What is a birth center?

A birth center is a facility that provides prenatal and childbirth care in an atmosphere that is typically relaxed and homelike. It can be free-standing or located within a hospital complex.

Your care at a center that is located within a hospital complex may be provided by nurse-midwives or physicians. Care at free-standing birth centers are typically provided by nurse-midwives.

If you experience complications during your pregnancy or labor your practitioner will consult a doctor — typically a specialist at a collaborating hospital.

What situations would make a birth center not the safest choice?

If you have or have had:

• Diabetes, chronic hypertension, a seizure disorder or any chronic medical condition
• A previous C-section
• Obesity
• Tobacco or illegal drug use
• A pregnancy complication, such as preeclampsia, preterm labor or significant anemia
• Twins or multiples
• A breech baby

What happens during labor and delivery at a birth center?

During labor at a birth center, you are free to do whatever is most comfortable for you. These may include, wearing your own clothes, laboring in the shower or bath, eating, drinking and moving around freely. The beds are generally comfortable double or queen size beds.

Your baby’s heart rate will be intermittently monitored, rather than continuously. Some birth centers, particularly those located within a hospital complex, offer narcotics for pain relief during labor. Epidurals, however, typically aren’t offered in free-standing birth centers because of the need for intravenous infusions, a urinary catheter and continuous electronic fetal monitoring.

Your care is provided by a professional who is skilled in natural birth. If a situation arises, with either you or the baby, that your practitioner feels cannot be safely managed at the center; you will be transferred to the collaborating hospital.

After your baby is born, your baby will remain close to you.  The newborn exam may be done on your bed and used as an opportunity to discuss your baby’s health and behavior. You will very likely go home after a few hours rest at the birth center. Your practitioner will follow you closely after your birth and your postpartum care may include phone calls and home visits and lactation support.

How do I choose a birth center?

If you choose to have your baby at a birth center, look for a facility that’s accredited by the Commission for the Accreditation of Birth Centers or the Accreditation Association for Ambulatory Health Care. Also, check with your insurance provider to be sure that your care is covered. The costs associated with using a birth center are typically much less than a hospital would be.

Pregnancy and birth are natural events and birth centers are a blend of the best things that both a homebirth and a hospital can offer.

Similarly to the discussion around home vs. hospital birth or “better” ways to give birth, parenting philosophies are often freely expressed with strong opinions. Although I would like to say that I am completely open and tolerant of others’ choices, I am afraid I am not yet that evolved. I do find myself, at times, thinking “what the … ?”

I have been birthing babies long enough to have seen just about everything. The family in this article have chosen to raise the youngest of their 3 children “genderless”, meaning they have told no one the child’s sex and do not plan to. They will allow the child to “decide” when he or she wishes to divulge the mystery of  being either a “boy or girl”.

I know such a family. This family also practices “un-schooling”, which basically means the children receive no formal education. When our children are small we can impart pretty much any ideal we wish on them. It is only as they grow and interact with the world around them that we see how they are impacted by those ideals.

I have two friends who were raised in “hippie communes” – their words. As soon as they were adults, both changed the name they were born with to a classically traditional name. And both freely express that they had to work harder in learning to manage the world once they left their nests.

I, in no way attest to know what is best, even for my own son. Parenting, like life, is often a “fly by the seat of your pants” process.  I do though believe that we have a responsibility to try, as best we can, to prepare our children to thrive in the world around them. Gender simply isn’t a philosophical issue. We are born either male or female. Is it really fair or healthy to pretend otherwise? I’d love to know what you think.

We have had friends visiting us so the kids have been up late playing in the sand dunes or on the beach every night. The house is so quiet right now — the dogs quietly wrestling on the floor and my coffee actually still hot as I drink it. A rather rare moment and I am fully taking it in.

A new video of mine is out on ParentsAsk.Com so I will share it here. In this one, I talk about some basic points to think about when you are considering home or hospital birth.

I hope, wherever you are today, that your day has a little bit (or a lot) of the magic of summer in it.

The first article I read about this, interestingly enough, came out of the UK and made it sound as though homebirth midwives were suddenly on par with complete outlaws, which definitely added to the dramatic effect of the article.“As residents of the world’s consumer capital, New Yorkers can have anything delivered to their door at any time… But there is one thing that is currently unavailable for delivery to those who live in this most can-do of metropolises. Women can not legally give birth at home in the presence of a trained and experienced midwife.”

The situation is much simpler than that. Fortunately, the New York Times published a more realistic article. There are 13 midwives who practice homebirth in the New York City area and seven of them had privileges with St. Vincent’s Hospital in Manhattan. According to New York law, a homebirth midwife must have back up privileges with a physician and a hospital. Regardless of law, this is the professional, ethical and moral responsibility of anyone practicing homebirth.

Certified Nurse Midwives who practice in hospitals or birth centers work within the context of a system. They provide complete prenatal care and manage normal, uncomplicated birth. They also have physician resources for known or unknown complications. In the case of the seven New York midwives, they had physician backup at St. Vincent’s who agreed to assume the care of those women who needed it.

These midwives have not found another physician practice willing to take over care in this situation. Without physician backup a midwife literally shows up on the doorstep of a nearby hospital with a mother and baby in the middle of a crisis situation. From experience, I can tell you that, very often, this is a disastrous situation. As one New York obstetrician accurately pointed out, “ By the time the mother arrives at the hospital, the situation is quite literally, a train wreck”.

This is exactly what happened with the birth of  Noa, who died as a result of the delay of medical care during a homebirth attended by Cara Muhlhahn. I have written numerous times about Ms. Muhlhahn, who openly states that she intentionally does not have physician backup due to the constraints it provides her.

Birth at home, in a birth center or in a hospital is normal and uncomplicated the vast majority of the time and I hope that these midwives in New York do find physician back up. Women should be able to choose to give birth wherever they wish. Where I always return however,  is the simple truth that birth is not ultimately about “the experience” but about a beautiful, healthy baby entering the world to a healthy mom.

I felt extremely honored to have been so graciously received here. By design, Sparrow Hospital was the first stop on my 100 Hospital National Tour – promoting “Positive Pregnancy, Positive Birth”. The reason I am doing the tour is to bring awareness that all across the country, women are choosing to give birth “as they desire” in comfortable, supportive, and safe places. Birth centers and hospitals are indeed the safest place to give birth. There is simply no counter argument to the fact that “most of the time, things go well… but when they don’t, they don’t very quickly”.

There has been much celebrity promotion of home birth recently and as I professionally sorted out why this was, it became clear to me that the appeal of home birth, to many, is the inherent fear that a hospital birth cannot, or will not be intimate and personal.

I was received warmly at Sparrow and was hosted by John Lux, the Director of Communications. I spent the better part of an entire day with nurses, physicians, residents, and administrators, as well as meeting the CEO and President of the hospital. What I found at Sparrow was an exceptionally progressive facility with the best of the best in options for women. Options ranging from natural labor to epidurals, VBAC’s (vaginal birth after cesarean), vaginal twin delivery in the labor rooms, rooming in with the baby and exclusive breast-feeding.

Sparrow has a Level 3 Neonatal Intensive Care Nursery (NICU) and is at the forefront of the most current research-driven, evidence – based practice. It is also a Magnet hospital, which means that it has been awarded a status of excellence in nursing care, professionalism and a leadership system that promotes advance practice nursing and nursing satisfaction. This creates a high level of patient satisfaction.

I wish to openly thank all of the people I met at Sparrow for taking time out of their day to meet with me. I have heard repeatedly from those who argue that hospital birth in America today is less optimal than home birth, that because my practice is in a major urban center on the west coast, that my opinions are skewed and that “the rest of the country is not like California”.

I am certainly not naive and know (and will discuss) that not every community offers every option in birth choices. However, clearly in mid-Michigan, women can expect a wonderfully positive pregnancy and birth experience.

Last week I was in the Midwest – Michigan to be exact.  It was a great trip and I was able, not only to have a wonderful professional experience, but also to spend time with my family and my very best friend. Quiet, perfect time.

The reason I went was for the launch of my 100 Hospital Tour – “Positive Pregnancy, Positive Birth”. Over the next several months I will be visiting 100 hospitals around the country to learn more about what they do, what they offer for families, and how they support a wide range of birth choices.

My decision to do this came as a result of being tired of hospital birth getting such a bad rap. And not because it was all deserving. The actress, Ricki Lake, with her book and movie about homebirth a couple of years ago got me started. It is simply well beyond time for someone to really bring to the forefront the positive and powerful experience being pregnant and giving birth within a safe, medical system can be.

So I began my tour in Lansing, Michigan at Sparrow Hospital. I selected it because I am an alumnus of Michigan State University and because I had heard wonderful things about the hospital. I wanted to immediately point out that no matter where you live in the country birth can be progressive, highly personal and extremely positive. My experience with the folks at Sparrow exceeded my expectations. I am going to talk in detail about my time with them tomorrow.

Interestingly enough, my tour comes at a time when homebirth and homebirth midwives are again in the news. This coming Friday I am going to spend time addressing the loss of lay midwives’ in New York City to have hospital backup and why this all ties in with my focus on putting positive hospital birth out in the forefront.

Spring has finally arrived here in Northern California. It feels as though it has been raining forever. All the spring flowers have me thinking about new birth. I thought this would be a good time to review some of my favorite labor coping methods. These are the the strategies I have found to be most helpful to women.

Think about the day of your labor as a working day. It’s not like a holiday celebration that has to follow a certain pattern. There is no use in worrying about how the day will go.

Don’t go to the hospital or birth center too early. Unless your practitioner gives you different instructions, use the 5-1-1 Recipe.

Do whatever will help you the most whenever it is most likely to help you. For early labor, distraction is the best coping tool.

Use relaxation, visualization, and breathing techniques. Some women use all these tools; others prefer only one or two. These techniques can help dramatically with active labor.

Know that labor takes on a life of its own. Although relaxation and breathing techniques can help you handle your contractions, you can’t control them. Let your body follow its own rhythms.

Move around so that you can find your most comfortable position. Change positions whenever you become uncomfortable.

Ask for the kind of touch or massage you want. Light touch is soothing for some women in labor but distracting for others. Firm pressure on your lower back may be very helpful.

Try laboring in water. Sitting in a warm bath or sitting or standing in a shower can often make a strong contraction feel entirely different and much more manageable. Your practitioner may ask you not to submerse yourself after your water bag has broken, but a shower is generally allowed anytime. Some birth centers and hospitals have large, inflatable pools that can be used in labor, and a portable one can sometimes be rented and brought in or used at home. (Except in home births, women generally don’t give birth in water.)

Keep hydrated and energized. Take regular sips of cool drinks, suck on juice bars or ice, and have an occasional spoonful of honey.

Trust in your practitioner and your support people. It’s really tough to have a baby all by yourself. Let others help you.

Always remember that labor lasts for a finite time. Try not to think of the hours ahead.

Take your contractions one at a time. No matter how strong they are, they will generally last only about 1 minute. You can cope that long. At the end of the minute, you will get a break.

Never lose sight of why you are laboring. Keep in your mind’s eye on the beautiful baby you will soon be holding in your arms.

Ms. Epstein spontaneously went into labor prematurely with her very small, breech baby and, although initially not planning to film it, does so. We see Ms. Epstein laboring at home and being checked by Cara Muhlhahn. Disturbingly, she does not call a back up physician (she does not in fact have one) or initially stress the importance of moving to the hospital. Finally, we see them taking a cab to the hospital with Ms. Epstein in very active labor.

In watching the movie, I was stunned at the lack of concern or alarm expressed with her very real possibility of giving birth to a premature, very small baby, outside of a hospital setting that could safely care for him. In her discussion afterward, Abby Epstein expressed disappointment that she didn’t have the experience she wanted and that she had needed to have a c/section.

Of course her emotions are valid but there is a serious disconnect here. Her baby weighed barely 3 lbs. She now has a healthy son who was fortunate enough to be born in an environment where his medical problems were both known and able to be dealt with. Where is the reality check of what is really most important here? Birth truly isn’t predictable, things really do happen, plans do, very much change. I have to ask, “Is labor and birth really just about getting what we want? About what the “experience” is like?”  Is there not a baby? An incredible human being. A gift. A miracle.

Money talks. Money can buy airtime. Money can produce movies and books and, this is where I get really steamed —  for some reason there is a general public belief that if someone  on TV says it or writes it, then it must be true. Aaachh!

Two years ago, Ricki Lake, a public personality, motivated by her own childbirth experiences made a movie called “The Business of Being Born”, and last year wrote a book entitled “Your Best Birth”. In both she asserts that women need to “take back” birth – know what their options are, and create the birth they want. If it were only that simple. Yes, it is important for a woman to understand what her options for the birth of her child are and to feel comfortable with her care provider. It is also important to help women prepare for the unpredictability of labor and birth and to be able to let go of  “trying to control” the experience.

Ms. Lake gave birth to her second child at home and has appointed herself the “spokesperson” for homebirth, although she terms it “choice”. The film has become a visual bible of sorts in presenting homebirth as an idyllic experience whereas the image of hospitals are limited to 1920’s footage and discussions of “designer births”, increased labor inductions, and carefully selected interviews with women who felt “cheated” (as Ms. Lake said she did) or denied an experience they had hoped to have had.

Ironically, on a recent talk show, Ms. Lake, when confronted with leading women to believe that homebirth was better than hospital birth, stated that she had had an extremely positive birth in a hospital with her first baby.

The movie gave misinformation regarding the side effects of several medications and blanket negativity towards women who make the choice to have  an epidural for their labors. There was no discussion on the positive side of pain relief, or on the situations when the true need for medical assistance exist. The most disturbing aspect of the film was co-producer Abby Epstein’s labor. I’ll talk about that next time.

I am going to focus on the discussion of homebirth and “natural” childbirth for the next several days. I continue to support well-structured homebirths and I have attended numerous homebirths. That means a birth attended by a Certified Nurse-Midwife with physician backup or by a physician, in very close proximity to a hospital.

There is research that shows that the safety of labor and birth in a normal, uncomplicated pregnancy and birth is the same whether the baby is born at home or in a hospital. Neither being BETTER. Yes, giving birth in a hospital involves the use of such things as electronic fetal monitoring, however, the maternal/fetal outcomes (as well as the level of maternal satisfaction) have been shown to be the same. I didn’t make this up. It is good research, not empirical data. And, of course, there is no argument that any normal labor or birth can change in an instant.

Unfortunately, the discussion becomes an “either/or”, “you pick a side of the fence” dialogue. Blanket criticism towards a birth-center or hospital birth seems to be fair game but the mere act of asking tough questions and pointing out not just the possible, but also the very real dangers of homebirth is considered to be “defensive and threatened”. Sounds like politics to me.  Let’s dissect this a little more.

It has been a bit since I have brought up homebirth but a news story over the holidays has once again sparked my desire to talk about it. It seems as though every time I pose a challenge to it I am criticized by someone for “being part of the medical establishment and for defending it”. Interestingly enough, I wonder if those same people actually even read my posts or follow the links that further outline the points I make.

Birth is, in fact, a natural and somewhat random event. How it goes; long or short, easy or difficult is not something necessarily within a woman’s control. The process definitely includes how a woman “copes”  — with the primal and completely uncontrollable course of action her body undertakes. How she embraces the process, accepts it, is afraid or not afraid of it and responds to it are huge. There are also, however, a whole cascade of physiological events that occur and that, at any time can change the course of a seemingly normal labor and birth.

That appears to be just what happened on Christmas Day to Tracey Hermanstorfer in Colorado Springs. She went into cardiac arrest during labor; my assumption is from an embolus (clot) that somehow, miraculously resolved itself. Both she and her baby had no vital signs for at least 4 minutes. Had she been giving birth at home, she may have recovered, but since her baby could not have been born immediately he would not have made it. Thankfully, Tracey and Coltyn went home safely and are doing well.

Over the next week, I am back in the mood to talk about homebirth. Put your seatbelts on.

I was really healthy during my pregnancy. A week before my December 24th due date, my water bag broke in the Christmas card aisle of our local drugstore (that’s another story) and within a few hours I was in booming labor. However, when I arrived at the hospital, my blood pressure was extremely high, 180/120. My normal blood pressure is about 90/60. I had noticed my feet were pretty puffy but did not realize that I had gained 9 pounds (in fluid) since the previous day. Shockingly and randomly, I had preeclampsia and was developing something called HELLP (hemolysis, elevated liver enzyme levels, and a low platelet count) syndrome, the most severe complication of preeclampsia.

Preeclampsia is a potentially life threatening condition that develops in approximately 5-7% of pregnancies. I was not at all in the risk category for it. HELLP involves blood cells, the liver, and the kidneys and is extremely unusual; only 0.5 percent of pregnant women develop it. That it had come on so suddenly meant it was especially serious. Within a couple of hours of arriving at the hospital, I was given medication to lower my blood pressure and to prevent seizures. I remember very little of the rest of the day, as I rapidly became sicker. Treatment for this disease is birth, but I was too ill to continue with labor. Alexander was born by cesarean section at 9:40 p.m.

I don’t remember Alexander’s birth or actually anything before noon the next day. When I look at photographs of myself holding and breastfeeding Alexander, I can barely recognize my swollen face. He and I went home from the hospital five days later. I lost 30 pounds in fluid over the next week. I had thought that I’d mapped out all the possible ways my labor could go, and this one had never even occurred to me. It was that unexpected.  And that happens. Not often, but sometimes.

Because I was so ill, I didn’t hold Alexander right after he was born; I didn’t breastfeed him until 6 hours later; and I ended up staying in the hospital for five days. None of this is what I had wished for. But that is what happens sometimes and the truth is that had I not been in a hospital or had it been 50 years ago, neither of us might have been okay. Today, I have a healthy, thriving son who has a healthy mom. I breastfed Alexander for a year, and we did not miss out on anything due to the seriousness of our first day together.  I am so grateful to have been in an environment that could safely care for us both. Honestly, I would go through it all again to have a child like him.

Giving birth is an amazing experience, whether it happens at home with a midwife, in a hospital with an epidural, or by cesarean section. Childbirth is not an end unto itself, but rather the beginning of an incredible life. For preeclampsia support, please visit the Preeclampsia Foundation and become part of their community.

Birthing babies is what I love most in the world. The fact that I now have women ask me “is it really bad for me to have my baby in a hospital?” breaks my heart and has forced me to come out swinging. Enough is enough. I can no longer sit back and listen to this dialogue about homebirth come up again and again without inserting some badly needed facts and a serious reality check. The argument is always the same by homebirth advocates. Hospitals are loud, hectic, bright, insensitive, uncaring machines full of greedy doctors and overworked “medical personnel” – (I am pretty sure as a nurse, that means me) who are just waiting to hook women up to unnecessary medications and prevent them from “trusting their bodies”.

The argument goes on to state that homebirth is safer, more satisfying, more loving, more empowering, less interventive, healthier for the baby, more spiritual and on and on. Anyway you shake it that very implicitly pronounces that to give birth at home is… “better”. Period. But always, at the end of any article, blog or comment about it by it’s proponents, are the words “but a woman should be encouraged to give birth wherever she feels most comfortable, including a hospital”.

Wait a minute. Is that what you just said? Let’s assume I am having my first baby. I am very excited and I want to learn everything I can, and of course, I want to do what is best for my baby and myself. Do I choose to have the “scary, cold hospital birth” that I was told about or the “loving, empowering, spiritually-fulfilling homebirth”? I am very likely to make the choice to give birth in either a birth center or a hospital but wow – what a set-up for feeling badly about my choice.

Let’s look at some actual facts about birth in the United States:

Over 4 million women give birth each year

97% of women choose to give birth in a hospital

2 million women live below the poverty line and have limited access to adequate maternity care

100 years ago, a woman had a significantly high chance of dying during childbirth . Medical advances, including the use of antibiotics, oxytocin to induce labor, safe blood transfusions and better management of hypertensive conditions during pregnancy, are directly responsible for the decline in maternal death rate.

Today, around the world, every 60 seconds, a woman dies during pregnancy or childbirth, often from an avoidable cause. There are no well-documented, large-scale studies that show that homebirth is either safer or more satisfying than hospital birth. We have “far from perfect” health–care in this country when it comes to taking care of moms and babies. However, there is truly a disconnect with what is really important here. Perhaps those who exert so much energy on faulting the U.S. maternal/health care system could spend even ¼ of their time working to provide better access to care for the 2 million underprivileged women here who really need it.

I have shared in the births of several thousand women at homes, in birth centers and in hospitals. I have seen miracles, tragedies, difficulties and wonder in all of those places. What angers me so deeply is the direct insinuation that giving birth in a hospital denies a woman a safe, positive and life-affirming birth experience. What kind of support is that? A woman deserves to feel nurtured by other woman, not faulted, questioned or criticized. There is no “better or best” way to give birth and I am no longer going to be quiet about it. ]]> http://www.thejoyofpregnancy.com/homebirth-vs-hospital-birth-the-gloves-are-off/feed/ 14