The Genesis of the
Vermont Birth Network

By Roberta Nubile

Laura Peer moved to Vermont in 2004 when she was seven months pregnant because she’d heard great things from friends about a birthing center here; in particular their low-intervention midwifery model of birth, or as Peer says, “mother-friendly and woman centered approach.” Peer birthed her first child there, and recalls a “great birth experience.”

Over the next few years, however, several midwifes left the hospital. “My friends and I were at a loss as [to] how to get the kind of midwifery care in Vermont that we wanted,” Peer explains. “By that I mean care that waits for the mother’s body to go through the natural birthing process with no timelines or deadlines. It’s called expectant management rather than active management where the provider responds rather than intervenes to make things happen.” According to Peer, in a hospital setting, the timeline for delivery is often dictated by institutional policies, despite the best intentions of health care providers. And, she notes, not every woman fits neatly into that timeline.

These developments spurred Peer and a friend, Linda Pruitt, to call the first meeting in March 2006 in Montpelier of people who wanted to create a freestanding birthing center in Vermont. It was not the first time a group of people sought to do this; most notably, prior to Peer and Pruitt, the much beloved late midwives Laura Mann and Sharon Donnola spent years learning state regulations, gathering information and pursuing funding to create one.

How does a freestanding birthing center differ from a hospital birthing center? While such facilities vary widely throughout the U.S., the primary difference is that freestanding centers offer neither epidurals for pain or Pitocin for augmentation and induction of labor. The result, according to advocates, is an approach to labor and birth less focused on intervention and more committed to following natural birth process. For example, rather than continuous fetal monitoring, freestanding birth centers opt for intermittent Doppler in order to allow women more freedom of movement. Policies governing how long a birth should take are also less restrictive than in centers affiliated with a hospital. The center is staffed by nurse midwives, nurses, and labor assistants, and has a working relationship with an obstetrician. In addition, they are often located near to a hospital should a transfer be medically necessary.

These differences seem especially relevant now, given the 53 percent increase in c-sections in the U.S. between 1996 and 2007. According to the Centers for Disease Control (CDC), almost one-third of all babies in 2007 were delivered by c-section, among all age, racial and ethnic groups. Amnesty International sees this as a human rights issue, recently calling on President Barack Obama and Congress to create an Office of Maternal Care in light of the U.S. ranking behind 40 other countries in terms of maternal deaths, including virtually all industrialized countries.

In 1998, the United States government set a goal of reducing c-section rates to 15 percent for low-risk, first-time mothers under the Healthy Peoples 2010 objectives. Since then, however, the national rate has gone up instead of down.

Studies have shown that freestanding birth centers serving low-risk women are low intervention, leading to better birth outcomes, as well as being cost effective. That one intervention “snowballs” into several, often leading to a cesarean birth, is well-documented in natural birthing literature. Henci Goer’s groundbreaking book Obstetric Myths versus Research Realities, searches through evidence-based research, illustrating how interventions such as labor induction, episiotomies, epidurals and cesarean sections are not as medically necessary as many women – and doctors – believe.

The National Birth Center Study published in the New England Journal of Medicine in 1989 concluded that birth centers offer a safe and acceptable alternative to hospital for selected pregnant women.” The study included 11,814 women admitted to labor and delivery to 84 freestanding birth centers in the US. The women were at lower-than-average risk of a poor outcome. The rate of cesarean section was 4.4 percent.

Peer and Pruitt held about six monthly meetings of “Friends of the Birth Center”, as it was called, engaged in research and were able to gather some of the notes that the then ailing Mann generously passed on to them. While the meetings were well-attended by nurses, midwives, consumers and birth activists, Peer recalls, “We knew it would be a full-time job to make this happen.” Meanwhile both were busy raising families and pursuing full-time careers. Peer commuted three times a week to Boston to pursue her masters in Maternal-Child Public Health. Pruitt ran both her e-zine Mama Says, and the Vermont Diaper Company, manufacturer of organic cloth diaper supplies with international sales, while working at as a librarian and pre-natal yoga and dance teacher. Eventually, the two realized they weren’t going to be the ones to do this – and no one else was willing to take it on. It wasn’t the right time to pursue their dream of creating the first freestanding birth center in Vermont. Not yet, anyway.

“We knew our approach had to change. This wasn’t the right time for anyone to take the lead. We needed to change the climate to help create a demand for more women-centered maternity care in Vermont,” says Peer. “We asked ourselves, ‘What can we do to help women have a natural childbirth within the existing options in Vermont?’” What the two birthed instead was the Vermont Birth Network.

The idea of a birth network came to Peer through a professor of hers in the Maternal and Child Health Department at Boston University School of Public Health, Eugene Declercq, who was also a technical advisor to the film, “The Business of being Born”. He sent her a link about a mini-grant from Lamaze International to establish a birth network. “This fit in to what we were hoping to create,” says Peer. The two received the grant from Lamaze, as well as generous donations from a close friend and labor doula, Sarah Keeley, and also from Jane Pincus, one of the founders of Our Bodies Ourselves (OBOS), also known as the Boston Women’s Health Book Collective (BWHBC), a nonprofit, public interest women’s health education, advocacy, and consulting organization. “We wanted it to be Web-based, to reach as many as we could as efficiently as we could,” Peer says. In 2007, they went live.

According to their Web site, the VBN is an “independent forum providing information, education, support, and advocacy on healthy, normal birth in Vermont.” It provides a wealth of resources; including Vermont pre- and post-natal wellness providers, midwives, labor support doulas, and independent childbirth educators, as well as links to helpful Web sites and books.

In keeping with their mission and philosophy, the VBN is decidedly pro-midwife and does not encourage the use of obstetricians for low-risk births. Via email Pruitt writes, “We are very fortunate to have skilled OBs available to assist American women in childbirth but OBs are trained surgeons. They are trained in surgical birth, trained in interventions and accelerations. They are not trained in the rhythms and realities of natural childbirth. At this stage in history, in our country, more interventions, and more medicalization is creating worse outcomes for moms and babies. Birth is not a medical emergency.”

One of Peer’s favorite sections is “Questions to Ask Providers”. Women forget they are in charge,” she says. “Our current health care system is not patient-centered. Women can make better choices and have better outcomes and experiences.”

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