East of the River
December, 15, 2017
Call the Midwife: Expectant mothers facing closed doors at maternity wards have other options
By Candace Y.A. Montague
The recent closures of maternity wards at United Medical Center and Providence Hospitals have left expectant mothers in a bind. The dearth of healthcare outlets in the East End is an S.O.S. of sorts. It is frightening not to have a birthing plan in place. It is even more unnerving to know that if something happens during the pregnancy you may have to rely on someone who isn’t familiar with your medical history for help.
But from the glass-half-full perspective, times like these can be a great opportunity to get educated on other choices for pre- and postnatal care. Enter the Certified Nurse Midwife. The title itself means “with woman.” More women are discovering that having a CNM with them throughout their pregnancy can mean access to more personable and personalized care.
Ebony Marcelle, director of midwifery at Community of Hope’s Family Health and Birth Center, checks on an expectant mom. Photo: Community of Hope
The Importance of Good Prenatal Care
In some cases, prenatal care is literally a matter of life and death. Recent reports indicate that maternal mortality rates in the United States have increased by 26 percent over the last 10 years. According to an estimate by the Centers for Disease Control and Prevention, black women are three to four times more likely to die from pregnancy complications than white women. The infant mortality rate (IMR) in the District has been elevated far above the national rate since 2004. In 2014 there were 72 infant deaths in DC, making the IMR 7.6 per 1,000 live births.
How can death be introduced so promptly at the beginning of life? It starts with basic prenatal care. One of the leading causes of death among infants before the age of one is low birth weight. According to the March of Dimes, the medical factors that could possibly cause low birth weight include pre-term labor and chronic health conditions such as high blood pressure and diabetes and infections. Having a medical professional, such as a CNM, monitor the mother’s health throughout her pregnancy with frequent checkups can reduce the chances of low birth weight.
Midwives Answer the Call
The African-American community has strong ties to midwives. In precolonial Africa, midwives were exclusively used to deliver babies. But they also were the healers and advisers to families. They supported mothers with issues like breastfeeding and nutrition and tended to their postpartum needs. The tradition continued through slavery as midwives helped deliver slaves’ and white women’s babies. Over the years, black midwives have become less present, but the need for midwifery services has not declined.
Certified Nurse Midwives can handle a variety of health care needs for women within their own community.
Many Ward 7 and 8 residents, including expectant mothers, have to travel 10 miles or more for screenings, checkups and medical procedures. However, the East End has a few hidden gems that can meet the needs of pregnant women.
Ebony Marcelle is the director of midwifery at Community of Hope’s Family Health and Birth Center, located off of Benning Road in Northeast. She says that midwives are often underused despite being right in the neighborhood. “We see a lot of people who want to have a birth-center birth, but because it’s not heavily utilized by their community they get scared. But the folks that we’ve had are very happy. We are the only freestanding birth center in DC. We have an amazing amount of wonderful midwives. We can take care of you at either location.” Community of Hope is also located on Atlantic Street in Southwest.
The birth center is a different setting for labor and delivery, and that is on purpose. Not only is the setting different but so is the approach. It’s mother-focused. Marcelle explains the difference between the hospital and birth center. “It’s very different when you go to the hospital. At a hospital, you get admitted. You have to stay in bed. Here we keep you upright and moving. So that’s a form of pain relief in itself.” She continues: “We also have our Jacuzzi tubs. You can turn on the jets. I’ve had moms who have had epidurals with previous pregnancies who have had far superior pain relief with the jets in the tub. Our rooms don’t look like a hospital. Our birth rooms look like bedrooms. We don’t have restrictions on who can come. It’s really nice to be surrounded by the friends and family that you want around you.”
What if something goes wrong? What if the pain is just too much? Marcelle says not to fear, CNMs are prepared for it. “If something goes wrong, it’s okay. We are monitoring you constantly. We monitor you while you’re pregnant, during delivery, and we monitor you while you’re here. If you leave the realm of normal, we transfer you. We don’t wait. Since we are an accredited birth center, we have to be within a five-mile radius of a hospital. We have attending midwives at Washington Hospital Center,” she explains. “If we feel like that baby needs more attention we will transfer them. Our transfer rate is about three percent. Most of the time we transfer because mom is just tired. She wants to rest.” Marcelle estimates that many of their patients deliver within four hours.
Midwives do more than catch babies. They also perform gynecological services and well-woman visits. They have a lot of clients who started coming to them for annual exams and then continue when they become pregnant. Midwifery services are covered by most insurance plans including Medicaid and Medicare.
Where to Go for Care When You’re Expecting
Community of Hope Family Health and Birth Center, located in Northeast, is a nationally accredited birth center. The midwives can provide prenatal care throughout the entire pregnancy. FHBC accepts Medicaid and Medicare as well as private insurance.
Mamatoto Village, also located in Northeast, offers maternity services pre- and postpartum. It provides support for breastfeeding mothers in home and at the office. It has a host of doulas, birth coaches who support the mother-to-be during delivery. Mamatoto Village hosts Hypno Babies Hypnosis, a six-week training for mothers who desire to deliver their newborns without medication.
Doulas of Capitol Hill has a variety of doulas to assist mothers during and after childbirth. They offer education so mothers know what to expect when expecting. They also offer breastfeeding support. Doulas of Capitol Hill rents tools for alternative pain management such as a birth pool, birth stool and transcutaneous electrical nerve stimulation (TENS) unit, a procedure using mild electric pulses to block pain.
So the news, while severe, isn’t all bad about maternal health services in the east end of the city. For some women it may be just a matter of taking a moment to get educated on their choices. Having a healthy baby is certainly worth the effort.
This article first appeared in East of the River.