Out-of-hospital births at Tender Gifts, elsewhere rise during pandemic

FORT COLLINS — Just as soon as the COVID-19 pandemic struck in spring 2020, Tender Gifts Midwifery & Birth Center in Fort Collins saw its business increase threefold.

“We had to bring on more staff than anticipated because we were so incredibly busy,” said Althea Hrdlichka, a certified professional midwife licensed in Colorado, Wyoming and Arizona and the owner and founder of Tender Gifts. “The calls started rolling in March or April of last year; it was almost immediately.”

Clients at the time said they did not want to go to a hospital to birth their babies, wary about being around those who might be infected with the coronavirus. They also didn’t like that they couldn’t bring family members and friends for support, while Tender Gifts allowed for visits, as long as social distancing was in place (appointments also were staggered). 

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“Some wouldn’t let the dads in. It was terrible. I did not do that,” Hrdlichka said.

The increased interest in Tender Gifts follows in line with a global trend of expectant mothers searching for options beyond a hospital and learning about midwifery practices, Hrdlichka said. Currently, Tender Gifts takes an average of 12 clients a month and has the capacity for 35 for births both at home and at the center.

“Infant and maternal mortality and morbidity rates are often better out of hospital for low-risk women,” Hrdlichka said. “It’s all about attention to detail, ability to give one-on-one care and going back to the relational [aspect] and the time spent with women and families in our care.” 

The word midwife means “with women,” and “tender gifts” refers to babies being tender gifts to care for, said Hrdlichka, who, over her career, has attended more than 500 births.

“Every baby is a gift to this world and to the individuals it’s born to, and they are a gift to us,” Hrdlichka said. “It’s a gift, not a job, to work with these families.”

The midwives at Tender Gifts provide personalized care and develop relationships with expectant mothers and their families from preconception to pregnancy, labor, delivery and postpartum care.

“Our environment is calm and welcoming; our staff is calm and welcoming,” Hrdlichka said. “The main thing that sets us apart is our ability to connect with our clients and being able to really understand what they need and want as individuals.”

Hrdlichka gained that understanding through her work first as a doula, then as a midwife. She started out as a birth and postpartum doula in 2009 after giving birth to her fourth child — she’d experienced different birthing options including a home birth, something she wanted to share with other women. That year, she also began doula training — doulas are nonmedical providers who help with the childbirth process before the midwife arrives. Doulas are suggested for Tender Gifts’ first-time patients and first-time, out-of-hospital births.

Wanting to expand to midwifery practice, Hrdlichka attended the National Midwifery Institute, graduating in 2016 and receiving her national licensure in 2017. A midwife is a trained medical professional in childbirth and serves as a medical provider.

In 2017, Hrdlichka started a home birth midwifery practice called Tender Gifts Midwifery, changing the name from the original Tender Gifts Doula. With just one assistant, she was limited in the number of clients she could take on, particularly with the travel involved, plus there was a lack of a local birth center.

Hrdlichka opened Northern Colorado’s first freestanding birth center in November 2020 in the Jessup Farm Artisan Village — the first birth there was Thanksgiving morning. Hrdlichka now has four certified midwives and a total of 10 on her staff.

The birth center offers natural family planning, prenatal care, well-women services, ultrasounds, labor and delivery assistance, and postpartum care up to six weeks. There also are childbirth and other types of classes and groups, including one for breastfeeding and a birth circle for new and expecting mothers.

“This opened up more options to care for more clients on a larger scale,” Hrdlichka said. “The demographics are larger than a home birth, but smaller than a hospital. That was a need I filled here in Fort Collins.”

Prenatal and postpartum care is identical in the center and at home — the difference is the location of the birth, Hrdlichka said.

Home births are conducted in the client’s home, while births at the center are in one of four birthing rooms. The rooms are equipped with large birthing tubs and a full-service laboratory, plus amenities like labor slings, birthing and peanut balls, and Swedish ladders. 

“It has very homelike features that look like a bourgeois hotel room. It’s a very cozy model,” Hrdlichka said.

Tender Gifts serves low-risk births only and has several risk-out factors that require a higher level of care, typically at a hospital. Those factors include multiple births, breaches, insulin-dependent diabetes, use of psychotropic medications and preeclampsia. 

For low-risk births, appointments often start with a hug and inquiries about how the client is doing, and not a handshake, Hrdlichka said. 

“We provide client-led versus provider-led care,” Hrdlichka said. “We look at them as a whole person.”

The appointments are personable and are about building relationships and foregoing the use of hard-to-understand terminology, making it easier to implement any suggestions, Hrdlichka said. They last 45 minutes to one hour, instead of the average of 15 minutes with a medical provider, she said.

“If you see them often and spend time with them, you are going to know if something is wrong with them when they walk in the door,” Hrdlichka said, explaining that the client may look different or have something going on emotionally. “We catch things earlier because of that time we spend with them.”

Hrdlichka and her staff educate clients on things like nutrition, medication, exercise and prenatal chiropractic care, which helps improve alignment and ease the passage of the baby during delivery. 

Births through the center are natural with little or no medication to protect the mother and baby and to decrease the risk factors that can arise, Hrdlichka said. Using epidurals, for instance, correlates with an increase in cesarean section rates (the rates are approximately 7 to 10% out of the hospital compared to 30 to 40% in the hospital and 5% at Tender Gifts). A cesarean is typically needed for a baby not able to drop, in the wrong position or wrapped in the umbilical cord; it requires a hospital transfer.

“I’m really excited about what we’ve done and all the women and families that came alongside me just to support us in this endeavor,” Hrdlichka said. 

Kellsi Daniels of the Cheyenne area has three children, the first birthed at the hospital, followed by a home birth and then a center birth through Tender Gifts. She disliked her hospital experience and wanted a home birth for her third child but needed to consider her options for a hospital transfer in case of complications, she said.

“We decided to go to the center instead because it’s near a better hospital,” said Daniels about her son born May 19. “It’s very homey, and it’s very relaxed. They let you labor how you want to. It’s much more naturally minded.”

Daniels also likes that she is able to work with Hrdlichka, she said. 

“She genuinely cares about you and your family,” Daniels said. “I didn’t feel like it was motivated by money or efficiency like it is in a hospital. … Statistically it’s safe, if not safer, for mom and baby. The postpartum care is so much better. … With Althea, they do at least four postpartum visits. There is so much more physical and emotional support for mom and baby.”

In the next six months to one year, Hrdlichka plans to turn the birth center into an in-network provider — currently, it is considered out-of-network. She also plans to bring in a family nurse practitioner to provide care beyond six weeks and to contract with three doulas, as well as expand her educational and service offerings, including the addition of play groups for moms. Educational offerings may include classes on childbirth education, natural family planning and holistic lifestyles, among other topics. 

“It’s getting more into the community and building good relationships as time goes on,” Hrdlichka said.