Pregnancy in Pittsburgh: understanding our prenatal care options

Raising healthy kids is an important responsibility. And it begins long before we first introduce our children to well-balanced diets or active lifestyles. It begins in utero, when a kaleidoscope of genetic and environmental factors combine to influence the long-term health outcomes of our children.

Luckily, Pittsburgh is kind to pregnant women. We have world-class tertiary hospitals. We have Level III Neonatal Intensive Care Units (NICUs). We have yoga-infused birthing classes and free doulas to help us along the way. And yet, our city’s neonatal mortality rates still loom over the regional and national averages, especially among our African-American families. At Kidsburgh, we believe these statistics need to change. And in this article, we address the issue by introducing expectant parents to prenatal care resources that can help them have the healthiest pregnancies possible.

First steps

For most women, the shock of that positive pregnancy test is followed by a lot of questions. This guide to a healthy pregnancy from the national Office of Women’s Health may help answer some of them for you.

According to the American Congress of Obstetrics and Gynecology (ACOG), early prenatal care is very important to the health of your baby, so the next step is to find a pregnancy care provider. If you have health insurance, you will probably look within your insurance network. If you are uninsured or underinsured, you might not know how to proceed. For some women, it might be as simple as logging onto Healthcare.gov to find the right insurance plan for you. But for other women with more significant barriers to health care access, it might be more complicated. In this case, we recommend starting with referral agencies like the Allegheny County Health Department’s WIC program or Healthy Start Pittsburgh to learn about insurance options, prenatal care providers and other supportive services that can help you.

Pregnant women in Allegheny County may qualify for a number of important services, including no-cost insurance through Healthy Beginnings, housing at the Genesis House in Bellevue, home visits through the Allegheny County Health Department, transportation through Mobile Moms and nutritional support through WIC.

Selecting a pregnancy care provider

The next step is finding the right pregnancy care provider for your family. Although many women assume they will see an obstetrician during their pregnancy, Pittsburgh actually offers several options in terms of providers.

Obstetricians

An obstetrician is a doctor with specialized training in prenatal care, labor, birth, high-risk pregnancy and surgery. These doctors attend births in a hospital setting and are also the surgeons who perform cesarean sections if they become necessary. An obstetrician can also perform any necessary surgical procedures postpartum if a woman should require this level of care. ACOG provides a search tool for patients to find a board-certified provider nearby. Your insurance network may also provide something similar. Also, if your pregnancy is considered “high-risk,”  you might see an obstetrician trained as a maternal-fetal medicine (MFM) sub-specialist. Both the UPMC and Allegheny Health Network systems have MFM doctors.

Family Physicians

Some families choose to see a family physician during their pregnancies. These doctors provide “cradle to grave” care to the entire family. Often, a family physician coordinates with an obstetrician if a patient needs a higher level of care, but sometimes family physicians can even perform obstetrical procedures like a cesarean section. With family medicine, general well-woman care leads seamlessly to maternity care to postpartum care and to newborn and pediatric care.

Both UPMC and Allegheny Health Network have family physicians who provide pregnancy care.

Certified Nurse Midwives

Certified Nurse Midwives, or CNMs, hold board certifications in midwifery in addition to their registered nurse degrees and specialize in normal pregnancy and delivery. They are independent healthcare providers who can prescribe medications and work collaboratively with physicians. In Pittsburgh, many OB practices have CNMs on staff who see patients for both prenatal visits and deliveries. There are also all-CNM practices within Magee-Women’s Hospital of UPMC and UPMC Horizon in Farrell, but there are not currently all-CNM practices within any hospitals outside the UPMC network. The American College of Nurse Midwives offers a search tool to help patients find a CNM nearby.

Patients select this midwifery model of care because they are looking for care providers who, according to the Midwives at Magee, have “a philosophy that focuses on the specific needs of women, offering a variety of care options to minimize unnecessary interventions.” Some women using CNMs choose pain management techniques such as epidural during labor while many attempt drug-free birthing. Typically, CNM patients undergo all standard blood work and testing during their prenatal care.

Selecting a location for birthing

In many instances, choice of caregiver directs where a woman births her baby. If the location of your delivery is important, it might guide your choice of prenatal care provider. Here’s a rundown of your local options for delivery.

Large Tertiary Hospitals

The largest labor and delivery hospitals in our area are Magee-Women’s Hospital of UPMC with over 10,000 births per year, West Penn Hospital with about 3,000 births and UPMC Mercy with about 1,200 births. Each of these hospitals has high-risk obstetrical units and Level III NICUs, so they can accommodate low-risk women and the women who need the most specialized care during their pregnancies and deliveries.

Smaller, Local Hospitals

Tricia Trotter, who lives on Mt. Washington, chose to deliver at St. Clair Hospital because she plans to eventually relocate to the South Hills. She liked being in a quiet environment where six births meant a busy weekend for the staff. In Allegheny County, many smaller hospitals have closed their labor and delivery units in recent years. However, families looking for a smaller hospital experience can find one at Heritage Valley Sewickley, St. Clair Hospital, the Forbes Regional campus of West Penn Hospital and the newly-opened obstetrical division in Jefferson Regional Medical Center in the southern suburbs. Each of these hospitals anticipates around 1,000 births per year.

The Midwife Center for Birth and Women’s Health (TMC)

This free-standing birth center nestled in the Strip District boasts an amazing mural on the outside (featured photo above) and three nature-themed birthing suites on the inside. The facility is staffed by Certified Nurse Midwives.

Clinical director Ann McCarthy points out that women seek the type of care offered at TMC to avoid interventions in their delivery. McCarthy says the cesarean rate for low-risk women nationwide was 25% in 2013 while TMC had a rate of 8.5% with no increase in morbidity or mortality, even considering their practice takes on women seeking vaginal birth after cesarean.

Executive Director Christine Haas points out that TMC is a cost-effective choice for families, noting that some families never even meet their insurance deductible throughout their prenatal care and delivery. TMC accepts most private and public health insurance plans and is committed to working with families who need to self-pay. Women seeking an intimate experience away from the bustle of a large maternity unit can feel safe knowing TMC has admitting privileges with nearby hospitals if the need for a transfer arises.

Women requiring transfer can have a seamless experience, where their midwife comes with them, remains their primary care provider and offers follow-up care after delivery. Most patients requiring more care will transfer to UPMC Mercy, but Haas says  TMC has a transfer agreement with West Penn Hospital for women with Highmark Community Blue insurance.

Finding a childbirth education class

Many families seek out a childbirth education class during the course of their pregnancy. We live in a region where these families have many options for prenatal education, the most common being Lamaze classes within the hospital where mothers plan to deliver. UPMC offers several courses and has even added an online childbirth class to help prepare families for birthing. The Allegheny Health Network also has a variety of courses for families, including weekend sessions.

Located on Butler Street in Lawrenceville, Shining Light Prenatal Education is another option for families looking for an out-of-hospital childbirth education class. Owner Deena Blumenfeld, a Lamaze-certified childbirth educator, explains that families might seek out independent courses like Shining Light’s for a number of reasons.

For starters, she says childbirth educators in a hospital-based class might be restricted in the types of referrals they can make for clients. Blumenfeld says, “I have a broad range of professionals all over the city who can fit my students’ needs,” and she is able to suggest names of massage therapists, doulas, chiropractors or any other type of community resource her expanding families need.

Independent courses are often more comprehensive, covering more material and integrating pain management postures, diet suggestions, exercises and yoga routines. “I provide personal attention to all my students and make sure I’m available via email or phone for questions students might have after class or after speaking with their care provider,” says Blumenfeld.

Other popular types of childbirth education in our area include Hypnobabies, which is another comprehensive course that incorporates hypnoanesthesia techniques, and the Bradley Method of Natural Childbirth–a comprehensive course that focuses on the birth partner as coach during labor.

Of note, most insurance policies will offer reimbursement for students taking a childbirth education course from a Lamaze-certified childbirth educator, and teachers throughout the area are familiar with the forms from various insurance providers.

Finding a do-what? 

Taken from the Greek word for “a woman who serves,” a doula is a trained childbirth supporter. According to Doulas of North America (DONA), an international certifying body, the presence of a doula leads to shorter labor, fewer complications, healthier babies, higher rates of breastfeeding success and decreased incidence of postpartum depression.

Amy Farr, a local birth doula and childbirth educator, explains that a good doula helps enhance the birth partner’s role. She says, “sometimes the doula just holds space in the room while the partner provides all the support.” Usually, though, a doula will help a couple define their desires for the birth and the immediate postpartum period, apply comfort measures for mothers in labor and help families advocate for themselves. Farr points out that nursing shifts will change and different doctors might come on duty, but the doula remains with the mother through the entire birth to provide unconditional support.

The cost for a doula in Pittsburgh varies, but averages around $500, which includes several prenatal visits and support during the entire course of a mother’s labor and birth. Farr points out that she is able to accept Flexible Spending Account funds for payment for both doula and childbirth education services.

Pittsburgh has several large doula groups in addition to independent doulas. Since there are so many to choose from, families often find it helpful to attend a “meet the doula” open house. Blumenfeld keeps a list of the various doula options on her resources page. The page also contains referrals for complementary services like chiropractic care and acupuncture.

For women with low-cost UPMC for You health insurance, a project called The Birth Circle offers doulas at no cost. Program director Megan Shope explains that as long as mothers are planning to deliver at Magee, Mercy, West Penn, Forbes or TMC, they can take advantage of this service. Birth Circle doulas typically meet with clients for four prenatal visits, the delivery itself and three postpartum visits.

Birth Circle doulas work with a unique population of mothers with various socioeconomic barriers. Shope says, “We walk alongside our clients to ensure they have a voice in their care. This is crucial in that it prepares moms to be able to speak up in a very vulnerable time, and hopefully that translates into their journey into motherhood.”

The Next Step

Congratulations, newly-expanding families! You’ve entered Kidsburgh–a whole new world of resources and options. Rest assured that we’ll be right there with you, reporting on the latest news tailored to your Pittsburgh family.

Editor’s note (2/23/2015): It was noted after publication that some women in Pittsburgh choose to have planned home births under the care of Certified Professional Midwives or traditional midwives. Contrary to some public perception, home birth is not technically illegal in the state; however, the state of Pennsylvania does not regulate or license home birth midwives as health care providers at this point in time. For more information regarding your option to have a planned home birth, please visit the Midwives Alliance of Pennsylvania website and this article by ACOG.

Featured photo: The Midwife Center mural, “Celestial Weaving Girl” by Lucas Stock, Photo by Eric Cohen