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Saturday, July 12, 2014 |  Madison, WI: 71.0° F  Mostly Cloudy
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ISTHMUS PARENTS

Special delivery
A survey of Madison-area birth options


Credit:Jennifer Downey
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Whether you're a new mother-to-be or a veteran, it pays to be aware of the options for delivering your baby in the Madison area.

While many of you may say, 'I have (blank) insurance, so I must go to (blank),' it's a naive and often stifling line of thinking that isn't always true. As a customer, you want options ' and let's be honest, a pregnant woman is a customer. If you're looking for prenatal care for the first time, are unhappy with your current provider, or it's been a long time since you last gave birth, educate yourself about the local birthing options. We live in a city that is more than usually baby-friendly, and we're lucky to have so many choices.

Meriter Hospital St. Mary's Hospital

These two are not grouped together because they are the same, but because both offer what you'd expect from large facilities: birthing suites, newborn (or neonatal) intensive care units (NICU), lactation specialists, birthing classes and more.

One significant difference is your stay in a birthing suite. The beauty of a birthing suite is that a laboring woman isn't made to feel she is having some kind of major surgery in a cold, sterile hospital room. Suites are much like hotel rooms ' that have IVs, fetal monitors and nurses standing by ' and are comfortable, homelike surroundings in which to give birth. CD players, televisions and even whirlpool tubs help to make the labor process as enjoyable (and I know 'enjoyable labor' is a bit of an oxymoron) as possible.

At Meriter, your stay in a birthing suite begins with labor, continues through delivery and extends to recovery and postpartum care. At St. Mary's, however, a mother receives postpartum care in a separate room after her delivery and recovery in a suite.

Carla Griffin, director of birth suites at St. Mary's, suggests scheduling a tour of the hospital OB unit: 'It's a great way to the see the facility, ask questions, and meet some of the staff.' Good advice with regard to any care facility.

Other minor differences between the hospitals might come down to personal preference (some mothers I spoke with raved about the great chocolate shakes at St. Mary's), but realistically, they differ most in the prenatal care clinic options that feed into either hospital.

UW Health and DeanCare

For some women, a larger health-care affiliate with multiple locations and many physicians to choose from is a logical choice. If your insurance is from a local HMO like Group Health Cooperative, Unity, Physicians Plus or Dean, the most prevalent choices in the area for prenatal care are UW Health Physicians and DeanCare.

UW Health physicians deliver babies at Meriter. UW Health does offer midwife options, and you may find you get more personalized attention and time spent with you during a routine prenatal visit if you go that route.

'An obstetrician sees about 40 patients a day, whereas [the midwives] see about 12 a day,' says Julia Vance, a midwife with UW Health. Many women view the option of having a midwife as comforting, and having access to a physician if the need arises is like a safety net.

Since St. Mary's and DeanCare are intrinsically united, those who receive prenatal care through Dean Health Systems deliver at St. Mary's Hospital; St. Mary's Family Birth Center provides prenatal care. The Dean Clinics do not, at this time, offer midwifery as an option.

Melius, Schurr and Cardwell Associated Physicians

For some pregnant women, having a connection with their prenatal care provider (and the person who delivers their baby) is very important ' it is, after all, most likely going to be the individual who first holds the newborn. If personalized service is most important to you, investigate the smaller practices in the Madison area.

Melius, Schurr & Cardwell in Fitchburg is a practice of just four doctors. Dr. Michael Cardwell, OB/GYN and co-owner of the clinic, underlines that 'Our patients get to know us individually, and we get to know them.' Mothers-to-be have the option of scheduling visits with all four obstetricians in order to get to know each, as one of them is guaranteed to deliver the baby.

Associated Physicians is another smaller group in private practice. Founded in 1946, the multi-specialty clinic has a staff of five obstetricians, all of whom are female.

'We believe that making and delivering babies is a natural function,' says Dr. Jenny Hackforth-Jones, an OB with Associated. 'We offer personalized care, much like you would receive with a midwife, but we can do all the 'technical stuff' too.'

While Melius, Schurr & Cardwell maintains a no-residents-in-the-delivery room policy, Associated Physicians believes that resident doctors are necessary to act as a liaison until a doctor can arrive at a delivery. 'We see residents as an asset,' says Hackforth-Jones.

The two clinics are the only private medical practices in the area that provide pre- and postnatal care, and both make their deliveries at Meriter.

Madison Birth Center

There are only about 200 independently owned birth centers in the U.S., and the Madison Birth Center (MBC) is the first of its kind in Wisconsin. Owner Aszani Kunkler is a Certified Nurse-Midwife: 'We specialize in natural methods. We trust in the process and trust in the women,' says Kunkler. 'Birth shouldn't be this rushed, nervous thing. Birth should be a calm transition.'

The center, located in Middleton Hills, offers birthing at the facility as well as home-birth procedures, all attended by one of the three midwives on staff. There are no doctors.

Since the center is not located near a hospital, what about emergencies? Kunkler says that this is a rare occurrence. 'If your pregnancy has been normal, then there is low risk for an emergency, but we are indeed equipped for it. We are nurse-midwives and can handle any common complication. Out of 84 births this year, only two have been transferred to a hospital.'

MBC is not currently under contract with any local HMO, but several insurance providers will cover the center's services. 'About 30% of our clients pay out-of-pocket for their care,' says Kunkler, 'and it generally costs 50% less than a normal hospital birth.'

Community Nurse Midwives Doulas of South Central Wisconsin

Home birthing is nothing new. A hundred years ago, almost all deliveries were done in the home. Community Nurse Midwives operates out of the home of Ingrid Andersson, CNM, who, along with her associates, delivers babies in her clients' homes.

Andersson attends 40-50 births per year and has to close her practice most months due to high demand. 'Home birthers are not risk takers; they tend to be careful, conscientious people who do their research,' says Andersson. 'I think many women find the ide0a of birthing in their own home instinctually 'right.' Most women who come to me want to avoid the alienating, one-size-fits-all approach of the mainstream healthcare system.'

Several local insurance providers cover Andersson's services. She also offers an all-inclusive fee of $2,400 out-of-pocket for those who are uninsured. 'This is about one-quarter of the cost of conventional care,' says Andersson.

Doulas, sometimes called 'birth assistants,' help a mother through the birthing process but do not deliver the baby. The doula acts as a liaison between the mother and the hospital or doctor. There are even postpartum doulas, to help new moms navigate the first days of motherhood. Doulas are unlikely to be covered by insurance plans.

'Women should feel welcomed and comfortable with their prenatal care,' says midwife Julia Vance. 'Investigate your insurance options. Interviewing people is a viable thing to do. If you are not happy with your provider, look elsewhere. And tell your provider you're unhappy. He or she should know.'

Check with your insurance provider to see which practices are covered under your plan, and go from there. Or work backward: Find a facility that meets your needs, and its staff will help you understand which portions of the services are covered by your insurance, and how the remainder is paid.

While actually giving birth can be painful (pain with a purpose, as they say), your prenatal care and overall delivery experience shouldn't be. Don't settle for something you're not comfortable with.

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