More maternity care choices for the Plain community

By on September 6, 2017
Times have changed. Many members of Lancaster County's Plain communities are opting to have babies in hospitals instead of at home.

Times have changed. Many members of Lancaster County’s Plain communities are opting to have babies in hospitals instead of at home.

For generations, the Plain Community preferred midwives for maternity care and had their babies at home. Many still do.

But in the second decade of the 21st century, there are more choices for Amish and Mennonite families as well as more data and information to help them make an informed decision on what’s best for them.

The greater Lancaster County Plain community welcomed nearly 2,000 babies into their families in 2016, according to Steven Nolt, senior scholar at the Young Center for Anabaptist and Pietist Studies at Elizabethtown College. They were born at home, birthing centers, and area hospitals, including locally at Wellspan’s Ephrata Community Hospital and the Heart of Lancaster Regional Medical Center in Lititz.

Some individuals interviewed for the story believe there have been increases in hospital births and some speculate it might be generational with young families who do more research — including having internet access — than older generations had. However, despite advances and changes in modern medicine and ongoing hospital and birth center outreach to the community, many times in a Plain family, if the expectant mother’s mother or grandmother had children at home attended by a midwife, many don’t see any reason to change.

Accurate birth location data isn’t easy to find, so trends in where Plain families’ babies are born is at best an educated guess. The big choices are location and care. Women can have their babies at an area hospital in a birthing center or at home. They can be cared for by medical doctors or one of several different groups providing service under the name midwives.

The two local hospitals have long-standing relationships with the Plain community and continue to reach out to them and the medical professionals — doctors and midwives — who serve them. Strong communications’ channels have been established between the hospitals and the community to help provide support if needed, regardless of the birth location or choice of medical service provider.

From the hospital side, Dr. Sharee Livingston DO, a 25-year OB/GYN, who has been on staff at Heart of Lancaster for the past 11, years stresses, “It is important to establish and maintain a strong relationship with the Plain community using good communications and education programs to establish trust.”

Livingston, as does everyone involved in bringing babies into the world, believes the key is that the patients get the best and safest care. Dr. Livingston says that data from both American College of OB/GYN as well as the American Academy of Midwives show the safest births are in hospitals.

The Plain community’s mothers-to-be can interact with hospitals in several ways. They may choose to have all pre- and post-natal care in the hospital and give birth there. They also can opt for pre- and post-natal care outside the hospital setting, but give birth at the hospital attended by a doctor or a nurse/midwife (CNM) who is certified and able to provide in-hospital birthing. They also may use a CNM for maternity care and birthing at home or at a birth center.

Joanne Eshelman, director of Plain community relationships at WellSpan for the past 10 years, and a 25-year Ephrata hospital administrator, says that the formal outreach program to Plain families at Ephrata dates back at least a decade, although the hospital always has cared for a significant number of Plain patients.

“Trust is the foundation of our relationship with this community,” Eshelman says echoing Dr. Livingston’s comments, “And we reach out to church leaders so that families are aware of pre-paid maternity packages as well as other package priced services, too, making care more affordable and accessible.

Finances will always play into medical decision, including where to get maternity care. It not only is a factor for the Plain community but now, with insurance and health care in a state of flux in the U.S., also is a concern for their “English” neighbors.

Both Livingston and Eshelman say the hospitals are up-front with package plans for their services. At Wellspan, a group of liaisons or as Eshelman describes them “navigators” — including one from the Plain community — help Amish and Mennonite families understand how to access and pay for their care.

Professor Nolt, who studies the Plain community at the Young Center, believes health insurance among at least the Lancaster Amish remains very rare.

“Many,” he says, “have deacon-coordinated Amish Aid plans that would pay something toward hospital stays, but not the full cost.”

Amish churches also cooperate with each other and provide aid for members who needs help with expenses in a catastrophic illness or accident that entails very expensive hospital care and services.

Also, what some call “skin to skin” or a “baby friendly” approach which has always been important in Plain family births has found its way into hospital care too.

“Mothers want to hold their baby immediately after birth,” Livingston says, “like would happen in a home birth. Hospitals are adjusting to meet those wishes.”

Dr. Livingston says that even though home births for Plain families has gone on with midwives’ care for generations in low risk pregnancies, she says the words “low risk” may not apply to all birth situations today with mothers possibly having other medical conditions that are being treated at the same time making a hospital birth with back-up for emergencies very helpful.

“We have seen an increase in hospital births from the Plain community,” Livingston says. “Maybe the word is getting out there that hospitals can provide a ‘baby friendly’ environment that offers much of what people hope for in home delivery now right at the hospital.”

Going forward, hospitals continue to refine their communication and outreach programs to Plain families, including Wellspan’s efforts to bring hospital administrators and doctors to meetings in the community to discuss options in medical care and answer questions.

Recent studies have shown that about 98 percent of all births in the United States are done in hospitals with about 92 percent attended by physicians. Those figures probably do not hold true to rural parts of the country, including Lancaster County.

In Lancaster County with Plain families and English families too, there always has been a strong midwife presence.

Historically, evidence of midwives has been found by archaeologists as far back as 5000 BC. Midwifery was a recognized profession for women during Egyptian times and there is reference to midwives in the Old Testament.

Today, there are a number of individuals who call themselves midwives and provide services to the community for birthing and maternity care, but training can vary.

Maren Ketcham, executive director of Birth Care and Family Health Services in Christiana, says “In Pennsylvania, the only midwives who can be licensed, which allows them to have hospital privileges, are Certified Nurse Midwives (CNM).”

These midwives are registered nurses with a nursing degree from a four-year college. They also have a graduate degree — a master of science degree in midwifery. Today, they provide services at homes, in doctors’ offices, clinics, birth centers, and hospitals.

There are about 15 CNMs in Lancaster County including seven fulltime and two part-time at the Birth Center and two at Heart and Hands Midwifery Care in New Holland.

There also are certified midwives (CPM) who have training in providing midwifery model care at home. They have a health-related background other than nursing and then graduate from an American College of Nurse-Midwives (ACNM) accredited program and pass the same certification examination as CNMs.

And there are individuals that may be called traditional, direct entry, or community based midwives providing services to segments of the Plain or English communities. And finally, there is a group of trained doulas who provide continuous physical, emotional and information support to a mother before, during, and after childbirth.

It can be confusing.

Add to the mix a facility like the Birth Care and Family Health Services Center where expectant mothers can receive pre- and post-natal care from CNMs and choose to deliver their babies at home, under a CNM care, or in a hospital at the Center.

Ketcham explains, “There are three birthing rooms at the Center and mothers are able to be released four hours after birth and be home quickly, as many prefer.”

Midwifery practices establish relationships with hospitals that provide back up with tests, as needed, as well as assuring availability of a higher level of care if the patient’s condition becomes complicated rather than low risk.

“The Plain community is much more educated on their choices for maternity care than is generally understood,” Ketcham says.

Some 75 percent of the Birth Center’s practice is with Amish families and their CNMs are involved in births at the hospital, private homes, or the Birth Center.

It is generally believed that the Plain families of the northern part of the county have embraced more of the new services available to them for maternity care while the families at the southern tier have stayed with the older traditions.

In 2016, the Birth Center midwives delivered 60 percent of the 575 (average) births at the Center, and it handled 25 percent of at-home births, and 15 percent at Ephrata hospital.

Ketcham explains that 10 years ago, up to 50 percent of the birthing mothers delivered the babies at home.

“We have seen a decrease in home births over the past 10 years,” Ketcham says “with more women taking advantage of a home-like setting in the Birth Center and the ability to go home, if there are no complications, the same day.”

As small communities within the county become more attuned to changes in maternity care, they are investigating the Birth Center and Health Services model and Ketcham has hosted a number of groups seeking information about starting a similar operation.

There is no question times have changed for the Plain communities on obtaining health care and in particular maternity services. No doubt, that in the second decade of the 21st century, the Plain people who embrace many of the traditions of the 19th and early 20th centuries, now have more choices and more information at hand when making important medical decisions, and are taking advantage of advances in medicine for their families’ care.

Art Petrosemolo is a freelance feature writer and photographer who recently retired to this area from New Jersey. He welcomes reader feedback at artpetrosemolo@comcast.net.

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