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Birth centers are a good choice to have integrated into our health system.
Emphasis on CHOICE.
My fear is that women will become pressured both financially by their insurance company and socially by the natural birth moralizers. And end up losing choice, much like with the awful trend of taking away baby nurseries and keeping new mothers from getting rest in the name of breastfeeding absolutism.
I gave birth three times in a hospital with an OB, epidural, and used the nursery regularly. I wanted a birth that was as safe and painless as possible and to rest during my stay.
I fear my 3 daughters may not have this choice in the future, especially if insurance companies and hospitals latch on to some nature mama trend as an excuse to cut costs, as they have with the awful "Baby Friendly " (and "Mother Unfriendly ") hospital initiative.
2
Should you? Drop this language. People need to pick and choose what works for them. And I'll tell you how birthing centers worked for three women I'm close to. My mother: in the 1970s she had my 13+ pound brother at a birthing center and by some sheer stroke of luck everything came out okay (no pun intended). My cousin: Nearly bled to death after whoever was supposed to massage her uterus forgot this most basic duty and she was only saved because her husband was with her to yell for help when she collapsed in the bathroom, gushing blood. My childhood bestie: at the birthing center her own mother worked at for over two decades, she was given an epidural that did not work and had to have a c-section. She was basically cut open without anesthesia. So when you ask what the best option is, it is weird how the one woman with the high risk pregnancy had a good outcome but the women with low risks had terrible outcomes. Is this due to differences in care in the 70s and now? I don't know. All I know is two women I care about suffered trauma from trying to have a positive birth experience.
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There is no comparison between having highly educated, skilled, experienced mid-wives attending a birth and pre-modern era home births. My daughter delivered both of her children at free standing birth centers with excellent mid-wives. I was nervous, but had been assured by a highly regarded OB in town that the mid-wives were of the highest caliber. Her birth experiences were fantastic. I went with her to her birthing classes and her mid-wife spent one class on getting all the families comfortable with the notion that if the mid-wife decided we were going to the hospital, we were going to the hospital. No questions asked. It's the best of both worlds, access to a modern hospital for intervention, if necessary, and all the control over your birth experience, yourself, if not.
3
I had a vaginal birth that was so painful, despite the epidural (which did help a great deal) and tore me apart. I recovered at least six months from it and my bladder has never been the same. I had my next children by scheduled C-sections, which were fantastic. Like the spa, seriously. I recovered so quickly. Looking back, I wish I had never tried to have a vaginal birth. I cannot imagine going to a birthing center, seems barbaric, honestly.
1
@PL Every woman should have the kind of birth SHE chooses! 'I want the epidural starting the minute the preg test turns positive, until the baby is 22' is a valid choice. That's how we get our best outcomes.
So nobody should be pushed into a situation or venue she doesn't want - regardless of how many babies she's had or is having; regardless of her weight, age, BMI, blood pressure, medical status etc. FREEDOM OF CHOICE FOR ALL WOMEN!
2
The article doesn't cover the new-born nurseries in hospitals and birth centers.
Are there statistics about infections in new-born nurseries in both?
Is rooming in available in both?
Occasionally one reads about infectious diseases in new-born nurseries, sometimes with infant deaths, and necessitating closing the nurseries...
Where is this least likely to occur?
Well, I had both my children at a highly respected free-standing birth center in NYC with wonderful midwives. At this center the expectant mother and the pregnancy were carefully assessed from the get-go for the adviseability or not of non-hospital birth. Then mom was very actively involved in pregnancy care and monitoring from day 1. At birthing time, well known and reputable hospital was a max 10 minute ambulance ride away if any risk were to arise. Once baby was born, excellent pediatrician on call came in to examiined her / him.
The first birth took a loooooong time- as is not unusual for the first birth. I thank God we made this choice as maybe in a hospital the "delivering" MD's impatience or other commitments may have resulted in a c-section. (It is shocking and imo scandalous to read that about 1/4 of births are now done by c-section.)
Second baby - at one point fairly early on in the birthing process, I had to get up to use the potty... While using t.p. afterward, I felt something protruding from me -- and hurried back to the delivery bed for the birth of my second son.
In both cases, fortunate to have no complications, we returned home hours later to spend the next 19 years raising two fine young men. No regrets.
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Many, many women are having children later and are deemed “high risk” simple due to age. With few exceptions insurers block these women’s ability to give birth in maternity/birthing centers. We need birthing centers to accommodate all risk levels, insist insurers offer this option and change our thinking about the birthing process being carried out in hospitals which are places designed for sick and injured people, not healthy well people.
2
In the early 20th century, childbirth was a leading cause of death for women of child-bearing age. The author of this article seems to have forgotten that the role of modern medicine in the intervening years in making injury or death during delivery a virtually (but not entirely) unheard of phenomenon.
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@AMA The US with its ACOG -driven revenue-seeking push for earlier interventions, inductions, restrictions on labor - position, timing, and forced medication - has the worst maternal-fetal outcomes in the medicalized world, while blaming all this on the patients, despite OBGYNs' narrow man-made misdefinitions of our physiologic processes, which continue this violent trumpery of birthing women for the sake of revenue. We need other better models, and wider choices for women, who should indeed be telling the medical world what we want, instead of vice versa. AND: the physiology of childbirth should be taught starting in 7th grade biology. The persistence of manarchist taboos around anything 'down there' - especially our natural reproductive physiology - is long overdue for revision.
1
Every mother has an anecdotal birth story, but anecdotal evidence is only evidence of anecdotes. The research shows that midwifery care improves outcomes, and that birthing centers are a safe option for low risk mothers. My anecdote: My third child was delivered in a teaching hospital, with a midwife. Because I needed an induction, the OBs, residents, fellows, and med students started trooping in. A few decelerations later, and the OBs wanted to section me. The anesthesiologist came in, everything was becoming chaotic, when the midwife said, "Wait, let's have her try getting on her hands and knees. Everyone looked at her as if she had two heads. Guess what? I did, and my son was born, crying away. He graduated college this year.
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The hospital I gave birth at offered a superb L&D class. It was taught by a mom of 4 who was a former career L&D nurse and then a practicing midwife. Every new parent-to-be should have that class. It was a deep-dive education of the birth process. She really gave the truth about hospital birth experiences and did not gloss over epidural/pitocin problems or episiotomies. I concluded if I was planning on a natural birth I would: 1 practice yoga breathing & meditation daily during pregnancy 2 give birth at a birth center supervised by midwives in/next to a hospital. Personally I have had 2 scheduled c-sections at a rural hospital that has a fantastic skin-to-skin policy (baby with mom a minimum of 23 hrs a day during stay). I got immediate skin contact with my babies out of womb, successful breastfeeding, no infant bathing or required immunizations/antibiotics at a HOSPITAL. Remarkable what you can get if you notify the entire medical team ahead of time and have it all set up. The c-sections were no cake walk for me, physically grueling both times.
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I started off delivering my son in an in-hospital birthing center and was transferred midway to regular labor & delivery because of a few issues (baby was face-up and his heart rate was erratic, and they thought we might need an emergency vacuum delivery). The midwife and nurse stayed at my side the entire time. The only difference between the birthing center upstairs and the hospital room downstairs was an obstetrician kept checking in and a pediatrician was present.
I did not feel like I'd failed by not achieving a birthing center birth. I was in good hands, my son came out the natural way, everyone was healthy, everyone's decisions made sense. No vacuum or pain meds needed but I'm glad the experts were there.
Also, being wheeled into the elevator mid-contraction while giving a thumbs-up to the custodian trapped in there with me is a memory I'll always cherish.
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As an Anesthesiologist who has done thirty years of obstetrical anesthesia, I totally agree that competent midwives working in a well-run birthing center can offer a beautiful and safe delivery experience. That is, unfortunately, not the case with all centers and midwives. I have been on the receiving end of dozens of disasters over the years, parturients who have been thoroughly mismanaged and arrived emergently at our hospital from home births as well as birthing centers. There is no doubt that a hospital birth can be negatively affected by pitocin, epidurals, physician schedules and obligations. The best solution to this issue would be to have responsible oversight of birthing centers and midwives.
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Recent news reports tell us that babies born outside hospital settings (at home or in birth centers) may have their US citizenship questioned years later, or have difficulty renewing passports. This issue needs to be addressed as well.
1
I had my first child at a birth center in Massachusetts in 1984. I was an earth mama and wanted everything to be natural. After an extremely long and painful labor (though she was posterior, no anesthesia), I was given an episiotomy. Through that excessively long time pushing, I also developed epic hemorrhoids.
Four hours after giving birth to my daughter, I was sent home. There was no home care, no follow up—nothing to help me with my ‘roids or startling amount afterbirth detritus. It was terrifying and painful. Other than my clueless husband, I was alone to figure it all out.
Two years later, I gave birth in a hospital. Though I still opted out of pain relief, there was ‘round the clock care, bedside meals, and all the meds and rest I needed. Those three days felt like a luxury!
Unless birth centers have changed, I’d go the hospital route again—and opt for the drugs to boot!
4
Most pregnancies are uncomplicated, until they're not. Most babies are healthy, until they're not. My wife and child would both have died had she not delivered in a hospital, due to complications and birth defects not detected despite thorough pre-natal screening and care. I understand all of the arguments against hospital birth and the benefits of birthing centers. Those benefits are not worth the risks.
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It’s quite amusing to read some of the hysterical, fear mongering comments from some people on this thread, including a number of medical professionals. In Europe and the UK midwife-led neonatal care and childbirth are absolutely the norm. You are unlikely to come across an Ob-gyn at any time during pregnancy or birth unless complications arise or intervention is required and why would you need to? I am always surprised by the number of utterly unnecessary internal examinations performed during pregnancy in the US. In-hospital midwife-led birth centres are also the norm in other parts of the world. They offer pain relief options such as gas and air and pethidine but no epidurals. It is always the case that if a woman wants an epidural or complications arise she will be immediately transferred to the adjacent labour ward, usually down a corridor. Ob-gyns and anaesthetists need to admit that they can also make mistakes and that giving birth in a hospital is no guarantee of a health baby and/or mother. US statistics make that pretty clear. This is an argument for choice. If you wish to have an epidural or elective c-section or your pregnancy is complicated then you birth on a labour ward. If you want to aim for a less interventionalist experience you choose the birth centre, safe in the knowledge that you can be transferred if you change your mind or the need arises. Straightforward pregnancy and birth are natural processes and there is absolutely no need to medicalise them.
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@Katherine East you make very good points. I don't think any American health care provider (I am an anesthesiologist) would disagree. You describe a system which is not available in the US. The article describes American birth centers which may be many miles from a hospital as opposed to just down the hall. Society has also given us rules strictly enforced by malpractice courts (also different in Europe.) If our patients are willing to 1. show up for prenatal appointments 2. follow the midwives orders around diet, exercise, medication and follow-up, 3. have realistic expectations and tolerance for discomfort and 4. not sue when they don't have the outcome they want, then we can move toward a different experience. As the healthy, educated, low risk patients who are willing to do the above move to birth centers, money will move away from hospitals and more OB departments will close, causing it's own domino effects. This is all a reminder that, for better or worse, America is not Europe.
@Parag I agree but think though that what a lot of the comments on this thread show is the refusal to even consider that birth centres, either in-hospital or across the street/down the block, might be a safe, sensible and viable alternative for low risk women. There is such a focus on everything that could possibly go wrong, and the potential for the very worst outcome. I think it probably skews people’s perceptions of risk which in turn prevents them from exploring other options. Of course any neonatal doctor/anaesthetist will have plenty of horror stories because they work in hospitals where people go when they are very sick. It would be interesting to have these professionals observe practices in a birthing centre and compare when and how they would intervene compared to midwives. I suspect that the approaches would be quite different as someone else’s anecdote about the birthing stool proves.
3
If you are after a truly low-cost, natural birth experience, you can have a healthy baby right at home. You literally need no one for it. It will happen completely on its own. You just have to wait for the mother’s body to do it. At the end, you can give mom a bath, throw away the placenta, and you’re off to the rest of life.
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A large birth center just opened near the hospital where I plan to deliver in a few weeks. The birth center had a booth at a recent festival downtown. I asked one of the women in the booth if anesthesia was offered. She laughed and said no. I was surprised but not shocked given what I know about these places and the people who run them.
You can count me out of birth centers. I didn’t have a great hospital “experience” with my first birth but there is no way I will give money to a place where the misogyny is so ingrained that women in extreme pain are denied and laughed at for needing relief. (By the way, these misogynistic attitudes towards women who choose an epidural are almost always perpetuated by other women). Yes, perhaps in an age dominated by METOO headlines it is important to remember women can be misogynistic too.
It would be easy for them to have anesthesia as well. These clinics are nurse-led and nurse anesthesia is a rapidly growing and well regarded field. So it’s really because they don’t want women to have pain relief.
Finally, I agree with other posters that these clinics are only safe if everything goes well. Better to choose a hospital—you never know when things can go wrong.
5
I gave birth to my wonderful daughter in 1985. I went to a birth center on the upper east side, and I mean to tell you the midwives were really mean and uncaring. I had a long labor and was transferred to St. Vincents. They weren’t all that nice either. I hope mothers today have much better care.
1
About 2 months ago, I attended the delivery for my sister's first baby. The hospital is one of the largest in the City, it did not have any of the activities mentioned in the article which could be typical of the birthing centers... it did have great nurses, a midwife and an obgyn who looked after my sister. The nurses, midwife, obgyn were all warm, caring and treated us as if we were family. They were SO respectful of the occasion by observing our privacy, and so gracious!
I think personal perceptions and expectations about what the birthing experience has shifted, such perception and expectations will differ so vastly from woman to woman.
All women in our family had a sense of security provided by a hospital and a team to support the deliveries we have had.
A woman our family knows delivered her son at a birthing center, and what was supposed to be a normal delivery wasnt. Mother was ok, but baby wasnt. Alas, she was in the percentage of women who end up transferring to hospitals.
The birthing experience is ultimately yours. You make it spiritual, you make it warm by surrounding yourself with people who care deeply for you.
5
No! The most uncomplicated pregnancy can end up in a difficult delivery! Babies can be in distress. It is possible to have a simple unmedicated birth in a teaching hospital. I had two unmediated birth at NYU in 2001 and 2003. I showed up at the hospital when I was respectively 6 and 9 cm dilated and they let me get up and take a shower a couple of hours later. God forbid a transfer by ambulance if something goes!
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I am a midwife and was safely delivering babies next door at Bellevue in the Bellevue Birthing Center, employed by the NYU School of Medicine, when you birthed your children at NYU.
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I am all for delivery by midwife... in a hospital setting!!! For me a bed is a bed, but the safety of having a crash cart and the OR down the hall is priceless!
I gave birth in 1997, 2000 and 2004, all in the same bed in the same room at the same birth center. I received prenatal care from a midwife and my pregnancies were uncomplicated. There was a hospital across the street if an emergency arose. I chose the birth center because I wanted an intervention-free birth. Epidurals can slow down labor, then pitocin is administered to speed things up, and then episiotomy often becomes necessary, or c-section. At the birth center, I wasn’t hooked up to a fetal monitor so I was free to move around however I needed to move things along. Fetal monitors do not improve outcomes, they lead to increased interventions, including c-sections.
At a hospital, the main concern is, get that baby out by whatever means necessary. At a birth center, birth is treated as a normal, natural event, not a medical emergency. The vast majority of births do not require interventions. My births were attended by me, my husband, the midwife and a nurse. My baby was placed right onto my belly the minute he came out. There’s nothing like it. We remained in the same room together and received attentive care in a home-like setting.
A birth center birth is not for everyone, but it’s an excellent choice for those with uncomplicated pregnancies who want an intervention-free birth. Those who judge it otherwise would do well to do their research and make the best choice for themselves and hold their judgment of others’ choices.
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@TG I'm glad you had a good experience with your deliveries. Your description of hospitals, however, is almost completely wrong. Your understanding of epidurals, pitocin, episiotomies, C sections... all completely wrong. What is true, is that hospitals are held to a very high standard for excellent outcomes. When you are willing to lower your standards, and can skim off the "easy" patients, then a birthing center makes sense.
3
And yet, fetal monitors, pitocin, and c-section have also saved lives...many lives
“Your description of hospitals, however, is almost completely wrong. Your understanding of epidurals, pitocin, episiotomies, C sections... all completely wrong.” Current research supports the overuse of all are very bad for mother and babies. The US infant/mother mortality rate has been climbing since the1950s and is now the highest in the developed world. Overuse of pit, episiotomies and c-sections are huge contributors to the problem.
My experience of many years leads me to believe you are a young doctor. Over the years I have worked at multiple large teaching hospitals in neonatal units and have experienced many residents rotating thru. Unfortunately, medical schools and residencies are teaching that caring for patients is all about test results and machines. The advances and amazing tests are fabulous and lifesaving. But they lead to ignoring the big picture and the human patient. Medical personal have not been trained to stop, look and listen to the patient. Common sense, knowledge of history, knowledge of basic science is greatly lacking in medical care today. Recently as a patient my husband (physician) and I have had to fight to get information and convince the “medical professionals” to think about their decisions & advice.
I chose a local birth center for both of my daughters. Cost was a major deciding factor. It was about 1/10th of the price of a hospital delivery. My insurance carrier at the time (blue cross) has a separate deductible for pregnancy so once you’re not pregnant you have another deductible to meet.
The safety of the clinic, it’s proximity to the hospital and the level of personal care all made me a very happy customer, with two very happy healthy baby girls who were both born in the same room 2 years apart.
7
This article, and many of the comments I’ve read, made me think about how differences in perception of the “hyper-medicalization” of childbirth in a hospital can mean the difference between a terrifying, harrowing childbirth experience, and a comforting, reassuring one. I’m a nurse practitioner and feel quite at home in the OR. During my c-section, I remember looking around and thinking, “Okay, role call. I have two surgeons (who I chose), an anesthesiologist, a neonatologist, and two registered nurses completely focused on delivering my baby safely while keeping ME safe and comfortable,” and I found that to be just about the most heavenly feeling in the world. Anecdotally, nearly every female physician friend of mine chose elective c-section for the same reasons (and mine was also elective). I’m actually not making an argument for either side of the debate, as there are obviously pros and cons to both scenarios, just...interesting.
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@NurseKaoru
Honestly you are supporting medical intervention instead of mother nature? As a nurse you ignored science? You don't think the the baby and mothers body knows when the baby it cooked? In my experience as a nurse you are the exception, docs, nurses, medical people don't put the mother and child in danger for convenience. The US is now at the bottom of all developed nations in maternal/baby mortality. Part of that is due to lack of a good science education. It is not conclusive yet but studies are showing infant mortality in c-section babies are higher than vaginal deliveries. In Sweden c-sections have been linked to lifetime asthma and allergies. Vaginal deliveries prepare babies lungs to breath air and their intestines are populated with necessary bacteria. Science science folks is a good thing!!!
1
Pregnancy and birth are not illnesses but natural processes. We should expect that a birth can occur healthfully, outside a hospital, with qualified midwives. At the same time, we should also acknowledge that diseases may be present during the pregnancy potentially creating risks for mother and child, where the natural outcome may be death. Those are the cases we should try to prevent, recognizing that there’s nothing inherently wrong in letting a woman with no foreseeable risk choose a birthing center.
5
When something goes wrong in a birth center, people die. Low risk is not no risk, and when things go bad they go horrible fast. So no, people should not give birth in a birth center. It's that simple.
11
Science does not agree with you.
4
@M
And, despite all the supposed advantages, people die in the hospital too.
1
No epidural? No way.
18
Why? When you’re done, you’re up and running within half an hour!
2
@Rose
Not everyone needs one, but it's your choice.
1
@Rose
Amen. I gave birth to my second without an epidural because the labor was too fast. It was the most horrific experience of my life. No one should be expected or pressured to endure that pain. I don't care how "natural" it supposedly is. If someone chooses it, fine, that is your business.
My third baby I scheduled an induction so I wouldn't miss the epidural. It was by far the best of my three birth experiences.
Hooray for modern obstetrics!
Firstly, the economics are arranged to take unfair advantage of hospitals. They have to shoulder the very expensive burden of being ready at all times to handle the unexpected emergency. When one does happen, the birth centers simply slough these cases off to the hospital. This is not a sustainable model.
Secondly, they just aren't as safe. The complication rate is small for properly selected patients. However, they do happen. Since they are rare, they do not move the statistical needle significantly. But if you are one of those patients, or if your new baby is in distress, then the time to get to a hospital can really matter.
14
@MHW
How, exactly, does expecting hospitals to fulfill their assigned role constitute "taking advantage?"
1
My son was born at 32 weeks with an emergency c section. No complications up to that point. It was in a hospital with a Level 1 NICU. I was unaware that the hopsptal even had a NICU.
At birth there were over 30 medical professionals in attendance. I did not know a single one nor did I care if they were abrupt with me. They had a mission to save my son's life and that's all I cared about.
If he had been born at a birthing center he would have died. There was simply no time to chopper him to a children's hospital for the care he needed. Keep these thoughts in mind that if you use a birthing center and things go wrong quickly, it can have life long consequences for the baby or even death.
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@DS I'm sorry for your traumatic experience, but this really isn't an argument for using or not using a birth center. Birth centers never handle emergencies of this kind. Of course an emergency C-section would always happen at a hospital, like any other emergency procedure. If you had planned to use a birth center, you would have gone during your emergency to the hospital associated with that birth center rather than to the birth center itself. Your midwife would have met you at your hospital and stayed by your side while the hospital staff did its job. That's the way it works.
12
@throughhiker:
You seem to be living in a mysterious world where birth emergencies can somehow be anticipated. That is not the case on our world.
(That’s even why we can them “emergencies”; they emerge very suddenly.)
7
Hospitals are dehumanizing, not a respectful way to usher women into motherhood or babies into humanity. Women who can afford to consider other options should. They should of course make sure they have access to medical intervention should they need it.
3
I certainly didn’t feel that way at all. I went to the hospital to push a baby out. It’s not supposed to be a resort!
10
My hospital birth experience was great.
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@C
My hospital experiences were all very good.
I had an epidural during birth, a quiet birthing and recovery room, and nurses and a well baby nursery available to take care of baby when I wasn't nursing so I could get a good rest.
I felt little pain during the birth and had 48 hours to sleep, eat roomservice meals, and shower.
Felt pretty humanizing to me.
This has been studied extensively.
The evidence (from Canada, the UK, and elsewhere) shows that birthing centers and home births are extremely safe with excellent outcomes for most women. Hospital delivery on the other hand increase the risks to the mother, especially in the US.
Medicine should be based on the evidence, not emotion.
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A very well done article but missing the most important fact to report. In the US, one in three births is Surgical (c-section) and the rate has increased in modern times. This is much higher than other developed nations.
Once you intervening, it’s a slippery slope. Pitocin leads to an epidural which means you can’t move around which reduces natural options for labor progression and increases your odds of a surgical birth. Hospitals are focused on the outcome and the risk, as they are should.
The birth center model is an excellent middle ground where labor can proceed naturally when it is possible. Does this mean that 100% of births in a center are free of complications? Absolutely not. As this article correctly states, quick access to a hospital is extremely important for any birth. Meanwhile, having the option to eat and drink permits longer labor without intervention, and without the escalating costs of a hospital stay.
My wife gave birth at home to both our sons. We are about 500 meters from our hospital and we both felt extreme confidence with our midwife. If a complication had occurred, we were prepared and we also knew how challenging such a situation could be for everyone, medical staff included.
Our excellent insurance plan covered part of the midwife fees for the first birth and none for the second. We effectively paid a penalty for saving them tens of thousands of dollars. It’s not hard to see how backwards this is, that insurance promotes surgical births.
2
@Surgical Birth. “Pitocin leads to an epidural...”. No. It doesn’t. Had pitocin. No epidural.
@Surgical Birth
What is wrong with epidurals?
Do you get a medal for experiencing pain in childbirth?
The impersonal nature of hospital deliveries is vastly overstated. Maybe that true in the US 20 years ago, but most hospitals listened to their pregnant patients and now provide many of the techniques used at so-called birthing centers. So you can reduce risk and create a loving birthing setting.
15
You do not address the real potential for life long birth defects for the baby if there is an emergency at the birthing center and there is a delay in the C-section because of transport to the hospital. This happened to my niece who was brain damaged at birth after being stuck in the birth canal, swallowing meconium (stool) and having to be transported to hospital for emergency C section. The birth experience is overrated compared to a lifetime of dealing with an injured child. These issues do not become known immediately and are probably not properly tracked (it took the parents over a year to see the developmental delays). The risk is not worth it. One day of an unpleasant hospital birth to avoid a potential lifetime disability.
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I had all 3 of my babies (now 32, 29, and 27) in the hospital, attended by wonderful midwives.
For the first, I needed an epidural, but the midwife still stayed on the case and was there for me. If there had been an emergency, I wouldn’t have had the risk and anguish of a hospital transfer. I also did the prenatal care with them. The care was wonderful and I bonded with the whole group.
Why doesn’t this integration of midwifery and hospital happen more? Seems pretty obvious.
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It is happening more and more.
2
Great comment. It is such an obvious no-brainer to use the hospital site, but the softer touch of the non-clinical experience, unless clinical intervention becomes necessary for some reason.
4
The hospital I work at has recently integrated midwives into practice and it has been a very positive experience for patients, staff and the doctors as well. It takes a load off the physicians, relaxed some of the rules regarding eating and fetal monitoring for patients, epidurals are available and if an emergency arises in labor, there is no transport to another site. Integration of the midwife model in our hospital works well. It has been a great improvement to our care and I believe patients are more satisfied.
1
I have had three children, all delivered at hospitals. For the first two, I had an epidural, and delivered vaginally. For the third, didn't have an epidural, and tried to minimize all other invasions. In not having an epidural, it wasn't my goal to be a "hero", I just get really bad headaches for days from epidurals. It seems that the hospital is safest place to deliver a baby simply because something always can go wrong, even if the baby is completely healthy and full term. Women should be more aware of the fact that no intervention can be forced on them--not epidurals, vaginal checks, even a fetal monitor. If they choose, women should be left alone in a hospital to labor until they need an intervention. That, in my mind, is allowing her body to do what it was born to do, and if there is a problem that needs medical intervention, it is available just down the hall.
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For every goodd story, there is a bad one. My first birth was at a birthing center and although it was an uncomplicated birth, a number of things went wrong. My next three births were in a hospital.
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"Birth centers offer lots of other ways of coping with pain besides an epidural, like a warm bath, massage and encouragement from a midwife." This comes back again and again in conversations about birth centers and it irks me to no end! There is absolutely no way these coping methods even start to compare with the utter, immense relief that an epidural can deliver. Why this revolutionary solution to pain is being constantly diminished and scorned upon these days is absolutely beyond me. If a mother wants to experience an unmedicated birth that's her absolute right, but let's stop blindsiding first-time moms into believing that the methods touted here are comparable "alternatives" to an epidural.
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I don’t think the epidural decision is really so clear cut. I personally rate relaxation techniques over epidurals for an easier time for all. I had my first with an epidural and, although I did have a midwife, it was still a pretty harsh experience. The medical staff were impatient about my difficulty pushing, which was due to loss of sensation. And the baby swallowed fluid and had a lower Apgar, probably because of the delay.
My next two in hospital births (also midwifed) were medication free. I used the breathing techniques and was surprised I could stay on top of the pain and also somehow felt happier than I had when I was medicated and just lay there watching the monitor. And without an epidural no one needs to yell at you to push. Your body knows. Both babies were born in better shape because their births were calmer and quicker.
So I feel relaxation techniques are not as masochistic as you might think and may actually work out better in many cases. The important thing though is not to put too much emotional freight on the birth process, however it goes, and instead rejoice in any healthy birth.
5
Subsequent births are almost always calmer and quicker than the first.... regardless of epidural etc
1
This is worth exploring further especially with the rising costs of healthcare. Why should I have to be charged for skin to skin contact?
Asking questions and being kind, but sensible is important. Fortunately, a lot of states are regulated already.
The Back Up Plan should still be the hospital. Even at the best birthing centers who employ or contract massage therapists with hands like soft butter, things still go wrong.
Sadly, higher risk pregnancies (which can’t always be prevented) are growing more common making them doomed with a steep hospital bill. Keep regulations for birthing centers open but we also need more universal healthcare now.
The birthing experience is sooooo overrated. It’s a minuscule part of your child’s life. Many women today make such a big deal over ambiance, personnel and hospital protocols during labor it’s ridiculous. Safety first for your child should be your first priority by delivering in a hospital.
33
How did you deliver your children, Susan?
@Susan
You're assuming hospitals are safe. Hospital practices can do more harm than good, sometimes causing the problems we seek to prevent.
5
Actually the birth process, whether in a hospital or in a birthing center, is emotionally very important for the mother and the child. Do not underestimate it. Babies carry birthing trauma. Not to say one is better than the other- both have their advantages. I gave birth to my first at a hospital and second at home. Both beautiful experiences with wonderful nurses and midwives.
6
And hospitals are supposed to maintain full facilities for all of those just-in-case scenarios but without the steady flow of routine births. Try figuring out that financial model, society. And all these go-natural, don’t have a epidural prophets are just taking women back to the Middle Ages when the first attempts painkillers and anesthesia for anything were derided by The (male) Church that said accept the pain, it’s a gift from God. Move forward people, not back. Mood lighting and a warm bath are no substitute for expertise.
15
I was skeptical about alternative birthing methods before my pregnancy, but the research I've done and all I've learned about the often harrowing experiences that many women have in hyper-medicalized hospital settings have convinced me that a maternity clinic (comparable in many ways to a birthing center) is the right choice for the birth of our first baby.
Fortunately, I will be giving birth in France, a country that recognizes the benefits of midwife-led care and has greater respect for women's birth choices. Is it any wonder that the infant mortality rate here is almost half that of the United States? And the cost, even without the public health insurance, is fractional in comparison.
Women in the States really get a raw deal.
16
This is the second article in as many days suggesting fairly absurd measures to save on medical expenses. Yesterday’s article suggested taking an Uber rather than an ambulance to the hospital. It seems that we have reached a point of desperation in this country because we cannot make any sense of why or how medical class came to be this high. I think hospitals, doctors, and perhaps the entire system need to rethink what it is that’s going on. This is not a consumer decision.
5
I think these suggestions are merely hinting at the measures the working poor goes through to save on costs with the current costs of healthcare today. That’s the elephant in the room that needs to be solved.
I personally don’t know any swift Uber drivers around here, though I might second think that in NYC.
1
My wife was low-risk until she wasn't. We were lucky we were in a hospital; she was wheeled down to the ER and four units of blood later (and a bunch of other stuff) she was hauled to the ICU.
There were no issues or indications previously. Childbirth is always a risk, and you really need to balance the risk of death against your desire for a pleasant experience.
31
Sure, if you want to prioritize experience over your health and safety and that of your child, giving birth without an OB is a great option!
As long as nothing goes wrong, an uncomplicated birth can take place anywhere and anyone can deliver the baby. As long as nothing goes wrong.
23
This story is similar to one I wrote for the Washington Post Style Plus section in October 1994! Birth Centers were a good idea then and they're a good idea now.
12
Midwives are great but just be certain you are with minutes of a hospital O.R. otherwise your infant could die in a worst case scenario.
7
Very irresponsible article, NYT. In the time it takes to call 911 and get EMS transport, a baby (and mom) can die or suffer devastating injuries. Please, please give birth in a hospital.
20
Right to choose. Choose among what? That’s the subject of this article. It doesn’t try to promote anything except knowledge that there are multiple options.
3
@Hmm.
Please, please, do your research. Other countries use models similar to the ones laid out in this article, and their infant mortality rates are far lower than ours. Integrating non-hospital options into the overall system is the key.
1
After having our first in the hospital, my wife and I did a home birth for our second with a midwife and it was extremely smooth with no issues. It's not for everyone, but generally speaking a home birth is a terrific option and something I now encourage everyone to at least consider.
U.S. hospitals engage in far too many unnecessary interventions.
For example, the C-section rate is now over 25%, which is absurd. These interventions, including unnecessary inducement, put the health of the mother and child at risk. Additionally, hospitals rarely encourage proper amounts of skin-to-skin contact after giving birth, which stresses the baby and makes nursing harder.
I could go on, but the bottom line is that routine childbirth is not an emergency and shouldn't be treated as such, which makes a home birth a great option in the right circumstances.
14
Actually, @badger, skin to skin contact immediately following birth is the standard of care in all the hospitals in the area I work as a registered nurse. It is not rare, but done with all deliveries, including C sections, as long as the baby is healthy and vigorous. It maintains infant temperature, blood sugar, and babies remain calm staying with mom and her familiar smell, heartsounds and voice. In addition, many infants are observed latching on to breastfeed by themselves.
As you may already know, all of these things factor into better health outcomes and bonding between mother and child.
1
The issue for me wasn't a choice for my wife and I between a hospital versus non-hospital setting per se. But by default it was ; here is why: You want to be in the same building with a level 2 or level 3 NICU, just in case your baby faces a real distress situation. 2% mentioned in the article is a big percentage for emergencies. And that's while cherry picking the "best out come scenarios" in advance. Accept no substitutes. Have a NICU at hand.
12
This ignores the problems of unnecessary intervention in a hospital birth. Take a look at the c section rate for your birth site. Consider the hazards of infection in a hospital. Consider what the pain relief or epidural anesthesia might impact for the labor and delivery. My takeaway is that midwife assisted birth at a birth center is as safe often safer than options with a nicu on site.
18
@MarkThe body has 5 liters of blood- the placenta gets 1 liter per minute.It takes minutes to bleed to death. Rare but.....
Hospitals have been focusing on decreasing maternal death with protocols that standardize post part bleeding care.I recall walking around an very old cemetery on Cape Cod- the number of women dying from childbirth in the1800's was shocking,.
.As a mentor of mine said "Obstetrics is a bloody business".
16
@Ron Ozer if you look at up to date research you'll learn that properly administered epidurals, even in the very early stages, actually do not slow labor. Another unsubstantiated "risk" to demean a very safe, very effective pain management method. Funny how this doesn't happen when talking about male pain management.
9
I had a normal, not high risk pregnancy with my first child. I had planned to have a natural delivery w/o an epidural (my sister had already had both of her children this way... she had very fast deliveries). I went into labor at 40 weeks and labored long enough that I finally agreed to an epidural. After laboring many more hours, our baby's heart rate was dropping and he was in distress. I ended up having an unexpected emergency c-section. I initially cried when they told me that we needed to go ahead and go to the OR because I never even considered that I would need a c-section. Our son was delivered very quickly but was bluish/gray and had a low APGAR scores and was taken to the NICU. Fortunately, he recovered quickly and has had no long term complications from his birthing ordeal (he is now 13 years old). I never expected this to be my birthing experience and am very glad that I was in a setting that could react to this complication quickly. I am thankful that I left the hospital with a healthy baby. It was surprising to me how fast everything happened once they decided that the baby was in distress and needed to be delivered quickly. I think that you can never know what could happen during a delivery and I would rather error on the side of caution for something this important.
25
@Tanya The thing is : you would have been at the hospital anyway for an epidural, no matter where you started labor. At home or at a birth center, if the labor goes on too long, the midwife will take you to the hospital. If the woman decides that she needs an epidural, the midwife will take her to the hospital. And once you're at the hospital, then they can react to any complications that develop. Of course we are glad to have the benefits of modern medicine, when it's needed.
8
You may decide you need a hospital environment to play it safe, but for God's sake get a midwife. Only a midwife is an expert in the normal birth process. Doctors are experts in what can go wrong. Only a midwife will stay with you throughout the process of labor and delivery. I can't imagine delivering with nobody but a distracted nurse who pops in for a minute or two every once in a while, and a doctor who's called in for the last 15 minutes. Birthing is a lonely, lonely, painful, scary (and exhilarating) experience. Did I mention lonely? Husbands and family members help somewhat but there's nothing like a woman who stays with you and knows what she's doing to help you get through it. The first time, I stayed home as long as I could, gave birth in a hospital with a nurse-midwife, had a slow painful birth but avoided c-section. The second time, I wasn't taking any chances at all. I took Informed Childbirth classes with my husband, practiced meditation and visualizations, and hired a lay midwife to come to my home and then to go to the hospital with me, as well as a nurse-midwife at the hospital. Of course, the birth certificate only lists an MD I don't even remember meeting.
22
My nurses were really great. I remember them staying with me the whole time. It probably varies by hospital.
3
I'm just here for the dire predictions.
Medical people hate articles like this. They give their patients breathless accounts of their life-saving feats, and most people are too grateful and too impressed to ask questions.
Cascading interventions lead to otherwise unnecessary c-sections. Patients are often pressured or forced to submit to them, regardless of how counterproductive.
My first child was born in the hospital. I It was a traumatizing and abusive experience. My other two were born at home with a capable midwife in attendance. All three were unmedicated births; I only had to fight for that outcome the first time.
Evidence-based obstetrical care could be the best of both worlds. Obstetrics is rife with misogyny, and many doctors act on ego. Their comments are all over the thread.
50
A friend just had a baby at a hospital- all present were her regular OB, her midwife, both of whom she knew well.
It was a difficult labor with complications. She's glad she was in the hospital.
11
You should give birth at home, with a midwife. pregnancy is not a disease.
14
@Ron-and death is a very normal process, too-really not a disease. I’d rather have unnecessary intervention than an unanticipated poor outcome.
14
It is still not uncommon for women to die in childbirth.
1
The problem today is, everyone wants child birth to be this amazing “experience”. Though obviously everyone wants a healthy child & mom there is little thought put to their actually safety by the majority of the parents seeking delivery. I see more & more parents pushing the envelope of safety everyday. The majority of the public have no clue to how fast an “uncomplicated” pregnancy can go awry. I cannot tell you how many women I’ve had to emergently anesthetize because blood flow or oxygen to their baby had been diminished, essentially being strangled, but had refused IVs. Hearing the fetal heart rate drop to next to nothing while you’re trying to put an IV in someone so you can put them sleep (something that could have happened in seconds if an IV was present) and deliver their baby is terrifying. As mentioned, and again, I cannot count the number of maternal hemmorhages I’ve had to resuscitate that were deemed “uncomplicated”. People have no idea how fast a mom can bleed post delivery. I’ve had close friends do home birth & what I always say to them is: When you put your baby in a car, are you going to use a car seat? When you teach your child how to swim, will you use a life preserver? When you teach your child how to ride a bike, will you give them a helmet? If yes, then why at the most crucial point of this child’s (and mothers) life are you choosing to remove all safety barriers so you can have this “experience”?
66
@Anesthetist You are correct! Well said!
10
@Anesthetist It's the millennial "it's all about meeeeeeeee" mentality. And if anything goes wrong, they'll look for someone to blame (not themselves, of course) and sue everyone in sight.
4
Don't climb on the millennials, these birth concerns were started by us baby boomers.
4
Depends on if you want your kid to be able to get a passport.
4
Of course birth centers have a much lower C-section rate than the US average - because anyone with a higher chance of needing a C-section isn't a candidate to deliver in a birth center.
34
@Cheryl The studies show that it's not just a question of the choice of candidates. C-section rates for the same type of low-risk mothers are higher in hospitals than in birth centers.
6
A lot of people are tearing apart women. If they want a supportive environment or an epidural-free labor, they are vain, selfish, frivolous, murderous, moronic, wicked, or dumb narcissistic hippies who don't care if their babies die as long as they can have mood lighting and whale songs... - just to quote a few comments here.
Has anyone asked why the choices for women are so bad? Has anyone looked at our terrible outcomes versus the rest of the world? Our insanely high c-section rate? The downright traumatic way laboring women are treated in many hospitals? The bullying, snide meanness, and racism that many women experience? The completely unscientific, harmful, debunked practices in US hospitals that are done for the comfort and convenience of the doctors? The criminal disregard for women's future health and fertility by many doctors?
Has anyone asked why an American woman's only chance to retain control of her medical decision making or be treated as a human is to give birth away from the safety of emergency medical care? Has anyone asked why we can't have evidence-based medicine and some basic humanity? It is a sick society that forces women into this choice.
55
I agree with other commenters that a birthing center within a hospital is ideal (and it should become the norm). That way, women/babies can benefit from lower-intervention midwives while still having MD’s/hospital-services immediately if needed. That is how I gave birth twice.
My first birth had a lot more issues, which I suspect were caused by an MD inducing at 38.5 weeks (only because I had turned 35 yrs old two months before, which made me ‘high risk’). We ended up in the NICU several days because our son’s lungs weren’t developed. I was grateful to have MD’s there once we were in that situation.
For my second birth, I decided to see a midwife (at the same hospital/birthing center) and to give my baby more time to grow if they needed it, regardless of my age (37). I went against my first MD’s advice and my baby was born perfectly one day after my due date.
Of course I respect doctors and modern medicine, but liability issues are such a factor in prenatal advice, especially during the last couple of weeks. I liked having the option to be as low tech as possible (with midwives) and have high-tech on standby.
16
I had both of my babies at a wonderful free-standing birth center near Denver. Such a wonderful experience. such a wonderful outcome. I had two uncomplicated, comfortable, empowering natural births in a compassionate, caring setting.
I was extremely well prepared mentally for natural birth and had quite easy labors and deliveries. the first time my son was born within an hour of our arrival at the birth center. Two and a half years later, my daughter was born after a similarly smooth labor in the water tub.
I don't have confidence that either birth would have gone as smoothly or without any interventions had I been in the hospital. Birth setting is everything.
I highly recommend this route to childbirth to anyone interested.
13
My hospital has a birth center in it. I'm giving birth there in less than a week and I consider the in hospital nature of the birth center to be a big advantage- the ER is upstairs, the neonatal ICU is around the corner. Should I have a problem or my baby have a problem, we have access to hospital resources ASAP. Should things go as planned, I won't need any of that. But I'd rather have access and not need it than need it and not have it.
21
@Kj
KJ - As an obstetrician- I would 100% agree that the proximity your birthing center to hospital is entirely ideal! I hope that one day THIS will be the norm, comfortable birthing centers with every effort to be as low intervention as one could possibly be and give the mother as much agency as she needs and deserves. Unfortunately, it’s far from the norm here in the US, and for the numerous commenters in this thread they fail to recognize that. We (OBGYNs) sacrifice so much or our personal lives to ensure our patients have healthy and beautiful labors - it’s what we feel we are put in this earth to do - and if we could create an environment where our wonderful and caring patients/friends could have the best of both worlds, I can assure you 99% of us would be entirely on board. We need to lobby for our mothers and babies to incorporate normalcy into our experience of child birth, but it cannot be at the expense of our mother’s or children’s well being. And by creating animosity and hatred towards the people who love them and truly care about them, we are doing nothing more than making the likelihood of a collaborative movement towards this ideal birthing experience more unlikely. As unfortunate as that is. So let’s recognice that ALL OF OUR GOALS ARE THE SAME, and let’s work together. It will take patience and a whole lot of open mindedness, but I have confidence that we can do it! Thank you KJ
17
After two hospital births, third child was born in a birth center. We chose it because we had to pay for her birth out of pocket and it was substantially cheaper. If there had been any complications in my two previous births, I would have chosen a hospital but there weren’t. My birth center was across the street from a large hospital and I believe my midwife had privileges there (it been 11 years, I can’t remember).
My birth center experience was overwhelmingly positive and I recommend it to people who are low risk. I understand that sometimes things go wrong. I don’t think women who decide the risk-reward skews toward birth centers are negligent or don’t care about their kids (as some people in the comments are implying). The personalized and level of care made that time truly special for me and my family.
My heart breaks for families who lost a mother or child during childbirth. If the center is negligent, it should not be in operation. If the mother or child required care beyond what a birth center offers, I don’t think that means birth centers should not exist. Most families who choose them have positive outcomes. If you consider the risk too great, it isn’t a good option for you—don’t choose a center or midwife. For the rest of us though, please respect our choice.
9
A cord prolapse, an hemorrhage, sudden drop in the fetus’s heart rate, a newborn unexpectedly resuscitation need immediate care. Calling 911 and driving even just a mile to care can mean death or permanently disability. As a doctor who had had to take term babies off life support who would have been healthy born in a hospital I am so angry with this article. Yes, most people can deliver under a tree and things will be fine, but when your a baby needs resuscitation, the baby needs it immediately. Free standing birth centers may have oxygen or other support, but resuscitation of a newborn requires much more, and a skill set and experience that you do not see in theses centers. Ask any neonatologist (doctors who work in newborn intensive care centers) and the they will have stories of babies who are now handicapped or dead because of lack of immediate care. Everyone will have a story of parents who wished they delivered on a hospital, and have to live with that every day. .I can’t believe what a disservice you have done.
89
@Neonatologist Well said! As an OB MD I totally agree.
10
I absolutely agree with you!
11
The Commission for the Accreditation of Birth Centers I believe requires there to be a person present who is certified in neonatal resuscitation. Instead of discouraging birth centers from existing, why not encourage more women to be intelligently choose a birth center that is accredited? That's exactly what this article is saying. Educate yourself, ask questions, and make the decision that you're most comfortable with.
5
I wonder why the kind of attention and care that is provided in a birthing center can't be accommodated in a hospital?
Today, as I see it, the advantage of a hospital is in the event of a problem - something you can't be sure won't arise even in a "low risk" birth.
Too bad the best of both places can't be found in one place.
24
@A Seeker Actually, the birth center where my children were born in the 1980s was in a hospital, the old St. Mary's on the Mississippi River. My absolutely wonderful midwife group included an OBGYN. The birth center was physically its own unit with women in labor walking the halls (my midwives were big on the importance of plenty of walking). I had a lovely room with a double bed where I stayed the whole time with my husband, and later my new child. It was quiet, relaxed, and very personal. I will never forget the wonderful team.
The gift the midwife group gave was plenty of wellness teaching throughout the pregnancies. They encouraged women to make a birth plan which informed and opened opportunity for two-way communication.
Another gift they gave was that of listening and patience. I trusted them and relaxed in their hands.
When my daughter was in college she asked about the midwives. I gave her the copy of the birth plan. It was a wonderful experience for both of us.
5
A pregnancy is uncomplicated until it is not.
71
My uncomplicated pregnancy ended with an emergency c-section that saved my son's life. Never in a million years would I try to give birth anywhere else but a hospital.
67
If you live in a place with a level 3 NICU, with neonatologists to care for very small or sick infants, I recommend you deliver at that hospital. Anyone that promises your delivery will be uncomplicated is playing a game of chance with the heath and safety of both you and your baby, with little risk and sometimes profit for themselves, that can have potentially disastrous consequences. Infants who are already seriously ill after a poorly managed delivery are in much worse shape after a lengthy, often unskilled and ill-equipped ambulance transport to a NICU. I can't help but see parallels to the anti-vaccine movement when I hear about home deliveries or birthing centers without physician management. A midwife in 2018 should hold your hand, not make the decision about when to surgically intervene. We are so lucky to live in a society that people can't even imagine risks to their lives, but risk remains ever-present. In the United States, the maternal death rate averaged 9.1 maternal deaths per 100,000 live births from 1979–1986, but then rose rapidly to 14 per 100,000 in 2000. In 2015 the US rate was 26.4 needless deaths per 100,000 live births to 7.3 deaths in Canada. Causes range from severe bleeding, to unsafe abortion, to obstructed labor, all of which have highly effective interventions. African-American women are almost four times more likely to die of pregnancy complications. Charlatans are charging money to risk your life delivering by without a doctor's care.
56
If you are talking about death rates of mothers, you need to view the statistics of hospital v/s birthing center. You might be surprised. The hospital rate is significantly higher.
12
@Dr. S, you need to brush up. CNMs are well trained and are certainly able to recognize and call for physician intervention.
8
@Dr. S
You're conflating two different things, and implying (but not actually stating) that births outside a hospital are less safe. UNPLANNED births outside a hospital setting are of course emergencies and a lot can go wrong. PLANNED home births do have their risks but women are screened first and they are limited to low-risk women. I'm sure you know that a number of countries with better maternal and perinatal health numbers than ours have a large proportion of home births, the Netherlands being the prime example.
8
This article irresponsibly does not mention the significant difference between an inhospital versus a free standing out-of-hospital birth center. Inhospital birth centers are wonderful with all the advantages of safety together with midwifery led care of a birth center. Birthcenters that are away from a hospital are simply to far away to be able to care fir emergencies which can happen even in low risk pregnancies. We researched them and found more stillbirths and bad babies in them. Why did the free standing birthing center in New York have to close? Too many bad outcomes and liability problems. Inhospital birth center:Yes. Frestanding: No
Amos Grunebaum MD ObGyn
48
@AmosG
The free standing birth center that you are referring to is still open, and has been accredited since 2002.http://www.brooklynbirthingcenter.com/
2
Doctors ALWAYS share stats on home births; maternal mortality and fetal demise. Where are the SAME stats in Hospital births? Much harder to uncover I assure you. Unfortunately Birth is life. There will be complications. At this point in history, there are times when death is a part of birth. I am grateful for hospitals when people need them, but remember this is a very American ideal, and America IS NOT leading the world in Maternal health care, and is also failing in infant vitality compared to other “first world” countries. And then when we discuss healthcare and prejudice against minority and indigenous women, America should be ashamed. Do better America, don’t shame women and families for trying to change their paradigm.
13
@sagefemme52 - No offense to Brooklyn, but the birth center to which AmosG is referring is likely the Maternity Center Association (later the Elizabeth Seton) Childbearing Center which was in existence between 1975 and 2003. It did indeed close due to a rise in insurance rates, although not necessarily a rise in bad outcomes.
During the 1970s I had the pleasure of working in NYC's Childbearing Center operated by the Maternity Center Association. To this day, I apply the philosophy used by the Birth Center: family centered health care. The Center had risk and quality criteria to identify which parents were suitable for out of hospital birth experience. There were back up systems in place to ensure prompt action should the need arise. The Center's molde was adopted by many other facilities across the country.
13
@M I had 3 children at the maternity center, each time a wonderful experience. I felt completely safe there. The pre-natal care as well as the births helped to build the confidence for us to be parents without the overriding fear that seems to dominate health care issues in the USA. Staff were highly medically trained, and were treated with distain by other medical professionals, an attitude that obviously continues today. The maternity center later moved to St. Vincent’s, where midwives weren’t even supposed to talk about birth control.
3
@M You forgot to mention that the Elizabeth Seton out-of-hospital birthing center closed 15 years ago. Mainly because there were too many malpractice suits. Ddespite all these wonderful criteria to exclude risks. This is because even the lowest risk pregnancies can become high risk in a millisecond. The center was only a couple blocks away from the hospital, still too far to be safe in an emergency. https://www.nytimes.com/2004/03/15/nyregion/use-of-midwives-a-childbirth...
6
The article you quoted explained that Elizabeth Seton was, "driven out of business by rising medical malpractice insurance premiums," NOT malpractice suits, as you imply.
I safely had my first child there, almost 16 years ago, and chose home birth for my next two children (I had moved away from NYC and there were no free-standing birthing centers available.)
3
Not all risks manifest themselves prior to labor.
My second child was born in a hospital 23 years ago (no birth centers nearby) and once the membranes ruptured the nurses attached an internal fetal monitor. This showed a drop in the fetal heart rate with every contraction when I was on my left side, not an unusual position for a laboring mother. The decelerations did not happen when I was on my right side, the nurse declared "baby doesn't like the left side" and labor progressed.
When my son was born we found the cord was wrapped around his neck. Without the monitor it is quite likely he would have suffered permanent damage due to lack of oxygen from the cord compression if I'd been on my left side. Birth centers may monitor the heart rate externally but sometimes that's not sufficient. I know the sample size is small, but one brain damaged baby is one too many.
34
@Tessa. I also had a low risk pregnancy that unexpectedly and very, very quickly turned into a life-threatening situation (for me) immediately after the uneventful and normal birth of my son. For me, the advantages of a birthing center do not outweigh immediate access to emergency-situation care for mother and baby.
35
that sounds like a scary development during your labor! As a nurse midwife I need to just state for the record that positional heart rate changes are 100% something that can be detected with a handheld doppler, and the use of continuous electronic fetal monitoring has shown no association with better birth outcomes.
25
@Tessa I am glad that your son got good care and was born safely.
My 3 children were born in our local birth center with the help of midwives. The older two were both born with their cords around their necks. Our experienced midwives handled both births with aplomb. For our first birth the midwife was able to unloop the cord as our son was being born, but our daughter's cord was tighter, and when she was born she was initially limp and bluish, as the cord around her neck had apparently compressed a nerve that triggers newborns to take their first breaths. While that was momentarily alarming for us, the midwife, who was totally calm throughout, reassured us all would be fine, massaged her and within a few moments our baby was pink and crying and aced her Apgar test. Neither child suffered any ill effects from this experience. Our 3rd child's birth was quick and easy.
Adults now, all are flourishing. I am very grateful for the wonderful care and attention I and our babies got at our birth center. I hope that our children will also use birth centers when they have their own babies.
8
Happy to see this. My youngest is 12 years old so I am done with childbearing. I was fortunate enough to be able to have positive birth experiences under the care of nurse-midwives in the maternity care wing of a conventional hospital. At the time this seemed to be the best of both worlds -- very supportive, homey environment with top-of-the-line hospital resources right down the hall.
17
It’s a shame that some women are not finding the TLC in a hospital setting. I delivered my first child at a hospital, and thank goodness- my low risk pregnancy evolved into an emergency Cesarean after 3 hours of pushing. All of my doctors, nurses, and patient aides were more than emotionally available and kind. They made me feel safe, in charge, and welcome. I would have loved to have had a more straightforward labor & delivery but in the end, the safety of my child (and myself) came first and the surgery was remarkably calm. Very unfortunate that this particular experience isn’t the norm for some women in labor in hospitals. It’s what we deserve and what we need.
25
I’m all for the Birth center within the hospital setting. But if there is an emergency, being a mile away from a hospital can mean life or death for mother and baby.
34
I rather like the system I had in Switzerland. My children were born in hospitals, but in a "normal" birth, the midwife is in charge. In fact, when my third child was born, the midwife said the OB-GYN did not approve of the birthing stool, so she did not call him until after the baby was born. By the way, our son was born by candlelight and soft music, no bright lights, no infusions, no monitoring other than the midwife's stethoscope. But if there had been a problem, I was already at the hospital.
41
How is it possible that mood lighting, archaic pregnancy monitoring, and not being hydrated with an IV are worth an increased risk of serious injury or death? In a hospital, you can refuse an IV - although you loose a convenient route for medication, or ask someone to turn down the lights. Candles aren't recommended near the open oxygen sources that could save your life or the life of your baby.
24
childbirth is very psychological. The setting is very important for maternal comfort. Maternal comfort is very important for the progress of labor and delivery. it's not just mood lighting, it's being deliberate about the birthing environment - crucial for natural childbirth.
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I loath the word “natural” applied to this context. Post partum hemorrhage, septic endometritis, and preeclampsia/eclampsia are natural too.
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Birth Center care, especially in an accredited birth center, is a fantastic option for women and their families if they want care with midwives who know and trust the physiologic process of birth. Birth centers that are accredited must engage in a rigorous process that ensures adherence to evidence based "best practice".
While no locale, be it birth center, home or hospital can guarantee an optimal outcome, birth centers, which only accept "low risk" women into care, have an admirable record of safety as documented in the large US study referenced by the author.
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As a journalist I wrote about birth centers and alternatives to hospital births long before I had my own children. Since then I have had children in a birth center and at hospitals. No experience was perfect but I felt the birth center and the midwife attended hospital birth experiences were most satisfying and rewarding because I felt that the attendants were more "tuned in" and responsive to my needs. That's just one woman's positive endorsement.
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Sure, choose a birthing center if process is more important to you than outcome.
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@Someone Except the outcomes in freestanding birth centers are better than that of hospitals. Click the link to the study in the article.
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@Someone else Sure, because the patients are already screened to be low risk. Unfortunately emergencies are sudden and divesting and not always predicable. If he health of the mother and baby is the most important to a patient she will choose to be in or part of a hospital.
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@Someone else The outcomes in freestanding birth centers are actually much worse than in hospitals! https://www.ncbi.nlm.nih.gov/m/pubmed/23791692/
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Thank you New York Times!
Health outcomes in many areas are worsening scarily and maternal mortality stats are particularly frightening. This article is welcome.
Outcomes of birth center care are consistently excellent. So why would the NY Times place speculation in the center of this short piece? "Birth Centers who don't have great outcomes are probably not reporting what they are doing". Placement of such an unwarranted caveat centrally in the article is not merited.
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@loverslanebirthcenter. I agree. Our birth center doesn't report stats, not because we don't have good outcomes, but mainly because we lack the manpower to sit in the office and put data into a computer. We would rather spend time with our clients. We also found that Medicaid and most insurance companies pay so little, that we cannot provide services at that rate. In many states Medicaid and insurance companies pay midwives at a lesser rate than physicians for the same service. Many refuse to reimburse birth centers at all. The billing and coding system has become such a difficult system to navigate, even for professional coders and billers it is ridiculous to call them payment systems.
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No. Outcomes in birth centers are not better. Outcomes for babies are worse than births in hospitals even though birth centers births are supposedly low risk. https://www.ncbi.nlm.nih.gov/m/pubmed/23791692/
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Very informative article. The writer has clearly mentioned about the positive and negative aspects of this type of delivery worth noting.
The point I am mentioning here is not about the birth centre but about the birth certificate of the child born in such centres. Recently there was an Op - Ed published in this paper regarding the problems faced by her children in obtaining their Passports since birth certificates issued by the authorities concerned were found not acceptable. In her case the deliveries were done by a midwife in her house. May be it is applicable here also. As such one should be careful in this regard.
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@Sivaram Pochiraju This may be an issue with home birth but generally not birth centers! I am actually giving birth at the Minnesota Birth Center in this article and asked about birth certificates. Its the exact same procedure as if you are in the hospital and you walk out with the certificate!
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@Sivaram Pochiraju it’s also important to note that immediate pediatric care can be variable. I also delivered babies at the Minnesota Birth Center. My pediatrician from The Mayo Clinic was very impressed with the care and necessary documentation of records my son received upon delivery, as well as during the in home visit the following day. It’s possible that not all birth centers provide the same quality of care.
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@Ruthie Beahrs : I thank you and thank Christa Opheim for your valuable opinion. I appreciate.
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