Midwives are pioneers not only in Afghanistan

The ground breaking pioneers of the birthing landscape in South Carolina are the midwives of CCMC.

The Carolina Community Maternity Center (CCMC) in Fort Mill, SC, was shut down in September days after a baby was still born. It was reopened before Christmas 2013. While the reopening is getting no media coverage, its closure got plenty of speculative and sensationalist coverage. Death is painful and no one ever wants it to happen. Especially not a midwife; her profession is about bringing life into the world.

I delivered my third child at CCMC. I am thankful for all three healthy births and children, but a birth center birth was a breath of fresh air compared to my two hospital deliveries with the typical tension due to fear of pain and lawsuits, computer data input, IVs and needles, and numerous unneeded “medical” interventions that seem to be just waiting to be put in effect.

I do not shun medical doctors. During my pregnancy, I operated with a trio of midwife, neonatologist and pediatric specialist, to monitor a minor condition the fetus had.  However, labor and delivery was exclusively at CCMC and I could not imagine it any other way anymore. There, the midwives encourage mothers to embrace the natural potential of their bodies. Risk management is hidden behind soothing cabinets and curtains so mothers can remain focused on the vitality of their bodies and the baby.

At birth centers, births are considered and treated as natural and not medical events, where the body does most of the work with some moral and physical guidance from the midwife, who is a trained and certified professional. Sometimes intervention is necessary, as in my case, where a simple shift of positions made the process more comfortable and quicker. Mothers who deliver here are also not stupid. We know there are risks, we can get tired, and we know limitations, but we also know where the next hospital is, that in the event we need one, we can peacefully get to, since most of the time, the “problem” will not be a Hollywood-style blood-gushing emergency, but will be a move made from a well thought out decision tree of options.

Between two prenatal visits, my midwife took time to give me the status on CCMC and its ongoing battle towards being a mainstream option for women and families.

A few days after the stillbirth - in what was an obvious knee jerk reaction to the still birth - CCMC was given an emergency suspension order by South Carolina Department of Health and Environmental Control (SCDHEC) to which the CCMC regularly reports and with which CCMC has always had a compliant and normal business relationship. Nevertheless, at an emergency meeting after the stillbirth, SCDHEC decided to accuse CCMC of not having a doctor on call 24/7 and presented them with a list of false and vague infringements.

While SCDHEC does have a regulation in which birth centers must have a doctor on call 24/7, this has not been enforced for over fifteen years; no doctor can make such a commitment while keeping up with their practice, as well as due to “non-moonlighting clauses” with the hospitals they work for. So, instead of a mandate of having a doctor on call 24/7, all six birth centers in South Carolina provide SCDHEC with copies of the agreements with doctors who shall “consult by phone” in case of emergencies. This has been the mutually agreed upon MO for fifteen years.

CCMC smelled foul with this suspension order. The midwives set to prove how they had acted within compliance with SCDHEC and always with good intentions. Their acute goal was to open again, so they could be available as soon as possible for families. Long term their goal was to change the SC laws to make them more realistic, current and safe. And along the way, connections were put between the dots as to which doctors and doctor networks absurdly somehow feared the threat of the existence of birth centers (instead of welcoming them as an integral part of the fertility landscape) and used their connections to SCDHEC to enforce a suspension order.

While dealing with the negative pressures of “threatened” doctors, CCMC, decided instead to reverse the situation and create something productive for all birth centers; they worked closely with the American Association of Birth Centers (AABC) to claim the official, legal and logical stake of birth centers in SC by fighting to update SC’s 1993 statutes which were outdated and dangerous.  After a lot of networking with elected officials and numerous stakeholders in the “birthing landscape”, CCMC finally made SC DHEC come to their senses and got them to accept CCMC’s suggestion to update SC’s 1993 statutes to the current, modern, professional, safe and reasonable standards of the AABC, which already form the legal framework for other States such as Minnesota. These statutes not only make SCDHEC’s oversight role of birth centers easier and more streamlined, but the standards are safer. The bill is in line for the next SC legislative session to pass it.

So, in what was originally a battle to try and stay alive, the midwives turned out to be true Americans – pioneering new laws. Not only are they changing policies, these midwives are honest business owners, did not let themselves be intimidated by power players (connected and “threatened” doctors), and will continue to prove how birth centers should be an integral part of women’s healthcare services. Insurance companies and neighboring States should take a good look at the economics of birth centers – for one: a birth center birth is a tenth of the cost of a hospital birth.

The irony in all this, is that while the CCMC was suspended and not allowed to operate their birth center, the midwives were able to legally pursue their profession by delivering the babies of their clients in homes opened by friends and hotels scattered around South Carolina.