We finally decided on a birth center birth. I should say that I finally decided- Kraig made his decision a long time ago :) Of the two of us, I was more in favor of a home birth but I think despite his qualms with it (which are few, and none are related to safety) I would have ultimately still chosen the birth center.
We've found in talking with many different folks about our options and choices that there are lots of misconceptions about home birth and birth centers. I must be clear and mention that our birth center is NOT at all like most birth centers. Many modern birth centers are attached to a hospital and thus parents have the ability to choose to be transferred to the hospital for pain management and/or it is obviously much simpler and faster to transfer them to an operating room if it seems a c-section is necessary. There are also many birthing units that are only "birth centers" in title- they are simply just the birthing wing of the hospital but the hospital is trying to appeal to the more liberal-types who want a "more natural" (I do not prefer that terminology) birthing experience. They even "play up" the more holistic amenities, such as birthing tubs, water-birth option, the ability of the mother to walk around during labor, etc. I must be clear that those options are hardly ever available to the mother during actual labor- being in a hospital almost guarantees continuous fetal monitoring (which automatically disqualifies a mother from being in the tub or walking around) and there may not be tubs or jacuzzis in every room. I've even heard of hospitals that have a jacuzzi that has never been used- not because of a lack of demand, but because they simply don't want to allow it.
Thus, it's very important for a mother who wants to be allowed the choice to labor without unnecessary interventions to ask the right questions. I won't get into those questions, but simply wanted to point out the difference in that "style" of birth center and the birth center that we are birthing at.
Our birth center is run by a group of midwives- there is no OB on call at the BC- so any emergency situations (which are highly unlikely in midwife-based care, I'll tell you the reasons why in a moment) require transfer to the nearest hospital (which is usually very nearby. Ours is just a couple of miles away, and an ambulance is always called at the earliest sign of a possible problem).
At BCs that are similar to ours, the midwife has access to the exact same birthing tools and emergency equipment that she would bring to a home birth (such as oxygen and medications for hemorrhage). Because of that, it is not "safer" to birth at the BC or at home as long as access to ambulance and hospital are the same. Obviously if a mother wanted to birth at home but is an hour from a hospital, there are different protocols for emergencies (and often midwives will not agree to attend a home birth in that situation).
That is why it is surprising to me when people are "so thankful that we are not birthing at home" because that would have made them "nervous". Um, if safety is the concern here, first of all we believe that out-of-hospital birth is as safe if not safer (for low-risk mothers) than hospital births, and in case of emergency we are just as protected/unprotected (depending on how you want to look at it) at a BC as we would be at home.
Like I said- so many misconceptions.
Anyway, we definitely believe that having a midwife and birthing out of a hospital is safer (for us) than being in a hospital. Every single hospital intervention (fetal monitoring, narcotics, induction methods such as rupture of membranes, cervidil and pitocin, epidural, episiotomy, cesarean birth, forceps and vacuum-extraction, IV, etc etc etc.) carries risks. The risks are hardly- if ever- mentioned. For low-risk pregnancies (that is a very important disclaimer) it is safer to birth out of the hospital than it is to be in a hospital where it is extremely likely that one or more interventions will be used. (An interesting article explaining the problem of extrapolation when discussing home birth risk)
These websites explain the infamous Cascade of Interventions. (see here and here) The problem is that most women in hospitals are told of the risks to baby if an intervention is not used but rarely are the risks of the intervention explained. I think it is interesting that the same docs who want to point out the risk of true emergencies in home birth (which happen in about 3% of planned home births) fail to mention the risks of hospital birth. Let me be clear- I think there is a time and a place for interventions in birth. I also think these interventions are used FAR too often, sometimes to the detriment of the mother and fetus. (I also think it is up to each woman to decide if that 3% risk of emergency (that is not the risk of death, to be clear) is enough for her to decide to be in a hospital.)
I also want to vent here for a moment about risks of hospital interventions- I know that we all know many, many women and babies who are "fine" despite one or more interventions. Well, I also know many, many babies who were born at home and are fine. I also know many babies who were born in the hospital and are not fine, or their mothers are not fine due to intervention. I also know my own experience of being in the hospital. However, anecdotal evidence doesn't prove a thing. There is a funny story that sticks out to me: A NICU nurse was talking with a midwife about how she had a patient who was recently admitted to the NICU because he was a planned home birth. The midwife looked around and asked- well where were all the other NICU babies born? (The hospital...)
One of the major differences between in and out of hospital care is the philosophy of the birth attendant. It has been summarized in some circles that doctors believe birth is complicated until proven otherwise (which is usually a retroactive assessment) and midwives believe birth is normal until proven otherwise. I personally believe that doctors specialize in risk-management (and, unfortunately, financial risk-management clouds their view)- their training is in pathology, not normal births. When over 90% of births are "normal" it is a wonder to me that our c-section, induction, and intervention rates are so high (this is an American phenomenon). A midwife, on the other hand, views birth as a normal process yet and is trained as such, while also trained to to vigilant and troubleshoot any problems. A midwife is also in a better position to be able to accurately assess the risks of each individual labor because she is present during most if not all of active labor, unlike a doctor or hospital-midwife who is present for often less than 30 total minutes of any given labor/birth. Even the nurses monitor the mother from a central station rather than being at the bedside where s/he can assess what is "normal" for that particular labor. My midwife was making decisions about my care FROM OVER THE PHONE. She wasn't at the hospital! It is also worth noting that nurses (and sometimes the delivering physician) are often strangers to the mother while a midwife has spent hours and hours (and hours!) with the mother throughout pregnancy and labor. If given the choice, I'd choose a physician who knows me and my body over one who views me as just another body in a bed.
So, those are the reasons why we are much more comfortable with the birth environment and attendants we have chosen. I think you can see that once we decided for an out-of-hospital birth, deciding between home and BC was really a wash. For me, it came down to personal comfort. Many women are more comfortable in their home but I actually prefer the thought of going to "another place" to birth. It isn't about the mess involved (birth hardly causes a mess in most cases), and it isn't about safety, as I've pointed out. I really just don't want to worry about prepping my house for a birth (don't tell me I won't be concerned in the moment- I will), so the idea of going somewhere to have my baby seems preferable to me. There is also the benefit of Owen being able to stay here with our chosen caregiver(s) where he is comfortable (this is what works for my family- it may be different in yours). Besides, our BC is almost like a resort so I'm pretty excited about it. Huge, cozy rooms with gigantic jacuzzis? Postpartum doula to provide meals, childcare, lactation support, laundry services? Post-partum massage? Sign. Me. Up.
_________
I hope it is clear what is my opinion and what statements are intended to be taken as fact- based on readily-available evidence, of course. In as much as I can, I try to research statistics and reputable studies before making a statement. However, I am also heavily biased so some of the post is intended to be taken only as opinion.
No comments:
Post a Comment