Multimedia Reporting (Fred-Musser)

John-Mark and Jessica Miravalle won’t be in a hospital when their first child is born in about five-months. Horror stories of inattentive doctors and unnecessary procedures have caused the young couple to choose a birthing center in Topeka under the supervision of a registered midwife.

“We have just heard too many stories about hospitals.” John-Mark said. “It’s really just all about personal care for us.”

Births under the supervision of a midwife often seem like a practice of the prairie past, but are again growing in popularity. The Women’s Health Care Group of Lawrence and Overland Park started with just one midwife in 1994, but the group will add its sixth midwife at the end of the year in response to the growing demand for midwives in Kansas. Midwives perform a variety of women’s health procedures and they assist with in-hospital births, clinic births and at home births.

The Miravalles will welcome their baby in a birthing center under the care of nurse-midwife Norla Todd. Todd performs nearly all her births in either the birthing center in Topeka or the patient’s home. The Miravalles said walking into the Topeka Birth and Women’s Center took them aback. Located in a residential house with couches and queen sized beds in delivery rooms, the center doesn’t resemble a hospital at all. Nurses walk around in jeans and t-shirts instead of scrubs and family members of patients mingle in a waiting room that looks like a grandmother’s living room.

“The attitude is laid back but there is a feeling of tremendous respect for motherhood.” John-Mark said.

Certified Nurse Midwife Kathy Melton has assisted hundreds of births since she completed midwifery school in the early 90’s. Working for The Women’s Health Care group since its inception in the mid-90’s, a;; of her births were in hospitals as the group’s insurance requires.

Births in hospitals require physician supervision, but Melton says physicians trust the midwives and often never make an appearance during a birth. Relations with hospitals were not always so friendly.

“I did the first midwife delivery in a Lawrence hospital,” Melton said. “I think they thought I had horns and a tail. They didn’t want me there, and I think they had 15 people in the room during the delivery to watch me.”

Today, the midwives of Women’s Health Care Group get along just fine with doctors. Melton said doctors trust them to take care of birthing mothers and their children. Additionally, at the Women’s Health Care Group clinic, midwives provide routine women’s health care, natural family planning as well as birth preparation.

Certified Nurse Midwives complete extensive schooling from universities all over the country. The American College of Nurse-Midwives certifies the studies of students and requires at least two-years of clinic work before certification. Most midwives become nurses first and then begin midwifery training. Students complete the additional clinic work in birthing centers and women’s health facilities like the ones in Lawrence and Topeka.

The extra schooling enables midwives to do many of the same things medical doctors can do. During the birth midwives can administer some drugs and are often credited with avoiding unnecessary procedures that doctors use to speed up the birth process. But midwives cannot perform a cesarean birth or administer an epidural anesthetic. These limitation keep midwives from working with some patients.

Linda Easum, Practice Administrator of The Women’s Health Care Group, said they do not take patients who have high risk pregnancies, diabetes or previous cardiovascular problems. Even so, Melton said she has worked with patients who have had trouble during pregnancy. Having the birth at the hospital with physicians on call minimizes the danger.

The Miravalles said they are not concerned by the dangers of having a birth outside a hospital. The center where Jessica will give birth to her child sits across the street from St. Francis Hospital, and she says confidence in the care of her midwife, Todd.

“She has birthed people’s babies in a hall in their house. Plus, they can still perform minimal health procedures like provide IVs,” Jessica said.

John-Mark likes the reduced cost. Having the birth outside a hospital saves the Miravalles several thousand dollars.

“Our birth will only cost about $3,000, and that covers everything, all our visits before the birth, the birth itself and they come by twice after the baby is born.” John-Mark said. “If we had it in a hospital, it could cost as much as $8,000.”

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A middle-aged man wearing a long, black business coat places a jar of cherry edible body oil onto the checkout counter at Priscilla’s.

Manager Jennifer Terrel tells the customer the brand he selected is on special and he can grab another one for free.

“That one has a very pleasant taste,” she said.

Though Lawrence has only one other adult store, Naughty but Nice, both businesses know they are competing against each other, and also against a slew of online pornography Web sites and even people who throw home sex toy demonstrations, much like the Tupperware parties of the past.

Terrel said speaking to her customers as if each were regular shoppers-- and many of them are-- is one way she keeps them coming back to her store to buy adult novelty and sexual enhancement items.

“We try to provide a personable and pleasant staff; we have a nice atmosphere here,” Terrel said. “People can come in and ask questions and we give them answers and they don’t feel insecure.”

Richard Ofburn, manager of Naughty but Nice, said lower prices along with customer service are how his store attracts customers.

“We kill them with kindness,” he said.

Both managers agreed competition doesn’t always come from local businesses.

Adult merchandise, including toys like vibrators and dildos, pornography and even lingerie, can be purchased online from a vast market of adult novelty distributors.

Perhaps the most highly coveted adult items on the Internet are adult movies, which can be ordered off of the Internet and also downloaded from it.

Though online pornography statistics are widely disputed and often very politicized, one online research company, TopTenReviews, estimates 4.2 million pornographic Web sites exist on the Internet and there are also 68 million daily pornographic search engine requests, comprising 25 percent of all search engine requests.

Besides the Internet, satellite television services also carry adult movies on select channels, giving customers the privacy to choose the movies they want at home without the embarrassment of having to hand them to a store clerk.

“Privacy is a big issue,” Ofburn said.

Ofburn said another new source of competition for his store is the home toy party business, which provides demonstrations of adult toys at a host’s house and in front of a handful of the host’s friends, much like Tupperware parties.

Molly Easley, Lawrence junior, was one such independent consultant for Passion Parties, Inc.; a company based in Las Vegas that recruits representatives much like Avon and Mary Kay do for cosmetics.

Easley said she organized six parties from August to October this year in Lawrence, usually in front of five or six people, many of whom were college students but ranging in age from 21 to 35.

She said she became interested in the adult party business after attending one hosted by a friend who had recently broken up with her boyfriend of six years.

“Those are the three ‘Bs:’ bachelorette parties, birthdays and breakups,” Easley said.

After the party, she purchased a consultant demo kit from Passion Parties for $250. Once a consultant, Easley started organizing parties that allowed her customers to sample her merchandise and then place orders for Passion Parties through her. She would make a 40 percent commission from orders.

“You can make up to $200 a night for an average of 10 guests,” she said.

Easley said some of her products were similar to items at Naughty but Nice and Priscilla’s, but Passion Parties also sells a lot of exclusive merchandise. Prices for her items ranged from $12 for basic toys and perfumes up to $180 for a complex vibrator.

“If you pay more money for a toy, you’re going to get your money’s worth,” Easley said.

A sex swing with fitted stand for $240 is the most expensive item at Naughty but Nice, Ofburn said, and Terrel said the most expensive item at Priscilla’s is a set of bed sheets equipped with Velcro straps for $160 that allow partners to perform sexual bondage acts.

The majority of Priscilla’s sales comes from selling skimpy clothing to exotic dancers, Terrel said.

Though Naughty but Nice sells lingerie and other clothing, they are not the store's hottest items, Ofburn contrasts.

“Movies have always been our bread and butter,” he said.

A couple of unique items at Naughty but Nice are individually packaged paperclips and rubber bands. Ofburn is selling those items because he has been charged with operating an unlicensed sex shop in an unapproved location.

He said he had permission seven years ago from city hall to open his store that sits at 1741 Massachusetts St., but after an initial outcry from concerned citizens, he said the city found a 1997 Kansas law that allows the commission to relocate or close adult businesses that aren’t located on state highways.

This law allows Priscilla’s to remain open at 1206 W. 23rd St., because it is on a highway.

Ofburn said in July 2000 the city commission ordered for him to relocate or close his store within five years. Ofburn hasn't moved and will go to court in January.

Easley said she gave up the adult toy party business because she didn’t have time to schedule parties.

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Gardasil®, the vaccine that prevents contraction of the sexually transmitted human papillomavirus, or HPV, is becoming more frequent since its approval last June. Health officials encourage all females up to the age of 26 to get the vaccination and college-age women are responding to the suggestion.

Since the vaccine became available, Watkins Health Center has vaccinated 35 women. Despite initial low numbers, Watkins has seen a recent surge in vaccinations and it is expected to continue.

“It’s picking up,” Supervisor of Nursing at Watkins Patty Quinlan, said. “The reason is because insurance is picking it up.”

Insurance companies are slowly adding the vaccine to their programs, making it more affordable, Quinlan said. The vaccine Gardasil® was approved in June by the Food and Drug Administration (FDA). The Center for Disease Control names HPV as the most commonly contracted sexually transmitted disease. Health officials say clinical trials of the vaccine show it to be 100 percent effective in preventing the contraction of four strains of the HPV virus, two of which are known to cause cervical cancer.

Statistics show that 50 percent of sexually active people have HPV, making it more frequent on college campuses than people think, Quinlan said. After a suggestion from both her mother and her physician, sophomore Jordan Krouse decided to get the vaccine.

“I just think it’s a good decision,” she said. “Even if you don’t have sex until you get married, your husband could have HPV and you would still be exposed. It’s just safe to get the shots.”

The HPV virus causes 70 percent of cervical cancer cases, the second leading cancer-killer of women, and can be contracted through sexual intercourse as well as skin-on-skin contact. Statistics show that 80 percent of sexually active women will contract some form of HPV by the time they reach 50.

Krouse said her opinion is different from what she’s heard from other women. Conversations with friends make her think they don’t understand the seriousness of the disease she said. “I think people only think it’s an STD,” Krouse said. “And no one thinks they’re going to get an STD.”

Since the approval of Gardasil®, advertisements and public awareness campaigns have spread the word about HPV and the vaccine.

“I have two daughters in their 20s and I see the advertisements at the stores they shop at and the magazines they get,” Quinlan said. “It’s hard to say that there isn’t enough publicity.”

Women health advocates and political groups are strongly encouraging the routine vaccination of approved age groups, ages 9-26. Ellen Schleicher, a member of Women in Government, a non-profit organization of women state legislators, said that getting the vaccination is a good way to avoid contracting HPV and cut the risk of developing cervical cancer.

“The purpose is to help women with something they face everyday,” Schleicher said. “Cervical cancer is something that can be stopped with regular and required screening.”

The vaccine is administered in three shots over a six-month period and is available at most hospitals and doctor’s offices. A second HPV vaccine, Cervarix, is likely to be approved by next year.

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