Front & Center: The tender business of home birth
Margaret Lipton recalls exiting Interstate 90 at Altamont “moving like the freakin’ wind” when she noticed the police cruiser.
“I immediately pulled over,” she recounted, “and as the officer approached my car, I held my phone out the window so he could hear the anxious woman on the other end.
“I said, ‘Sir, I’m sorry, but I’m on my way to a birth, and that woman is about to have her baby in a car.’ ”
“Do what you need to do,” the officer replied calmly and sent her on her way. “But please don’t drive so fast.”
Lipton, a nurse midwife, normally attends home births.
But when a rural mother refused to believe she was in labor until it was too late, her husband loaded her, their other children, his mother and his mother’s dog into the family
They got as far as Ferris High School’s parking lot, where Lipton caught up with them and delivered a healthy baby.
No wonder when Lipton is asked how many hours a week she works, she says, “All hours.”
During a recent interview, she described the circuitous route she took to her current career, and the advantages of home births.
S-R: Where were you raised?
Lipton: In upstate New York.
S-R: What were your interests growing up?
Lipton: Music and art.
S-R: Where did you go to college?
Lipton: I started at St. John’s in Annapolis, Maryland. Then I studied opera at the Royal Conservatoire in The Hague before returning to the states and getting my undergraduate degree in fine arts from UC-Santa Cruz.
S-R: The Royal Conservatoire?
Lipton: My dad was with IBM in the Netherlands, and I was miserable at St. John’s, so I moved home. I thought I had applied to the Royal Conservatoire to be a music teacher, but I got the Dutch wrong and ended up at an audition for solo vocalists.
S-R: What did you sing?
Lipton: A tenor aria from Bach’s “Wachet auf” cantata. I had sung in choruses and chorals all my life, and I’d heard that particular solo so many times that I knew it. I didn’t realize it was bad form to sing an aria in a different voice than your own. But I was accepted, and was there almost three years. Loved it.
S-R: Did you aspire to an operatic career?
Lipton: No. But I felt I should be in school if I was living at home. Then my future husband, whom I’d met at St. John’s, came over and I decided to get married and start a family.
S-R: So you enrolled at UC-Santa Cruz. Then what?
Lipton: While I was finishing my degree, my husband and I were in full-time ministry. We took in foster children and young homeless adults. I thought I wanted to be an art therapist, but then I had my first child with a nurse midwife, and it was a truly transformative experience. I started going to all of my friends’ births to encourage them, and became what today we call a doula. I did that, taught childbirth classes and raising my kids from 1978 until I became a nurse midwife in 1994.
S-R: What training did that require?
Lipton: First I had to get my master’s in nursing, which took two years. Then another three years to get my certificate in midwifery, because I had a baby in between. Normally it takes two years after you have a nursing degree.
S-R: What brought you to Spokane in 2001?
Lipton: I was practicing in upstate New York when the dot-com bubble burst and the tech company my husband worked for shut down. We had a friend here whose church needed a pastor, and my husband had his master’s in theology. So he asked me how I felt about his leaving the business world and becoming a pastor. I said, “What? (laugh) We’re finally in the black!” But it was his turn to pick.
S-R: Is this state receptive to nurse midwives?
Lipton: Washington is great. The only problem I’ve had is that none of the Spokane hospitals will give admitting privileges to a nurse midwife who practices independently. They must be employed by a hospital or a physicians group. That’s not the case in Seattle and the state’s other major cities.
S-R: How much does malpractice insurance cost?
Lipton: About $12,000 a year for someone starting out, to over $30,000 for an experienced midwife in a busy setting.
S-R: What are your responsibilities during a birth?
Lipton: Exactly the same as a doctor’s or midwife’s in a hospital – monitor the mother’s and baby’s well-being, assess the woman’s progress in labor, and catch the baby.
S-R: After 20 years, has it gotten easier?
Lipton: Yes. I used to come home from births and tell my husband I was going to quit, because it’s so stressful. Now I’m more patient. Experience has taught me that it’s not my birth – it’s the parents’ birth.
S-R: Hospital births can cost three or four times what you charge. Besides saving money, what are the advantages to home births?
Lipton: Birth is a normal body event that hospitals try to fit into a business model that focuses on staffing needs and time frames. So, in Spokane, hospital births have about a 30 percent C-section rate, which is ridiculous, and an 80 percent augmentation or induction rate with Pitocin. Why are we speeding up that many labors? What are we doing to those babies?
S-R: Did the recession impact your practice?
Lipton: Probably half of my clients are on Medicaid, and that percentage increased during the recession. Medicaid only reimburses $2,200 for my services, compared with $3,400 with private insurance.
S-R: How about the Affordable Care Act?
Lipton: The biggest change I have seen is that young couples are not getting the same insurance coverage older workers used to get. I have families come to me very surprised to discover their out-of-pocket deductible is $6,000 before insurance picks up anything.
S-R: How many nurse midwives are there in Spokane?
Lipton: Twelve to 15 in hospitals, and three of us doing home births – which is pretty amazing, since there are only about 100 in the whole country doing home births.
S-R: Who are your typical clients?
Lipton: People very invested in a natural lifestyle who are making a health choice. Also, people in the Russian community and the home-schooling community who see birth as a family event. And about a third of my clients are abuse survivors looking for an alternative to what they find as a very frightening environment, because most providers in hospitals are male.
S-R: Do you ever reject clients?
Lipton: I have to turn away people with medical risks such as super-high blood pressure.
S-R: Describe the settings where you have delivered babies.
Lipton: Everything from custom homes with marble floors to rentals with toilets that don’t work. I do a home visit ahead of time to assess if it’s a safe environment – check for exits and, if we’re in the country, where a helicopter could land.
S-R: How crowded can home births get?
Lipton: I’ve had as many as eight or nine people present during a birth.
S-R: How about pets?
Lipton: When you’re working with an abuse survivor and they really need their dog or cat with them, it’s very hard to say no. But I don’t allow anything that might jeopardize the mother’s or baby’s safety.
S-R: What do you bring with you?
Lipton: Sterile instruments, medication to treat postpartum hemorrhaging, oxygen, IVs. And an assistant trained in neonatal resuscitation, because every once in a while both mother and baby need help at the same time.
S-R: How long can deliveries take?
Lipton: I’ve delivered babies five minutes after I arrived, and labors where I was at the house for three days.
S-R: How often do you transfer patients to a hospital?
Lipton: My C-section rate is 4 percent, and those are rarely emergencies. I tend to transfer early if I’m concerned.
S-R: What’s the best thing about home births?
Lipton: For a healthy baby at term, it is the safest and most physiologically supportive way to be born.
S-R: What’s the worst thing?
Lipton: Babies die. They die in the hospital. They die at home. The only babies I’ve lost were either stillborn or born with birth defects they could not survive.
S-R: What do you like most about your job?
Lipton: The families.
S-R: What do you like least?
Lipton: I don’t like the business side. I’m good at business, but it would be easier if I didn’t have to wear so many hats.
S-R: What’s been the biggest surprise?
Lipton: I didn’t become a midwife until I was 42, and I remember thinking I’d be too old for a career by the time I got there. I’m delighted that, 20 years later, I’m still happily delivering babies.
This interview has been edited and condensed. If you have suggestions for business or community leaders to profile, contact Michael Guilfoil via email at mguilfoil@comcast.net.