Henderson, Owensboro, Madisonville, Evansville, Newburgh
Do you know all of the options women have when it comes to prenatal care and childbirth in the tristate area? I bet you know some of them but not all of them. Women have to decide what kind of practitioner they want to see for prenatal care and what kind of setting they want to be in when they birth their baby.
In our area, the type of healthcare provider you choose to take care of you during your pregnancy and birth will likely dictate your birth setting. Likewise, if you are certain of the type of birth setting you desire you will have to select a care provider that works within that setting.
So what are the options?
I will provide a brief overview of the options available to women in the tri-state but keep reading because I will provide more details on each subject further down.
Your choices in birth settings include
Home birth
Birth Center birth (this will require travel)
Hospital Birth
Your choices for Health Care Providers include
Certified Nurse-Midwives (CNM)
Licensed Certified Professional Midwives (LCPM)
Physicians
So how do you know which healthcare provider practices in which birth setting?
Take a look at the table I created to easily showcase this information. But keep in mind that although certain types of providers can practice in various locations that doesn't mean that all local facilities allow or offer care from each type of provider in their specific facility.
| Certified Nurse-Midwife | Certified Professional Midwife | Physician |
Home Birth | X | X | x |
Birth Center^ | X | X | x |
Hospital | X* | | X |
^Nearest Birth Centers are located in Jeffersonville, IN, Indianapolis, IN, and Nashville, TN
* Certified Nurse Midwives have privileges in 2 local hospitals
x Physicians can practice within birth centers or attend home births but no local physicians provide care in these locations
Let’s start off with talking about
Home Birth
First, who are the local Home Birth Midwives?
Ashley Durham APRN, CNM
Covers an area within 1 hr radius of Henderson
Henderson Birth and Wellness, PLLC
125 1st Street STE 101 Henderson, KY 42420
adurham@hendersonbirthandwellness.org
Debra Lowrance CNM, WHNP, IBCLC
Lives in Illinois and comes to Evansville and Newburgh
309 N. Jefferson Street, Robinson, Illinois
laboroflovemidwifery@outlook.com
Jennifer West LCPM
Lives in Bowling green and covers about a 1 hr radius of Bowling Green
BGbirth@gmail.com
Jennifer Phillips CPM Bloomington, IN
Michelle Sanders CPM Bedford, IN
Many people probably don’t even realize that home birth is an option or they may not have an accurate understanding of what prenatal care for home birth patients entails or what the actual home birth process and event looks like. I will speak about my home birth practice specifically. Not every home birth midwife operates exactly like I do but likely similarly enough to be comparable.
I am a Certified Nurse Midwife licensed in Kentucky and Indiana. My practice is Henderson Birth and Wellness, PLLC. I take home birth clients within an hour radius of Henderson, KY who are generally healthy and who are having low-risk pregnancies. I provide all of the same care such as blood work, screenings, and ultrasounds that you would receive in a typical OB/GYNs office with the added benefits of much longer visit times, more personalized care, direct communication with me, flexible visit times, and so much more. Clients are continuously evaluated throughout their pregnancy, labor, and birth to make sure they continue to be good home birth candidates, if risk factors or complications develop that no longer make them good home birth candidates they will be transferred to a higher level.
The visit schedule throughout pregnancy is essentially the same as when going to an OB/GYN but visits are longer and more personalized. Visits are scheduled at 8, 12, 16, 20, 24, 28. 30, 32, 34, 36, 37, 38, 39, 40, 41, 42 weeks.
Clients will have blood work in the first trimester or at their first appointment, an anatomy scan somewhere between 18-21 weeks, gestational diabetes screen around 28 weeks, and GBS screen around 36 weeks.
Your midwife and the birth assistants will come to your home when you are in active labor and stay until a few hours after you birth your baby.
You and your baby will be monitored throughout labor to ensure you are both healthy and tolerating labor without issue.
Your midwife will help you birth your baby and placenta and will evaluate you and your baby to ensure you are both stable after birth.
Your midwife will do a thorough newborn exam before leaving.
The birth team will clean up and tuck you in to rest and bond with your baby while being in the comfort of your own home.
Your midwife will return between 24-48 hours to evaluate you and your baby and to complete state-required newborn screening for metabolic disorders and congenital heart defects.
During the postpartum period you will be in close contact with your midwife. You will be seen at least once in the first week postpartum, at least once in the second week postpartum, and again around six weeks postpartum.
As a nurse-midwife, I can continue caring for you throughout your lifespan for primary care and GYN needs. I can also care for your baby until they reach 28 days old.
The majority of the time everything goes smoothly and without complications but occasionally there is cause for intervention. Your home birth midwife is trained and prepared to manage many emergency scenarios including, but not limited to, postpartum hemorrhage, shoulder dystocia, and newborn resuscitation.
In a perfect scenario, I would have hospital privileges at one or more local facilities and would continue providing care to the patient upon transfer but this has not been put in place YET. A really great example of how this can be accomplished successfully is Clarksville Midwifery. Clarksville Midwifery located in Clarksville, TN is a home birth practice owned and operated by Christy Peterson APRN, CNM and Jenny Fardink LCPM. Jenny and Christy worked very closely with Amber Price during her time as the Chief Operating Officer at TriStar Centennial Women and Children’s Hospital to develop and implement safe transfer processes for home birth clients. In the process, Christy was able to obtain hospital privileges at TriStar Centennial which allows her to continue being the primary healthcare provider managing the client’s care after transfer to the hospital setting.
Hospital Birth
Hospital birth is the most widely known option. There are many physicians practicing within the local hospital systems. There are 3 midwives with hospital privileges in Owensboro and one in Evansville. The local hospitals with labor and delivery units include
1 midwife with hospital privileges
28 OB/GYNs
21 OB/GYNs
3 OB/GYNs
3 midwives with hospital privileges
Lisa Wimsatt APRN, CNM, FNP and Susan Johnson APRN, CNM employed by Dr. Ottman at Women’s Health Care Partners and Katie Melvin APRN, CNM employed by Owensboro Health
17 OB/GYNs, most are only hospitalists
3 OB/GYNs
Birth Centers
I wanted to talk about birth centers even though we do not have a birth center close enough to be feasible for most people in the tristate area.
A birth center is a healthcare facility for childbirth where care is provided in the midwifery and wellness model. The birth center is freestanding and not a hospital. Birth centers are an integrated part of the healthcare system and are guided by principles of prevention, sensitivity, safety, appropriate medical intervention and cost-effectiveness. While the practice of midwifery and the support of physiologic birth and newborn transition may occur in other settings, this is the exclusive model of care in a birth center.
The birth center respects and facilitates a woman’s right to make informed choices about her health care and her baby’s health care based on her values and beliefs. The woman’s family, as she defines it, is welcome to participate in the pregnancy, birth, and the postpartum period.
If you would like to view the Standards for Birth Centers a pdf version is available here.
There are no birth centers throughout the entire state of Kentucky due to Certificate-of-Need laws currently in place. There are 7 birth centers in Indiana but none of them are close enough to be a feasible option for most people. The two closest birth centers are located in Jeffersonville, Indiana and Indianapolis, Indiana.
What is Certificate-of-Need?
In 1974, the federal government passed the National Health Planning and Resources Development Act. This legislation withheld funds from states who did not enact certificate-of-need programs. By the early 1980s, every state except Louisiana had enacted a version of CON laws. These laws were originally put in place to control healthcare costs, increase healthcare quality, and improve access to care for low-income families.
But research shows CON laws have failed to achieve their stated goals, and have actually done the opposite of what they were intended to do. The federal government noticed these laws weren’t meeting their intended goals and repealed the CON mandate in 1986. Several states followed suit.
35 states have certificate-of-need laws.
Certificate-of-need laws harm patients by reducing healthcare quality and reducing access to care.
States with CON laws have 11 percent higher healthcare costs than states without CON laws.
The Kentucky Birth Coalition is fighting to have legislation changed surrounding birth centers and the CON requirements in Kentucky. I have no doubts they will be successful in the coming years.
The Kentucky Birth Coalition (KBC) is a consumer led grass-roots organization working to expand and improve birth options and outcomes in the Bluegrass. The KBC began as Kentucky Home Birth Coalition in 2012 when several parents and midwives got together to address the issue of licensing for Certified Professional Midwives. The initiative expanded over the next several years with the addition of a professional lobbyist and many consumer advocates. In 2019, our first major success was achieved with the passage of SB84 to license CPMs in Kentucky. Shortly after we changed our name to Kentucky Birth Coalition to reflect our focus on the expansion of all birth options, not just home birth. Since the passage of SB84, we have worked on the creation of the CPM Advisory Council under the Kentucky Board of Nursing, Medicaid coverage of LCPM services, and birth center access. Kentucky Home Birth Coalition was certainly not the first organization to advocate for birthing families in Kentucky. Over the past four decades, several iterations of consumer groups have fought for access to midwives. KHBC and KBC are simply the latest iteration of this, and we honor those who came before us in this work.
If you would like to support The Kentucky Birth Coalition and their fight to increase birth options for the women of Kentucky please visit their website to make a donation as well as liking their facebook page to keep up with their progress.
Why isn't there a birth center in Evansville?
Its not as simple as just deciding Evansville needs a birth center and then opening one up. Someone has to have the funds to build and operate a birth center, that person has to have a clear understanding of the laws relating to birth center operation, they have to have enough qualified and competent staff who believe in the birth center model, and there has to be a large enough pool of clients who want to birth in a birth center and meet the "low risk" criteria set forth by the State of Indiana.
Indiana actually has some pretty strict laws relating to birth centers. There main piece of legislation regarding birth centers in Indiana is 36 pages in length and is very specific about who is and is not "low risk". Indiana law also requires that a physician be named the medical director of the birth center. If you would like to read it here is the link
There are various options for prenatal care and birth in the Tri-State. I hope this post provides you with information to help get you started in determining which birth setting and type of provider would fit your needs best.
Choices in birth settings include
Home birth
Birth Center birth (this will require travel)
Hospital Birth
Choices for Health Care Providers include
Certified Nurse-Midwives (CNM)
Licensed Certified Professional Midwives (LCPM)
Physicians
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