Sunday, March 3, 2013

Where is a pregnant woman to go?


A home birth is an excellent choice for a low-risk pregnancy.  Midives attend home births. They tend to have a hands-off approach and trust birth. Licensed midwives take only a certain number of births per month and you can expect individualized care.  You will want to interview midwives to find one whom you share a common view of birth with.  Midwives are trained to attend natural labors and have many years of knowledge passed down to them.  At a home birth routine interventions are avoided and the body’s physiology is relied upon as opposed to technology. Your midwife will bring what is needed to your birth.

Hospitals provide a medical model of care relying on technology to monitor patients. If you have a high-risk pregnancy you may need to seek out a physician (OB) and birth at a hospital.  CNM’s also attend births at hospitals.  Interview your care provider to determine what their philosophy is on birth. Technology will be used to monitor your labor and you will be mostly attended by on-staff nurses.  Hospitals provide standardized care for women.  When finding a hospital to birth at, be sure to find out what policies, procedures and interventions are common for them as well as from you care provider.    
Birth Center

Not comfortable with birthing at home but don’t want to go to the hospital?  A birth center may be just the choice for you.  Birth Centers show a reduced incidence in c-sections and provide the midwifery model of care.  Commonly they are located near a hospital in case of emergency. 

Hospital Birth Center

Choose carefully to determine whether standardized or individual care will be offered and what policies and procedures are typical.  These may offer a home-like feel within the same building of the technology.

Frequently, women face controversy from well meaning friends and family when choosing where to birth.  This is a tough predicament for women to be in as most want to maintain their relationships with your family; who wouldn't?- They can be an intricate part of your birth/support team but that's the key, they have to support you. In order to do so you can take the initiative to provide them with evidence and knowledge and reasons to understand your choice but in the end it's your choice and their job, once given the knowledge, is to either support you or hold their peace.

In the 1920's birth in the United States was moved into the hospital.  This move was pushed forward by new and exciting options for pain management during labor, such as "the blessed ether" and "twilight sleep" but like many of today's hospital interventions those were not fully tested when made available to the public.  Today, we are still learning the ramifications of the epidural and having more negative than positive affects from the standardized electronic fetal monitors.  So are all hospitals evil??  No!! Medical interventions such as cesareans, iv's, pitocin and more have a time and place- when complications arise.  When there's a need these medical interventions can be life saving measures for both moms and babies and we are blessed to have access to them; the problem arises when the need for intervention is created by interventions. Hospitals offer technology that may be imperative to high-risk pregnancies; in low-risk pregnancies a hospital might be a good choice for a woman who wants to be nearest to the technology or who is desiring to birth with medication or who simply wants the immediate access to help in the case of an emergency like cord prolapse.

Pregnancy is not an illness!  Michel Odent, renowned French Physician said, "One cannot help and involuntary process. The point is not to disturb it."{Do No Harm} For this very reason many women choose not to birth in a hospital. The Cascade of Interventions is becoming a commonly known phrase, and not just in the birthing community, for a reason. Women who wish to avoid this cascade so as not to create problems in a low-risk pregnancy and birth will hire or doula or choose to birth outside of a hospital or both. A guest blogger on Banned From Baby Showers says,

Looking back, having a baby at home was the best experience possible. We didn't have to worry about the drive to the hospital. We didn't have to deal with any cranky hospital personnel poking and prodding all hours of the day and night. We didn't have to deal with hospital regulations, the nursery, and the list goes on. And I never had to deal with any bloody mess whatsoever!

The U.S holds the one of the highest maternal mortality rates in the developed world. Hospitals did not reduce that number but increased it. Compare us to Holland, where birth is common at home and it becomes shockingly apparent that hospitals are not the safest place to birth. Hospitals have a higher rate of infection, high nurse to patient ratio and many protocols that treat women like cattle rather than individuals. That may sound harsh but they are required to follow standardized care for all women regardless of individualism and that creates added risk in an uncomplicated birth. The nurses in a hospital rely on machines, that were introduces before fully understood, to monitor labor. In America our cesarean rate is 32% while the WHO recommends below 15%. You can research hospitals in your area to see their individual rates but the numbers hash out to 25-30% of women who give birth in a hospital setting end in a cesarean compared with 6% of those who choose a birth center to give birth in.

Birth Centers are licensed and/or accredited by ACOG as safe places for giving birth. The care provided is individualized; laboring mothers are closely watched and the midwives who watch over them are trained in knowing if a complication is beginning to arise. Instead of being monitored by machines, women in birth centers are watched over by their care providers. Birth centers have a transfer rate of 2%, the majority of which are non emergency transfers and can commonly be for prolonged labors that end in vaginal births. The risk for infection at a birth center is higher than of that at home but significantly lower than that of a hospital. Accredited birth centers have emergency medical equipment on hand and sometimes even a house physician. Accredited centers also have agreements with hospitals in case the need for a transfer arises and it is possible that your midwife will have privileges at the hospital of transfer resulting in no interruption of care.

Even more important than where you give birth is who you choose to attend your birth. Midwives are trained in birth, OB's are trained in medicine. That doesn't go without mentioning some midwives are extremely medicalized and some OB's are great at sitting on their hands; what's important is to find a care provider with a birth philosophy similar to yours who will be there to support the choices you make.  This alone is evidence to the safety of home births.  Home births are attended by midwives who have earned their degrees and/or license by their training, knowledge and experience.  This title wasn't handed over to them lightly, they worked for it and birth is their passion.  A good home birth midwife isn't out to manage your labor and deliver your baby but to walk beside you and support you in your pregnancy, labor, birth and postpartum period.

You birth your baby- where you choose to do this is your prerogative.  If you're most comfortable in your home, in your bed, with your comforts and surroundings, then in a low-risk pregnancy this could be the best choice for you.  Birthing at home doesn't mean you have to go with out all medical equipment; midwives carry oxygen, pitocin and other supplies should the need arise.  As said before, they are trained to know if a transfer is necessary and like birth centers, most transfers from home birth are not full scale emergencies.  Questions about how your care provider handles a transfer are something you'll want to discuss prior to making your decision to birth at home just like questions about cesarean rates and induction percentages should be asked prior to choosing to birth in a hospital.

After you've provided your family and friends with information, you can kindly ask them if they aren't going to be supportive to refrain from input. Pregnancy and birth are sacred and should be treated as such; to influence a woman negatively is not only disrespectful to her, it can also be harmful.

Today's evidence for birth centers is amazing! Congratulations on your decisions and pregnancy! Best of luck on your journey.

For a much more detailed analysis and what you need to know about choosing a place of birth:

Where will you begin your baby's Journey of Life?

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Jennifer Valencia | Labor & Postpartum Doula | 928.300.1337


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