Mary Carol Akers looks in the trunk of her car before she leaves for work to make sure she has all the necessary tools for her job.
"You can see the oxygen tank, medications. I've got catheter kits and IVs, anything mother and baby might need," she says.
Akers makes a lot of house calls. She is a certified midwife serving Hardin and surrounding counties in central Kentucky. The retired Army lieutenant colonel has delivered babies at military hospitals throughout the world, and over the course of her career, she estimates she has delivered six thousand babies.
In the car with Akers on her way to a house call, she explains why some women choose not to give birth at a hospital.
"I think that one of the things about birth centers and midwifery is high touch and low tech, and high touch and low tech require a lot more work than putting them on the monitor and going to the desk to watch it from there," explains Akers. "I've also seen women go to the hospital with a birth plan in mind and be bullied out of it."
The kind of relationship Akers builds with her clients was on display during a recent visit to the home of Brittanie Watson. Akers took a look at Watson's chart and assessed the progress of both mother and baby.
"Brittanie is due March 25th, but she's contracting like she's not going to wait quite that long," says Akers. "So the 25th of March makes you today 36 weeks."
Watson will soon deliver her third child. Delivery will be nothing new, but the method will be. She's chosen to have this baby at home.
"It's just more comfortable...and it's safe," remarks Watson. "I never enjoyed the car ride to the hospital. The hospital was a little better the second time around because I had a midwife, but it was still a hospital and as soon as I got there, they pushed interventions that I did not want or need."
Midwife Mary Carol Akers visits and develops a relationship with an expectant mom long before her due date.
"We have the relationship where we text or call each other any timer, Akers says. "She called me one evening when she was having pretty strong contractions and it was too early, so we talked through it. I asked if she wanted me to come over and she said 'Well, give it a while', and she texted me a few minutes later and said 'It's over. I'm going back to bed.'"
Establishing that relationship erased reservations Brittanie and her husband had about a home birth.
"That really eased my husband's mind after talking with Mary Carol. He's a hundred percent on board. She walked through what we would do in an emergency, and yes, we're close enough to a hospital if there was something that came up," says Watson. "We trust hurt and trust the process."
After a goodbye hug from Brittanie, Akers is back in her car and on the road to another client's house.
"This is a client whose baby I delivered a few months ago. We're going to be assessing her for postpartum depression and doing some followup care," explains Akers.
That client is military wife Shannon Huffer. She and her husband were living in Texas during her first pregnancy. Trying to decide between a natural or drug-assisted birth, she polled her friends about which option to choose.
"I had friends on both sides of the aisle," stated Huffer. "Some friends were like, 'Are you kidding me? Natural child birth is like natural dentistry, you just don't do it.' I had one specific friend in Austin who had five of her six children at home. Her first one was in the hospital and her next five were at home."
Shannon was pleasantly surprised when she chose to have her first child in a birthing center.
"It feels more like you're walking into a hotel suite, "exclaims Huffer. "You've got a queen size bed, a nice little bassinet, a bubbly tub. It's all private and you have your midwife and her assistant, and that's the only people that come in and out of the room, so you're so relaxed."
The birthing center, Shannon says, was a more intimate environment and allowed her husband to be more involved in the delivery
"My husband gets in the hot tub with me, hold me while I'm laboring. He actually caught our son and cut the cord, and afterwards, still in the same suite, they bathed the baby and handed him back to me. I started breast-feeding, my husband beside me, so we got to be a family in a relaxed environment," says Huffer.
After the couple moved to Kentucky, Shannon, who was pregnant again, was surprised to find out there were no birthing centers in the Bluegrass State.
"I was expecting one here almost more so because my midwife in Texas told me about the midwifery school in eastern Kentucky. I looked all around and thought I was going to have to go to a birthing center in Indiana," says Huffer.
At her home in Hardin County, Shannon's baby sleeps in a swing rocking back and forth. It's in this same room that five-month-old Akira was born. Absent a birthing center, Shannon considers herself fortunate to have found Mary Carol Akers.
The practicing midwife of 32 years wants to give women in Kentucky more birthing options. She has applied to open the first alternative birthing center in the state. Akers maintains Kentucky is losing business to neighboring Indiana and Tennessee.
"Kentucky is losing some potential clients because they're leaving the state to have the birth they want," comments Akers. One said 'I bleed blue and I wanted my baby to have a Kentucky birth certificate, but I needed to birth in my own way more than I needed the birth certificate.'"
This week, Akers will testify at a certificate of need hearing in Frankfort. Akers' application says the proposed birthing center would have spacious suites to accommodate "normal uncomplicated births." Mothers would not be confined to beds or even their rooms, nor would they be encumbered with monitors and IVs. The facility would have three midwives on staff and a physician's presence.
Three hospitals oppose her plans. Dr. Stephen Toadvine, Vice President and Chief Medical Officer of Hardin Memorial Hospital in Elizabethtown, says the hospital has a full range of obstetrical services, as well as midwives who practice there.
"We also offer alternative birthing plans for the mothers who are interested, so we don't really see that this is bringing a new service to our area," says Toadvine.
The hospitals say it's not about losing their monopoly on labor and delivery. Instead, they say it's about patient safety.
"We know from national studies that emergencies are a small percentage of the cases at birthing centers," concedes Toadvine. "It's a situation where unpredictably there is a sudden emergency and a threat to the health of the mother and baby. When we get into that kind of situation, minutes are crucial to the survival and health of the infant, particularly in regard to brain injury."
Midwife Mary Carol Akers says the land where she has chosen to build her facility is less than five minutes away from the hospital.
A decision from the state on whether she can open Kentucky's first birthing center is expected in April. Everyone has a birth story, and in Akers' view, a mother should be able to write her own story.