Updated: Oct 4, 2021
There are only two birth centers that come up when you Google "Phoenix Birth Centers", and I have now worked with both. The differences between them are mind boggling, so much so that I felt it necessary to write this blog outlining my experience under the care of each and giving an honest review of their practices.
My hope is that this article will save others the stress, mistreatment, shaming, time, and money that I had endured and spent. I have not had my baby yet, so I will be updating this blog as time goes on until baby Lux is born. Again, my focus will be on my prenatal care throughout this pregnancy.
Blossom Birth Center
My journey with Blossom began last year when I was pregnant with my first baby. I've spent a lot of time working in the health field and have come to appreciate the route of least intervention when it comes to health and wellbeing. With pregnancy, that means letting the body do what nature intended, and a birth center seemed like the best option for that.
Another reason why I wanted to work with a birth center was because they have a better track record of respecting mommas' autonomy and ability to make informed decisions. Hospital staff tend to be poor at communicating the nuances of every decision you need to make and often just make decisions for you, which I find to be completely unethical in many situations, but necessary in others such as in life saving interventions.
Now, for those mommas' that do opt for the conventional hospital route, I'm not discounting its potential value. Some women need to go that route for medical reasons, and other women may simply feel safer working with an OBGYN. For me, I have a lot of negative experiences in hospital care and would prefer to avoid it if possible. If I do end up needing to birth in a hospital because of complications down the road, then I'll be prepared with a doula and other advocates for my care.
Collectively, these were some of the foundations through which Blossom initially appealed to me. They advertise empowering women to be in control of their birth experience, giving personalized care to women with respect and dignity, allowing the birthing process to happen naturally within their facility, and having an OBGYN on staff to provide additional support if needed, such as heading up any hospital birth that ends up being required.
Unfortunately, I didn't have an empowering or dignified experience at Blossom.
One of the biggest issues I have with many folks in the medical field is that they are led by their ego. They think their credentials or experience grants them superiority over those they work with, which ultimately limits their ability to provide truly patient-centered care. I try to avoid working with these types as much as possible unless an emergency warrants it. We often forget that we hire our medical professionals due to the authoritarian nature of standard allopathic medicine.
Most of the staff at Blossom was respectful, but their two primary midwives (Mary and Erin) fit into this egoic category. The most common time it showed was when I would ask questions about my care, almost as if they interpreted my inquisitive nature as an attack on their knowledge and experience. The reality was that I just wanted to understand the rationale for decisions regarding my care.
Nothing degrades patient trust like “do what you’re told"
I'm not passive when it comes to my life. I ask questions. I seek understanding. Birth centers are meant to be patient-directed care, and yet I was scolded, shamed, and treated as a burden whenever I'd try to start directing my care. It did not at all seem like their goal was to help me make informed decisions, but rather to dictate to me what they believed was in my best interest.
And I'm not the only person who has been treated this way. I encourage you to look at other reviews too (Yelp, Facebook, Google, etc.). Some individuals had experiences similar to mine, while others had wonderful experiences opposite of me. I can only assume that these latter folks were the types who quietly do what they're told, don't ask many questions, regularly praise the midwives (stroke their egos), and don't have much background in medicine, scientific research, or integrative healthcare.
It's easy to think that birth centers in general are a great option if you are familiar with only the allopathic model of care, or have experienced only hospital births. If Blossom seems like a good fit for you, then I truly hope you have the birthing experience you've wished for. Many women have. For me, they weren't a good fit.
Aside from an incongruity of personalities, Blossom has some questionable billing practices that warrant caution. Even among women who had a great birthing experience, the financial side of things left a bad taste in their mouth per other reviews. I had a similar experience.
The overall financial agreement seems simple: You pay $5000 maximum for all prenatal care and the birth itself. Where things become complicated is when you want to understand how health insurance is involved, primarily because Blossom wants you to prepay the $5000 by 32 weeks gestation, or else they terminate your care.
Alex (my husband) and I had one hell of a time trying to understand how they could be contracted with our health insurance and expect payment for services not yet rendered. After spending a couple hours on the phone with their financial person, as well as in person with the owner (Mary), it became clear that they worked on a "good faith" basis where you prepay the amount, they bill your insurance at time of birth, and then you are refunded what insurance pays (if anything, assuming you have met your deductible).
We didn't have an issue with this billing practice because the up-front collection is simply a precaution against someone receiving prenatal care, giving birth in their facility, and then disregarding the bill for whatever reason. They are a small practice, so I can appreciate their desire to take precautions.
Where the issues popped up for us was (1) when we inquired about all of this and (2) when we left the practice. As mentioned, we talked to Blossom's billing person over the phone and to the head midwife / owner (Mary) in person. Their financial agreement was not easily understood when it came to how insurance was involved, and Mary did not take kindly to us trying to understand the nuances of their billing practices. She even told us several times that we could just go somewhere else if we didn't trust them.
Then, when they terminated care with us at 23 weeks gestation, they did not refund any money that we had prepaid towards the global cost. Rather, they said they would bill insurance for all the prenatal visits we had with them and keep what we owed. First, why would they not just do this from the get-go and bill insurance at services rendered? Second, this was despite them assuring us that they would refund the money if we ended up needing a hospital birth or other care for whatever reason.
Blossom wanted us to operate on a good faith basis with trust between us, so we did, and we ended up getting betrayed. Kudos, Blossom, for not giving the same trust you demand of your clients nor keeping your word in good faith.
This issue was compounded by the fact that they would be billing our insurance for all the "problem visits" I had, rather than just billing us for the standard of prenatal care. I put the term in quotes because it's Blossom's terminology, not mine, and because there was no medical "problem" that these visits addressed.
Blossom is huge on monitoring serum progesterone levels throughout pregnancy, which is likely due to he head midwife / owner (Mary) being an advocate of the Creighton Model FertilityCare System (CrMS) and Natural Procreative (NaPro) technology.
The CrMS and NaPro technologies are the developments of the Saint Paul VI Institute for the Study of Human Reproduction, founded by Thomas Hilgers, MD in 1985. Basically, they are based on empowering women to take charge of their body by charting various hormonal biomarkers throughout the menstrual cycle and using such information to help inform decisions regarding fertility and other reproductive disorders.
This method of reproductive care came about because the Catholic Church is strongly against assisted reproductive technologies like in vitro fertilization (IVF) and intrauterine insemination (IUI), claiming they are morally unacceptable acts against God. So, obviously this Catholic man (Dr. Hilgers) saw an opportunity to help women constrained by religious beliefs. Notably, the head midwife / owner (Mary) is catholic, so her embracement of this system makes sense.
Now, I became pregnant by working with my phenomenal reproductive endocrinologist to diagnosis my fertility problems and implement medicated strategies to overcome them. You can read about this part of my journey here. Part of that involved looking at hormones throughout my menstrual cycle, similar to what NaPro does, so I'm certainly not against charting and becoming more aware of your own biology. In fact, I support it.
What I don't support is unscientific prenatal care.
The big overarching problem with NaPro is that there is very limited credible evidence to support its efficacy. Most of the evidence comes from decades of observation by the Pope Paul VI Institute, observations that have not been peer-reviewed, are prone to confounding, and amount to no more than aggregated anecdotes (the plural of which is not data).
Of the few peer-reviewed studies available (published in 2008, 2012, and 2021), all are authored by the same family physician from the University of Utah, Dr. Joseph Stanford, and all are simply observational studies in which infertile couples undergo care with NaPro and have their pregnancy and birth outcomes reported. There is no way of isolating the effect of NaPro and determining that it was the cause of any observed outcomes, an intrinsic limitation of observational research.
More importantly, none of these studies deal with the whole of pregnancy, just conception. My issue with Blossom was that I had "problem visits" to monitor my progesterone without any good reason for why it mattered. Mary just wanted me to line-up with a chart she got from the Pope Paul VI Institute to reduce my risk of preterm labor. I had no indication that I was at risk of preterm labor (such as a previous preterm birth, short cervix, multiple pregnancy, etc.). So treating me based off her chart that has ample literature to refute it's validity, was akin to treating me based on an energy reading.
I was using vaginal progesterone during my first trimester, at the request of my reproductive endocrinologist, because progesterone levels matter greatly after conception to prevent miscarriage, particularly in women with a history of recurrent miscarriages, PCOS, and luteal phase defect (like me).
But, he said that I could come off the progesterone around 14 weeks gestation because the risk of miscarriage by that time is much lower and the placenta should be pumping out plenty of progesterone to support fetal growth. After that (i.e., second and third trimesters), there isn't a strong basis for using exogenous progesterone to prevent preterm labor or stillbirth.
Yet, Mary has a handy dandy chart printed out to give to clients showing what their serum progesterone levels should be and prescribes progesterone to chase that number. These were my "problem visits" that I'm being billed for, despite no medical basis. Worse yet, I was being lectured about how I needed to hit that number if I didn't want to lose my baby.
This is actually a perfect example of why integrative medicine comes under attack by allopathic medicine as quackery or pseudoscience. Practices like Blossom bill for unnecessary procedures saying "you will lose your baby unless you do X, Y, and Z". Of course the scared mother-to-be will agree to these tests under those circumstances, especially when they have little to no knowledge on the subject or ability to obtain such knowledge.
I'm going to share my experience with direct reference to the individuals I worked with because I think it may help give some more background information.
Blossom From My Perspective
If you want a birth center that adheres to “do no harm”, this is not the birth center for you.
I was let go as a patient of Blossom at 23 weeks gestation in response to how I answered a sensitive question asked by one of the primary midwives, Erin Yocom. She had asked if I was vaccinated against Sars-CoV-2, to which I replied with a simple "no". Rather than drop the issue and move forward with the remainder of my appointment, she pressed the issue with comments about how all major pregnancy organizations recommend vaccination during pregnancy. I assertively stated "and we think that is highly unethical."
Silence paired with an eye-roll from Erin...
The remainder of the visit was uneventful, and we received a phone call 15 minutes after it ended telling us of our termination as clients of Blossom. I knew she didn’t like my response, but I never would have thought a birth center would terminate prenatal care at 23 weeks over a rather benign expression of opinion when pressed on a given topic.
Everyone tells pregnant women they are at an increased risk of severe COVID outcomes, but no one tells them by how much. A recent study out of Israel followed 10,000 pregnant women and 10,000 non-pregnant women matched for demographics, none of whom had been previously infected by Sars-CoV-2 (which provides greater immunity than vaccination does). Over the course of nearly three months, only 3% of unvaccinated pregnant women were infected, only 1.5% had a symptomatic infection, only 0.3% were hospitalized, and only 0.05% had a severe case of COVID.
The vaccine definitely further reduced the likelihood of these events occurring, providing 96% protection against infection and 89% protection against hospitalization with full vaccination (i.e., at least a week after the second dose), but the risk was already so small! In fact, the number of severe cases of COVID were so few that the researchers couldn't even perform a statistical analysis to compare to the vaccinated group, and no deaths occurred.
As far as vaccine safety goes, we have only observational studies currently available. One such study looking at over 4,000 pregnant women in Israel found no differences in pregnancy, birth, or newborn complications between the 20% that were vaccinated and the 80% that weren't. In another study, similar conclusions were reached when outcomes of vaccinated pregnant women in the US were compared to historical averages.
But these observations can only get us so far, and the randomized placebo-controlled trial we desperately need to discern causal effects of vaccination in pregnant women is not planned to be completed until October, 2022. Even then, the women recruited into this trial must be in the second or third trimesters and not at an increased risk for complications, meaning it can't be extrapolated to women in the first trimester, or to women with recurrent miscarriages, or to those with gestational diabetes, and so forth.
As someone who spent over a year doing fertility treatments and who has had multiple past miscarriages, I'm not going to take any chances with vaccination, and I shouldn't be shamed for making that choice.
Now, if Erin wanted to have a discussion about my rationale for not being vaccinated, which I summarized above, then I would have gladly conversed. But that didn't happen; she didn't even ask if I wanted to talk about it. Although, if I'm being honest, I doubt she would have been familiar with the hard data I laid out above given her appeals to authority.
Anyway, the entire final appointment was strange. Blossom had us meet for most of it outdoors in 104-degree weather, with masks and social distancing required. We were under cover that provided some shade, but such practices are still strange, particularly when dealing with pregnant women who show no signs of being infected with Sars-CoV-2 (I filled out a questionnaire prior to every appointment).
One could say that they are almost scared of their patients and, consequently, treat them like contagious lesser beings. I wouldn't normally conclude such things from interactions like mine alone, but others have left reviews on Google that add weight to this view. One women was even required to drive to a drug store and take a COVID test while in labor before she could enter the birth center (like, why didn't they have tests on hand or a protocol for these situations?). That is a huge issue because when you plan to deliver a baby at a birth center you labor as long as possible at home.
In short, Blossom provided me with an excessively stressful and traumatic experience as someone who has struggled to become pregnant and has had recurrent miscarriages. To have to suddenly need to find a new birth center at 23 weeks gestation is unimaginable, especially after tolerating being shamed, bullied, and treated like a lesser human.
As far as my thoughts on the individuals working at Blossom...
Dr. Nichelle Whitehead, OBGYN, had good bedside manner, was logical with her thoughts, and communicated clearly and directly. The office made her sound like a strict or harsh monster, but I think that's just because they are much more emotional and interpret direct communication as some kind of attack like they did with me. I personally liked Nichelle and thought she was very polite and well-spoken.
Mary Langlois, CPM, was polite and professional on most days if I just smiled and nodded when she talked. The only times I ever engaged in conversation with her gave me some uncomfortable vibes because she would become defensive, try to establish control over me as her patient rather than us being cooperative equals, and talk negatively about anonymous patients she has had.
Erin Yocom, CPM, was egoic and hostile with her communication. Talking to her always left me feeling unheard, as she had a habit of being dismissive of my inquires or using passive-aggressive tactics to shame me. She also seems to be the most fearful of COVID at Blossom, to the extent that it greatly inhibits her ability to care for her patients. After all, she was the reason Blossom let me go, simply because I disagreed with her opinion. She also seems to be intolerant of strong boundaries and obtains ego satisfaction by forcing her beliefs on others, which is certainly not compatible with midwifery.
Office Staff were always friendly and helpful. While Blossom was largely disorganized and had issues with timely communication, I'm not sure this is an issue with the office staff per se. Mary and Erin definitely seemed to point fingers at the new receptionist, Sidney Mertens, when it came to complaints on these issues. Yet, you'll find reviews on the exact same issues that precede Sidney's time at Blossom by years, so I think it is simply a larger issue with how Blossom is operated as a business.
All in all, my primary issue with Blossom, and the one that I recommend you consider strongly, is that they don't appreciate the importance of informed consent and individuality. That is, they make you come to them rather than trying to meet you halfway, and if you don't do as they say, they'll simply fire you as their patient (something they reserve the right to do at any time).
Ethical midwifery prides itself on giving patients as much information as possible so that the patient can make informed decisions about their own care. While they certainly provide their professional and personal opinions, they do not coerce or scare patients into action, something that was common with Blossom.
I'm going to leave with an excerpt from Ina May's Guide To Childbirth;
The pregnant woman is in a uniquely vulnerable position. There is the fear of losing her provider should she speak up. She may anger him or her, and then what? There is such a national perception that turning control over to a doctor is the only option because he/she will always have your best interest in mind that it makes coercion so easy as to be insidious to the patient and the provider.
Blossom From Alex's Perspective
My wife was terminated as a client of Blossom, over the phone, 10-15 minutes following our monthly check-up visit, at 23 weeks pregnant. A suitable explanation was not provided, simply that we were not a good fit.
In retrospect, termination was probably for the best, as there were a number of issues we had with Blossom that we had overlooked due to the simple desire to have a healthy baby under a more holistic and natural setting.
I'll do my best to succinctly explain these issues and our experience surrounding them. I will not be talking about specific individuals, but instead focusing on our care as a whole.
ISSUE #1: Blossom does not work well with assertive, inquisitive, and self-advocating individuals.
My wife and I both work in the health industry, with my career in particular being that of medical and nutritional research writing. We like to (1) understand the rationale, whether scientific or not, for the decisions our healthcare providers make, (2) perform literature searchers and reviews on our own time about topics we are unsure about, and (3) form our own conclusions and decisions about our healthcare. We are both direct with our communication and like to have a complete understanding about our prenatal care. This necessarily involves asking, at times difficult, questions about the scientific underpinnings of their recommendations.
We believe this contributed to our termination, as there were times when our comments, questions, or clarifications on scientific findings were taken personally as an attack on their knowledge, when instead our only goal was to have a complete understanding of our care.
One example of this related to pregnancy nutrition, as we tried to inquire about Blossom's opinion regarding weight gain and calorie intake (to supplement our own knowledge), and they could not provide an answer beyond that we should gain 25-35 pounds in total during pregnancy. It was evident that they did not have special knowledge regarding pregnancy nutrition, and our inquiry seemed to offend them.
Another example relates to progesterone, as we were curious about why they monitor it throughout pregnancy despite virtually no clinical research showing that it improves birth outcomes past the first trimester. Similarly, they didn't seem to be aware of key pharmacokinetic differences between vaginal and oral progesterone, which leads to vastly different serum levels despite having equivalent outcomes (if not vaginal superiority) when compared in head-to-head trials. It really felt like they were just chasing a number without considering the bigger picture of care or route of progesterone administration.
Lastly, we had issues with vaccination against Sars-CoV-2 (which causes COVID-19). They strongly recommended that my wife be vaccinated, and politely declined. Instead of just letting the issue go, they continued to press with fallacious appeals to authority by mentioning that all major organizations recommend it, and then had the audacity to be offended when my wife stated very directly, "and we think that is highly unethical". The conversation ended after that, with the midwife clearly being upset.
Note, our decision here is not uninformed. The only safety data available for pregnant women is retrospective observational data, which has never before in the history of medicine been adequate to make such a recommendation. Current randomized controlled trials are not set to complete until the end of 2023. My wife made an informed decision for her health, and it's completely absurd that a birthing center would attempt to shame us for this.
Fundamentally, Blossom's ideal client seems to be someone who is passive about their prenatal care and simply does what they are told without question.
ISSUE #2: Blossom is disorganized and has poor communication.
It took weeks for Blossom to obtain medical records for my wife. After our anatomy scan, for example, they did not have the results for weeks afterwards, despite us seeing them in person and calling. They stated they would request the records again, yet the issue didn't resolve until I called the anatomy scan location and asked them to re-send the results to Blossom. They had also told me they had initially sent them the day of the scan and hadn't been contacted by Blossom since, despite Blossom saying they would.
Another issue was that Blossom had poor follow-up on blood labs for progesterone, despite my wife's serum levels being "too low" for what Blossom likes to see. Most times after the results were in her patient portal, we needed to call Blossom to discuss them rather than being called by them.
Lastly, Blossom refused to talk with me over the phone about my wife's care despite my wife releasing her medical information to me by signing appropriate doccuments and personally requesting that they speak with me because I was more informed about the scientific evidence around certain issues like progesterone administration. It was frustrating and prevented having the most productive conversation possible.
ISSUE #3: Blossom has an unclear financial agreement and unusual billing practices.
Blossom was contracted with our insurance, and it wasn't made clear in the financial agreement how insurance played into things, particularly because they expected payment in full before birthing services were rendered, at which point they stated they would run the birth through insurance.
We spent a great deal of time over the phone and in person trying to understand how everything worked because insurance is not an area of knowledge for either me nor my wife, but Blossom appeared to be annoyed by our desire to have a crystal-clear understanding of the financial agreement. They made dismissive comments about how we could simply find somewhere else if we didn't trust them.
This issue was compounded further by their refusal to talk with my mother about all this, despite our request because my mother has 30+ years working in health and benefits directly with insurance companies. She is the best person to understand the nuances and then communicate back to us in simple terms, but Blossom had no desire to help us understand. They just wanted us to "trust them".
Baby Moon Inn
Deep breath... WOW.
Alex gave them a call the day of my termination from Blossom and they had us come in for an appointment the very next day. We received a tour of the facility, talked about every important detail of prenatal care that I didn't know existed, and even had an appointment with a midwife who was between established clients.
Baby Moon Inn was professional, organized, knowledgeable, kind, funny, relaxed, and a complete polar opposite of my experience with Blossom, all in under 2 hours. I felt welcomed and cared for almost immediately.
I will not be completing my review of Baby Moon Inn until after birth, but I've had enough interactions where I feel that I can point out some major differences between it and Blossom for those of you trying to decide where to receive your prenatal care. As such, what follows will be primarily a brief comparison rather than an in-depth review (which will come in a future blog about my birth experience).
From the time I walked into Babymoon Inn, the entire operation was different. The office was organized, clean, everyone was smiling, and the appointments are held inside an air conditioned building with masks optional. I was not treated as a nuisance that had the plague.
Our first visit started with an orientation to see if Babymoon Inn was the right fit for us, and I learned more about their core philosophies in 60 minutes than I did in the months that I worked with Blossom. They are a patient-centered facility that believes in personalized evidence-based care. They aren't just claiming to be, they embody it, which was obvious to my husband and I from the first time we visited. They were aware of the reasons Blossom didn't work out for me and didn't shame me for my decisions; instead they offered me respect and honored my autonomy.
Our first appointment with the midwife was around an hour of just getting to know one another, collecting health history, and teaching me about their practices around birth. There was a strikingly apparent lack of ego in these conversations that made them much more productive. I wasn't told once to find somewhere else if I didn't trust them when I asked simple questions (as Mary did at Blossom), or attacked for asking all the same questions in regards to my health (as Erin did at Blossom).
A huge thing to note is that I feel safe at this practice due to the information given at each visit, informed consent put into practice, and their midwives superior credentials. Feeling free from fear and feeling like their team can adequately care for me if something was to go wrong is a huge asset to a natural birth.
Blossom markets their business as having an OB on staff. That’s their “gotcha”. Despite a number of reviews where their patients ended up at the hospital without Nichelle anywhere in sight for the duration of the birth. But something that I thought was interesting is that Babymoon has a OB on call if you have an emergency and need to birth in the hospital. The OB has a staff of midwifes and practices informed consent. Their team will ensure you have your wishes honored in a hospital setting. Babymoon also sends one of their Doulas to the hospital if you end up there!
Babymoon Inn is around the same cost as Blossom, with so many more perks that it's going to be hard to summarize them all here but I will try my best. Some are at an additional cost like chiropractic care and physical therapy, but the rest are included in the birth package. None, and I mean none, of this was offered at Blossom.
Healthy Prenatal Pregnancy Group
Mind-body Movement Prenatal Group
Mama-baby Hour with Belly Mapping
5 Week Lamaze Series
Back to Work Pumping Class
Prenatal Massage and Facial
Postpartum Home Visit
2 Week Postpartum Visit
6 Week Postpartum Visit
Postpartum Support Groups and Activities
Large Facebook Group
I truly hope this review helps someone make the difficult decision on who to go with. If I would have interviewed both birth centers when I started on my journey, it would have been an easy decision for me.