birth center

Birth Story: The Birth of Olivia Victoria

This birth story was shared with us by our dear and wonderful client, Valerie, about the birth of her baby girl Olivia, at the birth center on October 5, 2018. Olivia was the very first baby to be born at Nightingale Birth Center, which makes it even more special!


I chose a natural labor with little to no medical intervention. Instead of drugs, I used breathing and relaxation techniques that I learned from yoga and hypnobirth (self-hypnosis) and my experience connecting my body, mind, and breath. My husband and I felt very comfortable with the decision. I also chose a provider that supported us, was patient, and gave us the best chance of having the birth experience we wanted. I had a healthy and low risk pregnancy and the baby was full term so I felt comfortable going this route. I also had a birth doula who gave me evidenced-based information and helped me during labor so that my husband could focus on loving me and being present on her daughter's birthing day.

On Thu Oct/4 at around 7am I woke up and had liquid running down my leg. It wasn’t a big gush but more like a small leak. After using a pH test strip, it turned out that my bag of waters broke. I immediately woke up my husband to tell him the news. Contractions hadn’t even started, but I knew the baby was going to make an appearance soon. Looking back, my body had been trying to tell me something since the night before when I had a discharge that looked very similar to what they call the “mucus plug”.

Later that Thursday morning, my husband and I went to visit our midwife who recommended some herbal supplements in order to get labor going and minimize the risk of an infection. We followed the instructions all afternoon and evening. I ate yummy and healthy food and took a walk to try to get things moving. I could feel very mild uterine waves (contractions) without a pattern. At around 10pm we had a call with our midwife and agreed that we were going to go to the birth center at 1am in order to start a first round of antibiotics (these are recommended after a certain number of hours since the bag of waters breaks). My husband and I grabbed our birth bag and took a 2-hour nap before heading to the birth center (1 min away from our house). Things were going to get interesting once we were there….

Friday 10/5 1am: Active Labor

I stayed at home until Fri 10/5 at 1 am when my husband and I went to the birth center and got the first round of antibiotics going.  Even with the IV in place, I was able to move and walk to the bathroom. The birth center had a queen size bed so my husband and I were able to rest for a little while. At around 2:15am I went to the restroom and noticed some bleeding, which is what they call the “bloody show”. Almost immediately after, I started feeling stronger uterine waves with more pressure moving things down. The only way I can describe the feeling is that of an icing dispenser bag being squeezed :)

In between uterine waves, I was able to rest while listening to the hypnobirthing relaxation audios. During each uterine wave, I practiced calm belly breathing (inhaling deeply through my nose expanding my belly and exhaling through my nose contracting my belly). My husband monitored the uterine waves using an app and by 3:30am they were 3 minutes apart for 1 minute for about 1 hour.  I did my best to remain relaxed throughout to avoid stress, which causes the fight, flight or freeze response. (Note from husband: “Valerie and I were lying down next to each other on the bed. She would fall asleep for a few minutes and then would tell me ‘there’s one coming’. I immediately would hug her from the back and start singing the song we had agreed on, that talks about peace and faith, to her ear. I could hear Valerie practice the belling breathing to “ride” the wave and mitigate the discomfort.  After a minute or so Valerie would tell me that the wave was over and in a matter of seconds she would fall back asleep to the point of snoring.”)

Every five or so waves I would stand and walk to the restroom while waiting for the next one to arrive. At about 4:30 am our doula arrived and started helping with massaging my back and legs during uterine waves for the next hour.

At around 5 am, I felt my breath changing from calm belly breathing to a strong ujjai breath (ocean breath inhaling and exhaling through my nose) and I also had the urge to push and a thought of escaping went quickly through my mind so at around 5:30 am I asked the midwife if she thought it was worth checking how many centimeters of dilation I had and she agreed to check. (Note from husband: “About 30 minutes before this I had asked the midwife how far along did she think the process was. She told me that it was hard to tell because Valerie didn’t seem to be in that much pain or she was managing it extremely well with her breaths.”) When the midwife checked she just said: “I feel no cervix, you are fully dilated!”. At this point I was super happy that things seemed to be progressing well so I decided that it was time to move from the bed to the water tub. I went in by myself and went through about 10 uterine waves while the doula was massaging my back and my husband was singing to my ear. After a few minutes I asked my husband to join me in the tub. I was hoping things would progress as quickly as they had so far...

Friday 10/5 at 5 am: Birthing Phase

As soon as I got into the birthing water tub the water felt great. My husband was in the tub with me and the doula was massaging my back. The midwife was instructing me to push with each uterine wave, which we tried for various waves using different positions. I didn't make much progress there and the waves seemed to be spacing out so the midwife suggested trying something different. As second option, I tried using a squat stool for several minutes, but it never felt 100% right for me so I wasn’t relaxed enough to make it work. Because initially I was seeing a lot of progress on the bed, I decided to try side-lying on the bed. The uterine waves continued to slow down so we started using a breast pump to stimulate milk production and keep the waves going at a good rate. During each wave, the midwife could see a glimpse of the baby’s head with remainder of the bag of waters in front. The midwife suggested removing the of bag of waters that was blocking the baby's head from coming out. We consented and a bit more of amniotic fluid came out and now they started seeing more of the baby’s hairy head :)

Still the side-lying position wasn’t being effective.

Friday 10/5 at 12 noon: Baby emerges

In between one of the uterine waves I went to the bathroom. I told my husband that for some reason the sitting position felt better and that I wanted to try something like that. The second midwife suggested trying a hands and knees position, but I had the needle of the IV close to my wrist so I couldn't bend it. We got creative and placed a birthing ball on top of the bed where I rested my arms and head while my knees were on the bed. I told my husband “I am going to breathe our baby down” and I tuned into my body and sent my ujjai breath down. My husband just said: “listen to your body” as he re-started playing the hypnobirth affirmation audios in the background. I tuned everything else out and went deeply within, trusting my body and baby to know what to do. (Note from the husband: “this is when things seemed to get back on track. It was like we had lost focus for a few hours trying to follow instructions as opposed to listening to what the baby and Valerie’s body wanted to do. It would be impossible for me to describe the determination on Valerie’s eyes as she started to breathe the baby down”.)

During every uterine wave, I kept sending my ujjai breath down. Instinctively, I started moving my hips down to my heels with every exhale, thus expanding my pelvis and allowing gravity to help. With each inhale my hips would move back up and I would try to rest while my husband, who was standing next to me, wiped the sweat from my forehead. The midwife told my husband that this was the most progress she had seen so far and gave me space to listen to my body. After about 10 uterine waves, the midwife asked me to reach down to feel the baby’s head. I was able to feel the crown of her head and her hair too! This alone gave me so much strength and confidence to keep going knowing I was so close to finally meeting her. As I kept breathing her down, I felt what’s known as the “ring of fire” (look it up) while my doula reminded me to just keep breathing. After that everything happened super fast! I let go and just let my instinct and inner power take over. I had the impression that I was screaming throughout the process but my husband says it was a deep exhale and moan. (Note from husband: “at this point the midwife told me to look down as the baby was about to come out. I started seeing her head come out with her little hand resting next to her face. As soon as her head and hand came out, her whole body quickly followed (usually it’s head first and then shoulders). The midwife quickly gave the baby to Valerie. At this point I was crying, laughing and everything in between”.)

My baby emerged so fast! I looked down and there she was on the bed in front of me. The midwife put her on my chest, skin-to-skin, my husband was crying. I was relieved, thankful, and full of emotions and love for both. At that moment, the room was full of life and we could suddenly feel her presence. Olivia was born on Friday Oct/5 at 12:24 pm. It was such a beautiful and magical experience.

Olivia’s precious little hand up by her face had delayed the birthing phase, although in my mind it felt much less because of the time distortion created by the hypnobirthing techniques.

 
Valerie Wong.jpg
 

The Birth of the Water Baby

 
The cover of Midwifery Today magazine from Autum 2015

The cover of Midwifery Today magazine from Autum 2015

 

“In 1977, a state hospital near Paris began quietly changing the way women gave birth.

Obstetrician Dr Michel Odent believed that childbirth had become too medicalised and he wanted a more natural approach.

So he introduced a pool to ease the pain of labour and eventually some babies were even born in the pool.

Witness speaks to Dr Odent about the innovation that has become a revolution using the power of water.”

This intriguing 4 minute BBC Witness video documents the introduction of the birth pool to labor and delivery. Watch it here.

7 Reasons Why Families Choose to Birth at a Birth Center

 
birth room.jpg

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!

 

CPMC St. Luke's May Be A Slam Dunk If You Want To Have A Natural Hospital Birth

St. Luke's Hospital Labor & Delivery

St. Luke's Hospital Labor & Delivery

Yesterday, I went on a tour of what has been argued for years by homebirth midwives to be the best hospital in San Francisco to have a natural birth. Not having had occasion to transfer there myself, I was curious to learn about their facility and policies. This is what I learned...

One of the nurses guided myself and 3 pregnant couples on our 45 minute tour at 5pm on a Tuesday evening. She started by explaining that in labor, patients should come in through the main entrance, unless it is the weekend or after 8pm, in which case patients should enter through the emergency department off of San Jose Ave. There is a cafeteria on the 2nd floor that is open Monday through Friday from 6:30am to 6:30pm where guests can get hot food and snacks. 

Labor and delivery is on the 3rd floor. There are 3 delivery rooms and 3 triage rooms. The delivery rooms are smaller than the rooms at some of the newer hospitals like UCSF Mission Bay. The triage rooms are very small, and are used for patients who are not yet in active labor. Both the labor and the delivery rooms have attached bathrooms - although none of them have bathtubs, and only the delivery rooms have showers. 

All rooms, according to our guide, have telemetry units, also known as wireless fetal monitoring. This allows for monitoring of the baby without requiring that you be hooked up to a static machine at the bed. The monitor hangs around your neck so you can move about. 

The nurse estimated that St. Luke's does about 80 deliveries a month. On the evening of our visit, all 3 delivery rooms were occupied, and 2 out of 3 of the triage rooms were occupied. For that reason, we were not able to see an actual delivery room, just one of the smaller triage rooms. Our tour guide assured us, however, that it is very rare for them to be so full as to have to deliver patients in the triage rooms or reroute patients to another CPMC campus. 

One of the triage rooms at St. Luke's. 

One of the triage rooms at St. Luke's. 

Next, we went up to level 5 to the postpartum unit. The postpartum rooms are also small and uninspired. There is a hospital bed, a television, a fold out chair for partners, and a small sink area. They also have a connected bathroom with toilet and shower. The typical stay for a vaginal delivery is 2 days, and for a Cesarean section, 4 days. 

Postpartum room

Postpartum room

PROS

  • Midwives are the primary providers at all low-risk deliveries. There is a midwife and a physician in the labor and delivery unit 24 hours a day, 365 days a year. The physician attends deliveries only when it is deemed medically necessary.
  • Intermittent fetal monitoring is an option and wireless monitors are available in all rooms.
  • Group prenatal appointments are available in cohorts of 10 families per group. The program is modeled after the Centering Pregnancy model, but was developed by CPMC. In this model, prenatal appointments and pregnancy/childbirth education are blended into bimonthly group appointments. Afternoon and evening meeting times are available. The groups fill up months in advance, so sign up early.
  • The hospital started allowing VBACs in October of 2017. I do not have any more information on the requirements for a VBAC, policies, or rates of successful VBAC at St. Luke's.
  • Laboring patients are allowed to move freely during labor and to push in positions other than flat on their back in bed. In fact, our guide assured me that babies at St. Luke's do not have to be born in the hospital bed - that babies are born on the birth stool, in a squat, on hands and knees, and in a variety of positions. This is a BIG DEAL. I don't know of any other hospital in the Bay Area that will let you deliver your baby anywhere other than in the hospital bed.
  • Baby rooms in with mom.
  • A lactation consultant and social worker are available on the postpartum floor Monday through Friday.
  • There is no restriction on the number of visitors you can have in labor and delivery or postpartum.

CONS

  • The facility is old and the rooms are small.
  • There are no bathtubs in any of the rooms, and only the delivery rooms have showers. 
Ensuite bathroom for one of the postpartum rooms

Ensuite bathroom for one of the postpartum rooms

Unfortunately, our guide didn't have a very good grasp of the actual hospital policies or practices around things like GBS, VBAC, induction, eating in labor, C-section, or pain management options.

I was able to glean some information about St. Luke's C-section rate from online. According to the California Hospital Assessment and Reporting Taskforce, CPMC St. Luke's had a NTSV C-section rate of 21.7% in 2014. For reference, the statewide rate for that year was 26%. The NTSV C-section rate includes only first-time moth­ers giv­ing birth around their due date, hav­ing a single baby that’s po­si­tioned head down.

Without knowing much more about key procedures or policies, all of the obvious cons are related to the facility. And guess what - there's good news here. CPMC is currently in the process of building a new campus for St. Luke's. The new campus will be right next door to the current one, and is on track to open towards the end of August 2018. That's in 8 months, folks! So many of you reading this will benefit from the new facility, which is certain to be leaps and bounds better than this one. I'm told there will be bathtubs :-)

If you are healthy and are having a healthy pregnancy, then having your baby at home or in a freestanding birth center is the best option if you want to avoid a C-section or other restrictive or invasive procedures. That being said, if you are absolutely set on a hospital delivery, you should seriously consider St. Luke's for your care if you are desiring a natural birth. Having a midwife as primary provider and being able to deliver in the position of choice makes St. Luke's much closer to a mother-baby friendly model of care than most other hospitals in the Bay Area. I wouldn't be surprised if many of their other protocols are similarly progressive. 

In my opinion, once St. Luke's is in the new facility, it'll be a slam dunk for Best Hospital in the Bay Area for a Natural Delivery.

Addendum: Shortly after I published this post, the lead midwife at St. Luke's reached out to me by email to clarify some aspects of the facility that my tour guide hadn't been completely accurate about. Those updates have already been made in the body of this post. She also emphasized that along with the move to the new facility, St. Luke's was working to implement changes to make the midwifery-centered approach even stronger. This is really fantastic to hear. While a nice facility can certainly make your experience more pleasant, there is nothing more important than the values of the team that is providing your care. 

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).