Birthing Options
Here in U S of A we are blessed to have so many options when it comes to where you want to give birth. The hospital, birthing center, or home - you can do it all! Well not all at the same time…but you get what I mean. When I was pregnant with my first baby, over 10 years ago, my sister-in-law told me about the childbirth class that she had taken, and she insisted that I take it too. Boy, oh boy, am I glad that I did! I mean, where else would have I heard 94% of the things that we talked about! Surely no one else was telling me about different birthing choices, the stages of labor, how my husband could be supporting me throughout, or freely talking about going (cough) number two (cough), during birth. Us ladies lead a glamorous life I can tell you that! So, shout out to “The Bradley Method” childbirth classes! I was planning an unmedicated birth at a wonderfully rated local hospital. Actually, I initially was going to give birth with a different OB at another hospital in the area, but after learning about their local stats and how anti-natural childbirth he was, I switched providers. (Always make sure that you and your care provider are on the same page!) My childbirth educator however had a home birth with her daughter and spoke a bit about that, and another woman in my class was planning a birth center birth. Either of those options had literally never crossed my mind! This could be because I didn’t know that birth centers in our area existed and exactly what they were, also my mental image of a home birth was an old lady coming to your house in Birkenstocks yelling at your husband to gather towels and boil water. Turns out - that’s not actually what happens.
So, since I don’t want you to be me from ten years ago, I figured this would be the perfect place to break down the differences between your options!
Providers
Ob - short for Obstetrician
Obstetrics is the branch of medicine related to medical and surgical care before, during, and after a woman gives birth. Obstetrics focuses on caring for and maintaining a woman’s overall health during maternity.
This includes:
pregnancy
labor
childbirth
the postpartum period
OB-GYNs (Obstetric/Gynecologist) can conduct office visits, perform surgery, and assist with labor and delivery. Some OB-GYNs provide services through a solo or private practice. Others do so as part of a larger medical group or hospital. An OB can attend births in and out of a hospital.
[https://www.healthline.com/health/what-is-an-ob-gyn#obstetrics]
Nurse-Midwife
A registered nurse with additional training as a midwife who delivers infants and provides prenatal and postpartum care, newborn care, and some routine care (such as gynecological exams) of women. Licensed by the nursing board. NM’s can attend births in and out of a hospital.
Midwife
A "licensed midwife" is an individual who has been issued a license to practice midwifery by the Medical Board. The practice of midwifery authorizes the licensee to attend cases of normal pregnancy and childbirth, and to provide prenatal, intrapartum, and postpartum care, including family-planning care, for the mother, and immediate care for the newborn. The practice of midwifery constitutes the furthering or undertaking by any licensed midwife to assist a woman in childbirth as long as progress meets criteria accepted as normal. A licensed midwife is only able to attend births at birth centers and home.
[http://www.mbc.ca.gov/Applicants/Midwives/]
Doula
So many people hear this word and still don’t know what it means, or think of a doula as a midwife. A doula is NOT a medical professional. They cannot perform a cervical exam, give you meds, or hook you up to an IV. But they can and will support you and your partner throughout pregnancy, birth and postpartum. Doulas have been proven to be an amazing support to parents, be it your first or 5th pregnancy.
“Numerous studies have documented the benefits of having a doula present during labor. A recent Cochrane Review, Continuous Support for Women During Childbirth, showed a very high number of positive birth outcomes when a doula was present. With the support of a doula, women were less likely to have pain-relief medications administered and less likely to have a cesarean birth. Women also reported having a more positive childbirth experience.1
Other studies have shown that having a doula as a member of the birth team decreases the overall cesarean rate by 50%, the length of labor by 25%, the use of oxytocin by 40%, and requests for an epidural by 60%.2” - americanpregnancy.org
Places
Hospital
I am sure you all know about this option. But, did you know that you could chose different providers within a hospital? You can stick with your OB, or some hospitals have the option of having a nurse midwife attend your birth and some even have birthing centers made up completely of midwives. If you are planning an unmedicated birth and can’t find an OB that you feel is supportive, a NM (nurse midwife) or midwife may be the way to go for you! I ended up having 2 attend the birth of my eldest, and they were so excited about an unmedicated birth and super sweet and supportive! Also, of course there are plenty of amazing OB’s! With any provider make sure to interview them, see if they align with your birthing plan. Studies show that births will most likely go the way the provider desires, so make sure your provider wants the same thing you do!
If you are a “high-risk” pregnancy, for whatever reason, you may want to consider whether the hospital you are interviewing has a level 3 NICU. This is a neonatal intensive care unit that is capable of caring for very small or very sick newborn babies. Level 3 NICUs have a wide variety of staff on site, including neonatologists, neonatal nurses, and respiratory therapists who are available 24 hours a day. They may also be called subspecialty care centers or subspecialty NICUs. Most hospitals have a NICU but making sure it’s a level 3 will ensure that you and baby stay at the same hospital no matter what happens. Infants born at less than 32 weeks gestational age and weight less than 1500 grams (53 ounces or 3.3 pounds), as well as critically ill newborns of any gestational age and birth weight, should be taken care of in a level III NICU.
Some hospitals have different amenities that you may want to research. Such as a tub to labor in, birthing balls, squat bars, and peanut balls (this is not a food!). You can also ask the hot topic question, “do I have to share a room?!” You can give birth medicated, by cesarean, or unmedicated here. For a vaginal birth you should plan to stay here for between 24 and 48 hours. If you have a cesarean the average stay is 3 - 5 days.
In hospital birthing center
Some hospitals have a separate floor from regular labor & delivery that operates as a birth center. These in hospital centers are available to low-risk mothers who desire to have an unmedicated birth. Unlike a regular labor and delivery room, they have tubs to labor in, large comfortable beds, ambient lighting, medical equipment hidden behind pretty pictures, and more! Not only is the feel of the rooms different, the staff is different. You will have a midwife as your care provider and everyone will be supportive of an unmediated birth! Some of them also have free volunteer doulas to support you while you are in labor. It’s the perfect option for parents who are wanting that out of hospital feel, without actually stepping out of the hospital. They are still in a hospital so, protocols will coincide with regular labor and delivery parameters but your odds of having an unmedicated birth greatly increase when you labor in an environment that supports that goal. Due to the lack of interventions and medications used in birthing centers families are able to go home sooner than typical labor and delivery stays. Plan to stay 24 hours after giving birth here.
Free standing birth center
According to birthcenters.org - Independent birth centers are facilities designed to provide care to women with low risk pregnancies who want a choice between a hospital and home birth and want to participate in their own care; they are separate from and not owned by hospital organizations. They have established partnerships to work collaboratively with near-by hospitals and physicians for mothers who need their services before or during labor, or after childbirth. They provide prenatal and postpartum care, labor and birth services, and may also provide childbirth education, annual exams, birth control, and fertility counseling.
Our local freestanding birth center is chalk full of classes, prenatal support, and also has a natural baby store attached. It’s beautiful, functional, and I just love the space so much! They also have the option of hiring any midwife that you like (that is contracted with them), not just who is on staff. Talk about a win-win. Also did you know that free standing birth centers have all of the medical equipment that you would find in an in hospital center? That’s right. They are loaded up with the “in case” devices and medications that one might need until transport happened to the hospital. Another perk is that you can go home as early as 4 hours after birth here. Before kids that would have sounded like way too soon, but after staying in the hospital with my first (picture my husband on a tiny chair for a bed, and too many beeps and alarms to count alllllll night long), 4 hours sounds great!
Home birth
Spoiler alert. It’s exactly what it sounds like - but it doesn’t mean that you are giving birth by yourself [that’s actually called “unassisted birth”], so you will have a care provider with you. Depending on your state, community, and price range - that could be an OB or a midwife. Your care provider will bring all of the equipment found in a birthing center and usually, at least, one apprentice. Some people may believe that having a home birth is risky business, but for low-risk mothers it’s actually been proven to be a safer option than a hospital birth. Why? Because you experience less interventions and that leads to fewer complications for mom and baby, along with less cesarean’s and admissions to the NICU (neonatal intensive care unit) for babies. You can check out the study here.
The perks - you NEVER HAVE TO LEAVE the comforts of your own home! Your kitchen, bed, pets…the list goes on…so stay there as long as you’d like!
Where are you planning to give birth? Have you looked into all of the options in your area? Make sure to interview providers until you find someone that you love and that has the same priorities as you do. Ask their cesarean rate, episiotomy rate, transfer rate (if out of hospital), and ask if they are going on vacation around your EDD. There is so much to prepare for and I hope that you are making a list of your needs in order to get them met!
