There is only one place where expectant mothers in Kodiak can give birth. Elke Barnes, a Certified Professional Midwife, is planning to change that.
Barnes recently launched a new midwifery service in Kodiak, providing women the option to give birth in their homes as an alternative to Providence Kodiak Island Medical Center, the island’s only hospital.
The tradition of midwifery has long existed on the Island, Barnes said, but Kodiak went through a “dry spell” in the mid ‘90s, when there was no midwife in the town of Kodiak. Barnes has worked in Kodiak intermittently since 2010, but in recent years she has lived in Anchorage and provided only limited service to Kodiak mothers.
An avid surfer, Barnes fell in love with Kodiak at first sight.
“I’ve just really missed the island. I’ve missed being here and serving people. The families here are extremely appreciative,” she said. “When I came here I just absolutely loved it. I just felt right at home right away.”
Barnes said Kodiak has “an extreme need” for a midwife service, since there are no choices when it comes to giving birth on the island. She noted the Kodiak hospital provides “a very good” service, but not everybody wants to have a child in a hospital.
Barnes now hopes to spend half her time on The Rock. She also has hired an additional provider who will live on the island full-time. Having more than one midwife on the island allows Barnes to “cover all the bases,” ensuring that her clients will always receive the care they need.
“There will always be someone here,” she said.
Barnes is originally from Anchorage, and entered the field of maternal care with a background in biology and scientific research. In 1996 she conducted research on lactation and artificial insemination in a university setting. Eventually, she became interested in health education and doing childbirth education in a hospital environment.
Then, her second child was born at home. She was “amazed.”
“When I had my second birth at home, it totally blew my mind. It was incredible,” she said. “That’s when I started going in that direction and became a doula, and started doing labor support, and then I started training to be a midwife, so it was a long path.”
The training to become a midwife includes a three-year full-time program with extensive clinical training. It took Barnes seven years to become fully licensed and credentialed.
Alyssa DeConte, the midwife hired by Barnes, intends to move to Kodiak in April. Right now, DeConte is working in Guatemala. Another midwife may join the team later this year.
“It’s just a nice number to have three, because you ideally have two providers at each birth,” Barnes said. Having somebody in Kodiak full-time will put people at ease in case they go into labor or have any needs in the middle of the night, she said.
Barnes said her visits with clients usually last an hour, significantly longer than typical medical appointments. When it comes to client relationships, Barnes said, “we get to know their dogs and we eat out of their fridge and we play with their kids and it’s a more personal approach.
“This is how midwifery was traditionally. It was a person in the community that you knew and trusted. And it was like a grandmotherly kind of relationship,” she said. “My clients can text me any time of day or night … So we do a lot of preventive care that way, because we have a very intimate, attentive relationship.”
Barnes said she also has the advantage of not having a large caseload. Midwifery always will be “a niche market,” because there are a lot of prerequisites for having a home birth.
“We just are dedicated to a small number of healthy, motivated pregnant women,” she said. “You have to be healthy and you have to be motivated. We don’t just see anyone, because to make home birth safe, it’s a two-way street.”
Barnes said she works hard to keep mothers safe, but expects the mother to invest a lot of effort as well.
“So they have to be willing to do things like walk every day and eat well and do their research and set up their lives so they can be healthy and have a healthy birth,” Barnes said. “A lot of people aren’t interested or motivated to do that, or even able. Some people would like to have a home birth, but they’re just too high-risk.”
According to a study published in 2017, 1.6% of births in the U.S. happened in a non-hospital setting in 2017. Home births in the U.S. increased by 77% from 2004 to 2017, while birth center births more than doubled.
However, in Alaska, 7.88% of births happened outside of a hospital setting in 2017. Of those, 5.64% were in a birth center, while 1.97% were in a home setting. These numbers are significantly higher than the national average.
This might be explained by the healthcare coverage options offered in Alaska. More than 85% percent of out-of-hospital births are covered by Medicaid or private insurance in the state, a significantly higher rate compared with most other states.
Barnes said she can accept most types of health insurance, including Medicare, Blue Cross, Blue Shield, Aetna and Cigna.
While some might assume that Alaska’s high rate of home births may have to do with the higher number of remote communities, Barnes said out-of-hospital births in remote communities are actually rare due to the lack of midwives in those locations.
There are 50 midwives and nurse midwives in the state of Alaska, Barnes said, and most are concentrated in the Anchorage area.
“That’s one thing people should really value,” Barnes said. “The opportunity to have a midwife in a remote small town is exceptional.”
Barnes attributes the high rate of out-of-hospital births in Alaska to the established farming and fishing communities in the state.
“It’s popular with the commercial fishing people because they’re used to fierce independence, doing things on their own. They’re very familiar with the natural course of things. And they’re not intimidated by hard work or pain, because their job is way harder than birth. Anyone who’s worked on a fishing boat, or even a setnet site, I have no worries about them in labor, because fishing is so much harder than birth,” Barnes said. “Hard living prepares you for birth.”
By limiting her clientele, Barnes is able to provide high-quality service, achieving a 4% cesarean section rate. According to the CDC, the average cesarean section rate in the U.S. is 32% of births.
Barnes said the Kodiak hospital provides excellent care, and attributes her success rate to the time and preparation she dedicates to each of her clients.
“Women tend to birth well in privacy and uncomfortable environments, and places they’re undisturbed,” she said. “When there’s people milling about and strangers and noises, and you’re being poked and prodded and they’re making you sign papers and all that under bright lights, it tends to disturb the natural process. So it just makes it harder to have a normal birth.”
Barnes is trained in water births, herbs, massages and positioning, managing gestational diabetes, and fetal positioning.
“So even if they’re not perfect candidates for community birth and need to be in the hospital, we can do a lot of amazing preventive things for them to go along with the care that they’re getting with the doctor,” she said.
As a midwife, Barnes said she takes a unique approach to prenatal and postpartum care.
“Usually when someone has a baby, they get discharged after 24 hours or 36 if it’s a C-section,” she said. “We will go to a person’s house every single day, if they need us. For two weeks, we will be there for an hour every day, helping them recover.”
Barnes said it would not be uncommon for her to spend more than 48 hours with a new mother, which may include 14 hour-long prenatal care appointments, and 14 hour-long postpartum appointments.
“We nurture the mom because usually it’s like the mom’s the wrapper, the baby is a candy. We pay a lot of attention to the mom until she has a baby and then we just toss her out and forget about her. And so postpartum mood disorders are an epidemic. Women are definitely not supported postpartum here as much as they need to be,” she said. “So we will be there every single day, helping them get on their feet.”
Barnes says she carries three duffel bags of equipment to every home birth, including an oxygen tank, herbs, massage oils, and objects that provide physical comfort. But she acknowledged that some mothers may be uncomfortable giving birth in their home, and may want a more discreet environment. She intends to establish a birthing suite in Kodiak in the coming months.
For more information on Barnes and Kodiak’s new midwifery service, interested individuals can go to birthgoals.com.