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Dr. Steven Calvin knows better than most people what can go wrong during childbirth. The Minneapolis obstetrician has specialized in high-tech medicine for the riskiest and most difficult pregnancies.
Yet he's come to believe that there's no reason for most women to have their babies in hospitals.
"Yes, pregnancy can be a disaster," he said. "But most of the time, it's not."
At 57, Calvin seems like an unlikely recruit for the natural-childbirth movement. But this spring, he became the first doctor in Minnesota to open a freestanding birth center -- a home-like setting where women can give birth with the help of midwives and never set foot in a hospital.
The Minnesota Birth Center had its first delivery -- a girl -- at the end of May in a renovated Victorian house in south Minneapolis. Eventually, it expects to care for as many as 240 women a year.
Freestanding birth centers are more than a fad, Calvin said. He sees them as a way to cut costs and to reduce medical meddling in normal childbirths, while providing a safety net for those who need it.
"I think we have to provide women better options," he said.
On average, birth centers charged $2,277 in 2010 for a normal birth, compared with $8,900 at hospitals, according to the American Association of Birth Centers. That's just for the facility, not counting professional fees (for doctors or midwives) and tests.
But in hospitals, the dollars quickly add up, Calvin said, even when there's no sign of trouble. "A lot of it goes for ultrasound after ultrasound, fetal testing after fetal testing," he said. "I got to the point of saying: 'Boy, we don't do this very well. How can we do it differently?'"
Calvin's is the third independent birth center to open in the Twin Cities in three years, and is part of a growing trend. Nationwide, the number of birth centers has grown 30 percent in just five years, reaching 240 today, said Kate Bauer, executive director of the American Association of Birth Centers. Only about 2 percent of U.S. babies are not born in hospitals, she said, but interest has been soaring since passage of the 2010 health law, which requires Medicaid to cover birth-center deliveries. That same year, Minnesota started licensing birth centers for the first time.
Calvin knew that his center would ruffle some feathers in the medical community. He set up right across the street from Abbott Northwestern Hospital, which is building a $50 million Mother Baby Center. It includes a labor and delivery unit, with neighboring Children's Hospital. Abbott officials would not comment, but issued a brief statement saying: "We believe the hospital is the safest birth place, and within that environment, we do our best to honor every mother's birth plan."
'Like a bed and breakfast'
Calvin raided his retirement fund -- about $1 million -- to buy and renovate a blighted two-story Victorian at 2606 Chicago Av. He jokingly calls it his "401-K" house.
Today, the birth center is awash in warm hues and homey touches. Each of the two "birthing rooms" features a queen-size bed, designer sheets and pillows, a whirlpool bath, soft lighting and private bathroom. The only visible sign that this is a clinic is a stethoscope hanging from a dark-wood hutch; other medical equipment is tucked discretely inside the furniture.
"The room itself feels more like a bed and breakfast than a hospital," said Catherine Tong, 29, who is expecting her third child this month. "I never considered a home birth, because I'm scared that something could happen," she said. But after two hospital births, she jumped at the chance to become one of the center's first patients.
"I feel like the birthing center is the perfect kind of middle ground."
Tanya Muller, the center's nurse midwife director, said women can choose from multiple delivery methods -- on a stool, in the whirlpool, on hands and knees -- "anywhere you want."
The staff also is clear on what they won't do.
"You all realize there's no pain management, no medication," said Mary-Signe Kelly, a nurse midwife, as three prospective couples toured the facility. They use only natural methods to mitigate pain, and they screen patients carefully to ensure that they're low risk -- meaning no twins or women who have had C-sections.
The birth center, staffed by three nurse midwives and a nurse, charges a package rate of $8,500, which includes midwife fees, prenatal care, labor and delivery, and post-partum care. For now, it's covered as an out-of-network provider by major health insurance plans, but the staff hopes to negotiate contracts with all of them.
The two other birth centers in the Twin Cities -- Morning Star in St. Louis Park and Health Foundations in St. Paul -- are owned by midwives and operate somewhat differently. But they share Calvin's philosophy, said Paula Bernini Feigal, Morning Star's owner.
"The pendulum is swinging," she said.
"We don't need to [treat] normal, low-risk women as if they're obstetrical emergencies waiting to happen."
Calvin noted that birth centers have been endorsed by the American College of Obstetrics and Gynecology as a safer alternative to home births.
'Playing the odds'
Calvin estimated that 10 to 15 percent of the patients who start out at the birth center will transfer to the hospital because of complications. But at his center, unlike most others, the midwives have hospital admitting privileges, meaning they can accompany patients to Abbott and continue to treat them there.
In addition, a physician group of newborn specialists has agreed to drop in at the center to assess a baby, if needed.
Dr. Virginia Lupo, head of obstetrics at Hennepin County Medical Center, said birth centers may be an "attractive alternative" to many women, but that they should realize they're playing the odds.
"I have seen the most normal labor turn bad at the last moment unexpectedly," she said. No one can predict who's going to have an easy delivery, Lupo said, and even with good backup, "it's only a matter of time until something happens."
But Jennifer Lindquist, who's expecting her first child in January, doesn't seem worried.
"I have more qualms ... giving birth in a hospital," she said. At 39, she says she'd actually prefer a home birth, but her husband, David Shannon, is more comfortable with the birth center.
Nicole Collins-Kwong, 31, who is due in February, said she felt the same. "I trust that they'll have the care in place to get me what I need, especially being directly across the street from Abbott," she said. "It's like you're close, but not quite there."
Maura Lerner • 612-673-7384