our region shows a shifting landscape with options for women changing with some frequency. In the last 20 years, we have seen the opening and closing of a freestanding birth center in nearby Montour Falls, the coming and going of low-intervention physicians and midwives, and the closing of an entire maternity care unit at Schuyler Hospital. Our local hospital, Cayuga Medical Center, which at times has had up to four obstetrical practices with varying styles attending births there, currently has only two. In general, the landscape looks less full than it once did, with more limited maternity care choices available to women here in town. Some women are finding what they want and need here, and others are looking to practices outside of town to meet their maternity care needs.

One bright light for expectant and new mothers is the wide variety of complementary care practitioners in Ithaca — people who provide services to pregnant, birthing, and postpartum women in a variety of modalities. We have doulas, childbirth educators, breastfeeding support people, massage therapists, chiropractors, acupuncturists, counselors, and more — all people who either specialize in working with women in the childbearing year or who have experience and interest in doing so.

How can we expand birth options in Ithaca? BirthNet of the Finger Lakes is a consumer group that supports the birth choices of all mothers in our community through education, advocacy and support. One way that BirthNet helps to expand and sustain birth choices locally is to bring together and organize families to ensure the consumer voice is represented when key decisions are made that impact women in the childbearing year. If you are interested in helping with that work, please see the BirthNet of the Finger Lakes website (www.birthnetfl.org) and come to one of our meetings.

Want to learn about what is available now? One of BirthNet's current projects is an update of our comprehensive birthing resource guide into a web-based, searchable guide for all birth- and breastfeeding-related services in the area. The goal is for newly pregnant mothers to be able to go to one place and learn about maternity care options and complementary services available to them in the region. If you are a provider of maternity care or complementary services to pregnant, birthing, or postpartum women, and you would like to be included in the guide, please go to our website (www.birthnetfl.org) and follow the links to our online survey. If you are pregnant or are hoping to be pregnant in the future, the guide will be online this fall at www.ithacabirthguide.org, but support and information are always available by contacting us through the BirthNet website.

Lauren Korfine, PhD, supports women as a doula and a consumer advocate. She is a founding member of BirthNet of the Finger Lakes, and a board member at Citizens for Midwifery. Lauren received her degrees from fancy universities, but her education from her three children. She lives and loves with her family in Ithaca.

Jeanette McCulloch, IBCLC, supports mothers and babies locally as a lactation consultant (www.jeanettemcculloch.com) and as a member of BirthNet of the Finger Lakes. She also advocates for mothers nationally as a board member of Citizens for Midwifery, when she's not out splashing in the gorges with her partner and two children.