Judy Major is a woman on a mission. Her vision is to create a nonprofit community birth center in Asheville, close to a hospital but freestanding — a place where certified nurse midwives can offer care to all women who want an out-of-hospital birth experience.
In a region where alternative health practices of all kinds are flourishing, it’s somewhat surprising that Western North Carolina doesn’t have an alternative center for natural birthing. After working for 12 years as a doula in the Asheville area and recognizing this need in our community, Major, now retired, has thrown herself heart-first toward her goal. And she’s not alone.
“We need a birth center,” says Major. “Pregnant women in our community need it, they want it, and it’s an important alternative that bridges the divide between home birth and hospital birth.” The birth center vision is this: It will be close to Mission Hospital, equipped with three to four birthing suites — each furnished with a bed, a water-birthing tub, a private bathroom and a rocking chair. Also, the birth center will be a certified nonprofit that accepts both private insurance as well as Medicaid. Major hopes that by expanding eligibility to cover patients on Medicaid, the center will meet the needs of all people, regardless of their insurance policy.
WNC has had a birth center before: Lisa Goldstein, a nurse midwife who is now retired, ran The Fern Kingham Memorial Women’s Health Center & Birth Apartment in Burnsville from 1997 through 2012. The center, says Goldstein, “was a small little house; half of it was my office, and half of it was a birthing apartment.”
The Fern Center was also close to Blue Ridge Regional Hospital in Spruce Pine. The center was “mostly for people who lived too far away for me to do a home birth for them, because, to do a home birth, one of the [safety] criteria … is to have a relationship with the nearest hospital, so that if you have to transport, it’s going to be a smooth transport, and the patient will get the best care.”
Dr. Carol Coulson, a high-risk obstetrician and maternal-fetal-medicine specialist (meaning that she works with only very complicated pregnancies and births) at MAHEC, supports Major’s goal of creating a new center in Asheville: “I have spent my entire career in residency training programs … and I don’t understand why, of all communities, Asheville doesn’t have a birthing center.”
For Coulson, a birthing center near a hospital offers women medical alternatives with a safety net. “I believe strongly in patient autonomy, [in an individual’s] ability to make a decision about where to birth. But I’m also very interested, in a bit of a maternalistic way, in keeping people safe, because I don’t think [people] always understand the nuances involved [with birthing, or all] that can go wrong — probably won’t, but can — and they have to be able to live with that decision. So a birth center gives us a great option for safety, as opposed to our Asheville underground.”
In WNC, women have two options for prenatal care and delivery: They can go through a hospital; or they can elect for a home birth with delivery care attended to by a midwife. Here’s the tricky part: Not all midwives have the same level of medical training, says Major. Certified nurse midwives are the only midwives licensed to practice in North Carolina, and they must be backed by a physician — verified by a signed notification called a collaborative agreement.
These agreements, notes Major, are very hard to get. “The options for home births are limited, as New Dawn is the only certified nurse-midwifery practice in our area. If not [New Dawn],” continues Major, “then [mothers-to-be] can go out into the community and they look for what we call ‘lay’ midwives or ‘community’ midwives who have different degrees of training. Some of them are certified professional midwives, and some of them have no training at all and call themselves midwives because they’ve attended birth and they have a passion for the birth experience.”
Experience and proper medical training are absolutely necessary in order to properly monitor the birth process, says Aimee Feste, a certified nurse midwife at MAHEC and a Hendersonville native. She worked at a freestanding birth center in Maryland before moving to Asheville to start a family of her own.
Feste says she wants to see a local birth center in Asheville because she believes in the midwifery model. “Continuity of care is a crucial point here, where you’re seeing your midwife, or a small group of nurse midwives, who have time to … talk about anticipatory guidance, education, childbirth classes,” says Feste. “That is another need in this community.”
To create a birth center in Asheville, Major and the steering committee need both community support and monetary contributions. This need inspired Major’s Midwife Physician Challenge and startup fundraiser. “I was trying to think of how we could come up with some seed money to get us going, and because I knew so many of the physicians and midwives personally, I thought, ‘You know what? I’m going to go to them [directly].’ I [had] 31 one-on-one interactions and said, ‘Will you make a pledge, a generous pledge?’ And I actually gave them an amount that I wanted. ‘We will pool all those pledges together, and I will ask you to make good on that pledge if we can match it in the community.'”