by Paula Meyer, DONA certified birth doula
As a doula, I often get approached because expectant parents want extra guidance and information regarding important childbirth decisions. However, I typically interact with them after the first trimester – after many people have already made THE most important decision regarding their birth.
Wait, there’s actually a decision that is THE most important? Yes, there sure is, and most people don’t even think about it as a decision.
They’ve pretty much settled on it without much thought.
The location where you decide to deliver a baby is the most important decision you will make. This decision will dictate the providers to which you have access. This decision can affect whether you receive a medical model of care, or a midwifery model of care. (To be clear, not all midwives practice a midwifery model of care and not all OB’s or hospitals have a medical model of care.) The decision of where to birth will determine the likelihood of interventions and ultimately, your chances of having a cesarean delivery.
The current national cesarean birth rate is 32.2%. With nearly 99% of births occurring in a hospital setting, simply choosing to deliver in a hospital facility puts your chances of cesarean delivery at 1 in 3. On the other hand, the current cesarean delivery rate for a freestanding birth center is just 6%. Why might that be?
It’s largely due in part to the fact that freestanding birth centers accept low-risk clients only. People with healthy, normal pregnancies can use a birth center, whereas those who are higher risk and therefore more likely to need a cesarean, see an OB in a hospital setting. It’s sort of like going to a massage therapist for regular bodywork while healthy vs. seeing an orthopedic doctor after an injury or to have surgery. Midwives at birth centers manage physiologically normal births because that is what they know best. OBs are trained surgeons and they know high-risk pregnancies best. Birth Centers follow stringent standards and policies to ensure good care is accessible for low-risk pregnancies, but sometimes complications present during labor after an uneventful low-risk pregnancy. Therefore, criteria like the list below are used to handle emergencies:
Prevent emergencies by careful screening, continuous monitoring and comprehensive education of the mother.
Have a well-rehearsed plan for action spelled out in policies and procedure.
Be able to initiate treatment while implementing the plan of action for transport.
Optimize your communication with the mother and the family.
Understand the capability for the receiving facility to respond to the problem and properly inform them so they can be ready.
Great, so you’re low-risk and now you’re thinking a birth center might be an option… you’re probably wondering, but what exactly is a freestanding birth center? And what will my experience be like there?
A birth center is a home-like facility that offers comprehensive care throughout pregnancy, childbirth, and postpartum. It is part of the healthcare system, but does not connect or directly belong to a hospital. It’s truly a maximized home, not a mini-hospital. The atmosphere is cozy, comforting, and bed & breakfasty, minus the 3 course breakfast. There’s likely a tub for hydrotherapy or water births, various pieces of furniture for position changes, space for movement, and very few medical devices or machines in plain view.
Typically, a birth center is run by certified nurse midwives (CNM’s), certified professional midwives (CPM’s), or a combination of both. The midwifery model of care approaches birth as a natural physiological process, not a handicap, disease, or pathological state. It is viewed and celebrated as a normal part of life! You’ll get personal attention, more comprehensive education and preparation, and a supportive team involved in every step of your care. This video is a fantastic overview of what makes a birth center different! Seriously, take three and half minutes to envision what the childbirth experience could look like. For many parents, it is a beautiful and empowering rite of passage.
What does it look like to choose a birth center for your pregnancy and delivery? You’ll follow the same schedule of visits as you would at the hospital with an OB. Your appointments will likely be an hour or longer, with ample time to discuss fears, concerns, questions, nutrition, and development. You will be treated more like family, not a clinical patient. You’ll have met and enjoyed numerous face-to-face visits with the providers who will attend you during delivery so you’ll have familiar faces around you when the big day arrives. Chances are you’ll feel confident and calm despite the challenges of childbirth. No bright lights, no machines making rude noises, no forced pushing positions, and no sudden influx of extra strangers in your delivery suite! Then, you’ll return to the comforts of home within 4-8 hours after delivery. Your midwife will then typically do 24 hour, 3 day, and 7 day check-ups in your home, so you don’t have to travel anywhere with a new baby!
Sounds too good to be true, right? For many, it is. There isn’t a birth center within reasonable distance for far too many communities. Many expectant parents drive a few hours to get to the nearest one, because they believe strongly in the difference of care. Like most things, however, when the demand rises, access will follow.
For more information on birth centers or to find one near you, please visit birthcenters.org and use the links under the “For Parents” tab on the right. Consider calling your local birth center(s) and asking for a free consultation and tour!