C-section

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).

Pregnant? Get. A. Doula.

It’s that simple. And it’s something I can’t stress enough....

Having a natural home birth? Get a doula. 
Having your baby at the hospital with an epidural? Get a doula. 
Having a natural birth at the hospital? Definitely get a doula.
Having a C-section? Get a doula.

In the ten years I’ve been attending births, I have never seen a more effective way to increase your chances of having a positive birth experience. Doulas are unique among the birth team in that they are trained professionals that provide continuous support for the laboring mom. This means a doula will never leave your side. Your midwife, your OB, the nurses, everyone else - they have other tasks to attend to - charting, prepping, making sure everyone is safe, not to mention other patients/clients (if you’re in the hospital). But a doula, she is there with you from the moment you need her until well after your baby's born and you've done your first breastfeed. She will rub your back, breathe through contractions with you, help you stay calm and focused, help you talk with hospital staff, support you in breastfeeding, get you something to drink, get your partner something to eat, and the list goes on and on and on. 

One of the most important things a doula does is to help your partner support you. Let’s face it, sometimes partners get tired, or they get overwhelmed, or they plain just don’t know what to do because they’ve never been to a birth before! Have no fear. Doulas have often been to many births, and are experts in managing the interpersonal aspects of labor. They are very intuitive about knowing how to support partners and help them feel comfortable, as well as helping to manage relationships with other family, friends and birth team members, all according to the mother's wishes, of course. 

A few things a doula does not do: 

  • She doesn't do anything clinical - no vaginal exams, blood pressure checks, fetal heart tones, etc.
  • She does not replace your partner. 
  • She does not speak for you or represent you to birth team staff. She can help hold space for you, and help you to think through decisions, but you or your partner are still responsible for communicating directly with your birth team about your needs and desires.

I know a lot of you out there are numbers-oriented folks, so let’s look at what the statistics say about having a doula at your birth. A meta-analysis of 22 studies comprising over 15,000 births showed that overall, women who had a doula at their birth experienced a:

  • 31% decrease in the use of Pitocin
  • 28% decrease in the risk of C-section
  • 12% increase in the likelihood of a spontaneous vaginal birth
  • 9% decrease in the use of medications for pain relief
  • 14% decrease in the risk of newborn being admitted to the nursery
  • 34% decrease in the risk of being dissatisfied with the birth experience

I advise all of my clients to get a doula. They are worth their cost many times over. I have never heard a mom say she wished she’d saved the money she spent on a doula. In fact, I’ve often heard women say that they would have paid much more if they had known what a valuable service a doula provides.

In recognition of World Doula Week, I urge everyone reading this to learn about doulas and get out there and spread the word. Educate yourself and the women and families you know about the amazing benefits of having a doula. ALL mothers deserve a doula!

P.S. In this post I am specifically talking about birth doulas, but I also want to acknowledge postpartum doulas, who are equally as wonderful, and are often a godsend for families who are learning how to incorporate a newborn into their lives.

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