Choices in Childbirth
Childbirth Educator, Birth and Postpartum Doula, Birth Activist
Knowing your options and choosing the best one for you.
Chose your birth Settings
CHOOSE YOUR BIRTH SETTING
Many women make the mistake of looking for their medical caregiver
first, and then must to go to whatever hospital that caregiver is
affiliated with. This hospital may not be their preference at all. Instead,
find out what birth setting choices are available in your community
before choosing your medical caregiver.
Read the Coalition for Improving Maternity Services document
“Ten Steps of the Mother-Friendly Childbirth Initiative for Mother-friendly
Hospitals, Birth Centers and Home Birth Services”.
Consider all of your options.
Women who choose a home birth over a hospital birth tend to have very specific ideas of what they want and don't want for their birth experience. For many, it is simply a philosophical decision based on their belief that birth is inherently a very normal and natural process with minimal--if any--intervention required. Many couples choose home birth for the intimacy and privacy their own home provides. Others prefer the control it gives them over whom they have as their care provider as well as how many people they can invite to assist them during labor. There are also couples that want their children to be allowed to attend the birth if they are comfortable in doing so, a choice that is not an option in most hospital settings. Lastly, a home birth may be the only setting that waterbirth is an option.
The choice of care provider means is by far one of the main reasons women choose to give birth at home. In many communities, midwifery care is not always an option in the local hospitals. At home births, women may be attended by a Licensed Professional Midwife (LPM), Certified Midwife (CM) or Certified-Nurse-Midwife (CNM), Unfortunately, midwives are not always available in every geographic region.
The freedom of choices you have in how you cope during labor, as well as minimizing the interventions that you may encounter in labor~ unless there is a true medical emergency~ makes home birth a desirable alternative for many women.
On the other hand, some women-especially those who have never given birth before- may lack confidence in the normal process of labor and birth and feel reluctant to give up the idea that the hospital is "safer". Studies in both the United States and England have shown that home birth is as safe or safer than hospital births for healthy women with normal pregnancies.
"Recognizing the evidence that births to healthy mothers, who are not considered at medical risk after comprehensive screening by trained professionals, can occur safely in various settings, including out-of-hospital birth centers and homes...Therefore APHA (American Public Health Association) supports efforts to increase access to out-of-hospital maternity care services."
"Increasing Access to Out-of-Hospital Maternity Care Services Through State-Regulated and Nationally-Certified Direct-Entry Midwives (Policy Statement)". American Journal of Public Health, Vol. 92, No. 3, March 2002.
WHAT IS A BIRTH CENTER?
"The Birth Center is a homelike facility, existing within a healthcare system with a program of care designed in the wellness model of pregnancy and birth. Birth centers are guided by principles of prevention, sensitivity, safety, appropriate medical intervention, and cost effectiveness. Birth centers provide family-centered care for healthy women before, during and after normal pregnancy, labor and birth."
National Association of Childbearing Centers (1995)
Birth with a Licensed Professional Midwife (LPM), Certified Midwife (CM), Certified-Nurse-Midwife (CNM), a family physician or an obstetrician at a freestanding Birth Center--if one is available in your community-- is another option for your labor and birth. Birth Centers may be freestanding (independent) or part of a larger hospital. They are designed for women with normal low-risk pregnancies and births and usually offer very few medical interventions. Most Birth Centers are established to give women a home-like setting with many of the comforts of home such as showers, baths, Jacuzzi's, CD Players, rocking chairs, Birth Balls (Physical Therapy Balls used for comfort during labor), and comfortable furniture and birthing aids. Most (but not all) Birth Centers are equipped to deal with emergencies.
"Birth centers offer a savings in cost and minimize the rate of cesarean section. Few innovations in health service promise lower cost, greater availability, and a high degree of satisfaction with a comparable degree of safety. The results of this study suggest that modern birth centers can identify women who are at low risk for obstetrical complications and can care for them in a way that provides these benefits."
New England Journal of Medicine (12/28/89)
To find a birth center in your area or to learn more about freestanding Birth Centers and the national accreditation process, research your options at the American Association of Birth Centers (AABC).
If you decide to have your baby in a typical hospital Labor and Delivery setting, it is important to choose one only after carefully researching as much as you can about that particular hospital's statistics, policies, birth philosophy and choice of care providers.
Find out what the hospital's statistical rate is for Cesareans (the World Health Organization recommends a cesarean rate of 10-12% for truly medically necessary cesareans), Forceps/Vacuum Extraction deliveries, VBAC--Vaginal Birth after Cesarean--rate (current research indicates a percentage of 65-75% to be an achievable goal for a hospital committed to reducing their cesarean rate), and Induction (artificially starting labor) rate.
It is important to find a hospital with a birth philosophy similar to yours and one that offers the physical comfort amenities that appeal to you, such as Jacuzzi's, birth balls (physical therapy balls utilized for back pain relief during labor), birthing stools or rockers, refrigerators (to eat and drink during labor). Ask direct questions about their policies for moving around during labor, fetal monitoring, choices of positions for the birth, etc., so that you can decide if this setting is one you would feel comfortable laboring in.
Your options for your care provider in the hospital setting is an important factor in your decision as well. Hospitals may offer OB-GYN's, family physicians, Certified Midwives (CM's) or Certified-Nurse-Midwives (CNM's). It is vital that you choose a medical care provider that shares your birth philosophy and offers respectful, evidence-based care.
The Coalition for Improving Maternity Services (CIMS) provides guidelines for identifying and designating "Mother-Friendly" birth sites including hospitals, birth centers and home-birth services. The Mother-Friendly Childbirth Initiative (MFCI) outlines the Ten Steps for Mother-Friendly Care. A consumer version of the initiative, “Having a Baby? Ten Questions to Ask”, can assist you in your search for an appropriate birth setting and medical caregiver.
Photo courtesy of Nova Natural Birth Center in Chantilly, Virginia. Check out their facility here.