Midwife specializes in home births
North Country hospital locations widespread
Across the North Country, places to give birth are few and far between. Some expecting parents driver for hours to reach the nearest hospital. Others choose to deliver at home.
In St. Lawrence County, almost one in 10 babies is born at home. In 2022, the county’s home birth rate was 9.9%, almost 10 times higher than New York’s overall rate.
Sunday Smith is one of the only certified midwives in the North Country who practices home birth. She used to spend all her working days and nights crisscrossing the region in her car to meet every client at home.
In 2021, she opened her own birth center in Potsdam. It’s one of the only freestanding birth centers in Northern New York.
People turn to Smith — and to home birth midwives in general — because they don’t want to give birth in a hospital. Some are determined to give birth at home because of fear, expense or cultural tradition. Without home birth midwives, they would give birth alone, with no one present to read potential danger signs.
This winter, a mother in Potsdam named Jen gave birth to her seventh child. She asked that her last name not be published to maintain her family’s privacy.
“She knows me, she knows my name. And I trust her with everything in me,” Jen said of Smith.
In the cold wee hours of a Sunday morning, Smith knelt on Jen’s living room floor, pressed into the side of an inflatable birthing tub with her arms submerged in the warm water while Jen cradled her newborn. She showed the baby’s older sister how to cut the umbilical cord.
Smith weighed the baby before she left, then rushed off to the birth center to catch her 500th North Country baby.
A need for more midwives
Desiree Greenwood, a birth doula who grew up in Morristown and Ogdensburg, says the North Country desperately needs more midwives.
“A lot of women, especially in the North Country, don’t have the ability to have autonomy over their own choices because there are no options,” Greenwood said.
Greenwood is currently training as a midwife in Brooklyn. She plans to move back to the North Country once she’s certified and work as a home birth midwife. One of her goals is to provide care for people who don’t currently have good access, like migrant farmworkers.
Regina Willette is a retired North Country midwife. She attended home births here for decades.
“We need more midwives, especially midwives who are trained in community birth, and cognizant of the Amish culture,” Willette said.
Willette says the North Country’s large Amish and Mennonite populations increase its home births. Both times I visited Sunday Smith’s birth center, I saw families from those communities in the waiting room.
Smith wants her services to be accessible. She gives Amish and Mennonite families a discount of more than 50% on her regular $4,500 fee, which includes prenatal visits. If they still can’t pay, she says they find a way to work something out. One client built a brand-new wooden deck for the birth center.
Smith also takes clients with Medicaid. The reimbursements she gets aren’t as large as the ones from private insurance companies, but she says she wouldn’t feel right turning anyone away.
“That doesn’t feel like service to me. That doesn’t feel like access to me. That feels like I’m saying that this is a service for the wealthy, but what I believe is that it’s a service for the healthy,” Smith said.
Demand for Smith’s services is high — so high that she sometimes worries she can’t keep up. Last October she delivered 16 babies. She wasn’t getting enough sleep, and she said she had to ask herself whether she was rested enough to ensure her clients were as safe as possible.
Higher than average C-section rates
One reason there’s so much demand is that some women believe avoiding the hospital will make them less likely to have a C-section, a surgical procedure where a doctor cuts a mother open to deliver a baby. North Country hospitals do have higher-than-average C-section rates. For example, the latest available rate at Claxton-Hepburn Medical Center in Ogdensburg is 47%. That’s 13 percentage points higher than the state average. The rate is only slightly above the state average at Canton-Potsdam Hospital (CPH), at 38%.
Dr. Mazin Abdullah became the head of the OB/GYN department at CPH in 2018. Since then, he says the hospital has taken measures to reduce C-sections.
“C-sections are always worse than vaginal deliveries, as a general thing, so it’s something to be avoided. And it’s something to be utilized when appropriate,” Abdullah said.
Abdullah says CPH’s C-section rate has a lot to do with its geographic isolation from other large hospitals.
CPH has become the main OB/GYN unit for all of St. Lawrence County, which is geographically the largest county in the state. And it’s been serving more patients from farther away, outside St. Lawrence County, especially since the Alice Hyde maternity center in Malone closed in 2022.
Some patients have to drive hours through snow to reach the hospital. That means they arrive in a later and sometimes riskier stage of labor. The nearest high-level neonatal intensive care unit is in Syracuse, hours away by ambulance, so if Abdullah thinks a delivery might be going poorly, he will choose to operate sooner rather than later because he knows a baby in poor condition won’t make it to the NICU fast enough.
“‘Cause the alternative is a disaster — dead baby, a baby who’s damaged permanently or a mom that’s damaged permanently, or mom’s death, versus my Csection rate (being) worse,” Abdullah said.
Patient health is a big factor
Abdullah also says C-section rates are more influenced by the health of the population than by the decision-making of individual doctors.
He gave his own work as an example. Abdullah sometimes helps out at Carthage Area Hospital, right by the Fort Drum Army base.
“Their typical patient is young, healthy, athletic, eats well, not likely to be diabetic or have hypertension,” he said.
In Carthage, his personal C-section rate is only half what it is in Potsdam.
“Do I perform worse in Potsdam? Am I dumber in Potsdam? (Do) I have less experience in Potsdam? Obviously not,” Abdullah said. “I actually have better staff in Potsdam, better facilities in Potsdam and better backup in Potsdam. But when I’m in Carthage, I have these young, strong women in the military that are like perfect health.”
Doctors’ rates of performing C-sections are usually higher than midwives’ rates of sending patients to receive Csections, but Abdullah says that’s mainly because midwives see healthier patients, on average. But even the healthiest people can run into life-threatening complications. Just last week, one of Abdullah’s patients had a placental abruption.
“She lost a liter of blood. And we did everything perfect,” Abdullah said. “Now imagine if that’s at somebody’s home?”
A matter of minutes can be the difference between life and death, and Abdullah says it’s always safer to have a doctor on hand.
‘What feels safe to you’
Canton-Potsdam Hospital is just down the street from Sunday Smith’s birthing center, and Smith does send clients there often.
“I transfer about 12% of my people over to the hospital,” she said. “And we don’t call it a failed home birth. We call it smart utilization of local resources.”
Smith wants to keep expanding her practice, but she can’t do it alone. She’s waiting for more midwives to finish training and hoping they come to the North Country.
In the meantime, she’ll keep serving as many clients as she can herself. She says women come to her because she makes them feel safe.
“If what feels safe to you is all that technology, and the bright lights and the multidisciplinary team, and if that’s what feels safe to you, that’s what you should do,” Smith said. “But if what feels safe to you is soft lights, your besties taking turns rubbing your back, soft sounds, being able to move as your body guides you, if that’s what feels safe to you, then that’s what you choose.
“It’s not that one of these facilities is doing it right and the other one is doing it wrong. We’re just serving the populations in the way that they want to be served.”