The Business of Birthing

Answering what they say is a call by local women for more natural choices in birthing, a team of providers are opening The Renaissance Center, Tulsa’s first birth and naturopathic center.
Operated by three midwives brought together by that common goal, the center, at 1217 E. 33rd St., will open March 14.
Tiffany Koss, DEM, is an independent midwife who has been practicing in the Tulsa area for six years. She, along with Heather Forrest, who is training to become a certified professional midwife, and Kerrie Long, ND, who is a midwife, lactation specialist and naturopathic doctor, own and operate The Renaissance Center, which houses Renaissance Maternity Care, Renaissance Naturopathic Care and Renaissance Chiropractic Care.
All of the services provided at The Renaissance Center are geared primarily toward women and children and include midwifery care, naturopathic care, chiropractic care, massage therapy, doula and monitrice care, fertility specialty, lactation specialty, grief counseling, child birth classes (both hospital and homebirth specific), breastfeeding education classes and a variety of support groups. The center is privately funded by its co-owners.
Their approach to business is characterized by the same desire to provide warmth and comfort to birthing mothers.
“Initially, I hadn’t planned on doing this until my son (who is 3 years old) was a little bit older,” said Koss.
But, she received a phone call from Long, who is from Tulsa but was living in the Los Angeles area and exploring the possibility of moving back to town.
“My daughter (who is 14 years old) had asked me for some time to move back to Tulsa,” said Long over the phone as movers packed up her California home. “I told her, ‘If I can do my work there, we can go.’”
Long began making contact with local practitioners, calling and e-mailing midwives, chiropractors and other naturopathic doctors in Tulsa to find out how their practices were being received in Tulsa and what the likelihood of hers being successful was. Long was a practicing midwife, lactation specialist and grief counselor who was finishing her doctorate in naturopathy.
She made contact with Koss in November 2008, and, as both women explained, “we just hit it off.”
Together, they put down onto paper what they thought Tulsa’s needs were, what they’d like to offer and how they’d like to do it. By January, they had seen and signed a lease on a space in the small business center just off of Peoria Avenue where the center is located. They two women had only met face-to-face one time.
Home Care
The Renaissance Center has a decidedly homey feel, even though it was nearly empty when the Tulsa Business Journal visited. Koss and Forrest had just begun moving in, but the space is warm and inviting and resembles a house both inside and out.
The front room of the 1,800-SF space acts as a reception area. Koss’ office occupies one room, and there is one birthing room, an office for Long, an office for a resident chiropractor (Carlene Bolen, who practices in Broken Arrow, will offer her services a couple of times a week until Koss can either hire someone full-time or convince Bolen to stay on full-time) and a kitchen.
Koss’s office consists of a small desk, a couple of comfy chairs and a futon, which acts as her version of a medical table, on which she examines her patients (though she refers to them as her “moms”). The birth room, she said, will be set up much like a bedroom, with a bed and a portable tub so moms have the option of having a water birth. Most of her patients, though, will still birth their babies at home, she said.
“A lot of women are interested in having a birth with a midwife and having that experience, but they either live too far away from a hospital or they live in areas where the labor and delivery units have shut down, which a lot of the smaller towns are doing. Or, they just feel more comfortable going somewhere else.
“We’re not going to be that big of a difference between someone having a baby at home and someone having a baby here. A lot of women can just make that shift in their head, that they’re going somewhere else and they’re more comfortable there,” Koss said.
She said the center will also serve women living in areas of Oklahoma, Kansas and Missouri who don’t have access to a midwife. She has had moms travel hours both out of state and within the state in order to birth their babies with her. Before opening the center, those women would sometimes have their babies in Koss’ home.
Warm Welcome
Koss recognizes that naturopathy and midwifery are still somewhat new concepts to many in Tulsa.
“I think most mainstream people think (about midwifery), ‘People still do that?’ I think a lot of people have the perception that a midwife is a hippie, bra-burning rebel,” said Koss.
But, enough people are considering midwives for their births over doctors and naturopathic medicine over conventional medicine that the women found this center necessary.
The partners point out that, with the majority of babies born in Oklahoma born in hospitals, many of their births are marked by intravenous medication, fetal monitoring and other medical intervention. About a third of them end in cesarean section, they said.
Koss and Long said their services are in demand because many women have become disgruntled at their births being treated like medical conditions rather than natural occurrences which their bodies are capable of handling.
Koss said the response so far, even in such a short amount of time, has been very positive. She said she’s received encouragement in the form of phone calls, e-mails and letters.
Likewise, Long said, after speaking to a few local practitioners and deciding to move here and start her practice with Koss, “I started receiving e-mails from other practitioners saying, ‘Are you really coming? Because we need you.’”
“I lived in the (Tulsa) area when I had my daughter 14 years ago. (The prevalence of naturopathic doctors and midwives) has grown leaps and bounds from what it was then in terms of interest,” said Long. “I’m hearing Tulsa is up-and-coming in embracing this and learning to take care of themselves.”
Because there are no laws legalizing or outlawing naturopathy and midwifery in the state, it is not regulated and therefore not covered by insurance. That can have positive and negative affects on how Long and Koss conduct their business, both said.
“It’s less complicated to practice here because it (naturopathy) is not uniformly regulated in every state,” said Long. “Different states have different regulations, and in California, the market is quite saturated. That’s why I’m so excited, because, at this point, Tulsa hasn’t had this. Oklahoma hasn’t had this.”
“(The lack of regulation) hinders (my practice) because insurance doesn’t cover midwives and Soonercare doesn’t, which is unfortunate because not everyone can afford a homebirth,” said Koss. “Aside from that, as long as you’re practicing responsibly, it doesn’t make a whole lot of difference.”
Koss does not carry malpractice insurance, because there is none available in the state for midwives to take out. And since she doesn’t have to carry the extra, expensive insurance that prevents most obstetricians in the state from attending VBACs (vaginal births after cesarean), she can provide women who’ve previously delivered by c-section a birth option most obstetricians can’t.
In states where midwifery is legal and regulated, midwives have the option of carrying malpractice insurance, but it is not required of them.
“If you practice responsibility, there’s no reason to. If you’re doing what you’re supposed to do, if you’re not taking chances that you shouldn’t be taking, there’s no need to carry stuff like that,” said Koss
“I don’t worry about being sued. I just don’t. Because I don’t do anything that would cause me to get sued. If something ever happened to one of my moms or one of my babies, I don’t know if I could go on practicing. It has nothing to do with being sued. I would be devastated,” she continued.
Alternative Medicine
Koss said her practice is similar to that of obstetricians in some ways. She conducts her visits similarly—“I check urine, blood pressure, pulse, weight. I palpate for position of the baby, do measurements, listen to the baby’s heart tones, do blood work,” she said. “I do pretty much everything except the ultrasound and genetic-type testing.”
She encourages her moms to visit a doctor for at least one ultrasound during pregnancy and provides them with information regarding genetic testing, should they decide that is necessary. She works with a doctor out of SouthCrest who provides ultrasounds and other services to her patients.
Unlike obstetricians, Koss will not induce a mom who is overdue unless it becomes medically necessary, and she will not send a mom to a hospital for a c-section unless it becomes medically necessary.
Koss has attended about 120 births, and her transport rate, both before and during labor, is about 10 percent, she said.
Maternity services at The Renaissance Center cost $3,000 and include lab work, birth supplies, doula services, use of the birth tub, six weeks post-natal care for mom and baby and access to Long during pregnancy and three months postpartum for any wellness needs.
Long offers naturopathic care for ailments like colds, stomach problems, heartburn, menopause, fertility, endometriosis, ovarian cysts and more. She will also offer grief counseling at the center and teach a variety of classes, including childbirth and breastfeeding education classes.
Long’s fees for clients who are not pregnant run about $120 for the first visit and $90 for any visit thereafter, though she said one person should not need more than about three visits.
Chiropractic and other services have varying fees.
Because insurance doesn’t cover care at The Renaissance Center, the providers there say they are willing to work with clients on payment plans and, in some cases, accept trade for some services.
Both Koss and Long say the thing that sets their practices apart from medical practices is the amount of time spent with each patient or client. Typical visits with Koss and Long can last anywhere between 45 minutes to an hour and a half, and both say they spend as much time getting to know their clients emotionally and psychologically as they do physically. It’s how, they say, they treat the whole person.

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