NWA Birth Center a Labor of Love

Shannon Bedore had her first child by cesarean section, her second in a natural birth at a hospital, and her third one at home.

Though grateful her children are healthy, the Bentonville mom, who works on the health and wellness team at Wal-Mart Stores Inc., felt something was lacking in each of the birth experiences.

 “So I felt like, wouldn’t it be great if women had options,” she said, “where they could deliver babies the way that they wanted to, and the way that they were in control of this very natural wellness process, and do it in a way that had physician backup and had integration within the current medical system.”

Bedore and business partner Cara Osborne, an assistant professor at the Eleanor Mann School of Nursing at the University of Arkansas and a Certified Nurse Midwife, shared this vision for an alternative birthing option in the region.

“There was a time that Cara and I were sitting around saying someone needs to do something about this and something should happen, and we kept telling people that they should do it, and no one was doing it,” Bedore said.

Finally, she said, they realized it was going to be up to them to make it happen. That’s how they conceived the idea for the Birth Center of Northwest Arkansas, which they envision as not only a mom-friendly place to give birth, but also a business model that can be replicated nationwide to lower health care costs while improving outcomes.

The center is scheduled to open in Rogers in the first quarter of 2013. It will occupy a 3,500-SF suite at 5302 Village Parkway, Suite 3, in the Village on the Creeks retail and office complex. When remodeling is complete, the center will have three homey birth rooms, each with its own bathroom, as well as exam rooms, a full kitchen and office space.

Prenatal, delivery and postpartum care will be provided by three CNMs, who also will offer women’s annual wellness exams. Plus, family-medicine doctors at nearby Mercy Medical Center will be available for consult or backup if needed.

Education will be a big feature of the birth center, Osborne said, with classes like Lamaze, prenatal yoga and parenting, along with breastfeeding support.

Although there are about 300 such centers in the U.S., this will be the only one of its kind in Arkansas, said Osborne, who earned a master’s degree and doctorate in maternal and child health at Harvard.

 The birth center is an option for healthy women with low-risk pregnancies, she said. That’s about 85 percent of all pregnancies, according to the Centers for Disease Control and Prevention.

The center’s also a community effort, Osborne said, with private donations supplementing the personal funds she and Bedore are putting into the project. They don’t have final figures yet for startup costs, but the permits for the suite’s remodel are valued at nearly $500,000, according to Rogers building inspection reports. Similar suites listed at villageonthecreeks.com lease for $17 per SF.

Osborne’s friend Genet (pronounced GEN it) Jones of Bella Vista said she’s thrilled the region will have a birth center.

Jones, the owner of Ganesha Editorial Services, is training to be a Lamaze childbirth instructor. She’s also a co-leader of the BirthNetwork of Northwest Arkansas, a chapter of the Michigan-based national nonprofit focused on helping women make informed choices about maternity care.

“I hear so many women say they wish there was an option between hospital birth and home birth,” said Jones, who had both her sons at home. “For a lot of women, home birth is a really powerful, great option, but there are women who aren’t ready for that.

“But if they’re low risk and healthy, there’s no reason for them to have a bunch of interventions. And a birth center is really a good way for them to be close to the technology if they need it without having it pushed on them for no reason.”

 

Expecting Change

Amid a political landscape of national- and state-level policy changes in the works, Osborne said, “there’s this sort of soup of things happening around new health care models in general.”

Borrowing an analogy from New Yorker magazine’s Aug. 13 article on health care by Atul Gawande, Osborne says she and Bedore want their year-old Birth Centers of America LLC to be “like the Cheesecake Factory of birth centers.”

“Whatever town you land in, if you’re traveling for business, you can know that when you go to the Cheesecake Factory, you’re going to have this wide range of options, and it’s going to be good, and you’re going to have a nice dinner, and you’re not going to pay a ton for it,” Osborne said.

They envision growing a chain of birth centers across the country, with each modified to suit the needs and demographics of its region. Between skyrocketing medical costs and a high C-section rate nationally, demand for lower-cost, higher-quality maternity care is coming from consumers, businesses and government entities.

CDC statistics show that about 33 percent of babies born in the U.S. are delivered by C-section. The World Health Organization recommends a rate of 10 percent to 16 percent, Osborne said.

In Arkansas, the C-section rate was 35.1 percent in 2010, according to CDC records, tying with Texas for the ninth-highest rate in the nation.

By comparison, in the U.K., where nurse midwifery is the standard of care, the C-section rate is around 10 percent, Osborne said.

Overall, health outcomes in outpatient maternity centers surpass traditional models of care, Osborne and Bedore say. These centers also have much lower overhead than a hospital, they pointed out.

Birth Centers of America LLC is the parent company of the Rogers birth center and its affiliated women’s wellness services, which have nonprofit status. The practice will be governed by an eight-person board of directors that already has been selected.

A for-profit side to the business was necessary to handle activities like classes and the sale of birth-related items such as breast pumps and maternity clothes, Osborne said.

“As a business model, it’s self-sustaining, not something that needs ongoing donations,” she said. They expect insurer payments to cover the center’s operating expenses.

Although birth center fee reimbursement is mandated by federal law, Bedore and Osborne have been working with both Medicaid and Arkansas Blue Cross Blue Shield for about nine months to get a reimbursement number. Sixty percent of Northwest Arkansas births are paid for by Medicaid, with the remaining 40 percent covered mostly by ABCBS.

“Both ABCBS and Medicaid have publicly and together asked for higher-quality outcomes with lower-cost alternatives for the perinatal episode,” meaning prenatal care and labor and delivery, Bedore said. “The birth center fits what the governor and ABCBS have been asking for, yet our team has not been able to get a reimbursement number.”

Steve Spaulding, vice president of enterprise networks at ABCBS in Little Rock, said he couldn’t comment on the center’s application for a reimbursement number other than to say it’s still in the review process.

State Medicaid director Andy Allison has been in budget hearings at the Capitol and unavailable for comment, a spokesman for his office said.

Under Arkansas’ Health Care Payment Improvement Initiative, begun last year, Osborne said Medicaid, ABCBS and Arkansas QualChoice “have all come together to say, ‘We’re addressing costs and health care in the state of Arkansas, and here are the various ways we’re doing it.’

“And one of the ways is to incentivize innovative care models. So this is totally in line with their conceptual drivers in terms of where they’d like to see health care in the state go.”

 

Home Suite Home

Osborne and Bedore want women and families who walk into their birth center to feel more like they’re walking into a friend’s home than into a clinic.

The front door opens into a room that will be set up and furnished like an open floorplan living room, with a fully equip-ped kitchen so families can prepare the foods they like during their stay.

The birth rooms will look like typical bedrooms, with TVs, nightstands and regular beds instead of hospital beds. The bathrooms will have both a tub and a walk-in shower.

Each birth room has windows that look out over the adjacent lake, and the partners said the lake with its landscaping, walking trail and soon-to-be-built fishing pier was one of the reasons they chose that location.

But perhaps what most differentiates the birth center from a hospital environment is what’s not there — no hospital gowns, no stirrups, and no IVs or fetal monitors to keep women in bed during labor. And though pain relief will be available, Bedore said, there’ll be no epidurals, which can slow the labor process.

Also unlike in a hospital setting, women will not only be allowed to eat and drink during labor, but will be encouraged to do so to keep up their strength, Osborne said.

The setup is meant to reflect a view of childbirth as a life-stage event rather than an illness. And they want moms to feel empowered throughout the labor and delivery process.

“We’ll provide all the tools,” Osborne said. “You pick which ones you want, and which ones you feel like are applicable to you and your family and your baby.”

In fact, Bedore said they call the mom the quarterback, and everyone there is the team that supports her.

“You’re calling the shots,” Bedore said. “You’re in charge. It’s your baby, it’s your birth. If you have a birth plan, we want you to follow your birth plan and we’re here to support you to make sure you have the experience that you want in this space.”