Not too long ago, pregnant women didn't have many options when it came to choosing a place to give birth. It was just assumed that they would end up at the nearest hospital, whether they felt comfortable there or not.
But today's moms-to-be have more possibilities than ever. They can find a hospital with the doctors and services that they prefer, they can opt to have a baby at home with the help of a midwife or doula, or they can find a birth center, an increasingly popular option for women who want to combine with the security of a hospital birth with the intimacy and comfort of a home birth.
What is a birth center?
Birth centers or birth suites are like a blend of a hospital room and a living room. They are staffed by midwives and doulas (labor assistants) who work closely with obstetricians and pediatricians in case of an emergency. They are designed to give healthy women with low-risk pregnancies the chance to have their babies in a more home-like setting. They focus on natural childbirth and usually don't perform surgical procedures or provide epidural anesthesia. Birth centers may be located next to or within an actual hospital, but more often are free-standing.
Birth centers vary depending on individual states' regulations. They can also differ in their own philosophies, including their approach to pain. If you're thinking about using a birth center, you'll want to do some homework long before the big day arrives.
How does a birth center differ from a hospital?
Birth centers often look more like someone's home or a resort spa than a hospital or doctor's office. Think soft lighting, Jacuzzi tubs, soothing music -- all there to help laboring women relax. Many centers have kitchens so families can prepare their own meals, a touch bound to make anyone feel more at home.
The centers are equipped with medical supplies such as oxygen, IV lines and fluids, infant warmers, resuscitators, and certain kinds of medication. But they usually aren't set up to give epidurals, and c-sections are out of the question. If you need such interventions, you'll be transferred to a hospital.
Are birth centers safe?
Birth centers are a safe choice, provided you're a healthy woman with an uncomplicated pregnancy. The landmark National Birth Center Study, published in the New England Journal of Medicine, followed almost 12,000 women with low-risk pregnancies who were admitted to 84 birth centers across the country. Only 2.4 percent of these women had to make emergency trips to the hospital; about 14 percent were transferred for non-emergency reasons. There were no maternal deaths, and only 4.4 percent of the women ended up having a c-section delivery, more than five times below the national average at the time.
The researchers concluded "that birth centers offer a safe and acceptable alternative to hospital confinement for selected pregnant women, particularly those who have previously had children, and that such care leads to relatively few cesarean sections."
Advantages to hospital birth
In recent years, hospitals have been working to improve the comfort and support of women in maternity wards. The days of laboring under bright lights by yourself while family members are forced to wait outside are basically over.
Most mothers still give birth in hospital, often for good reason. They don't have to be transported anywhere in case of an emergency, and specialists of every type are just down the hall if needed. Hospitals are also the only place c-sections can be performed, and they have far more options for pain control.
Benefits of birth centers
Although hospitals have come a long way, all of those medical amenities come with a cost, literally and figuratively. Hospital births can be expensive, and the policies can feel a little oppressive. You have to prepare to follow their rules -- perhaps no eating during labor -- or be ready to argue for what you want. In contrast, a birth center will let you walk around, eat, drink, and give birth in whatever position feels most comfortable to you.
Birth centers are intimate and private, something that can't always be said about hospital maternity wards. When it's time to give birth, you could very easily be the only laboring woman at the center. You definitely won't have a parade of strangers walking past your door.
How do I find a birth center?
The American Association of Birth Centers has an online directory of accredited birth centers by state. See: http://www.birthcenters.org/find-a-birth-center. If there is one near you, arrange to take a tour or attend an orientation where you can ask questions and get a feel for the place.
The AABC suggests asking the following questions:
- Are the birth attendants licensed providers? (doctors, certified nurse midwives, certified professional midwives, etc.)
- Is the birth center accredited by the Commission for the Accreditation of Birth Centers?
- What are the arrangements in case of complications? How far away is the hospital? How many women are transferred, and how many of those transfers are emergencies?
- It's a good idea to also inquire about things like fees, insurance, what type of medication, if any, is available for pain management during labor, and what type of postpartum care you will receive.
Will my insurance pay for care at a birth center?
Many insurance companies do. Call your local birth center to see if they accept your insurance, or contact your health insurance company to see whether they will pay for services at a particular birth center.
Whether you eventually decide to have your baby at home, in a hospital, or in a birth center, some thoughtful planning now can help you have the birth experience that's right for you.
Birthing Centers and Hospital Maternity Services Nemours Foundation http://kidshealth.org/parent/system/doctor/birth_centers_hospitals.html
The American Association of Birth Centers. http://www.birthcenters.org/news/press-kit/bcs-growing.php.
The American Association of Birth Centers. FAQ. http://www.birthcenters.org/birth-center-faq/
Birthing Center http://www.americanpregnancy.org/labornbirth/birthingcenter.html American Pregnancy Association