Winter 2003

Adrian Feldhusen, NHCM, CPM

I get this question all the time! And perhaps you are thinking: Why would someone birth in a birth center, instead of a hospital? Is it safe? What are its advantages and disadvantages? What is a birth center, anyway? This article will answer these questions, illuminate some key services offered by birth centers and suggest some questions for you to ask your provider when you consider your place for birthing.

Simply put, a birth center is a small facility, either free-standing or attached to a hospital, where a family can have their baby and receive their maternity care. If we look deeper, though, we see a place with a different philosophy. A birth center is not simply a set of rooms beautifully decorated to look more home-like; rather, it is an entire set of ideals and philosophies surrounding natural and normal childbearing. The general focus is on health, well-being, education, true informed consent, and options. The staff is friendly, very knowledgeable, and committed to helping the family achieve the experience they want. Interventions are exceptionally minimal, requiring the mother and baby to be low risk throughout the entire pregnancy and birth.

Safety First
Birth centers have proven their safety and usefulness time and time again. A study in the United States of 11, 814 women coming to 84 freestanding birth centers showed the perinatal mortality rate was as low as 1.3 per 1,000 births as compared with 8 per 1,000 for all hospital births.1 In fact, studies done recently show that birth centers with a trained midwife for the low risk mother and baby are actually the safest places to be- with home births following a close second, and hospital births ranking last.2 They are normally stocked with medical equipment necessary to handle most emergencies, with the option of transporting to higher medical care if needed. Midwives who own and work in birth centers are experts in normal childbirth, but they are also fully knowledgeable in how to recognize and treat complications should they arise. Ask the midwife what would happen if problems did ensue. The answers you get should be complete and honest. Safety is number one in any birth, regardless of the setting.

Environment
The atmosphere of a birth center should be comfortable, private, and home-like. When a family walks in, they should FEEL safe. Most birth centers will have a water birth tub or pool available for mothers to labor and birth in. Many women will use this as a fabulous tool for pain relief during their birth. Usually there is a gathering room which families use to socialize, hold classes, and interact. Extended family can normally stay with the laboring mother if she wishes, either in her room or in another nearby part of the facility. Children are welcome and encouraged to attend, which teaches that birth is not something to be feared. They are allowed to explore their feelings openly and with honest answers, which will set the groundwork of how they perceive birth for their lifetime. While we are on the subject, grandparents are often transformed through the birth experience of their grandchildren if allowed open and loving atmospheres to ask their questions and given honest answers.

Relationships
Every birth center is run differently. Often there are different kinds of caregivers. Some centers are staffed with Certified Nurse Midwives, and are either attached to a hospital or affiliated with one. Other centers are run by Licensed or Certified midwives and can have informal affiliations with hospital and doctors. When choosing a birth center, always ask what their arrangements are with formal caregivers, what their protocols are, and what they can expect if their situation changes. A more formal relationship may mean smooth transfers, but it may also mean more restrictive protocols. On the other hand, a less formal arrangement may allow more options and greater flexibility, but it also may mean the midwife may have less power once you leave the birth center. She will be there for advocacy but not for primary care. It is a choice you may have to make.

Quality of Care
Prenatal care at a birth center is from midwives who give personalized one-to-one care. The midwife should discuss with you the emotional aspects of having your baby, not just what the body will do. Midwives do not limit their care to performing tests and recording results; rather, it is an interactive experience that will enrich your life forever. The family and caregivers will become a team, individualizing care on all levels.

With loving support, almost all mothers will birth free of drugs, interventions, and with an intact sense of self-esteem. Most freestanding birth centers will not offer narcotics and epidurals. These medications are restricted to hospital environments because of their potential harm to both mother and baby. Midwives normally use other tools for pain relief such as massage, water immersion, acupressure, aromatherapy, self-hypnosis, and good old emotional support. Fear is the number one reason women request medication during childbirth. If we remove that fear and replace it with confidence in her body through prenatal education, almost all women can have their baby without intense pain.

Always inquire as to what will happen postpartum to both mother and baby. A birth center usually openly encourages the mothers to breastfeed their babies. Babies are treated with dignity, respect, and tenderness from their emergence. They are not separated from their mother, but tucked into bed with her from the moment of birth. Babies are not subjected to routine interventions; Low lights, soft voices, and tender hands should be what welcome your baby into the world.

Questions to Ask
There are many questions you may want to ask the providers at the birth center you are interviewing. The answers to these questions may spawn more questions. Make sure you obtain full answers before moving on to the next. As you move through your list, pay close attention to how you feel with the way your questions are handled and the impression you are getting.

• What can I expect during my stay here at the birth center? What can I expect for my prenatal and postpartum care?
• What is your transfer rate during pregnancy and birth? (It should be somewhere below 12% for most facilities) This will give you a good idea of what your chances will be of giving birth there.
• Do you ever induce labor? For What reasons?
• Is electronic fetal monitoring used? In what forms?
• Does the facility offer pain medication? What kinds? What other forms of discomfort relief can I expect from the midwives? Do you have alternatives to anesthesia and analgesics?
• What percentages of women require episiotomies?
• Can I walk around and move freely during labor and birth? What positions do most women assume during their birth?
• What is your policy on eating and drinking during labor?
• Can I use a birth pool for my labor? How about for the birth? (Sometimes facilities allow you to labor in the birth pool but not birth in one. Make sure you ask!) Is there any reason why I wouldn’t be allowed to use the pool?
• Ask about interventions and what percentages of women require them.
• Can others be present during the birth? How about my other children?
• What kinds of childbirth classes do you offer? Do you support choices in childbirth?
• Who will be with me during my labor and birth? Are there shift changes? (In other words, is their continuity of care?)

A woman should have her baby where she feels safest. For a growing number of women, that is not in a hospital. Demographic studies show that while only 1-2% of women will choose a home birth, still another 4-6 % will choose birth in a birth center if given the option.3 This number grows yearly. The cost-effectiveness of a birth center is seen and felt on many levels. As the rising cost of health care continues, midwifery attended births will increase. The low intervention rate of a birth center birth and low incidence of intervention-related problems saves consumers and insurance companies billions of dollars per year. As the concept of holistic health care grows throughout the country, more and more women will seek out a Birth Center for maternity care.

Here is what some of our clients have said about their birthing experiences:

“Thank-you for helping me have a peaceful, beautiful birth. It was wonderful to have complete confidence in my caregivers and of course, in myself. You helped me realize that birth is a natural process. The quality of care surpassed anything I had experienced with an obstetrician.” – Cara Yara, mother to Miasol.

"From the bottom of my heart, I want to thank-you again for the loving care given to me while birthing Lily. Thank-you too for such a memory that will last my lifetime, you have changed my thoughts of birthing as ‘painful’ to that of beautiful and I am forever grateful. And we thank-you for the opportunity to birth at your home- I was made at home- fully relaxed and calm as if I were home. The Birth Cottage is a blessing for all women who attend to come for your care. Go forth knowing that your power is so positive to the lives of women that you touch and to the first moments of life in each child born there." Joyce Suokko, mother to Lily
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Adrian Feldhusen is a New Hampshire Certified Midwife and Certified Professional Midwife. She owns The Birth Cottage, a freestanding birth center in Southern NH. She attends birth center births and home births in New Hampshire and Massachusetts. Adrian lives with her husband and 3 children, 2 of whom were born at home. She writes extensively for local and international publications, and teaches midwifery to a group of very gifted women. Visit her web site at www.birthcottage.com for more information.

References for Birth Center article:
1- Kitzinger, Sheila. Birth Your Way. Dorling Kindersley Limited, 2001. Page 62. 2- US Census, year 1999 3- www.birthcenters.org National Association of Birth Centers (NACC) web site