IS A BIRTH CENTER RIGHT FOR YOU?
“Boil the water, get some newspapers,” were some of the directives used in home births many years ago. No one really knew for sure what these items represented. Some claim the boiled water was for sterilizing the instruments but only in the last century did actual sterilization have real meaning. (We can compare the understanding of sterilization and germs to the controversy of masking today). Home births were considered a safer option than hospitals before the discovery of the germ theory since the risk of death by delivery was increased in hospital deliveries. Only the very poor used the hospital to give birth where disease was rampant and death by childbirth was not uncommon.
Many years later, hospital deliveries became the norm, and were considered the safest method of childbirth. Doctors were considered more knowledgeable than midwives who were not necessarily medically trained. In fact, a couple of centuries ago the only training that a midwife had was giving birth to her own babies and delivering neighborhood babies successfully. In the sixties and seventies there was an increase of the promotion of natural childbirth preparation classes and the enthusiastic encouragement of breastfeeding which offset the opposite advocacies of the previous decades of formula feeding and anesthetic hospital deliveries.
Why were these two responses popular in the fifties? Well, anything new is popular when it comes to medicine. One elderly relative explained to me why her obstetrician opposed breastfeeding. Her obstetrician advised her, “Why should a beautiful young woman such as you abuse her body by breastfeeding when formula is just as good as breast milk, and you will not be a prisoner to your baby?” In a previous conversation regarding childbirth this same woman admitted that she felt no pain during labor and delivery as she was put to sleep during both. In fact, she didn’t even know that she had given birth to her baby son until she awoke hours later.
In later decades, there was a reversal in the popularity of hospital births with many healthy women choosing to deliver their babies at home with a midwife. One woman remarked that she did not even have a midwife and delivered her baby by herself. There are several women who do not make it to the hospital and are forced to deliver their own babies in their cars or taxis. One EMT revealed that he has already delivered over twenty babies safely and the number continues to grow year by year. In theory a baby delivers itself, but most women would like to have someone take care of the delivery, preferably someone with a good bedside manner such as an experienced and compassionate midwife.
The midway path is usually the best. Instead of a sterile and cold hospital setting or a warm and cozy home scene, there is a better option today and that is a birth center. We must not confuse a real birth center with what some hospitals name a birth room where women have their labor and delivery.
Upon entering a birth center, the patient’s body automatically relaxes even though she is in active labor. She is not forced to lie down in bed unless she feels like it. Furthermore, the bed is usually a queen or king size, and the room is gently decorated. The patient is permitted to walk around, listen to music, watch TV and in some places go into a lovely comfortable hot tub to have their pains soothed naturally. The birth room is furnished by a specially trained decorator with special soft lighting to create the most relaxed atmosphere possible.
The furthest thing from the midwife’s mind is to infuse her patient with any internal medications such as an epidural. When a person is anxious the body tenses up and this is the worst thing for a mom in labor. By relaxing her body, the chances are better for the labor to progress more rapidly. At the time of delivery in a true birth center setting, she will not have to lie flat on her back defying the laws of gravity. There are some facilities that will let the woman transform from labor to delivery in the tub but that is not something that is routine. If the woman is in a lot of pain the midwife will use alternative pain relief options such as breathing exercises, massaging and even acupuncture. Hydrotherapy may be offered as well as a bit of laughing gas. There is a shower for the mom to relax in if that is her preference.
As long as the patient is in good health and at low risk, she should feel safe going to a birth center. Some centers always have a doctor on call and are situated near a reputable hospital so if there are complications, the patient will be transferred there. For example, If the patient is a candidate for a cesarean section she will have to go to the hospital. (Statistics back up the positive claim that C-section rates at birth centers are about 6% as opposed to low risk women who chose the hospital setting for childbirth which is 26%). So too, if the baby is in a breech position and cannot be turned, the midwife will advise her to leave the birth center and go into a regular hospital delivery room. Often multiple birth pregnancies are considered high risk therefore those patients will not be considered candidates for the birth center.
Visitors are encouraged at a birth center, and some will allow children to watch the birth or at least be with their mom until she is ready to deliver. After delivery the family will be allowed to gaze at the miraculous newborn. The new mother’s birth center stay will be shorter than a hospital protocol and she will soon be back home with her new addition to her anxiously waiting family. In other words, the mystery is removed from the natural healthy process of giving birth.
As important as the reputation of the birth center is, equally if not more important is the certification and experience of the staff. If the birth center does not have a doctor on staff, you should always investigate what would happen if a doctor was needed since a midwife cannot perform a cesarean section. The patient should check out the exact certification of the midwife that she is considering delivering her baby. There are different levels of midwife certification as listed below.
Nurse Midwives:
1) Certified Nurse-Midwife (CNM): This person is trained in midwifery and nursing as well. She is certified not only to practice in a birth center but also in a hospital where most of the training takes place.
Direct-Entry Midwives:
2) Certified Midwife: These people are trained to provide midwifery care to healthy women and their newborns in out of hospital settings such as birth centers. They have graduated with a masters in midwifery. They are just as qualified as a certified-nurse-midwife except they do not have nursing education as a prerequisite.
3) Certified Midwife (CM): These professionals have been previously trained in other health related fields other than nursing but conform to the same criteria as CNM’s.
4) Certified Professional Midwife (CPM): These midwives are trained to provide midwife care in homes and freestanding birth centers. In certain states these CPM’s can also practice in doctors’ offices and clinics giving well-woman and maternity care.
5) Traditional Midwives: These women believe that women should be allowed to choose anyone they want to deliver their babies. They have chosen not to be licensed and certified sometimes for religious reasons. Their own communities are the best recommendation to members of that same community.
Conclusion
Forty years ago, choosing to give birth with a midwife in either a home or hospital setting was not a popular option in the United States. The only choice a woman had was which doctor to use and which hospital he or she was affiliated with. You usually received personal care from the doctor as many were single practitioners. In fact, this author was able to get in touch with her obstetrician personally in the middle of the night fifty years ago. This devoted doctor had his office calls forwarded to his home phone.
As years progressed maternity doctors became members of group practices. A woman would not know who would deliver her baby until she got to the hospital, especially if it was on the weekend. The relationship between the obstetrician and his or her patient became less personal and more professional orientated. While the woman was recuperating from the childbirth, she was clueless as to which doctor would come to see her in the hospital. No one must be too explicit, but the woman’s body was no longer being taken care of by only one physician. No matter how competent the doctor was, the patient could not possibly develop a true relationship with him or her since she did get to meet this doctor that often during her monthly visits. Doctor-patient relationships were changed from personal to impersonal.
This situation caused pregnant women to look for a new source for their impending delivery and monthly examinations. Women who were in good health consulted with friends on a daily basis and realized that if they wanted a more personal relationship with a medical professional a midwife was the answer. Add the fact that a birth center is so much more inviting than a hospital, midwives have become very popular among the general population.