What Is Informed Consent?

What is Informed Consent?

Informed consent is a process of communication between you and your midwife. This conversation usually leads to an agreement or permission for care, treatment, or services during pregnancy and while giving birth.

While there are known risks to all births and multiple factors that will affect those risks, the journey of pregnancy and childbirth is yours and you have the right to approve or deny care in low risk environments. This is why, at Nightingale Birth Center we spend more time establishing relationships with our clients to discuss your choices.

The informed consent process makes sure that your midwife has given you all of the necessary information about your pregnancy, along with any and all testing and treatment options before you decide what to do. In the past, women have made decisions during labor when they are stressed and not in the best state of mind, only to wish something had gone differently afterwards. 

Why Is Informed Consent Such An Important Part Of The Pregnancy & Birth Journey? 

Informed consent is so important because you have choices and as your midwifery team we want you to know what those choices are. Meaningful conversations with you about those choices are just as important to us as they are to you. While forms and documentations on your consent to care are a part of the process, you can change your mind at any time, even if you have already started treatment.

Informed consent ensures that you know what all of your options are and the risks, and that you are happy and satisfied with your entire journey into motherhood, whether it’s your first or fifth baby.

The midwives at Nightingale Birth Center will educate you on your choices so that the consent you give always comes from an educated point of view and a place of feeling safe and cared for.


7 Reasons Why Families Choose to Birth at a Birth Center

 
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When a potential client comes to tour the birth center, sometimes they are sure that’s the route they want to go, and sometimes they are exploring their options and trying to find the right fit. Here are 7 reasons that you may want to birth at a birthing center:

1. The ability to relax - Let's face it. The bright lights, beeping machines, and incessant intrusion of strangers in your hospital room is not the best way to promote peace and relaxation. At a birth center, the entire space and experience is designed to be calm and comforting.


2. The comforts of home without being at home - Some families aren't comfortable with the idea of birthing at home, but want to birth somewhere that feels as comfortable as home. The birth center fits that bill, and it has all of the equipment, technology, and experienced care providers needed to keep you safe.


3. Freedom of movement - At the birth center you can move around freely, and even give birth in whatever position feels most comfortable for you. You aren’t restricted to the bed. Additionally, the birth center has birth balls, birth swings, and labor ladders to help you move your body into supported positions that are great for labor.


4. Water! - The birth center has deep birth pools in each room that are a lifesaver for many women. We call water “the midwife’s epidural” because it is so effective at providing pain relief! You even have the option to give birth in the pool if it feels right. Water birth has been shown to be safe for both the birthing person and the baby.


5. Support for a natural birth - You don’t have to fight with your provider about your desires for your birth. Natural birth, delayed cord clamping, immediate bonding with my baby - these and more are all the norm at the birth center, not the exception.


6. Knowing your birth team - Unlike at a hospital, you will know the midwives who will care for you during your birth. In fact, you will likely spend many hours with them over the course of your pregnancy at your relaxed 45-minute prenatal visits.


7. Cost - There's no way around the fact that finances came into play when choosing where to give birth, and the birth center is actually far cheaper than a hospital birth. The birth center is also covered by many major PPO insurance plans. All the amazing benefits, plus cheaper to boot.

It's a marvel everyone isn't having their babies at a birth center!

 

All About Birth Centers

 
Many birth centers offer the option of delivering your baby in the water, also called water birth. Very few, if any, hospitals allow water birth.

Many birth centers offer the option of delivering your baby in the water, also called water birth. Very few, if any, hospitals allow water birth.

 

What is a freestanding birth center?
A birth center is a freestanding building, not connected to a hospital, where women go to receive maternity care (prenatal and postpartum) and give birth. Birth centers cater to women desiring a natural birth, without medications or medical interventions. Birth centers only care for healthy mothers and babies. High-risk pregnancies are not appropriate for birth center care.

The American Association of Birth Centers has more info.

What is the difference between a hospital and a freestanding birth center?

A freestanding birth center is a home-like environment. Many birth centers have luxurious queen beds, dimmable lighting, and a warm and cozy interior. At a birth center, you are free to move around, to eat and drink in labor, and to birth in whatever position feels right to you. Medical equipment is often hidden in cupboards, easily accessible, but out of sight, so it doesn't detract from the environment. Intermittent monitoring of the baby's heart rate is done with a handheld doppler, as opposed to a continuous fetal monitor. Interruptions and medical interventions are kept to a minimum so as not to disturb the laboring person and the natural process of birth.

But not only do birth centers offer a different kind of environment, they offer a completely different kind of care than hospitals.

Monty Python’s The Meaning of Life illustrates the problem birth centers solve in a typically comical and dramatic fashion…

 
 

Birth centers, in contrast, provide care according to what’s called the “Midwifery Model of Care.” In the Midwifery Model, care is delivered by midwives, not doctors. Here’s what a family can expect at a birth center:

  • Personal attention
  • Time with their care provider
  • In-depth education around pregnancy, birth, nutrition, tests, options, etc.
  • Individualized care tailored to their specific needs
  • A care provider who will stay with them throughout their labor and birth
  • They will know who will be at their birth
  • The freedom to move, eat, make noise, and do as they choose in labor
  • A peaceful, private environment in which to give birth
  • Overall, high-touch, low-tech care

Here’s more about the Midwifery Model of Care.

98.8% of women using a freestanding birth center would recommend it to a friend and/or return to the birth center for a subsequent birth.

If birth centers are so great, why aren’t more women choosing them?

Good question — because there aren’t enough of them.

 
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But why would women desire a birth without medication and/or interventions?

Pregnancy and birth happen by a complex chain of events triggered by hormonal and other physiological changes. Every time we introduce something, like a medication or another type of intervention, we run the risk of upsetting this very fragile biological process. When the process of labor is interrupted, it causes problems which necessitate other interventions to stay on track and keep everyone safe. This phenomenon is called the “Cascade of Interventions.” It can be thought of like a snowball — one intervention leads to another, and then another, and another. The ultimate intervention, where the baby is removed by surgery to the abdomen, is called a Cesarean Section. In the US, 1 in 3 women is having a C-section. This is SO HIGH! And it has grown considerably over the last several years.

The World Health Organization believes we should aim for a maximum of 10–15% of women receiving C-sections. The US is currently at about 32.4%. Most women don’t want a C-section and one of the best ways to avoid getting one is to have your baby at home or at a birth center. Out-of-hospital births end up with a transfer to the hospital and a C-section rate of only 5.2%.

More Than Half Of C-Sections Performed In U.S. Aren’t ‘Medically Necessary’
Pregnant American women give birth via caesarean section at more than double the rate the World Health Organization…www.huffingtonpost.com

What’s so bad about C-Sections?

“Like any other major surgery, c-sections can have complications, like damage to other organs, internal bleeding, blood clots or infection. Recovery after a c-section is typically longer than that of a vaginal birth. Moms who have c-sections may experience as much as six weeks of post-operation pain and bleeding, versus bleeding and vaginal discharge for two to four weeks after a vaginal birth. Finally, women who have a c-section for their first baby will face risks for subsequent pregnancies, like a higher chance of the placenta implanting or growing abnormally, or uterine rupture along the site of the scar.” Huffington Post

There is also substantial lifelong risk to the baby, as found by a recent study published in the British Medical Journal and reported by CBS News (among others).

What about pain?

Birth centers specialize in unmedicated birth. They educate women and their families prenatally about what to expect in labor and how to cope with the intensity of birth. Most women do just fine. I have heard women say that labor was not nearly as painful as expected, and that having a spider bite incised was far more painful!

That is not everyone’s experience, however. So birth centers do offer tools like massage, hydrotherapy (water is very relaxing in labor), TENS units (electro-stimulation), and other natural measures to help women cope.

That being said, there are some pain medications that pose minimal risk and can be used safely in a birth center. Those medications are nitrous oxide (laughing gas) and some types of narcotics.

How much does birth center care cost?

Not only do birth centers provide more personalized, attentive care with fewer interventions, but they are also far less expensive than hospitals. The New York Times did a great job of summing up the incredible costs of having a baby in their 2013 article, American Way of Birth, Costliest in the World. Here’s an excerpt:

“When she became pregnant, Ms. Martin called her local hospital inquiring about the price of maternity care; the finance office at first said it did not know, and then gave her a range of $4,000 to $45,000. “It was unreal,” Ms. Martin said. “I was like, How could you not know this? You’re a hospital.”

[…] Add up the bills, and the total is startling. “We’ve created incentives that encourage more expensive care, rather than care that is good for the mother,” said Maureen Corry, the executive director of Childbirth Connection.”

American Way of Birth, Costliest in the World
LACONIA, N.H. — Seven months pregnant, at a time when most expectant couples are stockpiling diapers and choosing car…www.nytimes.com

By comparison, cost of care in a birth center is usually a flat fee and varies by cost of living in that part of the country. Ranges are from about $4000 in Austin, TX to $9000 in the San Francisco Bay Area.

Does health insurance cover birth center care?

YES! Most PPO plans cover some portion of birth center and midwifery care. The amount varies considerably by plan, but many plans cover between 1/3 to the full amount of the fees.

Are birth centers licensed?

In California, licensing of birth centers is optional, and there are a number of reasons a birth center might choose to forego licensure. All midwives, however, are licensed. Licensed midwives are licensed by the Medical Board of California. Many other states also have legislation for licensing midwives and birth centers.

Is birth center care safe?

Yes, it is. Midwives that work in birth centers are fully licensed and have followed a course of study that prepares them to safely care for families in a birth center setting. Birth centers stock a variety of tools to handle potential emergencies, including medications to stop bleeding, resuscitation equipment for both the baby and the mother, and oxygen. All staff are trained in Neonatal Resuscitation, CPR and Advanced Life Support in Obstetrics. Statistics for nearly 17,000 out-of-hospital births and their outcomes can be found here.

Do birth centers carry malpractice insurance?

Yes, birth centers and the midwives who work in them are required to carry malpractice insurance.

Where can I learn more about the maternity care industry in the US?

Ricki Lake did a fantastic documentary called The Business of Being Born that gives an enlightening look at the issues surrounding maternity care in the US. Here’s the trailer…

The full version of the documentary is available for free on YouTube.

So in summary…

Birth centers…

  • are safe
  • are consumer friendly
  • have extremely high customer satisfaction
  • provide more personalized care
  • offer a peaceful, luxurious environment
  • and are cheaper than the competitor (hospitals).
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