Although New Dawn Midwifery closes at the end of March, safe and supported birthing options abound in the Asheville area, including hospitals with obstetricians, hospitals with midwives and the WNC Birth Center, which is set to open this spring on South French Broad Avenue. Professionals across the region continue to advocate for education and support as the keys to making choices during childbirth.
Jan Verhaeghe, founder and president of New Dawn’s board of directors, is retiring after 19 years because of a death in the family. “We are making referrals for providers, and we are offering care up to [Thursday,] March 31,” she says. “We have enjoyed every minute of our practice.”
Staffed by certified nurse midwives, New Dawn was the only legal practice for attending home births in Western North Carolina.
Judy Major, volunteer founder and current board president of the nonprofit WNC Birth Center, had been a doula for 13 years, with the dream of opening such a facility in the region. “We hope as New Dawn clients look for a new maternity provider, they will consider continuing their care with us and having their babies at our midwives’ ‘home,’ the WNC Birth Center,” Major says.
Prenatal care will be available starting in April, but midwives won’t begin “catching babies” until July, Major says. Construction is underway for three large rooms — each with a standard bed and private bath with large tub and shower — will be available. The center is currently looking to hire a certified midwife to work at the birthing center.
“We have never had a birth center of this magnitude in our region,” Major says. “The vision is for a free-standing, certified, nursing midwife staff facility where couples can have their babies in a homelike setting right near the hospital.”
The center will be available to anyone regardless of income. Services are covered by insurance, including Medicaid, although only women with low-risk pregnancies will be accepted.
The biggest difference between the WNC Birth Center and a hospital is that the service is very mother-directed, Major says. The mother is calling shots on the birth, and her wishes will be honored unless safety issues arise.
Because the center will offer prenatal and group classes during pregnancy, as well as meetings with midwives, the environment will be familiar to birthing women, she continues. No pain medication will be used in the WNC Birth Center, for example. If a woman decides she needs it, she’ll be transferred to Mission Hospital.
“I have worked as a doula for 13 years,” Major says, “And I worked with close to 130 couples. Time and again they say, ‘How come there is not a birth center? I don’t feel quite safe at home, but I want that experience.'”
It’s important to provide options and make a safe space available to women who for one reason or another want to use a birth center, she says. “Birth is normal, and we shouldn’t be acting like it is something wrong unless, in fact, something is not right.”
A true emergency in a birth center is extremely rare, Major says. Chapel Hill’s birthing center had 500 births last year, with only one maternal transport and one infant transport, and both outcomes were fine, she notes.
EDUCATION EQUALS EMPOWERMENT
Beginning Friday, April 1, an all-inclusive center for education and support services, Homegrown Babies Health and Education Center, will move into New Dawn’s Charlotte Street space. Chama Woydak, owner of HomeGrown Babies, says she’s sad to see New Dawn Midwifery go, but she continues to see Asheville as a gem in the birthing scene.
“Because I have perspective outside of the Asheville area with birth choices and options, I can say we live in a very special place for giving birth,” Woydak says. “The camaraderie, communication, respect and integrity between birth professionals across the board is stellar. There are not a lot of boxing gloves up between professionals, but instead there is collaboration. There are diverse opinions, but it is always with the families’ best interests in mind. We agree to disagree, and that is pretty special here.”
Homegrown Babies’ center will offer counseling, cranio-sacral work, massage, acupuncture and doula services, all focused on patients’ childbearing years. Woydak has been attending births as a certified birth doula since 1999 and teaching childbirth classes since 2002.
A professional doula, Woydak explains, doesn’t need a college degree, but the practice does take a commitment to a certain number of classroom hours (which she offers), attendance at a set number of births, continuing education requirements and recertification every three years. A certified birth doula must also get completed evaluation forms from nurses, doctors, midwives and families, Woydak explains.
“Certified doulas must research 40 different community resources for childbearing years,” she says, “in order to differentiate how and when to refer out services and who to refer to.”
“The role of a doula is to provide continuous physical and emotional support and assistance for women and their partners through birth and/or the postpartum period,” says Roxy Robbins, a doula employed by HomeGrown Babies and a member of Doula Association of the Mountain Area.
Certified doulas are trained in pain-relieving measures, position changes, massage and movement to work with mothers during labor. “A postpartum doula can provide a safe space,” says Robbins, “to process emotions [and provide] newborn care information, self-care and guidance for mamas and partners to help set up a healthful, nourishing environment for you and your family.”
Whether getting an epidural or not, a lot of women benefit from hands-on comfort measures, Woydak explains. “We educate, support and empower,” she says. “It is really important that we stay evidence-based, that we give clients and families information; we are trained to know the difference between the gold standard study and bias study; and we allow clients to interpret the info however they want.”
Good education improves outcomes, says Cheryl Orengo, one of the founders and an instructor at Start from Seed, an Asheville nonprofit that provides childbirth education and is free to Medicaid patients. “Years ago [North Carolina] had terrible infant mortality rate,” she says, “but with education and programs like [the Mountain Area Health Education Center], Start from Seed, and the Nurse Family Partnership, it has improved.”
Education and knowledge about childbirth options empower women, says Orengo, who has been a doula for 26 years and a trainer for 16. She advocates for the Nurse Family Partnership Program, a federal initiative in which nurses visit low-income, first-time mothers at their homes for the first two years after the arrival of their children — a measure that has proven to improve birth outcomes, she says.
Trish Hickling Beckman, co-owner of The Women’s Wellness and Education Center in Asheville, agrees that education and support are key to mothers having the birth experiences they desire. The center offers health and sexuality education, massage and counseling. Such services help women make better choices, she says, which in turn makes birth a positive and empowering experience.
“Birth can be most amazing experience of your life or the most disturbing,” says Beckman, a nurse midwife since 1995. She has delivered about 2,000 babies at homes, hospitals and birthing centers. She currently delivers babies at Catawba Valley Medical Center in Hickory, although she worked at New Dawn Midwifery for several years beginning in 2001.
One of the greatest things available in North Carolina, Beckman adds, is chiropractic adjustments for pregnant women, which is covered by some insurance, including Medicaid.
April Macary, co-owner of Awakening Heart, offers chiropractic adjustments to make room in the pelvis for delivery. If the sacrum is out of balance, birth will put tension in the uterus, Macary says. The adjustment helps the uterus relax and creates the best position for birth, she explains.
Another resource for WNC women is massage during pregnancy and the postpartum period. Kristina Berkeley, massage therapist at The Women’s Wellness and Education Center and owner of Sattva Massage & Botanicals, says she hears from her clients that receiving regular massage during their pregnancies helps them to get in touch with their bodies in ways they never have. In a study reported by the National Institute of Health, massage therapy was “demonstrated to be effective during pregnancy. Women who received massage therapy reported decreased depression, anxiety, and leg and back pain. Cortisol levels decreased, and in turn excessive fetal activity decreased. The rate of prematurity was lower in the massage group.”
At times women make choices out of fear, Beckman says, so they end up having interventions they don’t need, which leaves them feeling unempowered. It is a natural biological function to have babies, she says, but risky cases occasionally require intervention.
“It is very important that we walk in the strength and knowledge that our bodies are made to do this. We have great science for when [birth] becomes complicated, but in the absence of that, you can do great things with great support,” she says. In her 20 years of practice, she estimates that 10-20 percent of women require some kind of medical intervention, but 80 percent can have births safely without intervention and do not routinely need epidurals and pitocin. Many of those interventions are common and bring more risk when the woman doesn’t need it, Beckman says.
Amanda Murphy, certified nurse midwife at MAHEC and director of the Centering Program, works with women who live in low-income and toxic, stress environments. The Centering Group is composed of 8-10 women who are all due around same time; they come together to learn their health and vital signs and talk about their pregnancies.
The center’s model is evidence-based, Murphy says, and the women who benefit the most are the ones who come from most toxic environments. “There is a decrease in pre-term delivery rate and decrease in low-weight babies, and the data supports breastfeeding and decreased smoking,” Murphy says. “The model is structured so that everything is intentional, so women can walk away feeling empowered.”
MAHEC serves as the safety net for local midwives and doulas, as it provides the accepting team for anyone who needs more than a home birth. And it allows women of all income levels to see midwives and doctors at its facilities for all their health needs, including pregnancy care.
Pregnancy and childbirth providers in WNC are unanimous about the ingredients for a safe, positive birth experience: education, support and empowerment. The Asheville area offers plenty of all three.
WNC Birth Center
The Women’s Wellness and Education Center
Start from Seed
National Institute of Health: scientific article