Brooke Bina, Portland, Ore., column -- Best for birthing: ‘Continuum’ of care

Talk about it

By Brooke Bina

PORTLAND, Ore. — What a delight to be visiting my hometown, pick up the Herald and see an entire section devoted to the dedicated and incredible people involved with getting babies born in this area (“The most powerful experience: An inside look at midwifery, home births in N.D., Minnesota,” Page B1, Aug. 27).

Clearly, it’s not just labor and birth that are “the most powerful experience.” Just as important is how powerful it is for women and families to be able to make the choices that are best for them and have care providers available who respect their choices.

I myself deliver those little sweethearts as a certified nurse midwife in Portland, Ore. Through my practice both as a medical anthropologist and as a nurse practitioner, one who has worked in circumstances ranging from home births to births in a tertiary care perinatal center, the one absolute I’ve found is that there are no absolutes — no easy answers — when it comes to childbirth.

Birth is just as delightfully mysterious and dynamic as the women and babies who do it, and there’s no hard and fast answer to how, when, with whom and where birth should take place.

Every person and every pregnancy is different. And just as diversity makes for stronger ecosystems, healthier births happen within a system that provides safe care in the many complex environments where people actually live their lives.

Pregnancy is indeed not an illness, and for low-risk women, planned home births attended by competent providers (whether they be doctors, nurse practitioners or midwives) are as safe as birth in-hospital.

Sometimes, complications arise; but overwhelmingly, “complications” in pregnancy are not emergencies. They require monitoring and teamwork, and it is a crucial part of my practice to be able to collaborate with obstetricians and perinatologists as part of a team that ensures safe care and a compassionate experience.

And it is having solid relationships within this team of professionals that allows for smooth coordination of care when rare emergencies do occur.

Out-of-hospital midwives feel comfortable transferring their clients to our hospital practice because of this policy of open communication. As “homebirth transport liaison,” I work with staff and consumers to make sure everyone’s concerns are heard and client’s needs are met.

Most often, the reason we transport from home to hospital is not because of medical emergencies, but because mom is exhausted and needs a nap or perhaps some medication to hasten the birth.

I admit I have it pretty ideal; I work in a collaborative practice in which home-to-hospital transports that remain low-risk during labor still are cared for by midwives — specialists in low-risk births.

Only if true medical or obstetric complications arise or if assisted birth or surgery becomes necessary do we transfer care to our obstetrician partners who specialize in high-risk birth.

Communication and respect are crucial to why this practice runs so smoothly. In places where this openness is unavailable to midwives and families, communities become disempowered, and so do mothers and babies.

So here’s to the opening of this dialogue in the valley. Here’s to learning from each other; to healthy births, wherever they may occur; and to acknowledging that it doesn’t have to be home birth “versus” hospital birth, but that it can be home birth “and” hospital birth along a continuum of healthy care.

I’m lucky to have been born and raised in North Dakota and to know first-hand the hard-working independent spirit and strong-family attitude that leads to amazing results there.

I’m grateful to the many midwives, doctors, nurses, doulas and others who work tirelessly to bring good care to birthing families. I thank them, and no doubt North Dakota babies do, too.

A 2001 graduate of Red River High School in Grand Forks, Bina is a certified nurse midwife in Portland.

Tags: op-ed columns, health care, opinion, health, childbirth, midwives, birthing, updates