Julia was in the thick of active labor when she arrived in triage at Mt. Sinai West hospital on Manhattan’s Upper West Side last May — and right away, she wanted out. The room was cramped. Julia, who asked to use only her first name for privacy reasons, was hooked up to a monitor that allowed nurses to check the baby’s heart rate, but also meant she couldn’t move. She felt claustrophobic.
As Julia dealt with contractions, her midwife was locked in her own battle, quietly negotiating with hospital staff to ensure her patient could move to the Birthing Center — a three-room unit that has, since 1996, been a destination for New York City women seeking low-intervention vaginal births. Julia chose Mt. Sinai West specifically for the Birthing Center and met the criteria women must to deliver there: her pregnancy was low-risk and she’d gone into labor naturally, right around her due date.
The only question was whether the hospital, which is permanently closing the Birthing Center on Dec. 31, would staff it with a few nurses for Julia. Frustrated midwives, moms and doulas who spoke to HuffPost say that even before Mt. Sinai West announced the upcoming closure with little warning last summer, the Birthing Center had been limping along, often inaccessible to women who have registered to deliver there.
Julia got in, and describes an immediate shift in her experience. The room was large. It had a bed big enough for her husband to sit in with her, and a Jacuzzi tub that helped enormously with her labor pain. There were homey touches like floral curtains, and the medical equipment was mostly hidden out of sight. Most of all, the room felt calm. Aside from the comings and goings of two nurses, Julia’s husband, her doula and her midwife, things were quiet and still.
“It didn’t feel like I was in a hospital anymore. It felt like I was in some weird, pleasant, Laura Ashley hotel.”
“It felt surreal in a really positive way. It didn’t feel like I was in a hospital anymore. It felt like I was in some weird, pleasant, Laura Ashley hotel,” Julia, 33, told HuffPost of her May delivery.
“I was completely naked the whole time,” she added with a chuckle. “And for me to be completely naked means I’m in a very comfortable environment.”
Birthing tubs, big beds and nudity might sound trivial in the broader scheme of bringing a new person safely into the world. But to women like Julia, they’re hallmarks of a rare hybrid birth environment offering women who want a more “natural” birth experience — by which people typically mean vaginal, with minimal interventions and no epidural — a shot at it, all within a modern, full-service hospital. They represent choice.
Many women prepare for their due dates with a birth plan, which may include anything from a playlist of music they’d like to hear to what medications and procedures they do or do not want performed, if the circumstances allow. Of course, often those plans have to be changed on the fly to address the safety of both mom and baby. But at birth centers — where the guiding ethos is to prioritize low-intervention vaginal birth and to honor, whenever possible, a woman’s wishes — women can take comfort in knowing they are, at a minimum, setting themselves up for a good shot at having the kind of birth they seek as opposed to delivering on a labor and delivery floor where their chance of medical intervention can be determined as much by hospital procedures or which doctor happens to be on-call that night as by the specific circumstances of their labor. Fans of the in-hospital birth center model say it is what makes the three-room unit at Mt. Sinai West so special — and what makes its closure so disheartening, not just to residents of New York City but to women and experts across the nation advocating for obstetric choice.
“In a hospital, interventions meant to improve safety can sometimes interfere with normal physiology,” Jessica Illuzzi, an OB-GYN and section chief of Yale School of Medicine’s Obstetric and Midwifery section who is on the board of the American Association of Birth Centers, told HuffPost. But it’s possible for hospitals to implement treatment protocols that maintain safety standards while still giving women the space and support to follow their bodies’ cues and hew to their physiologic, or natural, birth plans.
“Women shouldn’t have to seek home birth to have an experience like this,” she continued. “They should be able to give birth in a hospital feeling supported no matter when they go into labor and what team happens to be on [call].”
The Best Of Both Worlds
When the Birthing Center at Mt. Sinai West (previously St. Luke’s Roosevelt hospital) opened in 1996 — the first of its kind in a New York City hospital — it promised women a different experience from that on traditional labor and delivery floors. It offered the best of both worlds: a low-intervention approach with immediate backup when necessary.
“A lot of women don’t want to have a home birth, but this sort of has a home birth feel to it,” said Risa Klein, a certified nurse midwife with admitting privileges at Mt. Sinai West.
At the Birthing Center, births are largely overseen by midwives and many standard hospital policies for laboring women — limits on what they can eat, drink, and wear, as well as continuous fetal monitoring or routinely giving women IV fluids — do not apply. Klein said her patients are able to work through contractions on an inflatable birthing ball, for example, or use a squatting bar to support them as they try out different positions to try and minimize pain or bear down to push the baby out. Women are encouraged to eat what they want, to bring in electric candles and turn down the lights if they’d like and to labor in the tub if that helps ease the pain of contractions.
“Women are making a choice, and I too made a choice to come to St. Luke’s Roosevelt to attend birth in the birthing center,” said Klein, who moved her practice from New Jersey to New York a decade ago.
One reason some women seek out birthing centers — which make it a priority to reduce medical and surgical interventions during childbirth — is to avoid having a C-section if possible.
Nationally, more than 30 percent of all deliveries are via Cesarean section, and while it can be necessary and save lives, public health experts — and moms — have worried for decades about its overuse. Surgical deliveries, while generally safe, do carry health risks and can be considerably more expensive. Researchers quibble over what an appropriate goal C-section rate looks like, but generally agree that when it exceeds 10 to 20 percent of births, any benefits to moms and babies plateau. Studies also show that there is astounding variation in C-section rates across U.S. hospitals — from 7 percent in some to 70 percent in others. As a recent Consumer Reports investigation put it, the single biggest determinant in whether a woman has a C-section in this country is the hospital where she gives birth.
But C-sections are sometimes necessary, and when emergencies arise, a laboring woman must be transferred to a hospital for care.
“What’s really special about what’s now called Mt. Sinai West is that right, one floor above this birthing center, you have state-of-the-art operating rooms,” said Klein. “Because things can happen in birth. You’ve got a really safe haven at this hospital.”
“Some women feel the rate of Cesarean is so high that they choose out of hospital birth,” said Illuzzi. “As an obstetrician, I would prefer that we improve birth in the hospital and attract them to the hospital by offering them a birth center model of care in the hospital. I am very concerned that Mt. Sinai would be choosing to limit this option for women.”
The American Association of Birth Centers (AABC) says there are currently 355 birth centers nationwide, up from 124 in the mid-1980s. Those numbers include only freestanding centers that meet the group’s standards for what can and cannot be offered to laboring moms. “We only help low-risk women. There’s no anesthesia offered at a birth center. We don’t do forceps or vacuums. Surgery isn’t offered. We don’t induce or augment labor with pitocin. Continued electronic fetal monitoring isn’t used. We don’t [deliver] breech [babies] or twins,” explained Amy Johnson-Grass, AABC president.
There has been some research showing freestanding birth centers have good outcomes for moms and babies, including a recent report from the Center for Medicare and Medicaid Innovation that suggests freestanding birth centers have the potential to lower C-section rates among low-income women and decrease the number of babies born premature. A 2013 study of outcomes among women who delivered at 79 AABC member birth centers — co-authored by Illuzzi — was similarly positive, finding that the C-section rate was roughly 6 percent (those women went to a hospital for the surgery) and 1 percent required the use of forceps or a vacuum. (Those are generally used only in later labor when it has stalled or when the baby’s health is in danger, and pose some risk to moms and babies.) Those findings are limited by the fact that they were based on voluntary data provided by the birth centers.
But other research suggests there are real risks associated with out-of-hospital births, most notably a 2015 study that found fetal death was higher in planned home births and freestanding birth center births than in hospitals. Illuzzi pushed back on that research, saying it unfairly lumped together all out-of-hospital births ― including those done at home with a lay midwife, and those performed by a nurse-midwife at a birth center with a transfer agreement with a hospital. Her point of contention underscores why an in-hospital birth center is, in many ways, an ideal compromise for laboring women. If an emergency arises, they are only seconds away from an operating room or from a NICU.
Though there is no research that specifically compares in-hospital birth center outcomes with those on traditional labor and delivery floors, both Illuzzi and Johnson-Grass agree that the model offers women the potential for a low-intervention birth in a relatively homelike environment along with the benefits of a hospital delivery.
There is not data on how many in-hospital birth centers there are nationwide, largely because there isn’t a precise definition of what that means. Experts say many labor units call themselves “birth centers,” but do not meet the criteria set forth by groups like the AABC and the Commission for the Accreditation of Birth Centers — even those that have adopted certain practices aimed at minimizing obstetrical intervention.
The Birthing Center at Mt. Sinai West is among what experts estimate are only a handful of true in-hospital birth centers in the country.
One Less Choice
Mt. Sinai West has said it is closing the Birthing Center in order to add 13 new NICU beds as well as 15 new postpartum beds — expansions it called “critically necessary” in an email to HuffPost. It said the hospital will continue to support women who want a low-intervention birth and those who hope to deliver with a midwife.
“The newly configured Labor and Delivery area and NICU expansion will allow us to improve patient safety, comfort, and delivery of critical care to all mothers and infants, especially ill or premature newborn infants,” the statement reads. “While the three rooms that currently comprise the Birthing Center will no longer exist after December 2018, we will continue to support every woman’s birthing choice and will accommodate any delivery option they choose.” Hospital representatives did not offer specifics on how it would support these choices.
Those fighting to keep the Birthing Center open allege that closing it amounts to little more than a money-making scheme for the hospital, pointing out that private rooms at Mt. Sinai West currently cost $900 a night. (Mt. Sinai declined to comment on whether the 15 new postpartum beds would be in private rooms.) A Change.org petition started by a group calling itself Save The Birthing Center has more than 15,000 signatures. The group contends the hospital has artificially deflated the number of women who deliver at the Birthing Center by only staffing it at certain times.
“If you remove options for women who want to try for a safe, unmedicated birth, I think that is disempowering.”
As the clock runs out on the Birthing Center, pregnant women who had hoped to deliver there are searching for other providers who will support their effort to pursue a low-intervention birth, particularly as there are now only two birth centers left in New York City — only one of which is in a hospital: There are two birthing suites at New York-Presbyterian/Lower Manhattan Hospital, and the freestanding Brooklyn Birthing Center in Midwood. Women like Robyn, 35, who was 16 weeks pregnant with her second child when she spoke with HuffPost.
Robyn, who also asked that only her first name be used, labored at the Birthing Center at Mt. Sinai West with her first baby, and though she was ultimately transferred to the labor and delivery unit as her labor dragged on — seeking an epidural and some relief from the pain — she remembers the 10 hours she spent there fondly. Looking back, she feels confident she gave herself the best possible shot at having the kind of birth experience she dreamt of by at least starting out in the Birthing Center, where she felt certain the policies and providers were supportive of her vision.
“Even though I ended up going into [the labor and delivery unit] and getting an epidural, I feel like childbirth was the biggest accomplishment of my life. It’s just incredible,” said Robyn. “And if you remove options for women who want to try for a safe, unmedicated birth, I think that is disempowering.”
Robyn does not know where she will deliver now, and she said she is feeling a lot of stress about transferring to a provider who will support her as she tries for a low-intervention second birth.
“The Birthing Center has flaws ... but it existed,” echoed Julia, who said her labor and delivery experience at the Birthing Center left her feeling strong and proud. “I don’t have words to convey how angry and frustrated and sad it makes me that things are moving in this direction.”