Where to Have Your Baby

The Complete Guide to Where to Have You Baby in Tulare and Kings Counties

Where to Begin

Life has gotten a little more complicated in the 21^st Century when it comes to getting married, buying a house and starting a family. One of the biggest decisions facing new families is where to have your baby.

In the old days expectant mothers would simply give birth where their moms and grandmothers did. But in the modern world, young families don’t live where mom gave birth and they may not know the area.

They also may not realize the number of choices available.

In Tulare and Kings Counties there are three highly rated hospitals from which to choose, Kaweah Delta, Adventist Health Hanford, and Sierra View Medical Center. There are also four midwives available of varying levels of certification if an expectant mom wants to give birth at home.

With families moving into the valley from urban areas and Tulare moms not able to give birth in their home town after Tulare Regional Medical Center closed, it’s no longer assumed that a family will use the hospital closest to where they live.

Also, the completion of Highway 198 to four lanes between Hanford and Visalia makes Kaweah Delta and Adventist Hanford an attractive choice for the residents of both cities.

When a woman becomes pregnant her first job is to find an OB/GYN (Obstetrician-Gynecologist.) Who she chooses most likely is going to dictate where she is going to give birth. So researching which hospital best fits her needs is an important first step.

Doctors in Visalia are normally going to have privileges at Kaweah Delta and the same is true for doctors in Porterville and Hanford for their respective hospitals. When Tulare’s maternity ward closed two years ago  labor and delivery nurses and doctors split their services between Sierra View Medical Center and Kaweah Delta.

Moms can also request a Certified Nurse Midwife (CNM) instead of an OB/GYN to deliver her baby at any of the three hospitals. Almost all of the doctor’s offices involved with maternity care have CNMs on staff.

No matter what the mom’s preference is in primary doctor, choice of hospital or home birth, the Central Valley has her covered.

Sierra View Medical Center

The first thing you notice walking out of the elevator on the fourth floor of Sierra View Medical Center (SVMC) in Porterville is the incredible view. The snow covered mountains and foot hills buttressed by slopping orange groves might make a laboring mom forget for a minute she is in a hospital.

Probably not, but her family and friends will enjoy it.

The hospital’s entire fourth floor is devoted to maternity and the Newborn Intensive Care Unit (NICU.) SVMC’s small and private birthing center makes this the most intimate environment of the three facilities. Ample parking is also definitely a plus.

SVMC is the smallest hospital with 77 acute care beds and 4 ICU beds. But size does not matter and the hospital has a few qualities that distinguish their maternity care from the rest.

Smart Care California gave Sierra View their 2018 Achievement Award for meeting or exceeding the healthy people 2020 goal for low-risk, first-birth cesarean deliveries. To achieve this award, hospitals had to have a rate lower than 23.9%. Sierra View hospital’s overall rate of cesarean sections is an impressive 19.9%.

In addition, Leapfrog Hospital Safety Grade for episiotomies set a target rate for hospitals at 5%. Sierra View has a rate of 4.8%

In partnership with First 5 Tulare County, SVMC is also the only South Central Valley hospital to be designated as “Baby Friendly,” a designation they achieved in 2016 through encouraging and supporting new moms to breast feed.

According to Malynda Parsons, hospital public relations, “In order to receive the Baby Friendly designation SVMC implemented the Ten Steps to Successful Breastfeeding interaction and duration.” These practices include infants rooming-in with parents to maintain 24 hour interaction and encouraging skin to skin bonding between babies with both the mother and father during their stay at the hospital.

Part of the Baby Friendly protocols include the golden hour where mom and baby have skin to skin contact  and waiting at least 12 hours after delivery for baby’s first bath.

SVMC delivers approximately 1400 babies a year and has six CNMs with hospital privileges. SVMC does not accommodate moms that want a VBAC, or Vaginal Birth after C-section.

Their NICU is a level 2 that can handle babies born at 32 weeks gestation or older. Any baby born 31 weeks or younger will be delivered at, or transported to, Valley Children’s Hospital in Madera.

Sierra View’s NICU is equipped with a telemedicine link with Valley Children’s where a doctor can listen to the baby’s heart, check its blood pressure, and can visually observe the baby during the tele- conference with a SVMC NICU nurse. In addition, a Valley Children’s staff person is at SVMC 24/7 to handle any newborn or pediatric emergencies.

Adventist Health Hanford

When I met Amanda Jaurigui, communications director for Adventist Hanford, I was shocked to see they had a separate building for their birthing center. Three years ago Adventists Hanford opened its new birthing center in conjunction with Valley Children’s so now moms don’t check in at the emergency room but have their own private hospital.

Hanford is the size of Porterville so I asked Jaurigui how a small rural town could support such a large facility. Adventist delivers approximately 2400 babies a year and Jaurigui said the rooms are almost always full.

She pointed out that unlike SVMC that primarily serves Porterville, Adventist serves an entire county and then some. Adventist serves all of Kings and parts of Fresno County such as Coalinga that recently lost their hospital. Lemoore Naval Air Force Base, with all of their young families, also are regular clients.

Rebecca Mathews of perinatal services said their new state of the art facility creates a soothing peaceful environment. She added, “Our nurses are our best patient advocates. They love what they do. The nurses will make the birth the best experience ever.

Their new state of the art facility also has its own NICU level 2 six bed capacity room equipped with telemedicine and its own waiting area. Like SVMC only babies 32 weeks or older are born at the hospital. In the event of an extreme emergency Adventist has a helipad available to transport the baby and mother to Valley Children’s.

The birthing center has a baby store with gifts, baby necessities, and all the breast feeding equipment mom will need.

But best of all, Adventist birthing center has their own fully stocked café with baked goods, sandwiches and Starbucks coffee enjoyed not only by families but hospital staff. Mathews says that it’s becoming more often that the first thing a mom asks for after delivery is a cup of coffee.

Adventist Hanford is a medium sized hospital with 151 acute and 22 ICU beds and are happy to accommodate VBACs. They have three CNMs with hospital privileges. Leapfrog Hospital Safety Grade has reported that Adventist Hanford rate of Cesarean sections is 28.7% and their rate of episiotomies is 1.8%

Kaweah Delta Medical Center

Kaweah Delta is the largest hospital in the South Central Valley, eclipsing Bakersfield hospitals with 407 acute care beds and 41 ICU beds. The sheer size of Kaweah Delta provides the widest range of health services to an expectant mother facing a normal or high risk pregnancy. Handling higher risk pregnancies pushed their c-section rate to 32% and their episiotomy rate is at 6.3%.

Labor and delivery, along with a brand new operating room for c-sections, is on the 2^nd floor of the Acequia Wing. Recovery rooms are on the third floor and the new NICU will be on the sixth. The hospital has 21 labor and delivery beds and 42 postpartum beds. They deliver 5000 babies a year and are equipped to handle VBACs. A few of the recovery rooms are doubles but those are only used when the hospital is at full capacity.

Tracie Plunkett, Director of Maternal Child Health, said that their patient load increased by 20 births a month after Tulare Regional closed.

An expanded labor and delivery triage area allows pregnant women to receive faster and more private care. The area is where women, who are past 20 weeks gestation, receive treatment for a variety of health concerns related to pregnancy – signs of pre-term labor, mild cramping, pain, etc.

In the new area, patient beds are separated by walls and will also be seen by an obstetrician who will be in-house 24 hours, seven days a week, Sawyer said.

Kaweah Delta has a level 3 NICU, meaning they can take care of babies that would normally be of transported to Valley Children’s. Kaweah Delta’s NICU and Pediatrics Units are run by Kaweah Delta with medical staffing provided by Valley Children’s Medical Group.

But things are only going to get better in terms of serving the Central Valley’s tiniest patients.

This fall Kaweah Delta’s NICU is moving into the previously unoccupied sixth floor and expanding to a 15 NICU beds and 8 Neonatal Intermediate Care Beds facility where mom or dad can spend the night. Each room features large windows, soft lighting, personal refrigerators for breast milk or formula, and a sofa bed. These single-family units are designed for individualized care and invite more participation from parents who will have 24 hour access to their babies.

“Our goal is to support the care of the entire family not just the infant,” said Felicia Vaughn NICU nurse manager.

Moving to the sixth floor gives the staff more space to have their own nurses’ station, a classroom for trainings, a medication room, and a large supply area.

Vaughn said, “We’re caring for smaller, sicker babies and keeping our commitment to the community by keeping them close to home.”

There are 24 OB/GYNs that serve Kaweah Delta and three CNMs.  Rita Barron, a CNM, has delivered 7400 babies in 35 years and now works out of Visalia OB/GYN Medical Associates. In the beginning of her career she delivered a few babies at home but is wary that some midwives currently practicing in Tulare County are doing home births who have very little medical training and no certification. After becoming a nurse practitioner she received her midwife certification at Stanford.

Barron said some patients request a CNM because they might be afraid of doctors. Also, CNMs spend more time with their patients. “It’s more time spent person to person,” said Barron.

Adventist Health Tulare

Kevin Northcraft, Chair of the Tulare Hospital Board, said that getting Tulare Hospital’s maternity ward open is a priority this summer. “Whole generations of families have given birth there.”

According to Melinda Righi, Adventist Tulare communications manager, the first phase of renovations to the Tulare hospital valued at more than $10 million has begun in the hospital’s obstetrics department in anticipation of a July re-opening.

“We are giving the entire department a ‘design refresh’ with new equipment, new furniture, new flooring and, most importantly, a new infant security system,” said Associate Chief Nursing Officer Sheri Pereira, who oversees obstetrics services for the Central Valley Network. “We are very excited to re-open the OB and start delivering babies in Tulare. This is extra special to me because I was born in this hospital.”

When completed, the OB department will have 11 patient rooms and two triage beds, plus an infant nursery.

“Reopening our OB department is essential to the well-being of this community, and one of the service lines we are most anxious to restore,” said Randy Dodd, President of Adventist Health Tulare. “We can’t wait to welcome the first baby born this summer at Adventist Health and future generations born in Tulare.”

All hospitals

Thirty years ago moms-to-be were encouraged to make a birth plan before they arrived at the hospital. They would outline such things as whether or not they wanted an epidural or natural child birth or who would be their labor coach.

Labor and delivery nurses now say that birth plans are rare, and if a mom did have one, it was the first thing out the window once labor started. One nurse stated that those moms that did arrive with a birth plan usually ended up getting a c-section.

While no two births are the same, Tulare and Kings County hospitals are similar enough that a laboring mom could have the same experience at all three.

All offer child birth classes, tours of their birthing center, and encourage breast feeding. A lactation specialist will visit each new mom in their recovery room and all have a lactation resource center, breast feeding classes, a choice of breast pumps, bottles.

All nurses support a mom’s decision whether they choose to bottle feed or nurse. “We are either going to make the baby the best breast feeder or best bottle feeder,” said the head nurse of labor and delivery at SVMC.

All hospitals strongly suggest giving the newborn a vitamin K shot in one leg and a hepatitis B vaccine in the other. Nurses also put Azithromycin jell on the baby’s eyelids to avoid eye infections.

For practical and safety reasons the number of people allowed to attend the birth is three or four and only one person besides the mom can spend the night. No filming is allowed during the birth which surprised me after watching about a hundred babies being born on the 1990’s show “A Baby Story.”

All hospitals have professional photography services of your newborn offering portrait packages, birth announcements, and keepsakes.

None of the hospitals offer water births.

Laboring mothers will be moved three times and almost all are required to have an IV. The expectant mom first goes to triage, then a labor and delivery room, then are finally moved to a recovery room. This is more for the efficient use of hospital space than for the health of the mother. Kaiser Hospital and Maternity hospitals such as Alta Bates in Berkeley never move the mother and IVs for low risk pregnancies are optional.

For those moms who want to make their own rules, have a water birth, or just don’t like the medical protocols of a hospital, then home births are an available option.

Home Births

Detreh Hele is a retired Certified Nurse Midwife from Fresno who used to do 30 to 50 home births a year. Of those births, four or five would be in Tulare and Kings County. Her medical partner, Alex Michel, also from Fresno, took over Hele’s practice and will deliver babies at home in Tulare and Kings County. There are two other midwives from Fresno that do home births in our area and a midwife that lives in Visalia that is in the process of getting certified.

The midwives that do home births in Tulare and Kings Counties all have varying levels of certification, and some none at all.

Hele said there were three major reasons women preferred to have their babies at home. One, they had a bad experience in the hospital the first time. Second, a friend or family member had a home birth and finally, some moms have a fear of hospitals.

The one huge drawback to home birth is that no pain relief is available except a hot shower, tea, or a kind hand.

Once you are in active labor at home, as Millennials would say, there are no “take-backsies.”

Also, home births are not covered by insurance and will be paid all out of pocket.

With an experienced midwife the risks of having a child at home are the same as in a hospital. Complications are rare and at Kaweah Delta less than 10% of the babies end up in the NICU.

Hele said about three to five percent of her patients end up delivering at a hospital because of complications that manifests before labor starts. Less than 1% of home births are transported to a hospital due to an emergency.

Hele’s overall c-section rate was only one to two percent even including those that delivered at a hospital. One reason for Hele’s low c-section rate is that midwives only accept low risk pregnancies, but that’s not the whole story.

As explained above, most hospital deliveries are low risk, but their c-section rates are on average 25% or higher. Hele believes that most c-sections are doctor induced because the OB/GYN interferes with the labor. Also, a laboring mother’s mobility is restricted by the IV and monitoring equipment.

According to a report in the Journal of Perinatal Education, 47 percent of women have their labor artificially accelerated with medications, and 43 percent of women giving birth for the first time have labor artificially induced.

When using a midwife interventions are used only when medically necessary.

Hele’s advice to lowering the c-section rate?  “Leave the woman alone.”

For any woman considering a home birth, Alex Michel can answer your questions, offer her services, or direct you to the other midwives that do home births in Tulare and Kings County. Her number is 559 760-2282

From all of the Staff at the Valley Voice – Happy Mother’s Day

For a region that struggles to provide adequate health care for its residents its reassuring that Kaweah Delta, Adventist Hanford, and Sierra View Medical Center is at the ready to provide the best birthing experience possible.

So to all you expectant mothers, put your feet up and have a happy Mother’s Day. Our local hospitals and midwives have you covered and soon you will saying hello to your newest little bundle of joy!