In so many ways, this decision will determine your birth. Many of us don’t even know we have safe and affordable options! Birth’s best kept secret, I suppose. I wrote this section for expectant moms who want unmedicated births. Clearly, if you want a medicated birth, you would choose a hospital. If you plan on a medicated birth, it is still very important to research which interventions to choose and at which point in your labor you should use them. I recommend The Thinking Woman’s Guide to a Better Birth.
Hospital: Most women believe that the safest place to have a baby is the hospital. Having rarely witnessed normal birth (or any birth at all!), we rely on those awful TLC birth shows which generally feature terrified women clinging to medical technology to save them. As a witness of normal birth and as one who has experienced it, that is not they way it typically goes. Birth is like digestion. Most of us don’t need help digesting our food. And birth often takes time; sometimes a great deal of time.
Hospitals are systems. They have policies and traditions unique to their region, medical staff, and administrators. It can be a complicated and powerful machine. If you choose a hospital and want an unmedicated birth, you must become a savvy consumer and present yourself as a confident, knowledgeable woman. It takes a special woman to pull this off as a first time mom having never gone through the birth system. But those are the women I work with–special women who pull out all the stops to advocate for their births. If you are interested in the topic of hospital practices and birth history, check out Birth: An American Rite of Passage or Born in the USA.
If you chose a hospital birth or must have one due to high risk pregnancy, how can you learn and work the system? Choose a hospital with low C-section rates or high VBAC rates. Hospitals vary wildly in these statistics. Ask around. Take the hospital tour. Find out the policies. Ask questions. In which positions can I birth? Under what circumstances must I have continuous or intermittant EFM? What are my choices in how my baby is handled after the birth? Then hire an independent doula. I’m not saying that just because I’m a doula. Really, doulas know how things go at the hospital since we typically attend births at several locations. I would steer clear of doulas who are on the hospital staff. Doulas, by definition, work for the mom. They should have no other agendas or considerations.
Freestanding Birth Center: These are privately operated places for low-risk moms to have their babies. In my area, we have three birth centers that are operated by licensed midwives. Some birth centers take insurance. Some have a doctor on staff. Most feel like a bed and breakfast! Birth Centers in SC are licensed by DHEC and must meet rigid standards. Birth centers typically offer waterbirth, free movement during labor, choice of position for birth, privacy, ability to eat/drink, and most importantly–choice. Birth centers treat birth as normal and celebratory. One of the key differences I notice is how the baby is handled after the birth. The baby is given to the mom. Exams are done while baby is in mom’s arms. Breastfeeding is encouraged immediately. No one is rushing to get the baby tagged and footprinted! Now, the big question: what if something goes wrong? Sometimes they do. Nationally, about 2% of birth center births become emergency transfer to the hospital (it is slightly higher for non-emergency transfer). More often, midwives respond to emergencies in-house. They are highly trained in birth scenarios. At the birth center where I most often attend births, the staff have an emergency transfer vehicle and can be in the emergency room in 3 minutes. In the US, where the c-section rate is 30.2%, birth centers maintain a national average of 4-5% for women who begin their care with a birth center. Birth centers usually have a flat fee–no hidden costs for requesting an extra pillow.
Home: Why not have your care provider come to you? Recent studies show that for low risk pregnancies, homebirth is as safe as hospital birth. This study from the British Journal of Medicine proposes that it is safer! I think it was Dr. Bradley who observed that animals in labor will stop laboring if they feel unsafe. Their labor begins again when they are in a safe place. It is very common for labors to stall when a mom arrives at the hospital. She must feel secure. For some this means bringing music or objects from home. Hospitals try to help by creating “homey” rooms. Still, the IV, EFM, and machines-that-go-ping are difficult to hide. Home is your turf. Another reason homebirth can be safer is the scary germ factor. Your home contains your germs. Hospitals contain everybody’s germs and infections like MRSA are becoming more common. If you choose a homebirth, your midwife will bring her emergency equipment to your home. You can still choose waterbirth at home by renting a birth tub or using your bathtub.
Julie’s Two Cents: I do like attending hospital births. Sometimes, I feel I made a difference in the course of a birth. Still it is hard work and I sometimes drive home crying. And I’m learning that even if the hospital says it is fine to use the squat bar, certain OBs are not supportive of other-than-supine positions at all.
I love for women to choose out of hospital birth for their first birth. They may never know how different their birth experience will be from most of their friends and family. They will have an experience beyond imagining. They will be supported and trusted. They will not be treated as a sick person or worse, an incubator for a baby. Their natural hormones will be permitted to release giving them the biggest rush of their lives. And their babies will be handled gently and sacredly.
The cost factor: SC moms–if you have Medicaid, no worries! Medicaid covers midwives. If you don’t, I’ve found that it is often less expensive to pay for an out-of-hospital birth even without insurance than to pay the out-of-pocket costs with insurance for a hospital birth. Crazy, huh? Most midwives are passionate about serving women and don’t want cost to be a factor. Some will even barter for services. Make an appointment and find out. Find a SC midwife.