Rebeckah Orton - Astoria Birth Center and Family Medicine

Founder of Astoria Birth Center and Family Medicine, Rebeckah Orton tells her story of what led her down this path, and the ups and downs she encountered.

 She is committed to focusing on things that help women. "When we fully support women and families, we all win."

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Find me on my website: jan-johnson.com

Transcript

Jan Johnson

0:01

Well, hello, today we have the privilege of talking to Rebecca Orton, who is the founder of the Astoria Birth Center and Family Medicine. And, Rebecka, can you tell us a little bit of how that started and what kind of things lead you to be able to do that?

Rebeckah

0:21

Yeah, that's a long story Jan. Someday I will write a book. But the condensed version is that I am from Astoria, and grew up here, I was actually born at the local hospital. And as I grew up, so I moved away after high school and went to college and lived all around the world. And we came back about five years ago, and I had noticed something that I hadn't noticed growing up. And one of them was, among other things that had changed, one of the things that had remained very much of options for women, for women's health care and for birth. Historically, if you're from Astoria and you're pregnant, you have the option of delivering in one of the two local hospitals, depending on if you're closer to Astoria your Seaside, or you can have a home birth. If you want anything outside of those options, you need to travel to Portland, which leaves you with a two

Jan Johnson

1:23

options. Although I had a midwife when I was pregnant with Kyle, I had a midwife that came but it was not anything like a doula or anything that there was a lot of checking in with it was she was there at the last minute.

Rebeckah

1:41

And it makes sense to me that that's the way it is. And starting, you know, we only have about 400 births per month in Clatsop. County. So comparatively, it's rural, it's small. But even here, even with 400 births, you have the same problem that you kind of run into in a big city, that when you have a lot of people, you have to manage a lot of people, which means you have to have a pretty regimented one size fits most, if not all approach, right. And the trouble is that that works for a lot of medicine, and works for emergency medicine, it works for you know, when I'm going to go to the hospital, you know, hemorrhaging to death, or if I've broken leg or a car accident, and thank heavens for that. The trouble is that inherently, there's nothing wrong with being pregnant. It's not, it's not a pathology. It can be involved with them for sure, and requires medical care. But largely, there's just nothing wrong with being pregnant or having a baby and so it doesn't need to be regimented, one size fits all approach, there's a lot of room to have a really nice experience and to have what you want and to have your preferences, but we don't usually operate within a system that allows for that.

Jan Johnson

2:58

Right? And do you think there is maybe educating the needs to go on with women is to other options?

Rebeckah

3:07

Absolutely. It would be the number one, if I could have my list of wants, and everybody has them. I think number one on my list would be that everybody knows what is available to them. And that they know their rights, and that they know, a lot of information that I even feel that I was shielded from, not maliciously, but it just wasn't information that organically came up when I was pregnant, that I had all of these choices that I had all of these rights that I could just because the whole system was built into like, what I was saying this one size fits all type, right? Can you just sort of accept that? Right? 

Jan Johnson

3:48

And on one side, I thought it was great that I didn't have to stay in the hospital for eight days, like my mother did. That I could get out that very same day. That was pretty, pretty great. I thought things were going pretty good.

Rebeckah

4:03

Yeah, I mean, if you look at, like our grandmothers or our great grandmother's, depending on how old we are, a lot of them were sent to lying in clinics, they were put out with ether, or given I think it was scopolamine I can't remember the name of the drug. And then they were tied down originally with leather straps. And then when they noticed they were leaving marks, they changed the lamb's wool, not because you shouldn't tie around because you shouldn't leave a mark when you do it. And then they were given forced enemas and forced episiotomes and they were delivering in the least advantageous position and then they woke up, cleaned up in a separate bed with a clean dressed baby that they've never met. It was probably there's probably our grandma

Jan Johnson

4:48

and without a partner a spouse with you.

Rebeckah

4:51

Right? Yeah, no, no barriers. No.

Jan Johnson

4:53

Right.

Rebeckah

4:55

It sure it's gotten better.

Jan Johnson

4:59

So then give us a little bit of a background of, you know, where you came from, what did you study to get started? And how did this path come?

Rebeckah

5:09

Yeah, we talked about this off radio a little bit before. But it really this is sort of the culmination of a life, not really have an idea or have a couple of ideas over the last few years. But I've always known that this was my field. In one way or another since I've been a kid that I wanted to work with mothers and babies with birthing people, and children. And so some of the background is that I studied biology that I had intended to study high risk obstetrics, and then realize that that wasn't the path for me because my interest didn't lie in intervening with big problems, but in mitigating them. And that's when I became aware of midwifery it was I wasn't I wasn't until right about when it was going to graduate, I was studying for the MCAT to apply to medical school. It wasn't what I wanted. And the more I learned about Midwifery, the more it made a tremendous amount of sense. And then looking at the international standards, all of the nations with the best outcomes and birth in the world employ midwives. When you're pregnant, you just see a midwife first, because why wouldn't you do that?

Jan Johnson

6:20

What country has the best birthing rate?

Rebeckah

6:23

Well, it varies. I keep my tabs on the top five. So you have like the Netherlands, Sweden, England, Italy, Japan, it's a lot of European countries, but Japan always ranks very highly for birth outcomes.

Jan Johnson

6:38

And does Japan have a lot of midwives too? 

Rebeckah

6:42

They all have obstetricians, for sure. It's just the model of care when you're pregnant, you first see a midwife, almost always, unless there's something that's known that requires a higher acuity requires a different knowledge set. The one that I, the nation that I like to watch the most closely is the Netherlands, because they have the highest homebirth as birth center rate in the world, and they have the least expensive maternal health care system in the developed world, which just baffles me how they have these phenomenal outcomes. But I've talked to just some Dutch people and some Dutch midwives and Dutch government officials as well. Not very forthcoming. I called them and, and I said, Hey, so you know, I'm back. I'm calling from the United States. And they said, you know, so our outcomes aren't great. And yours are really good. He's like, Yeah, we know. This, like, we know that you guys a little bit stuck in this. This is why I'm calling to find out what makes your program so good. He's like, Sure, I'll send it to you in a What's your email, sent me a 28 page manual. That was their entire maternal health care system. It was the whole thing. It's beautifully simple. But what it basically starts with is that when you're pregnant, you see a midwife. And then if you need an obstetrician, certainly you shall have one. If you need a hospital, certainly you shall have one. But um, birth isn't viewed as an inherently complicated event.

Jan Johnson

8:19

So midwives are trained enough to be able to spot specific things that would be cause for alarm, just cause for pause? Yeah. How did COVID affect things?

Rebeckah

8:31

Well, so I, you know, with the little bit of background, that this is really a lifelong endeavor that my interests lie with maternal health with really supporting families, the family unit, because if you want to change, everybody has to choose what hill they're going to die on. But it's occurred to me that my contribution to society is going to be in supporting the family unit in as many manifestations. And so that's the foundation. And it was something I always knew that I wanted to do. But then, so COVID happened, what didn't COVID touch. So we own this building downtown, and we had hooked up at a birth center in it and like, I don't know, 10 or 15 years, like later -nebulous later that we all have in our in our drawer somewhere. And so we own this building, and the renters were very happy. It was a yoga studio in a dental office, and we were actually we were researching birth, and also having a family vacation in Denmark, and our renters called two days apart because COVID was just starting ,

Jan Johnson

9:35

oh,

Rebeckah

9:36

maybe we shouldn't be taking this vacation. Yeah. And they called anyway, and they said, Hey, we can't pay our rent. Gulp. So first the yoga studio, and then the dental office said, Hey, we're not gonna be able to pay rent either. We've been shut down. We're not making money. We can't pay you. So then here we are the landlords and we live off of partially off of this income. And we thought, well, that's not great. So we called our bank What happens when ou renters don't pay rent? And so fortunately, they were gracious and gave us a deferral for a little while. But then the yoga studio called us back and they said, Actually, we're never going to be able to pay rent again, because with the new restrictions on an athletic studio, they will never have enough people in here at once to make it work.

Jan Johnson

10:18

And you didn't know how long it was gonna last? 

Rebeckah

10:23

No, we didn't. And the dental office that you know, we're going to recover will be okay, we just need, you know, some time off here. And so we're okay with that. But then we have this opportunity that's like, well, we have this space, and we had hoped somebody would be a birth center. Let's call the hospital. Would you guys like to use this space? Because I know you're coming up with your surge. They called it a surge plan for like, what would happen if we had all these cases? What would we do? And I was like, Well, I'm worried about pregnant people still. Do you want to use this space? And they were like, oh, yeah, that that could be an idea. So I did all the legwork with the state to see

Jan Johnson

10:57

That that was brilliant. 

Rebeckah

10:58

I was like, well, thank you. But I'm so desperate, because the space but it's also that that's where it really comes down to is like, when you choose what you're going to do, if it has to be the meeting of what will meet your needs, your physical needs. And what also answers to that, like inherent? I don't know the responsibility to that calling. Does that make sense? 

Jan Johnson

11:20

Yes, it does make sense.

Rebeckah

11:21

that that hill that you will die on and so for me, and so I need to be more shameless about saying I have to make money, too. So there. So we went to the hospital, I said, Do you want to use the space in there? They said, Yeah, write us a proposal. So I wrote the proposal. And then we never had a surge. So they never needed it. But I'd already done all of the legwork to figure out okay, so maybe starting a birth center isn't I mean, it was hard. I never once thought that this would be easy. But then we're like, well, let's maybe just do it. And so we did a little research, some digging around, talked to people having babies talked to midwives, talked to other birth centers, went through all these trainings, and just this tremendous effort in gathering information and and crunching numbers to see if this would be feasible. And ultimately, we're like, alright, let's do it.

Jan Johnson

12:12

And your husband was all on board with this. 

Rebeckah

12:14

Yeah, shockingly.

Jan Johnson

12:19

Which really helps. Tell me a little bit about you being a doula before that. Talk to us about what a doula does, and how that kind of played into your wanting to do the birth center?

Rebeckah

12:31

Sure. So I had graduated in biology and I went into research because if you don't go to medical school, so I was doing research. And then I started sort of after I'd had a couple of kids was turning my attention back towards graduate school in midwifery. A lot of the Graduate Schools wanted you to have doula experience. I was like, what what's a doula and what do they do? And so I went through doula training and takes like two weeks, it's about like tantamount to CNA training. I've done both, it would say that they're similar in what they require. Not one's medical one's not medical, but amount of time. Anyway, so I went through doula training and having all of that like biological background and all of that research background I'm hearing all this data that they're throwing out very casually, about how having a doula present with someone having a baby reduces the overall risk of a cesarean by like 30%.

Jan Johnson

13:21

Unbelievable 

Rebeckah

13:23

And it gets even better because then there's indicated versus non indicated cesarean and non indicated means there's not like a super good reason that we did it we just did it did it. It reduces the nonindicated because 

Jan Johnson

13:34

maybe you could plan your day. 

Rebeckah

13:36

Sure. And I mean electively like people choose them. This isn't just like you know, evil doctors. I love doctors so if you're out there don't get the wrong idea. So anyway, but non indicated cesareans reduces the risk of non indicated cesarean inn this one study by 80 to 90%. Wow, just by having the person Wow. And having that support. 

Jan Johnson

13:58

So describe to us what a doula does.

Rebeckah

14:01

Oh, yeah. So a doula is, strictly speaking and non medical support person. And so people have birth coaches, things like that. But really, it comes from a poorly chosen Greek word, which actually means a woman slave. And that's not great. But let's be honest about what it is. And they've sort of changed it and opted it to meaning like a woman who serves. Now there are men who were doulas and so, just, it's now the name of the profession, the actual etiology of the word. So it's a person who comes normally they visit, do a home visit a couple times before the birth to hear about what that person's plan is for their birth or help them for a c-section or an induction or I want like a, you know, in a stream in the woods with a fox like how people just they want things. So they listen to that and help them to plan for those things. Whatever they are, their job is to not have a pony in the race, but to help that person to get what they want out of their experience and also to help set reasonable expectations. Like if you want a stream birth with Fox, like, perhaps we need to have some compromises if you have to be at the hospital, right? There's things we can do and some things we can't. They help us set realistic expectations. And then at the time of labor, oftentimes, they'll go to that person before they go to their chosen place of birth, and help them to establish their pattern and the rhythm and the breathing and the comfort metrics, because giving birth is a very athletic event. So it's like having a hands on personal trainer the whole time and to help your partner as well, to know how to be supportive, because a lot of people have like, never done this before. Right? And so yeah, they help whoever is having the baby, but then who, whoever is the partner, if there is one in that situation, and they stay the whole time, like the whole time. I think my personal record is I think, 42 hours. So my long is a week's worth. And then I know a doula who worked for me who Her record was 51 hours. I don't recommend that. But

Jan Johnson

15:59

yeah, yeah, it happens.

Rebeckah

16:01

And then they visit home as well, to make sure that their postpartum recovery is going well. Breastfeeding is going well. They're connected to resources, they're able to process their experience. That's a big deal to talk to your birth afterwards. So it's not rocket science. It's not hard academically, I should say.

Jan Johnson

16:17

And so you have, yeah, so you have some doulas that are associated with the birth center. 

Rebeckah

16:27

No actually, oh, this is separate. I started the organization because I wanted there to be less and while I very much enjoyed my time working as a doula as well, it was never my endgame to be one. It was my endgame that there were doulas.

Jan Johnson

16:40

Okay, and in this area before you brought them here, there were none?

Rebeckah

16:45

I have heard here and there that a person may have practiced as a doula. And so now there is a doula organization and for a while we taught childbirth education as well. Now they teach it or they taught it through the hospital, teach it independently. I have transitioned Northstar Doula Service to Sara Henry, she's the current owner. Who also owns Lumen downtown. And so she runs it.

Jan Johnson

17:12

Okay. So you have that Birth Center, and it is beautifully located on the Columbia River with big windows to look out. A person walks in to the Astoria Birth Center, and she's maybe a couple months pregnant or whatever. What's the process? Does she have to have insurance? How do you involve the family? I know, you involve the families with the husband, partner, and you even have a little family room for specialized place for you to feel comfortable with. Tell me some of the philosophy of of how it looks and why you have it that way.

Rebeckah

18:00

Sure. I tell this to everyone that I can. So if you've heard me say it before, then sorry. More than once. So when we when we give tours, I always tell people this, that everything that's in there is connected to a piece of data somewhere. Because that's very important to me. The reason that there's the doula organization is because that's a heavily evidence based service. It's very inexpensive to produce. And it has tremendous impact on birth outcomes. It's one of the most effective interventions and it's been said by a prominent figure in the doula community, who's an obstetrician. He said, If a doula were a drug, it would be unethical not to use it. So likewise, everything that's in the birth center is based on that, because I thought, well, now we have an opportunity to employ all of this data, right? It's out there, but why aren't we doing these things not readily available? Why was not everyone seeing a midwife? Why are we withholding food from people when they're pregnant? A very archaic process. Yeah, I understand. If you have a scheduled C section, like Yeah, but like in labor, you get hungry from time to time. Like if you're running a marathon, like you gotta keep up. And so there's some silly when you think about it, silly things like that, like you shouldn't withhold food from pregnant people. So we have a kitchen. And so I start with the kitchen to show like you shouldn't withhold food for people. And we talk about how we give everyone $100 credit to any local restaurant, which also supports any of our partners for their celebration. They have their baby, they can bring food, we can scramble an egg, or something in the oven for them, because they should eat. And so when somebody first comes to us to answer your question, we give them a tour so that they can see the beds, they can see the rooms they can see our gigantic tubs, they can see that it's homey, that it is very like a home with some significant added benefits, but not the least of which is the fact that someone else would clean up

Jan Johnson

19:58

And when I've gone in there I've noticed there isn't like a lot of medical equipment.

Rebeckah

20:03

Oh, there is you just don't see it. Yes, it is hiding because you don't need to see it unless you need to see it. Because one of the things about being pregnant is this entire new hormonal cocktail that's like flowing through your veins, that makes you vulnerable inherently. And it's not bad. It's good. It makes you rely on your community, it opens your heart and helps you to be able to bond with a baby. And rebond with your partner if you have one and helps you to rely on your community to build like each baby builds a community, which is a cool thing to think about. Think about your entire family up to your second cousin, oh, you had a kid they're affected by. So it's important for this is important. Anyway, the way that we treat pregnant people is critically important because not only are they more vulnerable, they have possibly, arguably the most power to change society because they're a generation of humans. Look at our current leadership. How were they born?

Jan Johnson

21:11

I don't know.

Rebeckah

21:13

What would happen if we had, you know, the gal that we hired to consult on our design , she said that what would happen if we had an entire generation of people born into love? Born into security? And so that factors into the place that, when people walk in, we want them to feel at home, we want them to feel like they can really breathe, and really be able to relax and let go and let birth happen the way that it can.

Jan Johnson

21:41

Yeah. Have you had since you've opened, have you had two birds at the same time?

Rebeckah

21:48

Just one/ It's unlikely to end it wasn't two births, it was two labors . Yeah, they were both.

Jan Johnson

21:56

So if a woman start to give birth, and you were seeing some issues, then what's the next step?

Rebeckah

22:06

Oh, that. I mean, very much is situation specific. So if that situation indicates that that person requires the care of a hospital, then we transfer to the hospital, right,

Jan Johnson

22:18

And fortunately, you're close enough. Very close. Yeah. And you have a fairly good relationship with the hospital.

Rebeckah

22:24

Yeah, yeah, we love the providers there. They meet with us regularly now, which is nice. And we talk about, you know, how we can improve experience for our clients that are transferring either from us to them or from them to us, and how we can work together to improve communication and things like that. So yeah, the that's going really well, I realized it was question. I didn't answer that when people come in, like,

Jan Johnson

22:46

so I just kind of go through. Yeah. 

Rebeckah

22:50

it's federally mandated birth centers, freestanding birth centers, like ours need to be covered by health insurance. Okay. And so we take like, all the insurances. Now, sometimes we're in network, sometimes we're out of network. So we're having like, fight with the insurance company. But we will always do that. 

Jan Johnson

23:03

So that's good to know. 

Rebeckah

23:04

Yeah, we do take that our visits look a little bit different. Just as per the midwifery model of care visits usually lasts about an hour, because it's critically important to the success of that birth

Jan Johnson

23:15

because you're developing a relationship 

Rebeckah

23:21

To have that relationship. That client needs to know the midwife. She needs to know their family, she needs to know the preferences. They need to have a really rock solid understanding of how birth works, so that they don't get in there and it hurts and they're like, Oh, I didn't know that was going to happen. A lot of times. No, I mean, never too late. But we spend a lot of time setting realistic expectations.

Jan Johnson

23:44

Yeah, and then I also noticed that you do massage,

Rebeckah

23:47

Yes, we have a massage therapist. She's wonderful. You can see she

Jan Johnson

23:53

is wonderful. She is wonderful. I know from personal experience. She's amazing. Okay, let's see. And so now you're expanding your business just a little bit. So you've got family medicine. Tell us about that. 

Rebeckah

24:07

There's this fantastic family practice across the street. It's Dr. Nygaard and Astoria Integrated Family Medicine. Girl I love that woman. She's just one of those few health care providers that you can really call a healer. You know, she just her science is, her craft and her passion. And one of the problems is she's overrun. so many clients and needs additional help. And so I was talking with her and I said, Well, hey, what if we hire another nurse midwife, that's also an FNP family nurse practitioner, and she can work with you and work with us. And then we can have like three providers. And we can all help each other and she'd like to attend birth too, but being on call 24 hours a day is not gonna work. She's got kids. And so that way we can do Call to see if she can attend some births, we can help take some of the weight off the family practice and it's going well. It's so much work. It's going well. So now people that come to us, one of our big complaints from our clients was after they're done with us, and they have to go someplace else. Right? And so now we can offer pediatrics and we can offer care for the whole family for their kids, for mom for dad, grandma, grandpa. 

Jan Johnson

25:25

Okay, so you're not just limiting to women, then? 

Rebeckah

25:28

No, now it's family. It's family medicine, okay. So primary care, vaccinations, whatever you normally go to the doctor for. And we can refer out for specialist visits, oncologist, or if you need extra this or that, then we just write the referral just like any other family practice, also do birth now.

Jan Johnson

25:49

This is just amazing. It's just such a wonderful thing to have in our Clatsop County just right here in Astoria, something that you don't have to go clear to Portland for anymore. And what a great experience. Well, so any other visions or you're working on anything else, you just gonna call it like, I'm gonna ride for a while and let this all...

Rebeckah

26:10

here because we've kind of been moving at breakneck pace for a while. No, because I don't ever want to lose sight. And if I ever do Jan and give you permission, publicly to punch me square in the face. That is if I ever lose sight of the fact that the reason that we are doing this is so that the individual person has excellent care, and has choices and has true healing with their health care. If it isn't, then I'm done. If I ever lose sight of that I need to be out of this field immediately. And so I don't ever want to be big. I just want to stay a small local family clinic and be able to see people for an hour and be able to really to know our clients and have them know us. And you just can't do that with you know, factory farms.

Jan Johnson

27:01

Well, and that's not what your vision was. Well, this is wonderful. Thank you so much for joining us today. This is just a delightful experience and I wish you the best