Pauline G. Stitt
A little boy listened intently to his mother and then exclaimed, “Oh! This is important! I think it calls for a tie.”
“Calls for a tie? What do you mean?”
“Opening this center is important,” the child replied, “so I think we should do everything just right. I think men and boys should wear ties. We want to show respect.”
Here in the land of casual “Aloha shirts,” the mother was surprised but her son’s face radicated earnestness. She went to the box where her husband stored old neckties, chose a favorite and slipped it around the boy’s neck. The old tie shimmered over his chest, reaching his lap.
“This is just right!” he said as he gently stroked the silk and admired himself in the mirror. “Now we need two more for the other boys.”
The mother began to protest that this was going too far, but when her son went on to name friends who would also be at the ceremony, she produced two more ties that he smoothed carefully and placed in a clean paper bag.
The occasion was to be the official dedication on July 5, 1983, of M.O.H.–Midwifery Options, Hawaii, an alternative birthing center which the boys had watched their parents work to establish and open a few months earlier.
An alternative birthing center, or ABC, is a homelike maternity care facility for healthy women expecting healthy pregnancy and childbirth. ABCs recognize that childbirth is a normal physiologic event requiring trained assistance, not interference unless clearly indicated, and they are founded on the premise that parents should have the kind of birth experience and environment they wish. The Latin root of obstetries, which means “stand by,” aptly describes an ABC’s function: to “stand by” a woman and her family from earliest pregnancy through delivery.
Professional support, however, does not disappear because birth is over. Most alternative birthing centers offer postpartum care and help through the newborn period when vital changes occur in mother and baby. Later, services remain available to help the mother maintain health supervision.
M.O.H. is owned, and operated by Midwifery Options, a nurse-midwifery service. The center is located in a cottage on the grounds of Wahiawa General Hospital, about 20 miles from Honolulu on the island of Oahu. Tiffany Coleman, a Certified Nurse-Midwife, developed the center with help from concerned members of the community, including hospital staff members, public health nurses and parents.
Families worked diligently to prepare the cottage for the opening, painting walls, fixing floors, refurbishing furniture, designing and hanging curtains and performing countless other acts of “nesting.” There was an aura of excitement as fathers, mothers and children worked together, inspired by a sense of purpose.
Families, center and hospital staff members and friends in the community attended the dedication ceremonies. Senator Daniel Inouye greeted the group and The Reverend Richard K. Kamanu gave the traditional Hawaiian blessing. In the midst of flowers and music, parents and children beamed with a sense of accomplishment.
The Ties That Bind
Since M.O.H. opened in March 1983, 50 women have been served at the center, including 14 women who were transferred to the hospital for delivery. Most of the babies, however, have been delivered by the center’s Certified Nurse-Midwives, working in conjunction with the hospital’s obstetric, pediatrics and nursing staffs and laboratories and x-ray units. Fundamental to the functioning of M.O.H. is the personal and professional support of Dr. William McKenzie, obstetrician, and Dr. Janice Smolec, pediatrician.
Pregnancy, delivery and the launching of newborn life are normal life events–until something goes wrong. Unfortunately, few healthy events can deteriorate more rapidly. Sound maternity and newborn care requires comfortable, capable support that is alert and responsive to signs of danger. If complications occur, there must be immediate obstetric and pediatric help.
One way to meet these combined needs is to locate alternative birthing centers near hospitals. When a homelike, obstetrically sound maternity care facility works with a first-rate hospital, families get the best of both worlds.
The collaborative effort between M.O.H. and Wahiawa General Hospital is evident from the moment a patient who believes she is pregnant arrives at the center. Patient safety demands that only healthy women who are free of obstetrical complications or other conditions which could lead to obstetrical difficulties should enter an alternative birthing program. Screening and patient selection are thus the first safeguards.
After a patient is accepted for care, center nurses and midwives monitor her carefully to detect and respond to any possible problems. If complications threaten, the woman is referred to the obstetrician. If he deems it advisable, the woman may be transferred to the hospital. He and the nurse-midwife may follow her there, and the nurse midwife may still do the actual delivery.
The need to transfer a patient can arise at any time. M.O.H.’s well-trained nurses and midwives are quick to recognize problems, and as a result of their connections with the hospital, transfers can be made promptly and efficiently. Although women moved from the center to the hospital may still have an uncomplicated delivery, the transfer assures that they will receive the necessary services should problems develop.
The M.O.H. program has four objectives:
* To provide alternative health care for healthy women through nurse-midwifery services.
* To establish an alternative educational site for student nurse-midwives (six to 10 weeks birthing experience on contract with schools of nurse-midwifery).
* To create an educational site for University of Hawaii students in health-related fields by observation of alternative concepts in health care delivery.
* To establish a consultation service and educational site for health workers in the Pacific Basin.
In keeping with the objectives, Tiffany Coleman is working with the Republic of the Marshall Islands to upgrade the training of “traditional” midwives from the outer islands in the Pacific Basin. The training is supported with funds from the University of Hawaii Maternal and Child Health Training Program.
The service and educational linkages are only a few of the advantages of an alternative birthing center. The informal setting attracts patients early in their pregnancies, at a time when women notoriously fail to seek care. Such early care not only contributes to a healthier pregnancy and delivery but also has a positive impact on subsequent pregnancies. In addition, it lays the groundwork for continuing health supervision for both mother and children.
A family’s use of center services also has a ripple effect: Satisfied parents talk about their experiences with other couples and often influence pregnant friends and neighbors to seek care early.
Another, although seldom recognized, group to reap both immediate and lasting benefits from family-focused maternity care is children. Certainly babies born at M.O.H. get off to a healthy start, but their brothers and sisters thrive, too.
Children of all ages come to the center with their mother or both parents for prenatal checkups and well-baby visits. (At delivery, the presence of children and family members other than the father is possible in certain circumstances, but selection is done on an individual basis and the well-being of each family member is taken into consideration.) In the center’s homelike setting and caring atmosphere, children see childbearing treated as a natural, valuable and respected part of life. Here, they have an opportunity to see themselves in families where children are cherished, and they are led to view, naturally and comfortably, their future roles as parents. When the nurses see a father and his young son open the car door, gently help mother to her feet and escort her to the center, they witness a child starting on the road to becoming a caring adult.
Life’s big mysteries at every age are birth and death–our entrance into and exit from this world. In children’s lively minds, a mystery can grow beyond the level of a piquant puzzle to deep anxiety. Fear grips the young more frequently than most adults remember, and children seldom have the support of adults who are aware of their fears or the comforting reinforcement of reality.
Family-focused maternity care allows children to draw close to adults in one of these mysteries: birth. Children seize information wherever they find it. Sometimes what they find out about pregnancy and childbirth is misinformation from peers. But when children visit a well-run birthing center and become comfortable with the reality of pregnancy and childbirth, their fears are reduced and their knowledge and understanding of the birth process are enhanced.
The values and concepts molded in childhood are the cornerstone of adult beliefs and actions. A little girl who observes her mother’s well-cared-for pregnancy acquires standards of excellence for her own childbearing years. A boy who sees responsible adults protecting his mother through prenancy has a valuable model for his future life as husband and father.
Indeed, the little boy who sensed the dignity and importance of the dedication of M.O.H. displayed a wisdom beyond his years.
COPYRIGHT 1985 U.S. Government Printing Office
COPYRIGHT 2004 Gale Group