Bill would allow state to cover midwife service

May 3, 2005

DAWN De BUSK/Frontiersman reporter

The newborn wasn't breathing, but midwives didn't panic.

Instead, they calmly resuscitated the baby as the mother, Jessica Sawyer, who had just given birth at home, touched and talked to her new son. One minute later, Stewart Keene Sawyer was breathing.

"Three minutes after the birth, I had him in my arms. I was with my family in my own home. I didn't have any stitches. I didn't have the emotional trauma sometimes associated with childbirth," Sawyer said.

Two bills currently working their way through the Legislature would expand the number of Alaska women who could opt to use a midwife. Judi Davidson and Sharon Evans, certified direct-entry midwives in the Valley, support the legislation - House Bill 111 and Senate Bill 22. The bills, if passed, would allow Denali Kid Care to cover the cost incurred by pregnant women who become birthing-center clients during their gestational period.

Denali Kid Care covers some prenatal visits but not the facility fee at midwifery centers. The state-funded insurance program foots the bill for hospital births. Insurance companies cover prenatal care and births at midwife facilities, but anyone using Denali Kid Care and wanting to have a natural birth pays out of pocket for most of the expenses.

Sawyer understands the mental turmoil of having a scary childbirth experience. Three of her four babies needed to be given cardiopulmonary resuscitation after birth.

Her fourth baby, Stewart, had shoulder dystocia, which cannot be predicted prior to birth and caused him to stop breathing. Basically, once the head is out, if the newborn's shoulders are too large, the baby gets stuck in the birth canal and needs quick assistance and neonatal resuscitation.

Sawyer went through labor with her first-born at a military hospital in England. She gave birth to her second child at a civilian hospital in Arkansas.

"They had complications and each required resuscitation. They were taken away from me. They weren't crying because they weren't breathing yet. It's still traumatic to think about it," the 33-year-old mother said.

Sawyer believes her ability to talk to and touch her fourth son helped him take his first breath sooner.

"It was so much calmer for everyone involved," she said. "I couldn't imagine it being handled so well by any other caregivers."

Although freedom to chose care providers appeals to many women, Davidson and Evans cite financial concerns as the main reason they hope to see Senate Bill 22 and House Bill 111 pass. They say the state ultimately would save money, since the cost of giving birth at a hospital is higher than the cost of using a midwifery.

The entire birthing stay for a low-risk labor and delivery could be $3,300 for a two-day stay for mom and baby, according to Pat Smith, director of the family birth center at Valley Hospital. Smith said that includes lab charges.

That doesn't cover an epidural, which is considered a high-risk procedure, said Smith.

Birthing centers charge their patients $1,500 a day, but waive facility fees for a second day's stay.

According to statistics gathered from a three-year study of seven statewide birthing centers, another money-saving factor would arise from a reduced number of Caesarean sections. Only 2 percent of the women who choose a midwife-assisted birth are transferred to a hospital for a C-section.

In an effort to push the passage of the bill, birthing center owners have agreed to waive $500 of their facility fees - saving the state additional money, said Davidson, who also serves as president of the Midwives Association of Alaska.

Both bills would add birthing centers to the list of health-care facilities approved for Medicaid coverage. However, the House version of the bill waits to be heard in the House Finance Committee, while SB 22 awaits a hearing in the Senate Finance Committee.

Evans traveled to Juneau earlier this year and talked to Sen. Lyda Green, R-Mat-Su, who also sits on the Senate Finance Committee.

According to Evans, the Valley-based senator said it could not be a worse time for this bill to pass because the federal government won't match the funds the state shells out to reimburse Denali Kid Care costs.

The whole responsibility would fall upon the state, according to Green.

"I happen to be a big advocate of midwives. It's a huge leap for us to go from not funding a program to funding a program," said Green.

Evans' three-year study revealed that each year, an average of 80 expectant mothers decide against using a birthing center because their Denali Kid Care coverage provides free hospital care. If those 80 women selected a midwifery over a hospital, the total savings would be $280,000. That's based on the average cost of each facility, Evans said.

Last year, 118 pregnant women in the Valley chose birthing centers for their child-bearing experience.

The percentages for last year or 2003 aren't yet available, but in 2002, more than 24 percent of the expectant mothers were patients of midwifery facilities, according to Evans.

"This trend is increasing," Davidson said. "It's not going away."

Davidson and Evans say that if the bills pass, low-income women would receive greater freedom regarding birth-related decisions.

"Giving birth has been taken out of the hands of women. We're the only mammals that have moved away from nature," said Davidson, adding that the current situation unfairly limits the desires of pregnant women who have Denali Kid Care.

"People are wanting to have more control over their birth experience. We work with them as partners in their care," Evans said.

Gynecologist Dr. Michael Fitzgerald, who runs Aurora Women's Health Care in Palmer, says the idea of birthing centers receiving state funding troubles him.

He thinks if Denali Kid Care covered natural-birthing facilities, it would encourage more people to use midwives.

"It's a question of safety. The state shouldn't pay for a procedure that isn't 100 percent safe. People could argue that for centuries, babies were born the natural way - at home, with midwives. Mothers died during childbirth, naturally. Babies died during birth, naturally. Do we really want to go back to higher mortality rates?" Fitzgerald said.

Some birthing centers hire lay midwives, who are not trained to deal with major emergencies associated with obstetrics, Fitzgerald said. He said there is a big difference between nurse midwives and lay midwives.

Davidson said state law stipulates that midwiferies must determine that a woman is low risk before accepting her as a patient. Those are the types of pregnancies with which midwives usually deal. If certain conditions arise, causing a person's pregnancy to go from low risk to high risk, the birthing center transfers the patient to another caregiver.

Amy Sanderlin gave birth to her daughter, Elana Josie Sanderlin, on April 16 at a local midwifery. Sanderlin's husband works seasonally for Alaska Railroad. The Sanderlins time their babies' births so the newborns will come into the world while dad is working, which is April through October. That way, his insurance covers the facility fee at the birthing center, while Denali Kid Care pays for the lab visits.

With Aetna coverage, the Sanderlins end up with a co-pay of $800.

The 29-year-old mom doesn't mind the extra cost. A lifetime asthma sufferer, Sanderlin appreciates that birthing centers do less intervention. At hospitals, the reaction to her asthma was overkill, with too much intervention, she said.

However, the midwifery requested that Sanderlin find an obstetrician/gynecologist who specifically understood asthma. That care provider was a backup doctor in case Sanderlin needed to be transferred to a hospital.

Elana joins two other siblings who were also born at the birthing center.

"We had a very good experience with my first one. Nothing was a big deal, no hoopla, no people rushing in and out," Sanderlin said. "We went with the concept that simpler was better."