The Bronx Ink

The Morris Heights Birthing Pavilion is one of the last few places in New York City where women have a real chance to labor naturally. Photos: Courtesy of Morris Heights Health Center

It was 9 a.m., on a cold November Monday, and the Morris Heights birthing center—one of only two free-standing clinics left in New York City—was buzzing.

Inside, three women were in the throes of labor, each in a private suite with a queen-size bed and home-like touches, including quilts, fluffy pillows, and cabinets.

As their births proceeded, two certified midwives shuttled back and forth, slipping behind spearmint-colored doors. They checked heart rates every half an hour, suggested position changes to alleviate pain, and helped the women in and out of their Jacuzzi tubs.

When the day was done, three healthy babies were born.

The scene seems timeless, and perhaps unremarkable. But in New York City, where the rate of births by Ceasarean section rose by 42 percent between 1998 and 2007, giving birth without medical intervention is increasingly rare. The Morris Heights Women’s Health and Birthing Pavilion is now an endangered species.

“Women’s labors can slow down when they get to the hospital, because they don’t feel particularly safe,” said Jennifer Jagger, a midwife who has worked part-time at the Bronx center for the past two years. “When they get to the hospital—boom!—it’s about what the hospital needs.”

There are currently just under 200 freestanding birth centers in the United States, centers not attached to a hospital that offer a homelike environment.  These are staffed by midwives who help low-risk women deliver naturally, free from medical interventions like inducement, Caesarian sections, or epidurals. Supporters of the natural-birth movement believe it is a better experience both physically and emotionally for mother and child.

Of the 175 some birthing centers in this country, a significant percentage are located in the suburbs. Jagger said she often tells her Bronx patients they’re getting a service that’s normally available only in wealthier, non-urban areas.

“There’s some truth to that,” admitted Ronnie Lichtman, chair of the Midwifery Education Program at the Downstate Medical Center in New York City. “In general, middle class, educated women are more aware of the options available to them and more assertive in seeking them out.”

But the irony is that in wealthier pockets of New York City, birthing centers have closed up shop over the years due, Lichtman said, to a variety of factors—budget shortfalls, management problems, and a medical approach that has made birthing a sickness, rather than a natural process.

Last year, a nonprofit group attempted to raise funds for an independent health and birthing center in Midtown Manhattan, near Macy’s.

The group had secured much of its funding and had put together a high-profile board of directors that included Ricki Lake, the talk show host turned-natural birthing advocate who, thanks to her 2008 pro-natural birth documentary “The Business of Being Born,” has become the poster mom for midwife-assisted labor.

But with the recession, Lichtman said the new center’s efforts were “stymied.” Investors dropped out and the center never opened. And several established centers have faltered as well.

In 2003, the Elizabeth Seaton Birthing Center—which was associated with St. Vincent’s hospital and was this country’s first birthing center—closed along with the hospital. Last September, Bellevue Hospital shuttered its birthing center as well.

The closing of these centers prompted New York City Council’s Committees on Health and Women’s Issues to host a joint oversight hearing on the status of birthing options in New York City earlier this fall.

Advocates who testified in the hearing argued that birth centers are key in helping to lower the cesarean section rate. Patients in natural centers are not hooked up to fetal monitoring machines, which frees them up to move around. Proponents of this approach say it gives women a better chance at laboring naturally, as it uses gravity to help the baby navigate the pelvis.

Low-risk mothers whose babies were delivered by certified professional midwives had significantly lower rates of Caesarean surgery—4 percent—than those delivered in hospitals—19 percent,  said Farrah Diaz-Tello, a lawyer with the National Advocates for Pregnant Women, citing a recent study.

Currently, only three birthing centers remain in New York City—the in-hospital center at St. Luke’s Roosevelt, the Brooklyn Birthing Center, and Morris Heights. The former is the sole facility that caters directly to low-income women, which it does by accepting Medicaid and helping those who don’t have insurance to get it.

“The only time we won’t accept a patient is if someone starts their prenatal care really late—our cut off is after seven months,” said Susan Billinghurst, a clinical manager at the center. “Otherwise, we accept anyone here.”

Indeed, the difficulty isn’t turning patients away, but it’s in attracting the attention of pregnant moms in the first place. 

“One of the biggest challenges is trying to find the time and help them learn and understand what a birth center is and how it works,” said Kristin Paul, midwife. “Many of them come here without necessarily being aware of what the potential benefits to an out-of-hospital setting are.”

To achieve that goal, the center conducts classes for new patients about the benefits of a non-hospital birth—more support, more time to labor naturally, and a judicial use of technology.

Jagger, the part-time midwife, added that there are certain immigrant populations in the neighborhood that seek out the center because laboring naturally is customary for them culturally.

“I’m thinking in particular of Mexican immigrant women,” she said. “There are a lot of them in this neighborhood and they tend to labor naturally out of habit—out of custom. They do it extremely well.”

But for all of that effort, deliveries still represent only a small percent of what the pavilion’s business. It also offers full-spectrum gynecological and women’s health care.

Indeed, of the 2,000 or so prenatal clients that visit the facility every year, Billinghurst estimates that 70 percent are not candidates for the birthing center. Only low-risk women are approved for a center delivery, which eliminates anyone with medical conditions like high blood pressure, obesity, and diabetes—conditions that are rampant in the South Bronx.

Of the remaining 30 percent of clients who come in for prenatal care, only about 60 to 100 actually end up delivering in the birthing center every year.  Some are unable to because of restrictions the center imposes. For example, a woman who plans to birth at the center, but fails to go into active labor within 12 hours of her water breaking is transferred to a hospital, as is a woman who goes two weeks past her due date.

But other women simply opt not to have a birthing center birth, choosing instead to deliver at Bronx Lebanon Hospital, Central Bronx, or one of the other nearby hospitals.

“It’s not easy to get women to be confident that they don’t need an epidural,” Paul explained, “or to be OK with their choice when everyone around them is going into the hospital to give birth.”

Because of the relatively low number of babies delivered, the center relies heavily on revenue generated from other services, like general obstetrics and gynelocgical care to stay afloat. Billinghurst said that some salaries at the center are covered by federal and state grants, but that the bulk of the money comes from billing patients or insurance. There is no set fee for services; the staff works with patients and insurance companies to charge rates according to what they can afford.

And the center also benefits from the fact that non-invasive births are relatively low cost.

In testimony from the September City Council hearing, Diaz-Tello, the National Advocates for Pregnant Women lawyer, cited a 2005 study that found that the national average hospital charge for childbirth ranged from $7,000 to $16,000, whereas a birth center delivery was about $1,600.

But that is true of all birthing centers, and yet Morris Heights is one of the few that thrives.

Billinghurst said that the real reason why the center has continued to succeed where so many others have failed is that it has been in the neighborhood “forever” and has built up a real trust. Women whose mothers, sisters, cousins or friends delivered in the center know they can go there and have the experience that they want, in a private comfortable room instead of in a shared room in a hospital.

“I recently had the privilege of delivering the baby of a 20-year-old first-time mom who was born at the center herself,” said Jagger. “There’s a community here that has been here for a long time.”

Co-owner and chef Alfredo Diego welcomes customers with a smile. Photo: Alexander Besant

On any weekday morning, Alfredo Diego, co-owner of Coqui Mexicano restaurant, is busy cooking slivers of chicken for tacos, spooning out avocados for guacamole, and chopping onions, lettuce and tomatoes for garnish.

He then wipes down the counters, sits near the window overlooking a bleak strand of Third Avenue near 161st Street in the Morrisania section of the Bronx, and waits for customers to come. Sometimes he waits for hours.

Diego and his girlfriend, Danisha Nazario, 37, moved to the area in 2001 and have owned and run their small Mexican-Puerto Rican fusion restaurant and deli for just over two years. The restaurant, which serves tacos alongside black beans, rice and other regional cuisine in a stripped down bodega with just three tables, is just one of a handful of restaurants in the area – and one of the only ones that does not specialize in fried chicken.

“We try to make healthy food here,” said Danisha. “The area needs more healthy places.”

But two years after its opening, Coqui Mexicano has yet to break even. Nazario said the restaurant is getting closer to reaching the $5,000 necessary to stay out of debt each month, but so far, their sales have not turned a profit. Diego estimates that the restaurant serves about 30 customers per day, mostly regulars and mostly those coming for lunch from other local businesses. The couple is not sure how much longer they can last at the current rate.

In many ways, the couple may be two fragile steps ahead of the expected resurgence in this neighborhood. “This is a place where people are just starting to play,” Nazario said. “But there is no foot traffic at night.”

Both remain remain hopeful. The restaurant lies at heart of a revitalization that is expected to include new housing units and restaurants surrounded the recently completed satellite campus of Boricua College. Construction has begun to attract hundreds of new residents, those who Nazario and Diego hope will become frequent customers.

However, according to Nazario, currently, the new population seems to prefer Manhattan for its nightlife, so far. Construction is slow, and the hints of revitalization she and Diego saw years earlier has not yet panned out.

Born in Puerto Rico, Nazario has lived most of her life in the United States. She graduated in International Marketing from Baruch College and later worked at Dallas BBQ, the New York City food chain where she met Diego.

Later, she took a position in the business center of the Essex Hotel in midtown Manhattan where she continues to head to work at 5:30 a.m. every weekday.

“I still go to work ‘till the business can hold itself,” said Nazario.

Diego, who now works full-time at the restaurant, was born in Acapulco, Mexico. Though he remains coy about his life story, he says that he learned to cook at home in Mexico where, as a boy, he would often make meals for his siblings to help his mother – an experience that put him off cooking for years.

He arrived in the United States some 20 years ago and has worked all over Manhattan in food stores, restaurants and bodegas, finally ending up at Dallas BBQ.

Diego and Nazario began renting the Bronx storefront in the spring of 2008 on the site of a former grocery store that, according to the couple, was a drug den that housed a brothel in a back room.

“The woman who owned it lived in New Jersey,” said Nazario. “She didn’t care about what her business was doing to the neighborhood.”

It took the couple three months to clean out the store, which was in abysmal shape, full of decaying food products and garbage. During the cleaning, Diego developed a lung infection from the noxious fumes that emanated from the debris found in the store.

“It was horrible,” said Nazario. “The store was disgusting.”

Though the couple had readied the restaurant for business in mid-summer, they were not given the go ahead by the city for another few months until Nazario went downtown and caused what she called, “a scene,” in the department that issues restaurant permits. They were awarded a license to serve food in September, after having spent $10,000 for five months rent without making a dollar.

The couple faced another obstacle just after opening: discrimination from the local community.

“There has also been a lot of controversy because I am Puerto Rican and Diego is Mexican,” said Nazario. “A lot of people in the community did not accept this. We would get racist remarks and everyday lots of people telling us to get out of the neighborhood.”

The couple’s problems went beyond neighborhood xenophobia, as they recognized that overhead costs climbed higher than expected and that the neighborhood had not changed as fast as they had hoped – many of the buildings around them were just being constructed with potential customers not moving into the area soon enough.

In that first year, business was slow.

In desperation Nazario got on the Internet and searched for cheap ways to promote the business. She joined Facebook and began randomly contacting residents of the area, asking them to come out and try the restaurant.

“I had never used anything like it before,” she said. “Facebook really saved my ass.”

She even began sending e-mail messages to local U.S. Rep. Jose Serrano, tempting him with homemade guava cake.

To get word out to the community, Nazario also helped to create an informal neighborhood pact whereby area business owners agreed to patronize one another’s stores to help support local commerce.

The pact includes a local bodega, a community college and a nearby Chinese restaurant owned by a husband and wife team who have experienced similar problems to Nazario and Diego.

“She and I have a lot in common,” said Nazario. “We tell each other our problems and about how business is going.”

Yet her efforts were still not enough to make the bills stop piling up and in March of this year, the couple was handed an eviction notice for having not made rent payments to the landlord. At that point, they were eating soup every day to save money for rent.

But just before their scheduled court date to fight the eviction, their luck changed.

The couple received an email from Agnes Rodriguez, 31, an arraignment clerk at the Bronx Defenders inviting them to a fundraiser at their restaurant. Rodriguez had organized the fundraiser after hearing that the restaurant, where many Bronx Defenders’ staff eat lunch, was struggling.

“We love them dearly at the Bronx Defenders,” said Rodriguez. “And I always want to support Latino businesses in the area.”

The couple was touched by Rodriquez’s gesture, which raised hundreds of dollars for the restaurant – money they needed to keep Coqui Mexicano alive.

On top of that, Rep. Serrano, who had finally come in to taste the guava cake almost a year before, helped Nazario negotiate a payment plan with the landlord, which came to an end this month.

“Even if we hadn’t survived it would be worth it because we made so many friends,” said Nazario.

These days, the couple is trying to build on their positive momentum, however slight, by generating a more solid customer base.

They have established a small lending library in the form of stuffed bookshelf near the front door that they hope will bring more people in, even if they don’t want to eat. And they have hosted concerts by local musicians, too, hoping to generate buzz around the restaurant.

Nazario admits that the difficulties of keeping the restaurant open have put a strain on her relationship. She and Diego take their problems from work home with them at night.

Yet she is adamant that they are not ready to give up. The couple plans to keep the business alive for as long as they can.

“We’ve been through so much,” Nazario said. “But we’ll pull through.”

A Shape Up student reads a free fitness brochure. Photo by: Catherine Pearson

On a blustery November morning, 12 middle aged women sat in a loose circle in a South Bronx dance studio, heaving dumbbells over their heads in unison, and then doing chair aerobics exercises while Motown hits blasted from a sound system.

“We do this because we love ourselves!” cheered their instructor, Kim Carr. Several of the women nodded, urging one another on.

They had come to the St. Mary’s Recreation Center in Hunts Point to get in shape, which for many is an uphill challenge.  The city’s Department of Health reports that  private gyms are rare in the South Bronx where nearly 40 percent of adults said they never exercise.

To help, the health agency partnered with the Parks Department to launch Shape Up New York, a citywide program providing free fitness and nutrition classes at park sites and community centers in neighborhoods with the highest rates of diet-related disease.

In many locations in Harlem, Brooklyn, and elsewhere in the Bronx, classes are led by volunteers from Shape, the glossy fitness magazine and Equinox, the pricey Manhattan gym.

But at St. Mary’s, most classes are led by Carr. Thanks to her popularity and the power of word of mouth, the center has among the highest Shape Up attendance rates in the city and an interest in fitness has begun to spread in the neighborhood.

“Normally we have at least 30 people in these classes—people just won’t stay away,” said Carr, herself a Bronxite who, lives near Yankee Stadium. “But you know,” she laughed, “it is hailing out right now.”

While other instructors bounce from center to center, Carr has taught at St. Mary’s for 14 years. She has built a dedicated following, attracting students from age six to 80, depending on the class.

“We try to make it like a family environment,” Carr said.

Many have been coming to Shape Up classes for years and some belong to the center, where an annual adult membership costs $75 per year.

But several students, like Michelle Genross, 52, are new recruits and come for the free Shape Up classes alone. After having been laid off as a secretary, Genross said she could no longer afford the $65 per month she paid to belong to the gym. Someone in her building told her about the program; now she comes two times a week.

“I’m a diabetic and things have been much better,” Genross said. “I only have to take insulin two times per week. And I’ve lost a dress size, too.”

She credits Carr’s classes for helping her change her eating habits.

“The energy you get in these classes—I’ve just been so inspired,” said Jacinta Lawson, 46, another student. “Now when I go home, I want to make sure I have good food to eat.”

But finding good produce and healthy snacks in the neighborhood can be tough.

“There’s a new BJ’s at the Gateway Center,” said Diana Fermin, who has been attending Carr’s classes for a month. “But locally we don’t have a lot of options at all. Sometimes I have to go into Manhattan to find something healthy.”

Carr knows the challenges her students face in finding fresh produce—as a Bronx resident, she faces them herself. Thus, if she finds a store locally that she likes, she tells them, and they do the same.

This, she says, is what makes the program really work. It’s people from the neighborhood helping one another out.

“It’s a great network,” Carr said of her students. “All year long, we help each other out.”

Barber Solo from Alexander Besant on Vimeo.

Edgar Colon, born in Puerto Rico and raised in the Bronx, is a pillar in his community.

After years spent honing his craft in other barbershops, Colon opened his own business eight years ago, blocks from his childhood home. In spite of the recession, Sharp Styles continues to provide refuge to people in the neighborhood. Colon keeps his prices low so that anyone can come in for a trim and a welcome break.

Felix Soto was arraigned for allegedly delivering more than two bricks of cocaine worth $250,000. (New York Post)

The undefeated Monroe Mustangs are going to Texas next week for the Division I men’s Nationals. (Bronx News Network)

Every Wednesday and Saturday, no matter the weather, hundreds of people stand in line on the sidewalks in front of the Word of Life Food Pantry in Morrisania.

They arrive at 4 or 5 in the morning, sometimes even the night before, hoping to draw a good number that will put them in front. Their goal, every week, is to leave the pantry with a full cart of food.

Some thirty members of a Hunts Point drug gang called Satan’s Bloods were arrested in recent raids, to the relief of area residents. (NY Daily News)