Chilkat Valley News - Serving Haines and Klukwan, Alaska since 1966

Jackie St. Clair was serendipitously surrounded by a team of doctors and nurses with a background in birth and labor when she gave birth to her son three weeks early at the Haines Health Center on Aug. 26-the newborn was the first baby to be born at the clinic in more than 10 years.

St. Clair and her partner Woody Pahl planned to travel to Juneau on Sept. 2 in preparation for her planned delivery at the Juneau Birth Center. After her water broke on the evening of Aug. 25, she went to the clinic and medical staff said the fetus was in good health. St. Clair said she hadn't started contractions and thought she would have time to catch a morning flight to Juneau. But the baby had different plans.

"He was ready to come and there was no stopping him," St. Clair said.

Her contractions started at 1:30 a.m. and increased by 5:30 a.m.

"They called a flight crew but they were three hours out in Anchorage," St. Clair said. "The clinic staff figured they'd be delivering the baby there."

While St. Clair's baby is healthy, there are increased risk factors for babies born three weeks early. Because a fetus's liver and lungs are the last organs to develop, premature babies can sometimes have difficulty breathing, jaundice, or trouble breastfeeding. Clinic staff had to brace for those outcomes without the necessary medical equipment and staff to address worst case scenarios.

"I would not want to be in the town of Haines with any of those medical emergencies," clinic RN Aimee Creelman said. "They're not common, but they occur and they can be very, very scary surprises."

Creelman, who has 25 years of labor and delivery nursing experience, was supposed to have the day off, but was asked to come in and work half a day.

"Jackie gave birth within that half day," Creelman quipped. "The people who happened to be working that day were people who happened to have labor and delivery experience. It was an ideal combination of healthcare providers that could offer the best we had to offer."

RN Keely Baumgartner, a Haines High School graduate who formerly babysat St. Clair, was also on staff at the time. Baumgartner worked in labor and delivery for 13 years in Anchorage and Colorado after earning her nursing degree.

"It's my passion. It was awesome," Baumgartner said of delivering St. Clair's son. "Since I came (back) to Haines, I've slowly been preparing an emergency birth kit and prepping our baby supplies and doing extra training and education with staff. About two weeks before Jackie delivered, we practiced what to do for a rural birth."

Clinic staff did their best to turn the emergency room into a birthing room by dimming the lights and massaging St. Clair. Many birthing rooms or suites have specialized equipment-everything from baby lights to yoga balls or jacuzzi tubs. Baumgartner scraped together what she could to provide the necessary medical care.

"We don't have a birthing room or birthing suite. Our little cart is squeaky and it has a broken wheel. We don't have a baby light," she said. "We're in the ER of Haines where I've seen people die. I've performed CPR. I've been covered in poop. In the middle of this birth, it was quiet and calm and peaceful. It was kind of surreal."

St. Clair's baby was born without serious complications, although they did have to travel to Juneau where they treated her son for jaundice. He spent one night under a bili light, which assists a jaundiced baby's liver to break down and remove bilirubin from their blood. The new family arrived back home last week.

"For a 37-week-old baby he's super strong and alert and just thriving," she said. "He's so sweet. Oh my gosh. I just stare at him all day. I can't believe he's here."

As of Wednesday afternoon, St. Clair's son was still unnamed. While she and Pahl have a "top- five list" under consideration, they're keeping their ideas private for now, she said.

"We thought we had a couple more weeks to figure out a name," St. Clair said. "We spend every other day calling him a different name to see what works."

St. Clair said while giving birth in Haines wasn't part of her plan, clinic staff were able to give her much of what she had hoped to experience at the Juneau Birth Center. She wanted a "hands off labor" that included delayed cord clamping and no pain medication. Delayed cord clamping allows an infant to receive additional nourishment from the mother's placenta and increase its iron intake.

"You wait until that cord stops pulsing. That was honored," Creelman said of St. Clair's birth plan. "The cord is clamped and cut often by the partner, in this case Woody. Then the baby is on their own and breathing. It's all happening on the mom's chest. That was in the birth plan, that is standard of care now in birth centers."

Creelman said allowing the baby to rest on the mother's chest immediately after birth for the "golden hour" is important for mother-infant bonding. During the delivery process and the golden hour, a chemical cocktail of "love" hormones courses through the new mother's body.

"Incredible bonding is happening at that time," Creelman said. "The body has a flood of hormones, oxytocin being the primary hormone, in that first hour, which is the hormone of bonding and the hormone of love. Interestingly enough, it is the same hormone that is released during orgasm."

St. Clair said she was grateful to her "dream team" for honoring what she wanted.

"My outlook has been whatever experience we have is the experience we're supposed to have. That experience just happened to be in Haines and, overall, it was super positive," she said.

Most women travel to Juneau for three weeks in preparation for delivering their babies. Although Medicaid covers the cost of housing associated with travel, private insurance does not. Haines School social worker Vanessa Salmon wrote her master's thesis on the possible negative effects of traveling outside of one's community to give birth, including, according to her thesis, the "loss of choice and feelings of powerlessness over the birthing process, a shift in the perspective of birth as a natural process to an at-risk medical process; and the diminished value of midwifery and cultural and traditional knowledge of birthing."

She called the process of traveling outside of one's rural community "Mandated Maternal Transport."

"The linchpin of my study, which I hope compels more conversation and digging into this issue, is the belief or understanding that health insurance may not cover a pregnant individual's care if they refuse transport, and that this feels like a threat to induce compliance, since most midwives and private medical providers cannot afford the malpractice insurance necessary to provide care in rural areas," Salmon wrote to the CVN.

Dr. Stan Jones delivered babies in Haines from 1963 until the late 1980s. Jones said the increasing cost of malpractice insurance made delivering babies too expensive. "My personal opinion is it's not fair to mothers to have to be out of town for a few weeks, a month or whatever before the baby comes," Jones said.

He said he probably delivered about 25 babies a year. The most he delivered was 40 in one year.

But as Haines' population has aged, fewer babies are being born. Baumgartner said it's impractical to have a facility in Haines that specializes in labor and delivery due to the infrequency of births, an assertion echoed by SEARHC director of marketing and communications Lyndsey Schaefer. While SEARHC administrators are in discussions about building a new facility in Haines, birth services are not at this time part of the plan.

"Sitka is the only location where SEARHC provides planned birthing services and there are no current plans to change that given the low volume of births in our other communities," she said.

While Baumgartner described assisting in St. Clair's birth as "the highlight of my career," she cautioned that she "is not open for business at the Haines clinic." Baumgartner said that while she understands women's desire to give birth in the communities they live in, it's impractical in Haines. She says her peers in the medical community do see birth as a natural process, but the risks associated with labor, however rare, should be taken seriously and be prepared for.

"I've seen all the what ifs and the bad things that go wrong," Baumgartner said. "As much as it sucks to go to Juneau for three weeks, I don't want people to start delivering babies in Haines. It is so infrequent that I don't know how you would staff it or even support it."

St. Clair said women should be able to give birth "wherever they feel the safest and the most supported."

"I think it would be so incredible to have the option to have medical support for birth here," she said.