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Birthing Center Plan Focuses on Options

  • Maeghan Finnigan, of Lebanon, N.H., discusses her pregnancy with midwife Katherine Bramhall, center, and Bramhall's summer intern Lauren Godfrey during an office visit in Lebanon, N.H., on June 27, 2018. Finnigan plans to deliver her baby at home. (Valley News - Jennifer Hauck) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

  • Midwife Katherine Bramhall listens to Maeghan Finnigan's baby's heartbeat during an office visit in Lebanon, N.H. on June 27, 2018. Finnigan plans to deliver her baby at home with Bramhall attending her. Lauren Godfrey, Bramhall's summer intern records the heart beat for Finnigan. (Valley News - Jennifer Hauck) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

Valley News Staff Writer
Published: 12/23/2018 11:51:11 PM
Modified: 12/25/2018 11:38:37 PM

Lebanon — Katherine Bramhall, a midwife based in Barre, Vt., opened an office in Lebanon after patients lamenting the impending closing of Alice Peck Day Memorial Hospital’s birthing center sought her assistance in delivering their babies at home.

Now, Bramhall is seeking to open a free-standing birthing center to offer patients an alternative to either a home birth or a delivery at Dartmouth-Hitchcock Medical Center. Since APD’s birthing center closed in July, DHMC is the only hospital in the heart of the Upper Valley offering obstetrics.

Gifford Medical Center in Randolph and Springfield (Vt.) Hospital, both federally qualified health centers, are the only other Upper Valley hospitals that offer labor and delivery services.

After several of her Upper Valley patients who had come to her this summer for help with their home births required transfers to DHMC, Bramhall said she realized that home birth and a birth at a large academic medical are really at the far ends of the spectrum of what women might want when they give birth.

“I’m no more of a choice than Dartmouth is if what you’re looking for is where you feel safest to birth your babies,” she said in a phone interview earlier this month.

A birthing center would offer something in-between — a location outside the home where women with low-risk pregnancies could receive prenatal care and deliver their babies — effectively filling the void left when APD closed its doors, she said. It would also offer the midwives a place to sleep while they are awaiting a birth, said Bramhall, who had just slept on the floor of her Bank Street office two of the previous three nights.

The news of Bramhall’s plans was greeted with enthusiasm by one of her former patients, Maeghan Finnigan, of Lebanon.

“I think it’s wonderful,” Finnigan said. Just having two choices — a home birth or hospital birth — “they’re just such extremes,” she said.

After APD’s birthing center closed, Finnigan delivered her third child at home with Bramhall’s assistance. Lettie, now 4½-months-old, was healthy, but Finnigan, who lost a lot of blood when the placenta failed to detach, had to be transferred to DHMC for an overnight stay.

Though Finnigan had no complaints about the care she received at DHMC and was especially grateful to the nurses for making her stay as pleasant as it could be, it was not the same as being in a small birthing center like APD’s, where Finnigan delivered her first two children.

“I do appreciate the intimacy of APD — I did,” Finnigan said. “That was what I was looking for again, but it wasn’t there.”

Dr. Timothy Fisher, a DHMC obstetrician-gynecologist who is studying the reasons for and impacts of recent closings of hospital birthing units in New Hampshire, said he understands why people might be enthusiastic about the idea of a birthing center in the Upper Valley.

“I think it’s really timely,” he said.

Though he and others at DHMC have worked hard to make the birthing pavilion a comfortable place for women and families, he acknowledged that the closing of APD’s birthing unit “represents a significant loss to women of the Upper Valley.”

With the aim of opening a stand-alone birthing center within 10 or 15 minutes of DHMC next August, Bramhall, a certified professional midwife, has teamed up with nurse-midwife Meghan Sperry, who currently operates Art of Birth Midwifery in Randolph.

“I think we are going to complement each other really well,” Sperry said in a phone interview.

In addition to assisting with births, Sperry, who has a master’s of science in nursing, can also provide a wide-range of women’s health services including birth control, annual exams, sexually transmitted disease treatment and referrals. An advance practice registered nurse, Sperry can write prescriptions, while Bramhall cannot.

But Sperry said she is looking forward to learning from Bramhall’s approximately 30 years of experience as a home-birth midwife. Sperry is newer to home birth, having done most of her training and work in hospitals, she said.

In addition to providing care and attending births at the proposed new Lebanon facility, the two midwives also plan to continue providing prenatal care at their offices in Randolph and Barre.

Though Sperry said they’d like to open the new birthing center by August, she understands that may be an “aggressive” timeline.

“It would be fantastic if we could pull it off,” Sperry said.

Between the two of them, they aim to host 50 births in their first year, she said. After that, they’ll need to increase their staffing. Their ambitions also include hosting educational programs and focusing on supporting women who have experienced abuse and trauma to get regular gynecologic care, Sperry said.

To accomplish their goals, their to-do lists are long. Top priorities include raising $200,000 and searching for an appropriate building. The facility would also need to be licensed by the New Hampshire Department of Health and Human Services and the midwives will be accountable to the state’s Midwifery Council, which certifies midwives and investigates complaints.

“If this birthing center is going to happen, it will have to be supported by the community financially and with help and support in every single way,” Bramhall said.

Bramhall previously worked to establish a birthing center in Haiti, which she said involved some of the same elements of pulling people together to accomplish a shared goal that she thinks this effort will take.

She’s aiming to be in the building by April 1 and then to set it up to suit the purpose of a birthing center. She and Sperry have a lot of the supplies they’ll need, including beds, linens, artwork and rugs.

“I can’t imagine this not working out,” Bramhall said.

The Lebanon center, if it comes to be, will not be the first in the state. There are existing birthing centers in New Hampshire — in Concord, Milford, Salem and Swanzey.

There are no stand-alone birthing centers in Vermont, Ben Truman, a spokesman for the Vermont Department of Health, said in an email.

The Concord Birth Center, which first opened in 2006, now employs three midwives, including the owner Kate Hartwell. The two-bed, 1,500-square-foot facility offers prenatal, labor, delivery and postpartum care to low-risk mothers, Hartwell said in a phone interview. Women are usually discharged between two and 12 hours following delivery, after which point the midwives make home visits to check on the women and their babies.

With 120 deliveries per year, Hartwell said they are at capacity.

Demand has increased since Lakes Region General Hospital in Laconia stopped providing labor and delivery services earlier this year, Hartwell said.

The Concord center accepts most insurance coverage, including Medicaid, Hartwell said. If patients were to pay with cash, the cost of a birth would be between $4,000 and $5,000, she said.

In comparison, a vaginal delivery — including a facility charge, professional charge and normal newborn care — costs about $22,500 at DHMC, according to D-H’s website. A caesarean section is an additional $11,000, approximately.

APD and Lakes Region are just two of nine New Hampshire hospitals that have closed their maternity wards since 2000.

Hartwell said that birthing centers, as a lower cost alternative to hospitals, may be able to help fill in the gap these closings have left behind.

Birthing centers are able to offer their services at a lower cost because they do not have all of the equipment that hospitals do. For example, they do not have electronic heart monitors. Instead, midwives use hand-held dopplers to detect fetal heart rates. The midwives also have anti-hemorrhagic medications, resuscitation supplies and suture gear.

But if a woman needs an epidural for pain management or has lost too much blood, the midwives work to ensure her safe transfer to Concord Hospital, which is about 10 minutes away, Hartwell said.

“Safety stuff is really important,” Hartwell said.

While a birthing center in the Upper Valley might offer a lower cost alternative to a hospital delivery that works for some women, Fisher said there will likely be some patients who require transfers to DHMC due to complications.

On average, he estimated about 12 to 15 percent of women who aim to deliver at birthing centers require transfers to hospitals. For women delivering their first child, Fisher said the rate of transfer is closer to 20 percent.

To ease such transitions, Fisher — who serves as medical director for the Northern New England Perinatal Quality Improvement Network, a collaboration of health care providers in the field — said it will be important for DHMC providers to continue to work with community members to ensure the safety of and good outcomes for women and babies.

If and when the new birthing center opens, Fisher said he is “looking forward to the opportunity to engage with their leadership (to) make sure we’re working closely together.”

Valley News Staff Writer Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.




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