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The Missoula Birth Center, reeling in the wake of the sudden death late last year of its founder and driving force, Dr. Lynn Montgomery, is in negotiations with Community Medical Center for a sale, partnership, or other arrangement. Both organizations confirmed the talks and a deal could be reached as early as this week. Since Montgomery died suddenly of a heart attack in October at age 51, concerns about the future of the center have been rippling through the community, especially among its patients. Gia Randono is one of about two dozen Birth Center patients who over the past few months have been circulating petitions and writing letters asking either St. Patrick’s Hospital or Community Medical Center to help keep the Birth Center in operation. The Birth Center and Community Medical Center are the only facilities in Missoula with dedicated labor and delivery rooms. “It would be so unfortunate to lose not only Dr. Montgomery but also the birth center,” Randono says. “It was still developing. There was so much potential there.”

Missoula Birth Center and Community Medical Center in Negotiations

The Missoula Birth Center, reeling in the wake of the sudden death late last year of its founder and driving force, Dr. Lynn Montgomery, is in negotiations with Community Medical Center for a sale, partnership, or other arrangement. Both organizations confirmed the talks and a deal could be reached as early as this week.

Since Montgomery died suddenly of a heart attack in October at age 51, concerns about the future of the center have been rippling through the community, especially among its patients.

Gia Randono is one of about two dozen Birth Center patients who over the past few months have been circulating petitions and writing letters asking either St. Patrick’s Hospital or Community Medical Center to help keep the Birth Center in operation. The Birth Center and Community Medical Center are the only facilities in Missoula with dedicated labor and delivery rooms.

“It would be so unfortunate to lose not only Dr. Montgomery but also the birth center,” Randono says. “It was still developing. There was so much potential there.”

Montgomery, an OB/GYN with training in high-risk pregnancies, came to Missoula in 1998 and started the Birth Center in 2006 with a vision of, as described on the center’s Web site, “an alternative and safe birthing experience for women with normal, healthy pregnancies opting for no intervention or medication.”

At the Birth Center, mothers labor and deliver in one of two birthing suites, which feature candles, flower arrangements, and electric fireplaces; patio doors open onto an outdoor walkway; and private bathrooms include easy-access showers and toilets with heated seats. At its peak the center, which also offers pre-natal and general women’s health care, was seeing about 75 patients per day.

Since Montgomery’s death, however, the number of patients has dwindled to around 25 per day, and the center has cut its staff from 16 to six. A temporary arrangement with another OB/GYN allows births to continue at the center for the time being, and new patients are still being accepted. But — absent a doctor able to replace Montgomery full time — it seemed doubtful that the Birth Center could continue to operate as before.

Neither the Birth Center nor Community Medical Center could comment on specific difficulties the Birth Center faces, but Kate Bauer, the executive director of the American Association of Birth Centers, shed some light on the various issues facing birth centers nationwide. Profit margins at birth centers are tight, due to skyrocketing malpractice-insurance costs. Also, while studies have shown birth-center deliveries to be safe, the idea of non-hospital births continues to struggle for acceptance among some medical professionals. “One of the obstacles to physicians working in birth centers can be the political climate in the medical community,” says Bauer. “If a doctor works with a birth center, will it be harder to work with other doctors in the community? Will it be harder to get hospital privileges? We don’t think of medical care as having politics, but it does, just like any business.”

As awareness of natural child birth builds, birth centers like Montgomery’s have come into new demand. The reasons vary greatly from mother to mother, but—according to the pregnancy book Great Expectations, which does not advocate any specific birthing option—births at hospitals cost on average two to five times more than at birth centers (at the Missoula Birth Center, deliveries cost about $3,200). Also, hospital births are more likely to involve forceps and vacuums or end in c-sections; mothers who give birth in hospitals are more likely to suffer post-partum depression or post-traumatic stress disorder; hospital shift changes mean the mother may encounter different staff members during her labor and delivery, increasing the chances that her birth plan may not be honored; and delivery rooms are not always designed to accomodate multiple family members.

For Randono, who had her first child in a hospital, the Birth Center experience was a marked change. “My midwife and nurse were there throughout my delivery,” she says. “There was natural light. It felt so good to be able to labor and deliver in a place that felt comfortable.”

“The whole atmosphere was very warm,” agrees Barbara Hall, a Missoula mother whose November delivery was the Birth Center’s 200th. Hall, a first-time mother, says she chose the Birth Center because she worried about giving up control of her delivery. “Women need support if they want to do natural childbirth,” she says. “I was afraid I might not get that support in the hospital.”

Hall says the Birth Center offers Missoula mothers an important and needed alternative. “If I lived in a place where there wasn’t an option like the Birth Center, I might feel like it was a place where I didn’t belong,” she says. “If someone wants to deliver in a hospital, that’s fine, but I really want the option to deliver naturally in a safe environment.”

Michelle Burton, another mother who has delivered at both Community Medical Center and the Birth Center, is even more emphatic. “If I have more kids,” she says, “and I can’t deliver at the Birth Center, I would feel forced to have the baby at home.”

About Sutton R. Stokes

Comments

  1. Angela Timm-Miller says:

    Thanks for such a great article!

  2. Sutton R. Stokes says:

    Thanks for your help, Angela.

  3. dig this chick says:

    Thanks for this article. I had my babe at the Birth Center and had the most wonderfully fulfilling experience. I know we can sign letters and petitions to advocate for the continued service of the Birth Center, but I want to know what else, specifically, I can do.

    We just can’t let this important resource disappear. Those of us who have had the opportunity to labor in those beautiful rooms and tubs with the incredibly gifted and supportive staff have a responsibility to ensure its existence for our daughters.

    Nici Holt

  4. Samantha says:

    Thanks for this update! My daughter was baby #42 born at the Center and I often say if (IF!) she has any siblings they’d have to be born there too. I had to fight with the in-laws tooth and nail — they are all nurses and said I was killing my baby, I’d be begging for an epidural within ten minutes, all sorts of crap. But we had a wonderful birth there and I’d do it again if (IF!) I were to have another one. Such a nice alternative to have and very important to the community.

  5. Geoff says:

    It’s a shame that people believe so deeply that MD’s are needed to have a baby. Nothing could be further from the truth. Women, reclaim your bodies! Have the kid at home!

  6. anna says:

    I’m glad to see another article that sheds positive light on the Birth Center. My daughters were babies #2 and #164 born at the Birth Center, and, as others, we had wonderful experiences both times. I have done everything within my power to support the Birth Center; I sincerely hope this safe, healthy (not to mention beautiful) facility continues to be a birthing option for women in the future. There is obviously a high demand for it in Missoula!

  7. Sutton R. Stokes says:

    Thanks for your comments, everyone.

    Geoff: though I know a center-based birth is different from what you are advocating, I just wanted to make clear that many women deliver at the Birth Center attended only by a nurse and midwife, no doctor present. As I understand it, though, the Birth Center does want to have a doctor available as an additional resource in case of emergencies — something the patients I talked to appreciated.

  8. Lara Mattson Radle says:

    As a local therapist that works with women suffering from Postpartum Depression as well as the Montana coordinator for Postpartum Support International I believe the more we can support women in ensuring they are able to make their own decisions regarding their births, as well as providing multiple options for them (home birth, birth center, hospital deliver) the better women will manage the incredible transition to parenthood.

  9. Angela says:

    While I support the idea of a birthcenter I don’t want the hospitals to make an agreement. A birthcenter should be able to stand on it’s own. I think we should look at the fact that people in a position to help the birthcenter are reluctant to do so. I toured the birthcenter and it didn’t seem very clean, and things can go quickly so wrong in a birth. I support having choices, but I don’t think we need to save this particular sinking ship.

  10. Amy Veltkamp says:

    I, too, have high hopes for the birth center to remain in operation. The idea that there is an alternative for moms who want a natural birth without homebirthing is comforting to many women. I do, however, have a problem with the comment made by the woman in the last paragraph, that she would feel “forced” to have a homebirth if the birthcenter were to close. Women, hundreds of them, have always and still do, have safe, comfortable and beautiful homebirth experiences. Maybe one of the steps we can take is to educate the medical community (yes, they don’t know everything) about the benefits of homebirth and encourage the AMA to insure nurse midwives to allow them to attend homebirths. There are other alternatives to the birth center.

  11. Sutton R. Stokes says:

    @Angela:
    It seems to me that I would be remiss not to counter your observation with one of my own: I took my own tour of the Birth Center and can’t imagine what you mean by saying “it didn’t seem very clean.” When I visited, the place seemed as clean and as carefully run as any medical facility I’ve ever seen.

    As for your argument that the Birth Center should be allowed to fail, that would make more sense to me if its travails resulted from a lack of customer interest. Instead, its problems have arisen from a stroke of very bad luck, DESPITE high interest from customers. At any rate, I doubt any “saving” is being contemplated: I imagine that Community Medical Center will proceed with a purchase or other arrangement only if the available terms make good business sense.

  12. Heidi says:

    Thank you for sharing this article about the important work that goes on at the Birth Center. I hope the center will continue to represent all the things they are known for. Honestly, I have only heard good things about the place, and know many friends around the country who have birth centers as an option. Given the known relationship between direct entry midwives and CMC, partnering with CMC wouldn’t be my first choice for a free standing birth center that is supposed to be promoting natural childbirth. Of course, they have to make the decision that keeps their clinic viable.

    Good luck to the Birth Center!! I hope wonderful things come your way.

  13. Kimberly James says:

    “If I lived in a place where there wasn’t an option like the Birth Center, I might feel like it was a place where I didn’t belong,” she says.

    This is how I feel. I resent that small-town politics play into how providers choose to service their clients (“patients”). It’s not an issue of there being a “market” for the birth center – it’s about bringing awareness and education to women and their families in Western Montana regarding their rights and advocating for access to a wide range of services. Philosophically, the WORST thing for Missoula women would be for the Birth Center to have an official financial relationship with Community. Community’s birth facilities are sub-standard. Community’s cesarean rate is too high. Community’s vaginal birth after cesarean (VBAC) rate is too low.

    There are other options, harder options, for the birth center to consider. They could form a co-op with homebirth midwives so that women who desire less interventive births could have access to nurse midwives AND certified professional midwives, for instance. The easy, most lucrative option – no. But it’s done elsewhere.

    I’m really disappointed in Missoula. This town shouldn’t be fighting against childbirth choices that are beneficial to the birthing culture of our town and state. We are obligated to see natural birth better supported in our community. Our moms, babies, and families are worth it.

  14. Jeanne Hebl says:

    I’m happy to see the community support. Thanks to you all. First of all I want to make clear that our doors have been kept open with the support of one local obstetrician. As certified nurse midwives we do not need an on-site physician because if there were problems, the mother and/or baby would promptly be transferred to the hospital. It is at the hospital that we need the physician. The problem is that the specific physician backing us up cannot do it alone (which is currently the situation). This would require 24/7 call.

    The other option has always been to include direct entry midwives but with a physician in the office, the malpractice carrier did not allow this. Now that we do not have a MD in the office, it can be considered…………..If we can keep the doors open.

    We have also tried everything to keep the doors open: recruiting another MD from outside the city or state; locums tenems MD’s; searching for any business that would lease the space that we are not using; and yes, lastly St. Pat’s and Community Hospital. St. Pat’s bowed out. CMC is in negeotiations but there are kinks to be worked out.

    If anyone knows of a business in search for office space (a health care related business), this would help us continue births at the birth center. The last thing the midwives want to experience is another death (of a birth center)

  15. Matt R. says:

    I gave birth to my son last year at the Birth Center, and have every intention of having a second child there, too (when the time comes). My experiences with their facility and staff are excellent.

    This is why I am very disappointed by the rumors I’ve been hearing about CMC’s deal with the Birth Center. I know that the Birth Center is in a rock and a hard place, so I place the blame squarely on CMC for what I see to be a joke of a deal. According to my reputable sources, they intend to keep it open as an outpatient clinic, but not allow labor or delivery there. That’s basically making the Birth Center into a NowCare for pregnant people. I’m horrified. The reason that the Birth Center is so valuable is that you can labor and deliver there on your own time, in an environment that is safe and non-medicalized.

    My husband and I have talked about this lately, “when we are ready to have a second child, what will we do if the Birth Center is closed?” And we agree that we’d rather do a home birth than go to CMC. Why? CMC has outdated practices that do not support natural childbirth. They also have a bad reputation for breast feeding support. Perhaps most troubling is that I’ve had many friends go there to have their children and come home with worrisome stories about their labor, the nursing staff, the doctors, etc. I’d much rather be at my house where I am confident in my care (I’d have a direct practice midwife and doula) then a hospital with staff I don’t feel I can trust to act in my best interest.

  16. Heidi says:

    I think the question that needs to be asked/answered if it hasn’t been already, is WHAT can the community do to keep it open. How can we help. In a way, these are private business decisions being made in the best they can given what is available.

    I will mention the additional disappointment that St. Pat’s did NOT go into the birthing business as it would give CMC some competition and maybe force them into better birthing practices. I heard a claim that doctor’s didn’t want to have 2 different hospitals to go to, and I can see the logistical inconvenience… The same thing was debated in Billings for years. And I don’t know what either of those hospital birthing practices are, but I do remember that it took many years for Billings Deaconess to add their birthing unit.

    COnsider across Montana, there really aren’t birthing choices for women. It’s hospital birth or home birth. From what I have read it seems that as soon as you set foot in a hospital to give birth, and only because you’re at a hospital, you’re increasing your chances of medical intervention and cesarean.

    I truly hope the community can help the Birth Center in some way. I don’t know if you are or have been operating as a non profit, if the B. Center can do fundraising or can apply for grants. Understandably, it makes more sense to run it as a viable business. I myself don’t have any/many connections, and hope someone who has them can provide the assistance that is needed.

  17. Lisa says:

    The Birth Center is a great place for those wanting the “natural” birthing experience. But if it’s fate is to close down, what is so horrible about delivering at a hospital? Pain medications were made for a reason, and the mother always has a choice to say no. I am a mother of 3. I have had two deliveries at a hospital and one at a birth center. I felt much better being in the hospital atmosphere. I cannot count the number of people who started out at the Birth Center and then had something go wrong, and had to be taken by ambulance to Community. For those of you who think hospital births are so terrible, maybe you should reconsider. After all, at least you will have numerous MD’s available at the drop of a hat if anything were to go wrong.

  18. Sutton says:

    Thanks for reading and commenting, Lisa. As an expectant father looking ahead to a delivery later this month at CMC with Dr. Mark Garnaas, I have every expectation of a good experience — we’ve heard very good things from CMC about natural childbirth, etc., and Dr. Garnaas has also been very supportive.

    Still, the Birth Center was a very attractive option, and, whatever one thinks of hospital births, it’s always a little sad when women’s health care choices decrease. I think a lot of commenters/Missoula moms were just mourning the passing of a facility they loved.

    One thing though. I can count the number of people who started at the birth center, then transferred to the hospital (according to the BC): 40; the number in an ambulance: 0.

    “Over 200 births since opening in May 2006; since that time, only about 40 transfers, none for emergency reasons. Of transfers, only about 5 were eventual c-sections.” (Non-emergency transfers could simply be because a woman had gotten exhausted laboring and changed her mind about wanting an epidural or that kind of thing.)