Childbirth Options: Choosing Your Environment
Alignment Matrix is pleased to introduce Esther Taylor. Esther is the Founder of Jatamansi Center Massage & Holistics, an educational and healthcare Center in Fillmore, California, as well as a practitioner of Ayurveda and Somatic Therapy. As a new mother, she brings her rich, personal experience, coupled with her diverse expertise in healthcare and patient advocacy to…
“Alignment for New Parents”
a series of articles on PREGNANCY, CHILDBIRTH & INFANT CARE starting with…
Choosing Your Environment
by Esther Taylor
“If I don’t know my options, I don’t have any.”
– Diana Korte – Author, A Good Birth, A Safe Birth: Choosing and Having the Childbirth Experience You Want
When most modern Americans think of child birth, what comes to mind is a frantic scene in a hospital room, filled with medical equipment, doctors, fluorescent lights, IVs, and epidurals. It may surprise the average American to find out that while 90% of people alive on the Earth today were actually born out of hospital, 99% of U.S. babies are still born in hospital. The Centers for Disease Control & Prevention (CDC) states, “Home births have a lower risk profile than hospital births.” Couple this with the fact that the United States has the highest first-day infant death rate out of all industrialized countries in the world and you may want to rethink your point of view regarding birthing options.
In this article we are going to compare hospital, birth center and home births in the U.S. and assess the differences between obstetrical care, midwifery and free birthing. The goal of this article is to help enable people to make informed birthing choices in an unbiased manner. We believe the most important thing to consider when exploring birthing options is where the parents will feel safest. Many will rely on hospitals to offer security and peace of mind while some will feel that home is the only place they feel truly in control, and still others will seek a middle ground in the more natural birthing center environment that is still close to or adjacent to a hospital.
Types of care available for birthing in hospital are provided by OB/GYNs, Family Physicians or Nurse-Midwives (CNMs) who are trained and licensed as nurses in obstetrics and gynecology and then educated in midwifery. CNMs are currently licensed to practice in all 50 states and are usually licensed in individual states as Nurse Practitioners (NPs).
Perhaps the biggest advantage to hospital birthing is access to a full emergency medical staff in the event of any serious complication, which may be an important factor in high-risk pregnancies. Having the option to use pain medication and epidurals may also be another advantage to hospital birthing for some women. If you are choosing to vaccinate, birthing in hospital can allow you to easily have your baby receive his or her first vaccines before being discharged. In addition, nearly all health insurance companies in the U.S. provide at least partial coverage for in-hospital birthing.
The primary drawback to hospital birthing is usually unnecessary intervention. As hospitals and physicians seek to avoid malpractice suits, standard operating procedures are implemented that may not take into account the differing needs of various women and their babies. The result is that mothers and babies often receive treatment and/or testing that is invasive, risky and often unnecessary. For example, many hospitals routinely override the natural chemistry of newborn babies and subject them to the trauma of injection by needle, to administer doses of Vitamin K in an effort to prevent a blood clotting disorder that occurs in fewer than 1% of the population. Another example is the increased use of intravenously administered synthetic Pitocin and/or Oxytocin, immediately after delivery of the infant to ‘speed up’ the delivery of the placenta and minimize the already small risk of bleeding out due to lack of continued contraction of the uterus. The list of possibly unnecessary intervention goes on and ranges from simple things such as not allowing the mother to eat anything during her birthing time, to more extreme things such as Cesarian Births (C-sections) that are becoming more common in the U.S. at an alarming rate.
A few more potential drawbacks to hospital birth include the heightened exposure to illness and an impersonal or even intimidating setting that hospitals tend to create. There can also be a lack of privacy in hospitals that may be unsettling to some women, and most hospitals have limited space and visiting hours for friends and family, in addition to significantly limiting a woman’s choice about who will be present during the delivery. A huge drawback to hospital birth for most women is the fact that most hospitals put the mother in a bed on her back and require her to be relatively still for purposes of monitoring, rather than permitting her to move about freely. This, alone, can drastically slow the birthing process and cause discomfort during delivery. The largest drawback to hospital birth for the majority of women seems, by far, to be the ‘mandatory’ separation of mother and newborn for medical screening and care, causing stress and anxiety for both the new mother and her baby in a new and unfamiliar environment.
The average cost of in hospital birthing in the U.S. ranges from $9,500 to $15,000 for vaginal delivery and $15,500 to $22,000 for C-section, not including prenatal and postpartum care. This is currently the highest cost of in hospital birthing in the world.
Birth Center Birthing
The type of care available for birthing in a birth center in the U.S. is direct-entry midwifery. Direct-entry midwives are educated and trained as midwives without having to become nurses first, and may be Certified Professional Midwives (CPMs) or Certified Midwives (CMs). The legal status and requirements for direct-entry (non-nurse) midwives vary from state to state. They are usually licensed in individual states as Licensed Midwives (LMs) or Registered Midwives (RMs). The laws and regulations in each state governing direct-entry midwives are tracked by the Midwives Alliance of North America.
The largest advantage to birth centers is that they are generally close enough to easily transfer to a hospital should a serious complication arise, while providing a comfortable, homier environment. Birth centers are a great option for parents who wish to birth out of hospital but do not have the space to do so at home. Most birth centers offer a birthing tub if a water birth is preferred. A full kitchen and the freedom to eat throughout the birthing process are common in birth centers, as is plenty of room to move around and frequently change positions, which can facilitate a faster, more comfortable birthing. In general, whether it be in a birth center or at home, direct-midwives refrain from intervention unless absolutely necessary. The pressure free, non-medical environment offered by birth centers can create a calm, anxiety-free birthing that parents who have chosen this path claim to be profoundly empowering and liberating.
The most evident drawback to birth centers is the need to transfer to a hospital in the instance of severe complication where emergency medicine may be necessary. In addition, conventional pain medication and epidurals are not an option in birth centers. For parents planning to vaccinate their infant a separate appointment with a physician will have to be made to begin the vaccination process, as vaccines are not commonly administered at birth centers. Most health insurance companies in the U.S. do not cover out of hospital birthing or direct-midwives, a factor that can be a deal breaker for many parents.
On average, the cost of birthing in a birth center in the U.S. ranges from $2,000 to $6,000 dollars including prenatal and postpartum care. This makes it a more affordable option for parents without health insurance who will be paying solely out of pocket. Most birth centers also offer payment plans and/or out of pocket discounts.
Types of care available for home birth are direct-midwives and free birthing. Free birthing or unassisted child birth is the act of birthing 100% unassisted, with no intervention or even the presence or supervision of a midwife or physician. While we do not necessarily advocate this option, especially in the case of a first delivery, it is an option that has gained some popularity in the U.S. over the past few years.
The advantages to home birth are pretty obvious, in that the parents can make all the decisions. If the parents choose to have a midwife present, the midwife will come to their home or chosen private place of birthing and assist in a natural, mother-led birthing, free of unnecessary intervention. If the parents choose a free birthing style of delivery they can birth in any manner, in any position they like without any pressure, rules or standard operating procedures. When birthing at home there is no need to pack anything or rush to the hospital or birthing center when the mother begins her birthing process. The parents and infant can sleep in their own bed after delivery with no worries about getting the mother and infant back home comfortably. There is a also considerably decreased exposer to illness and stress, the parents can choose who is present during delivery and there are no imposed limits to visitation.
The drawbacks of home birth are similar to those of birth centers with a few additional considerations. When birthing at home with a midwife, the distance to the nearest hospital may be greater than that of a birth center. One might want to consider that the number of homebirths ultimately requiring transfer to hospitals is extremely low and in some cases determined by legal rather than medical or personal considerations. If the parents are choosing a free birth, the additional considerations increase significantly, in that no medical assistance is available on site including those offered by midwives such as newborn medical care and testing and post partum procedures for the mother.
On average the cost of a midwife-assisted home birth ranges from $2,000 to $6,000 (generally the same as choosing a birth center, where the location fee is included in the midwife’s fee if she/he is affiliated with a center). Of course, free birthing is only as expensive as the cost of the birthing supplies, if any are purchased.
In conclusion, we can see that there are options to the commonly assumed choice of hospital birthing. Further, the choice to birth in hospital may not be ideal for everyone and is, perhaps, not as necessary as we have been lead to believe. Unfortunately in the state of Delaware, out of hospital birthing is now illegal and California is currently looking to outlaw out of hospital birthing as well. This kind of government control over parents’ right to choose the location of what is truly one of the most significant events in their lives as well as in the life of their new baby, is raising many controversial issues of morality and civil rights violation. We will be addressing these issues in more depth in upcoming articles in this series. Meanwhile you can find more information on the current affairs surrounding birthing rights in California (and potentially other states) at http://www.cafamiliesformidwives.org/#!call-to-action/ceu6.
Other Articles to Come!
Childbirth Options: Choosing Your Environment is the first in a series of bi-monthly articles on Pregnancy, Childbirth and Infant Care, which will address a number of topics including child birth hypnosis, water birth, placenta encapsulation and umbilical non-severance, perineal massage and stretching, elimination communication, co-sleeping, breast feeding, circumcision and vaccinations.
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