Sitting in a comfy, flower-print upholstered chair, Sunshine Tomlin asks if I want any water or hot tea. The soft colored walls are inviting and homely, welcoming guests to sit back and relax. The air is filled with the sweet smell of scented candles. It’s the calm, warm environment one would expect a loving home to be, so it makes sense this is how Tomlin would want to design her birthing center.
Located on the corner of Mission Street and Chrystal Terrace, the Full Moon Birth and Family Wellness Center is Santa Cruz’s first birthing center in more than four decades. The original Santa Cruz Birth Center was shut down in 1974, following a sting operation and raid by police resulting in the arrests of three local midwives. However, midwifery and home birthing have made strides in the past decades, with better laws and clearer understandings of what midwives actually do. Recent public interest in the commercial side of the medical industry has also led to a resurgence in natural and home birthing—inspired in part, it seems, by The Business of Being Born, a 2008 documentary produced by Ricki Lake.
“We really can thank Ricki Lake,” says Tomlin, a midwife for 12 years. “She knew the exact things to say, and the right way to say them. I’m still getting phone calls from people saying they just saw it and don’t want a hospital birth.”
As the name implies, the Full Moon Birth and Family Wellness Center is more than just a place for soon-to-be parents. The center currently has 18 employees—midwives, chiropractors, massage therapists and even an acupuncturist—along with weekly, monthly and single-day classes. Ranging from couples retreats to classes on topics like the natural development of babies and how to utilize chemicals released in the brain during birthing, Tomlin hopes Full Moon can be an alternative health center for the community.
“I want this to be a Wellness Center,” she says. “It’s not just about the births.”
Throughout human history, midwives have been assisting women throughout prenatal, childbirth and aftercare, usually in the home. Traditionally, their knowledge was passed down to apprentices through hands-on learning.
Because of changing times and laws, there are now two kinds of midwives in the U.S.: Certified Professional Midwives (CPM) and Certified Nurse Midwives (CNM). Both have to attend midwifery schools, but CNMs must also graduate from a registered nursing program.
According to the Santa Cruz Chapter of the Certified Nurse Midwives Association, approximately 1,200 CNMs are working in California, with Santa Cruz employing 35-40. Most practice out of Dominican Hospital and the Sutter Maternity and Surgery Center, but some also work with the downtown Planned Parenthood and the Salud Para la Gente Center in Watsonville.
To fully grasp why a new Birth Center and the changing times are so important to California midwives, it’s essential to understand their history of practicing under fear of arrest.
HISTORY OF MIDWIFERY IN SANTA CRUZ
“Every baby has a birth story,” Kate Bowland says with a hearty smile and chuckle. “We just don’t know what it is at first.” With more than 43 years of midwifery under her belt, Bowland has “caught” (the preferred midwife term) her fair share of babies—“a little over 1,000” she estimates. Retired in 2015, Bowland was one of the midwives arrested in 1974 for practicing medicine without a license at the original Santa Cruz Birth Center.
Established in 1971 by midwife, birthing advocate and Doctor of Oriental Medicine Raven Lang, the Victorian house located on Capitola Road near 7th Avenue employed 6-12 midwives at any given time and administered classes and prenatal care.
“It was never a freestanding birth center,” she explains. “We did a lot of home births.”
Bowland began her lifelong profession almost accidentally. While she was living in Oregon, Lang—a friend from college—invited her down to Santa Cruz to hang out. Little did she know she would be participating in her first birth, which set her on a life path that often skirted the law.
“When laws are unjust or immoral,” she wrote in the 2011 book Into These Hands: Wisdom From Midwives, “it is our responsibility to disobey.”
While she knew she was violating the law, Bowland also believed midwifery was essential to women’s rights. Even though the Santa Cruz Birth Center would not allow births within, Bowland estimates they still attended roughly 20 home births a month while active.
It was Bowland who first felt that client Terry Johnson’s chart was suspicious. In the book, Bowland explains how Johnson had missed prenatal visits, would not turn in her blood work and went into labor before her child was due. While most of the women did not want to work with Johnson, they sent two midwives out during her supposed labor anyway, out of good faith. Johnson turned out to be an undercover police officer.
“Thirty minutes later I looked out the window over the shoulder of the woman I was examining to see two cars pull up across the street,” she writes. “I knew immediately that they were plainclothes police.”
The midwives’ work at the center was illegal under California law, and Bowland—along with Jeanine Walker and Linda Bennett—were arrested. Over the course of the next three years, the women would fight their case to the California Supreme Court, where the judges returned the case to the municipal court. In 1977, the district attorney threw out the case over lack of evidence and, by that time, the laws had already begun to change.
The year the women were busted in Santa Cruz, California passed a law allowing the legal certification and practice of Nurse Midwifery in hospitals. Seeing the slow changing of the times, Bowland became a CNM in 1983, and continued her practice in hospitals. It wasn’t until 1993 that California legalized the licensed practice of midwifery. Even then, however, all midwives had to be supervised by a doctor until 2014, when the state removed that stipulation, but added others, restricting midwives from delivering twins or breech births.
But despite the struggles, Bowland remains firm in her views of the benefits of midwifery.
“Birth is one of the most important events in a person’s life,” she tells me. “Birth can be very empowering for a woman, or it can be disempowering and traumatic. While there are no guarantees a birth will be natural, midwifery supports a process of birth.”
SUNSHINE OF THE FULL MOON
Like Bowland, Tomlin didn’t always know she wanted to be a midwife. The daughter of an ER nurse and the mother of three, Tomlin didn’t begin looking into having an at-home birth until her third pregnancy.
“I was happy enough with my OB, but they tried to assign me a midwife through Medi-Cal, which I declined, because I wanted a “real doctor,’” she remembers. “When I finally learned about home birth, it was this ‘ah-ha!’ moment … Birth is normal. Birth is natural. Why are we messing with it?”
It was then she decided to enroll at the National Midwifery Institute, completing her certification in 2005. Throughout her training, she continued to work as a doula, participating in her first birth at Sutter Maternity Center in 2001. Unlike a midwife, doulas are there for emotional and physical support. As current doula and midwife-in-training Ashley Shea describes it, “a doula is a cheerleader and the midwife is the lifeguard.” Since doulas and midwives are so different by profession, a person can be a certified doula, but it is not required by law since there is no medical aspect.
After graduating, Tomlin opened Sunshine Midwifery in Ben Lomond, where she had an office for 11 years and delivered roughly 400 babies, along with participating on the board of the California Association of Midwives and as a membership director for the Bay Area Birth Information, or BABI. However, being located in Ben Lomond proved difficult for many of her clients throughout the county, so she decided to look closer to town. In May 2016, she signed the lease for the Mission Street office, and closed Sunshine Midwifery the following June.
“We’re closer to the hospital than some people in the county might live,” Tomlin says. Sometimes, complications arise during a midwife-assisted birth, and a hospital is needed. “Also, there are so many people [in Santa Cruz] who can’t afford to live in their home by themselves. They have roommates, or moved back with their parents, or their place is so small they aren’t comfortable in it. This gives them an option to have a home birth somewhere else, with the care they deserve to receive, and feel safe.”
Shea—who is in her second year of acquiring a Bachelor’s in Science from the Midwives College of Utah—agrees, with a first-hand experience.
“For my birth, I was living in a second-story apartment that was super tiny. I was so self-conscious about noise because my neighbors were right there,” she remembers. “To have a place where you can just go without worrying about pets, or your roommates or neighbors is so awesome for families to have that option.”
Shea says she always wanted to be a midwife, ever since one gave a presentation to her elementary school class. As she grew older, the idea always remained in the back of her mind, but she never knew how to find her way into the world of birthing. In 2008, she finally enrolled in doula training classes in Colorado, but thought she wasn’t prepared to do it because—at the time—she didn’t have a child of her own.
“I wish I knew then what I know now—that it’s much easier to be a doula while not being a parent,” she says with a laugh. “You can sleep all day after!”
As fate would have it, when Shea’s best friend asked her to be her doula, it was not only Shea’s first time, but Tomlin was also the midwife. Since then the two have formed a close relationship, working side by side to give women an alternative in how they want to bring life into the world.
“She’s a champion,” Tomlin says of Shea. “She’s vocal [about midwifery and home birthing], and you have to be.”
Since opening Full Moon last September—the grand opening also marked Tomlin’s 200th birth—the birthing center has made strides in becoming fully functional. Money has been raised through a three-day fundraiser, a benefit show at Don Quixote’s last month, and even a GoFundMe campaign. However, they estimate they’re still shy some $50,000 in funding, needed to install a shower, a permanent birth tub and other amenities for women in labor.
“When you think about how many people there are that want this,” Tomlin says. “Even if they gave just a little bit, it would add up so fast.”
Santa Cruz native Heidi Olson says she chose to have a home birth with midwives over going to the hospital for several reasons. When she was pregnant with her daughter two years ago, she sought out Tomlin’s care after hearing of her reputation, philosophy and care.
“I knew I couldn’t birth the way I wanted in a hospital,” Olson says. “Unfortunately we didn’t have any birth centers then … I didn’t necessarily want a home birth either, but I knew I wanted a hospital birth even less.”
She believes the birth center will open up a large array of new opportunities for soon-to-be parents, but that it might not be for everyone.
“I think women should talk to practitioners at both [hospitals and birth centers],” says Olson. “I think doing what feels right in your gut is what’s best for women. I’m just glad there’s another option here for those that want it.”
America is currently the most expensive country to give birth in. According to one study released last September by the U.K. medical journal The Lancet, out of 14 developed nations, the U.S. is “disproportionately more expensive” for hospital births than other high-income countries. Vaginal births are roughly $10,232 on average, and cesareans are $15,500 compared to Australia which is $6,775 and $10,500, respectively. A separate study released last November by The Lancet found that not only are childbirths 25 percent of all hospital discharges, but between 1996 and 2013, the cost of having a hospital birth within the country has tripled.
“My friend went to the hospital for a one-day stay, and her bill was $40,000,” says Brooke March, who teaches the Full Moon Mother’s Support Group. “Women used to give birth at home all the time. It used to be a beautiful thing where women were honored.”
Last July, the financial website marketwatch.com published a report from the healthcare information company Castlight Health that the San Francisco Bay Area is the second-most expensive place to have a child in the country—either vaginally or through cesarean—after Sacramento. Which is one of the reasons the women at Full Moon Birth are so adamant about the center.
“It’s amazing, because so many women are already afraid, because we haven’t grown up in this culture where it’s natural and normal and beautiful,” says March, whose first child was born over 52 hours in a hospital; her second was born at home in three hours. “This is what our bodies are designed for. Even when you go to the doctor for your prenatal care, it sets you up for a ‘doctor-patient’ relationship. There’s a hierarchy that’s not there with an at-home birth.”
“It’s protocol and fear,” she says. “As far as the place of litigation goes, it’s always safer to do the C-section than it is to allow someone to go 50 hours. That’s risky. What if something bad happens and they get sued?”
IN CASE OF EMERGENCY
A 2015 U.S. study in the New England Journal of Medicine found that perinatal mortality is higher among out-of-hospital births; however, the study was criticized for not taking into account factors such as lack of health insurance. It also found maternal mortality rates were at an all-time high in the last 25 years, regardless of whether the birth was in a hospital or at home.
Full Moon Birth asserts that at-home and natural births are well attended and safe, with their midwives following the pregnancy from start to finish. A typical birth is measured in 40 weeks, and the prenatal care the expecting mother receives is the same whether they go to an obstetrician or a midwife. Yet, unlike a doctor who might only spend small periods of time with a patient, the midwife makes time to get to know the patient and discover what other stresses are in their life, Tomlin says. She spends at least an hour in each face-to-face appointment with her patients, discussing dietary needs or restrictions, checking their blood pressure, measuring the uterus and feeling out their general well-being. She also does home visits on the first, third and seventh day after a birth, and then again two weeks after.
“Taking time to check in, see if they have any questions and even see how their family is doing,” she says. “The relationship that I build with people is part of what makes my care so special.”
“Also, midwives know not to take ‘high risk’ pregnancies,” March says. “There’s a screening process they give to determine whether the pregnancy is healthy.”
Because of the nature of her certification, and the way the laws are written, Tomlin has several restrictions, which is another reason to be located closer to a hospital. Tomlin, who graduated from the National Midwifery Institute in 2005, cannot administer epidurals or pain medication, nor perform cesareans. However, she is fully trained and equipped to resuscitate a newborn, stop hemorrhages and other complications that may occur.
“It’s almost never an emergency ‘right now,’” she says. “It’s more nutritional and preventative based. If the baby begins to breech, we get them to a chiropractor to see if we can fix it instead of doing a C-section.”
She estimates that of the 36-48 births a year that she administers throughout the Bay Area, about 5 percent (or two to three a year) need to be transferred to the hospital.
“It’s the spectrum of what birth could look like,” she says. “But if you start at the hospital, there are many things you can never experience.”
“The best-kept secret,” says Bowland, “is that home births are as safe as, or safer than, hospital births.”