C-Section Risk

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.

 
birth centers in the usa.png
 

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).

What is the Difference Between a Midwife and a Doula?

I get asked this question about once a week. Many people don't know that there is a difference and often confuse the two. Here it is, plain and simple:

A midwife is a primary care provider. She provides clinical care for the healthy mother and baby. For many women, as long as their pregnancy progresses normally, they will have no need to ever see another primary care provider, say for example, an obstetrician. The midwife oversees the general health of mom and baby throughout pregnancy and manages the delivery and postpartum period as well. You could say that the midwife delivers the baby, but I think most midwives would disagree. It's the mother who delivers the baby! 

A doula is an extremely valuable person to have on your birth team, but she doesn't have a clinical role. A doula's job is to support the mom and her partner in labor. She provides physical support (massage, labor coping techniques, etc.) and emotional support. She can help the parents navigate the hospital system if they are delivering in a hospital by educating them on different procedures and holding space for them to make informed decisions. The doula does not take the mother's blood pressure, assess the baby's heart rate, or do anything else clinical. 

 
Doula Yien supports a mama having a natural delivery at home by keeping her calm, focused, and on top of her contractions. Yien provides continuous physical and emotional support until the baby is born, never leaving the mom's side.  Photo by Pam Ellis

Doula Yien supports a mama having a natural delivery at home by keeping her calm, focused, and on top of her contractions. Yien provides continuous physical and emotional support until the baby is born, never leaving the mom's side.
Photo by Pam Ellis

 

Midwives and doulas often work in tandem. It is common to see both a midwife and a doula supporting a birthing mom together, each bringing her own set of skills to the process. 

In her blog, A Wondered Life, Rebecca Coursey explains the difference from another angle:

"Midwives are not just trained, and medically-board certified, to deliver babies and provide well-woman care, they are also trained in care of the newborn. They make sure all is well, checking for any abnormalities that are not caught during prenatal testing, making sure that everything is working properly and that baby is thriving. Often people confuse midwives and doulas, thinking that midwives are just doulas who decide they want to start helping women birth their babies at home. It is quite the contrary. Doula training is typically just a certification process from a 3-4 day class. On the other hand, Midwives have 3-4 years of schooling that is not only academic, but clinical as well. They bring with them a "mini-hospital" to home births (or at their birth centers)-- and have advanced training in life-saving support skills. They must pass national medical boards (the NARM) and be licensed through the state where they practice in."

 
Midwife Amy assesses a healthy newborn. The midwife works to keep mom and baby safe and healthy throughout pregnancy, birth and postpartum. To do that she monitors vital signs, draws and interprets labs, educates clients on tests and interventions, and is trained in normal birth, as well as emergency techniques. She works within the medical community and refers clients to outside providers as needed.  Photo by Sandor Weisz

Midwife Amy assesses a healthy newborn. The midwife works to keep mom and baby safe and healthy throughout pregnancy, birth and postpartum. To do that she monitors vital signs, draws and interprets labs, educates clients on tests and interventions, and is trained in normal birth, as well as emergency techniques. She works within the medical community and refers clients to outside providers as needed.
Photo by Sandor Weisz

 

Midwives in the United States deliver babies in hospitals, in freestanding birth centers (not attached to a hospital) and in homes. There are a few different types of midwives, and although there is some crossover, you will generally find Certified Nurse-Midwives in hospitals and Certified Professional Midwives in freestanding birth centers and homes. Doulas work and provide a valuable service in all settings and for all different types of births, including Cesarean sections.