Birth centers: Alternatives to hospitals
I want a natural labor experience, but I don't want to give birth at home. Do I have another option? Yes. If you're a healthy woman at low risk for pregnancy and birth complications and you want a more natural, family-centered experience without routine medical interventions (such as IVs and electronic fetal monitoring), you may want to deliver at a birth center. Birth centers offer a low-tech, high-touch, personalized, and comfortable place for childbirth. If you choose an accredited birth center, you'll be cared for by licensed professionals, usually a midwife and a nurse, with a backup hospital nearby and a doctor on call in case of an emergency.
Birth centers aren't mini-hospitals — your labor will never be induced or "helped along" there, and c-sections are never done at birth centers. But they are equipped with IVs, oxygen, medication, and infant resuscitation equipment, so if need be, emergency care can be started while you or your baby is awaiting transport to the hospital.
Typically, a birth center is an independent facility, though a growing number are affiliated with (and often housed inside) hospitals. At a freestanding birth center, you'll get prenatal care there throughout your pregnancy, give birth there, and go there for your postpartum checkups. Birth centers also offer childbirth education and breastfeeding classes. In-hospital birth centers operate a little differently. They're usually available to any midwife or doctor who has admitting privileges at the hospital, but your prenatal visits will probably be at your caregiver's office.
What are the benefits of using a birth center?
Accredited birth centers provide:
• A sense of control and involvement. Birth centers never routinely use interventions. You won't automatically be hooked up to an IV. And instead of continuous electronic fetal monitoring, which often requires you to stay in bed with a belt strapped around your middle, a midwife or nurse will monitor your baby's heartbeat intermittently with a handheld Doppler (like the one your caregiver uses during prenatal visits). IVs, oxygen, medication, and infant resuscitation equipment are available in case they're needed. And after you give birth, no routine policies or procedures require you to be separated from your baby. All of his examinations and his first bath take place in your room.
• Hospital backup. All accredited birth centers have a backup arrangement with doctors and a nearby hospital in case you need to be transferred there during labor, birth, or postpartum.
• Lots of encouragement to have a drug-free birth. The staff is trained to help coach you through labor and committed to helping you have a drug-free birth if you choose one. Analgesic drugs, such as Demerol, are often available if you want them, but epidurals — which require an anesthesiologist — are not.
• Freedom of movement and more. You can move around freely, choose the position you'd like to be in for labor and birth, and eat and drink anything you choose during labor.
• Your pick of invitees. Some hospitals limit how many people you can have at the birth, but at a birth center, you get to decide who's with you. And if you'd like your children to be there, they'll be warmly welcomed.
• Breastfeeding help and encouragement. Birth centers make it a priority to provide breastfeeding education and support during the prenatal period, for the duration of your stay after you give birth, and in the postpartum period.
• A warm and comfortable physical environment. A typical private room has carpeting, plants, pictures, a rocking chair, and a bed large enough for your partner to share with you. The rooms usually have kitchens where you can store or prepare food, too, and some also have large whirlpool tubs. Finally, there's often a separate family room where "invitees" can go if you decide you need more privacy, and children can rest or play when they need a break.
• Lower costs. Because women who deliver in birth centers usually stay for less time and use fewer interventions, the average cost is about a third less than a hospital birth.
• Speedier checkout. You'll be allowed to go home 12 to 24 hours after delivery, with the idea that sticking around really isn't necessary — or even desirable — if you and your baby are doing well. The birth center staff may call you to see how things are going, and you're always welcome to call them with questions. Some offer the option of a home visit a day or two after you give birth.
How can I tell if I'm a good candidate for a birth center? You can start by calling a birth center and talking to one of the staff members about your health history. They'll ask you, for example, whether you have certain pre-existing medical problems (such as high blood pressure or diabetes) or if you've had a cesarean delivery or some other invasive uterine surgery. If you don't have any significant risk factors that would require a hospital birth, you can make an appointment for a first prenatal visit. At that visit, a midwife or doctor will take an extensive health history, perform a complete physical exam, and order the necessary laboratory work.
If at any time during your pregnancy, your practitioner determines that it would be safer for you to give birth in a hospital, you'll be referred or transferred. This would be the case if, for example, it turns out you're carrying twins, you go into premature labor, or you develop preeclampsia. In some cases you may also need to change caregivers.
About one in eight women who starts labor in a birth center ends up needing to transfer to a hospital. In most cases, they transfer for non-emergency reasons, such as when labor isn't progressing and oxytocin (Pitocin) is required. Still, moving mid-labor is often discouraging and uncomfortable, and may require a change of caregivers. So before deciding whether you'd like a birth center birth, it's important to ask yourself how you'd cope with an unexpected, last-minute change of venue or provider.
How do I choose a birth center?
Before you settle on a birth center, get answers to the following questions (many of which are recommended by the National Association of Childbearing Centers):
• Is the birth center accredited by the Commission for the Accreditation of Birth Centers? What are the staff's qualifications and experience, and are they all licensed healthcare providers?
• What happens if I develop a problem during pregnancy?
• How does the center help women manage labor pain? What medications are available, and how often do women use them?
• What are the arrangements for care if complications arise? How often are women transferred to a hospital during labor or postpartum? How often do babies have to be transferred to the hospital? What percentage of these are emergency transfers? How long does it take to get to the backup hospital?
• If I need to be transferred during labor, will the midwife come with me? Does she have admitting privileges at the hospital? If not, will she stay with me for support?
• Who's the backup physician, and can I meet her during my pregnancy?
• What kind of problems has the center encountered?
• What kind of postpartum care will my baby and I receive? What's the minimum and maximum allowable postpartum stay?
• Will my health insurance cover your services? (You should also speak to your insurance company and find out what's covered if you start at the birth center and end up giving birth at the hospital.)
NOTE: If no birth center in your area meets your criteria, you may be able to find a hospital-based midwifery practice that meets your needs. You can get more information on this option from the American College of Nurse-Midwives.
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