While nearly every movie or sitcom dramatization of childbirth features the obligatory frantic drive to the hospital, a growing number of women are reconsidering the hospital option altogether. Why? Many mothers-to-be are re-evaluating their options and considering birth centers or homebirth because of concerns about hospital practices that are not based on the best evidence and because more information is available about the safety of out-of-hospital births for most women.
“A mother’s choice of a birthplace is one of the most critical decisions she will make during her pregnancy,” said Michele Deck, President of Lamaze International. “It’s important for mothers to take the time to consider what environment will improve their chances of receiving evidence-based birth practices that are safest for their babies.”
Maternity care advocates have long recognized a gap between the care provided in some settings and the practices research has shown to benefit laboring mothers and their babies.
Reflecting the growing trend among mothers, a recent meeting of midwives, doctors, childbirth educators and many other stakeholders in the maternity health community provided a platform for discussion on how best to meet the evolving needs of mothers and babies. The Home Birth Consensus Summit marked a turning point in the intensifying debate over safe and appropriate birthplaces and the decision-making power women should have. In fact, the summit was recognized during a speech in the U.S. House of Representatives by Congresswoman Lucille Roybal-Allard (D-CA), who cited it as an important step in improving maternal health in the United States.
Here are six tips to help mothers find the birth setting that’s right for them:
Choose a birthplace that allows you to be comfortable and secure.
The environment should enhance, rather than disrupt, labor and birth. Research has shown that birth is easier when you can freely move and change position in labor. Certain comfort methods, like activity and rest, eating and drinking, and bathing are more available to women who give birth outside of the hospital and/or are attended by midwives. Visit your prospective birth setting to get a feel for your comfort level.
Look for a caregiver whose philosophy about birth matches your own.
Places of birth and caregivers often go hand in hand. In making your choice, look for a caregiver who helps you feel confident and supported through pregnancy, labor and birth. Whether an obstetrician, a family doctor or a midwife, it’s important that your caregiver listens, respects your ideas and questions and encourages you to make informed decisions.
Find a birthplace where you are comfortable with the labor and birth practices.
Birthplaces follow different care practices during labor and birth. Taking a tour of the facility, and/or discussing the birth process with the caregiver, can help to ensure your needs are met by the birthplace and caregiver. Specifically, you should ask about common birth interventions, how facilities and caregivers address pain during delivery (drugs vs. non-drug coping measures) and opportunities for skin-to-skin contact and breastfeeding following birth. If you are considering a homebirth with a midwife, ask her about any special equipment that may be required and the protocols in case any issues arise.
Choose a birthplace that allows you to have the people you need by your side.
Every pregnant woman has her own preferences for who she’d like with her during labor and birth, whether it’s the baby’s father, other family members, friends, a doula and/or a midwife. Research shows that having continuous support from a loved one, friend or doula can help labor progress. Each birthplace has its own policies about who can be in the room during labor and birth, and it’s important to explore those policies and options before deciding on a birthplace.
If you choose an out-of-hospital birth, remember that hospital care is still available if needed.
Women who want to birth at home or at a birth center may worry about what would happen if they experienced complications. Most importantly, mothers-to-be should know that the vast majority of pregnancies are normal—85 to 95 percent, according to the World Health Organization (WHO).
For women birthing outside a hospital setting, a skilled midwife will closely monitor the laboring mother for any sign of complications. Most problems can be managed outside of a hospital, but if not, the woman can be transferred to a hospital for additional care. While there is an unfortunate lack of coordination in the United States between hospital-based and out-of-hospital care providers (one of the issues that the Home Birth Summit sought to address), every safe birth plan should include a physician and hospital backup.
Check with your health insurer to determine which birthplace options are covered by your insurance.
Birthing a child can be expensive and it’s important to find out what your insurance will cover before choosing a birthplace. Make sure to ask specific questions about the birth locations you are considering, including what you will have to pay in out-of-pocket costs.
Women can learn more about selecting a birthplace through Lamaze childbirth education classes. More information is available at www.lamaze.org.
published: June 22, 2012
