By: Children’s Bureau Centennial – CC BY 2.0I am pregnant with my second child and every bit of reading I’ve done has led me to believe I had an unnecessary cesarean delivery with my firstborn. At this point, I am not certain I trust any of the practitioners at my hospital and worry that a change of hospital may result in the same scenario being played out in a different location.
I’m investigating birthing at a center with independent midwives, but I’m pretty nervous. I don’t know if it’s just that I’ve been fed the babies-come-from-hospitals line my whole life, but I have two specific worries: first, I’m not sure how to tell people I’m considering a birth center without being defensive of my reasons. Second, I’m worried that something unforeseen could happen that would be better dealt with in a hospital than a center.
I would absolutely never be able to forgive myself if I put my birth experience over the well-being of my child. How do you know if birthing at a center (or outside of a hospital) is the right choice for you? — Bree
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Comments on How do you know if a birth center is the right choice for you?
This is such a hard decision, Bree, and one that I think about a lot, since we had our first son in a hospital, with a c-section, and are hoping if we are able to get pregnant again to not repeat the experience. I have looked into homebirth, birthing with midwives in a hospital, and a birthing center — and one midwife (at the hospital, actually) asked me a very good question: which do you fear more: being in a hospital or having something go wrong. I did lots of research about risk and realized (I am 99% sure) that it is former. So, if we are able to get pregnant again we will opt for homebirth. If you go that route (either homebirth or a birth center unattached to a hospital) I think it just helps to make sure your midwives are VERY experienced and can recognize early warning signs for uterine rupture. I did EONS of research, and it is a bit blow out of proportion in terms of how often it happens. BUT, if if happens to you, you want to feel safe that it can be caught early and you adn baby can both be safe. I am confident that with a skilled midwife this is possible. If you can’t find someone you are confident with, then I would go to a hospital.
It sounds like it would be really good for you to talk about emergency hospital transfer protocol with the midwives at the birth center. Just hearing that they have a plan for a situation like the one you’re worried about may put your mind at ease. It would also be good to discuss your previous experience with the midwives at the center, both your feelings of violation and disappointment and your desire for a healthy, safe VBAC now. Even if you do end up having a hospital transfer, the prenatal care you receive at a birth center is, in my experience, unparalleled.
I was lucky enough to birth at a great birth center that happened to be located on the campus of a hospital – so I got to labor in big, quiet room with a homey bed, a birthing tub, a rocking chair, and a birth ball with no monitors or IVs, knowing that if something went wrong, I would just be wheeled across the parking lot on a gurney to the hospital (which, incidentally, is just what happened when my midwife detected some meconium staining).
You are 100% right about needing to talk with midwives. So far I’ve only spoken with the head of the birth center, who was awesome but not the woman who’d deliver my baby. I also get the impression from others that a midwife would probably be more open to me asking lots of questions even if it’s not at an appointment, which is something a girl like me needs!
Absolutely. One of the very first questions I asked my midwife was about what her past emergency transfers have looked like. It felt a little awkward to start right off with that, but I knew if she had brushed it off or said, “Oh, we can worry about that if it happens” or even worse “I never transfer!” I would not have been comfortable in her care. But she was very reassuring, told me that there were several hospitals minutes away if there was a true emergency, and that she’d had good experiences transferring to several local hospitals and was able to continue working with her clients as a doula, in a non-medical role.
I loved giving birth at a birth center. It felt magical in a way I’m not sure I could have relaxed enough to feel at a hospital. And part of the reason I was able to relax was because I knew if there were any signs of something going wrong I trusted my midwife to see it and transfer whenever necessary. Go with your gut–if you talk to a midwife and don’t feel reassured, give birth where you’ll feel safe.
First off, I applaud you for giving this decision plenty of thought. Leaving the hospital is a tough conclusion to come to for lots of women. But lots of women are able to have VBACs. Birth outside of a hospital can be such an empowering experience!
I mainly wanted to address your first concern, namely defending your decision to other people. Just remember it is YOUR body and YOUR baby – not anyone else’s. Whatever decision you come to is perfectly legitimate and you can rest assured that you gave the matter plenty of thought. Most of the time, fear is the main driver of those who look down on birth outside of a hospital.
Something I reflect on from time to time is that I’ve never really felt judged with my parenting decisions. I mean, I’ve stood there and witnessed others actually judge me to my face, but I’ve always felt like, “hey, you’re not me, so it’s cool to have your own opinions, but my mind’s made up on this issue.” But then I start talking to my husband about doing something different for babytoo and I get completely defensive to someone who was right there with me last time. not cool. Anyway, that led me to do some searching and I realized that the very same birth center I’m considering hosts ICAN meetings – a support group for women who’ve had c-sections and, like me, need to talk it out.
Because you’re right – fear feels like my main driver right now, too.
Have you lloked into nurse midwives groups in hospitals? some hospitals have separate floors and birthing centers inside. And Nurse Midwives are very skilled, plus is something goes wrong you are already i the hospital. It is a hard decision to make, we are planing to get pregnant at the end of the year after we get married and i would really want to have a home birth, assisted by midwives at home in Puerto Rico. Now who knows what happens in the process. I have been seeing nurse midwives for my well women care for the last three years and i couldn’t be happier, i can’t imagine going back to an OBGYN unless i had a serious health issue, or the doctor was trained by midwives. I would suggest that if you haven’t take a look at The Business of being born documentary and do some research on the Farm midwives and Ina May Gaskin if you haven’t already, you probably have but just in case. Good luck in your search and Have a very healthy and happy birth!
Perhaps in hindsight, yes, your c-section was unnecessary, but your midwife probably went the “better to be safe then sorry” route. I think that researching the protocols for a birth center transferring you to a hospital is an excellent idea, it would let you feel more empowered and knowledgeable, as well as make decisions, about what is a worthwhile risk and what isn’t.
another thing that I intend to do this time: understand more about cesarean delivery. I pretty much assumed it wouldn’t heppen to me (which is kind of dull of me given that I knew the USA has a 33% cesarean rate) and was very afraid of the possibility. This time, I’m going to approach the fear head on. I saw the c-section coming last time (because I was doing some great puching but wasn’t progressing, which led to one intervention after another and so on), but refused to believe that’s where we’d end up. This time I plan on being more prepared on how to create an attitude of empowerment even if things feel like they’re slipping out of my control.
Honestly, your comment about putting your birth experience over the safety of your baby is why I’m personally not comfortable with the idea of having a baby outside of the hospital. Then again, I’m in Canada, and after having 3 hospital births, understand that protocol is different here. Still, though, as much as your birth is YOUR birth, it’s also your baby’s, and the possibility of endangering his/her life in the name of having the experience you want just doesn’t sit right with me. That’s probably an unpopular view around here, but I think that choosing a doctor or midwife (since alot of them attend hospital births) that you trust could really be the key. Find one that agrees with however you want to have your baby: drugs vs no drugs, asking for a second opinion if there’s time before reverting to an emergency procedure, etc. I think that that way you’re ensuring as much as you can that you’ll be able to give birth how you want to, while also having IMMEDIATE access to the hospital’s resources should you need them. It just makes me uneasy thinking that if something were to go wrong at a center, no matter how good the emergency transfer to hospital plan was, I would still have to wait for an ambulance to be called, for it to arrive, for me to get there, etc, and even if it’s only 15 minutes, that’s 15 minutes that I wouldn’t have had to wait if I was already in the hospital. No matter what you decide, though, if you’re 100% happy and certain on the decision, then it’s the right one for you. Good luck!
But you have an assumption that a birth center birth is automatically less safe than a hospital birth, which is statistically untrue. Outcomes for mothers and babies in planned, out of hospital births with trained attendants are identical in terms of morbidity and mortality to hospital births, with far fewer interventions. For a low risk pregnancy in a healthy mother, there is nothing extra dangerous about being out of hospital. Midwives are trained to identify problems as they arise and keep mother and baby stable. They are professionals with equipment and training. You don’t just sit there panicking until an ambulance shows up to save the day.
Bree, I would grill the midwives at the birth center. When we would transfer? Why? How? Talk about your feelings. Talk to mothers who have done both. Talk to your local ICAN chapter about your concerns. And then ask yourself what you want, in your gut. Go with your guts.
My babies were both born at home with a professional midwife and the experiences were wonderful, empowering, amazing, safe, and healthy. I didn’t endanger my children to get the birth experience we all deserved.
I have one child and I had a homebirth because there is not currently a birth center in my city. (Sad! But one is in the works!) I had similar concerns, and for me, it helped to talk through EVERY scary scenario with my midwife and know what might happen. I had an exceptionally skilled midwife who has been attending births for over 20 years and has handled postpartum hemorrhage, breech births, fetal distress, etc. Once we talked through every single scenario, I realized that, due to her skill and her reliance not on technology to monitor my health and my baby’s, but on actual in-person observation, the chance of a really crazy, life-threatening, last-minute crisis was exceptionally slim. The risk is ALWAYS there, yes. But given my healthy pregnancy and my experienced birth team, it was actually LESS risky for me to give birth at home than in a hospital. I had an amazing, empowering, beautiful birth and a strong, healthy son. I felt safe and confident in my birth team and knew my midwife would tell me transfer to the hospital if needed, and would make that call in enough time to avoid some crazy, TV-drama scenario. I also knew she could handle a number of emergency situations on her own, with her own arsenal of medicine – and herbs and physical techniques that most OBs don’t even know about! This enabled me to birth without the fears and doubts hanging over me, and I think it greatly helped me to have an easy labor and delivery. Fear is powerful, but it CAN be overcome! Figure out what YOU need to quiet those voices and find the birth option that is best for you and your child, whether that is gathering information, watching birth videos, talking to other parents, or just going within and listening to your own intuition. I needed all of that. But I was able to transition from a timid, frightening position to a confident, empowered one, and it has had an enormous and positive ripple effect in my life! I wish you all the best in your journey!
Yes yes, this comment. I just had a home vbac a week and a half ago and my confidence in the skill of my caregivers, plus my own research suggesting that the risks of VBAC were lower than the risks of a repeat surgery, convinced me. I asked lots of questions early in my pregnancy and picked a midwifery practice with LOTS of home VBAC experience and talked through everything with them. It was so the right decision for me and once I talk talk talked it out I felt 100% safe. (if you want to read my story it’s in the two most recent posts on my blog at http://www.jessbot.com)
“I was able to transition from a timid, frightening position to a confident, empowered one, and it has had an enormous and positive ripple effect in my life!”
THIS is exactly what I want and didn’t get last time. I’m still processing my feelings, but I was left feeling like my baby was taken from me rather than delivered into this world by me. I wasn’t prepared for the outcome I got and am certain it’s what led to depression and uncertainty after the delivery.
I’m also trying to keep a comment from Ariel’s post about her delivery in my mind at all times: some thing along the lines that she didn’t get the delivery she wanted but she got the experience she wanted. I think that’s the most wise way to approach this, regardless of what I ultimately choose.
I’m so glad I’m not the only one who worries about coming across as defensive about my choices! I find that once I come to the place in my own head where I know that I’m making the right decision for me, and that others will make the right decision for them, then I’m not that way anymore. It just sort of melts away.
I also find that an antidote to defensiveness in the “considering” phase is genuine listening and curiosity.
Finally, I’m not sure who “people” are, but lots of people don’t really need to know what your birth plan is, and whole bunch more don’t need to know your reasons (just say your plan with a confident smile).
I am currently in my last few weeks of pregnancy with my first child and I chose a birth center over a hospital. Your situation is of course a little being you’re hoping for a vbac (vaginal birth after c-section). But I think is the process in making the decision is the same.
1. Sit down and write out what your and your partner’s concerns are.
2. Write down or google a list of interview questions that will answer those concerns.
3. Interview your potential care providers at the hospital, obgyn office or birth center.
The offsite birth center I chose answered all my questions without hesitation, understood my concerns about my family history of difficult births and had no issue telling me what would prompt a hospital transfer. And the icing on the cake is that the location is less then a ten minute drive to one of the best hospitals in the area including a children’s hospital.
As for explaining to friends and family in my case I explained that I interviewed my care providers, toured the facility, saw the emergency equipment they have on hand and also looked into how far the local hospitals were from the birth center. So I felt that I made the best choice for my care and that of my unborn child.
The most important thing is that you feel safe, secure in the fact that you and the child will get the best care possible, that you can try for the birth you want and that all interventions are medically necessary. And those goals can be achieved in whatever birth venue you chose by asking the tough questions.
In people considering out-of-hospital birth it seems pretty common that they have seen The Business of Being Born, but just in case you haven’t seen it I would recommend giving it a look. There is also a sequel called More Business of Being Born (both available on Netflix) which has a whole section on VBAC which may be very helpful to you.
I just want to make sure this info is out there. In my state, midwives have to work under a supervising ob/gyn by law so there are no independent birth centers. This means that being attended by a midwife is either in a home birth or a hospital birth.
As a policy wonk, I have lots of opinions on these laws but the really good (probably unintended) outcome is that I gave birth to my first child and am preparing for a second in a hospital that is used to the philosophy of care of midwives in addition to the philosophy of care of doctors.
My practice has office on the hospital campus and there are 8 midwives on staff. I never had to meet with the supervising ob and they almost completely autonomous from the client end of things. I have met all during my check-ups and any one of them could be on-call when I go into labor. Since it took 4 days to have my baby, I interacted with at least three during that time. But no one pushed me to speed things along.
At the end, my blood pressure spiked so they called in the ob on call but it was totally non-intrusive and my midwife and I still made all the decisions together. The “supervision” is kind of a technicality and, again, the midwives chose to work with the partners because of how open they are to that style of care.
Post-partum, the hospital had all sorts of family-friendly policies in place -as policies- like preferring that babies stay in the room with parents and how soon they do routine testing. This is the kind of thing that a hospital would be trumpeting on its website, which could help someone make a first cut for finding a compromise between birthing center and hostile hospital. You could grill a hospital practitioner in the same way you would a birth center practitioner and then go with your gut regarding how comfortable you feel. There are also some web forums if you google the hospital that will give insight to people’s experiences of how well policies were implemented.
Bree, this may not help you in your state but it might help others.
It didn’t say so above, but my first birth was with midwives at a hospital. I originally felt incredibly lucky to have found them (a pair of midwives who were able to deliver most of their own patients) and loved the idea that I’d still be in a hospital if there were a need. But my take-away was different: in the end, reflecting on all my prenatal appointments and the delivery, I felt that they were too immersed in the hospital culture. For example, they were both certified to assist with c-sections. I originally thought that was a bonus… until I had one of my own and wondered if *maybe* that was a little too prepared of them. Like it made a cesarean delivery just one more option available to them, but pulled focus away from some of the things they could have done to help prevent the need for surgery at all. I hope that makes sense.
It sounds like you had a wonderful, best-of-both-worlds experience. You also raise a really good point – for whatever reason, I feel naggingly uncomfortable about grilling a doctor in a way I don’t think I feel about grilling a midwife. Doctors are still people who have to convince us they will provide the care we hope to receive, and I can’t let their white coats and antiseptic hospital smells intimidate me, right?!? Since I sent this question in to OBF, I was able to make a meet-and-greet appointment with a doctor who openly advertises his belief in VBAC and unmedicated birth, but I need to remember to take my inquisitiveness/ suspension of disbelief with me to that meeting. thanks for opening my eyes to that.
Before getting pregnant, I researched hospitals and birth centers, both in general, and specifically those near me. I watched The Business of Being Born (not recommended). Between all of that and the horrible hospital experiences I had in my past, I was sold on a local birth center. We toured it, attended an orientation, and I loved it. I had a few months of pregnancy with Kaiser and the rest at the birth center (insurance change) and I was surprised to find that my visits weren’t very different. There were some things I liked better about the birth center visits and others (suprisingly) that I liked better about the hospital. During the orientation we learned that a large number of patients didn’t actually give birth at the birth center. Just like you with the c-section, I was like “Oh, but surely that won’t happen to me!”
I imagine that every birth center is different, but my birth center would send you away to a hospital for any little thing that seemed worrisome. They did not take risks. So I agree completely that first order of business is asking them what guidelines they follow in this regard.
So during labor, I was sent to a hospital I had never even heard of (so much for research) and had a fabulous experience there. I don’t want to give my whole birth story, but suffice to say that they were totally on board with my view of childbirth and they let me insist on getting the kid out my vag when other hospitals probably would have feigned the need for a c-section. Meanwhile, I felt cast away and unsupported by the midwives from the birth center.
If I had to do it over again, I’d research more hospitals instead of rejecting them on the basis of their hospitalness. Specifically, I’d look for c-section rates, whether they have midwives, their feelings on birth plans, and how pleasant the environment seems. (Lol to my birth plan, btw. I still remember the doctor at the hospital holding it and asking me if I was sure I wanted an epidural as it said in my plan that I did not. “YES, SIR, I DO!”)
I am personally opting for a homebirth, but I did a lot of research of different options before making that choice. I looked at hospitals with high rates of unmedicated vaginal births, a birth center, and homebirth. I have a hospital picked out in case something is to change, and I picked them because 50% of their births fit the aforementioned criteria. In fact, they let a friend of mine bring her dog to her delivery.
I also found the birth center in my state had a lot of options for medical interventions and was a lot less “homebirthy” than I expected. I could definitely see it being a really comfortable place for someone with a lot of concerns about homebirth.
If you feel really anxious about the choice you make, you might have a more challenging labor. No matter what you decide, be vocal about your fears because they are all important and legitimate.
“No matter what you decide, be vocal about your fears because they are all important and legitimate.”
heck yes to this! I have so many, “that should have been a red flag,” thoughts about my prenatal care from last time. I put them aside because… well, I don’t know everything, and such and such proably IS scary, and every other excuse I could think of – when in fact I should have said, “I think my midwife is trying to scare me into behaving a certain way and I’m not sure how I feel about it.”
I was planning a homebirth because I trust my body and the midwife & doula I had lined up… then my midwife was no longer available for several reasons that I won’t divulge.
I am struggling between the place where we do things for our children out of fear (early vaccinations, hospital births, etc.) and the place where I believe I am right even thought my belief may not be “conventional.”
I chose my local birth center because home was not an option for me any longer and because it is a place for HAVING BABIES. And for me anyway, yes, not being in a hospital for SICK people when I am merely PREGNANT is more important to ME.
just a note to say thank you to all commenters and OBF for providing a really wonderful space to be able to ask and answer questions without feeling foolish or judged. It’s really awesome to hear everyone’s experiences and advice and I know I’m going to refer to this page frequently in the coming weeks as I come to terms with whatever it is I decide. this is a very unique community and I’m grateful to have found you.
I think a truly good midwife will be concerned about this too. I chose to have my son at a birth center, because it seemed a good compromise between the home birth I’d always envisioned and proximity to the hospital (I lived half an hour away from the hospital and that made me nervous). But my midwives were constantly making sure I remained a good candidate for midwifery care and out-of-hospital birth. They were very open about it, too, saying they needed to do such-and-such test to determine whether I could remain in their care or whether I should transfer to the care of an OB. In the end, I had a complications-free birth center birth that was wonderful. But I had awesome midwives that I completely trusted to make the call on whether or not I needed to be in the hospital. I know, had I gotten close to needing more intensive care, they would have told me. I hope that any good midwife would do the same. (Also, if you want midwifery care but are uncomfortable with an out-of-hospital setting, check your local hospital; many have midwives that practice within the hospital!)
One other thought is that in some ways you are choosing two different variables: 1) provider, and 2) setting. There is a wonderful midwife practice in the area that delivers at a hospital. That could be best of both worlds, but there are also hospital regulations that limit what htey can do (ie. mandatory monitoring for VBACs, time limits based upon financial considerations, etc.). So, perhaps it is helpful to both interview the a) provider, and find out about how the b) setting would impact your labor and birth experience.
I live in a small place in Canada where your birthing options consist of a hospital – end of options. We do not have ‘legal’ midwives yet and while many of you are probably going ‘Gasp!’ I would like to say that I had 2 births at my hospital and survived 🙂 In my province the OB basically just handles the ‘catching’ of the baby or the C section, if necessary but they are very pro choice. Their outlook is your labour is YOUR labour and all the decisions are up to you. The labour and delivery nurses are wonderful as well – their job is to make you as comfortable as possible – and they are very good at it. We have whirlpool tubs (love them!) and all the birthing equipment you could possibly want. Babies stay in the room with their mommies, we actually don’t even have a nursery and the only time the DR will intervene is if they feel there is a risk to you or the baby, otherwise you are left to labour as you desire. From other stories I have read I know that other hospitals are not so comfortable but I just really felt the need to share that birthing in a hospital can be a positive experience as well. Regardless of where you decide to deliver your new bundle of joy, my advice to you would be to make your wishes known. My first birth experience and my second birth experience are completely different, not in the quality of care that I received but in that I was a nervous girl that didn’t share what I wanted the first time and a confident woman the second time that didn’t hesitate to say what I wanted to happen. The staff was very open to whatever I suggested as long as I wasn’t putting myself or the baby at risk. I even got to labour and deliver almost in the complete dark because I found it to be more calming and tranquil that way. They only used minimal lighting during the actual delivery and to check the baby then off the lights went again until I was ready to have them back on (I actually waited for the sunlight to naturally light up the room – quite the experience). I am a strong believer in this experience will be what you make it – so claim it as yours and do what you want. Good Luck!
I haven’t made it through all of the comments, so please forgive me if this is redundant. I was lucky enough to have a free standing birth center ONLY a 45 minute drive (sigh). 5 minutes from a major hospital. we did all prenatal care and LOVED it. they were lacking in breastfeeding support but the birth experience was superb. I actually believe it IS safer for a baby born out of a hospital. At least in the US. If you would like more information about this, I highly recommend reading Jennifer Block’s Pushed. And have your husband read it! As a nurse who works in the hospital, I was rather terrified of the prospect of birthing in the hospital. Perhaps a little too much. My midwife informed me later that if I had been in the hospital I would’ve most certainly received pitocin. I highly HIGHLY recommend the birth center if you have access to it. But only if you can get comfortable with it as the safest thing for mother AND baby. and find one that will do VBAC. Good luck!
It’s always a tough decision about where to birth. I am a labor and delivery nurse who opted for a home birth the first time around, but am birthing at my hospital of employment this time around. I felt very comfortable with my decision to birth at home, but live 7 minutes from a high level hospital, and so I met the “30minute decision to incision” time that hospitals have to meet for emergency cesareans. I also think that you have to be comfortable with the knowledge that there ARE a few obstetrical events that could happen that may be handled more quickly in a hospital setting. Uterine rupture, cord prolapse, and fetal distress are some of them. Unfortunately I have also seen babies have poor outcomes with all three of those events, even in my wonderful hospital, with obs and anesthesia in house. The chance of those are all extremely rare, but I really think you have to acknowledge those before committing to an out of hospital birth. For me, the skill of the midwives (at both midwifery and fetal resuscitation), the protocols for transfers, the proximity to an excellent hospital with at least a level 2 nicu and in house anesthesia and obs, and your own health and pregnancy history would all be what would help me make the decision.
This is a tough decision, but what cinched it for me was finding a midwife-run/hospital-connected birth center. I got the low lighting, the jacuzzi labor, zero intervention, and peaceful waterbirth I was aiming for; but across the way were hospital staff and equipment for the “just in case” scenarios.
I’m pregnant again and considering a freestanding birth center, but I am looking for one in reasonable proximity to a hospital, just in case.
Seconding this. As a Canadian living in the UK, it took me a little while to get my head around the idea of midwives and birthing centres at all. I really liked the idea of a less medicalised environment (I’m pregnant, not sick!!), but wanted to be in proximity to emergency help if something went wrong mid-labour.
The birthing centre attached to the hospital gave me the low-intervention labour I wanted, but also peace of mind as I was only a hallway or two away from lots and lots of intervention if it was needed. It had the added bonus of giving my (Canadian) parents peace of mind, too. As they said more than once during my pregnancy, I am THEIR baby and they wanted me to be safe!
I’m not sure if this is an option for the original poster, but it is certainly the approach that worked for me.
Forgive me for not reading all the comments (I read most and skimmed the rest and possibly repeating something) but I second the research idea. I would research the hell out of every option you have and then some. Grill the midwives and anyone who might be involved. But be prepared for what you might here – I hate to be Debbie Downer but I live in coastal Georgia and in this state midwives are prohibited by law from delivering VBAC. At least in a birth center (lucky for me I live 15 minutes from the only free standing birth center in Georgia). Your state laws may vary. That being said, to “qualify” as a birth center patient (read: no complications) we all had to go through sort of a screening and during that process, issues like “what would happen if I needed medical intervention? What are you qualified to do? What happens if it’s beyond what you’re capable of here?” were addressed. That being said, I can’t stress ownership and asking questions enough. I didn’t ask many questions, assuming I’d started with no complicatibs a
We decided on our birth center based on transfer rates to the hospital (which happens to be across the street). Transfer was very low, but was reassuring that a transfer to a hospital was available IF medically necessary. Just because you plan on birthing in a birth center doesn’t mean that a medically necessary hospital birth is out of the picture. Birth centers will transfer you if your delivery is too unsafe for their hands.
I’ve been thinking about you, Bree, and how much thought you are putting into this.
If you can’t find a solution that makes you 100% comfortable, I would suggest that you look into hiring a doula to labor with you wherever you labor. Our birth instructor told us that research shows that just having another woman in the room with you reduces c-section rates. She’ll help you step back and make your decisions about care during labor in a more objective way to hopefully help you steer yourself away from unnecessary interventions, regardless of the preferences of your attendants.
Having had a doula, it’s an amazing assist for self-advocacy.
I’m not sure how it’s done elsewhere but births at midwife run birthing centers are referred there by a gynae. This is because birthing centers (and home births) are meant primarily for low risk pregnancies.
Essentially, the option is open for you to ask for delivery at a birthing center but the final decision is not yours, but is rather determined by the progress of your pregnancy, your and baby’s health risks etc etc.
the ‘right’ to have a delivery at a BC may be revoked or lost if the course of your pregnancy changes at any time and yours becomes anything but low risk.
In addition, BC’s are usually fully equipped with an operating theater and are situated near hospitals with ICU facilities so should there be any eventualities, the appropriate teams (paediatrician, anaesthetist, obgyn etc) can be contacted and have recourse to escalate your & babies care.
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This is such a hard decision, Bree, and one that I think about a lot, since we had our first son in a hospital, with a c-section, and are hoping if we are able to get pregnant again to not repeat the experience. I have looked into homebirth, birthing with midwives in a hospital, and a birthing center — and one midwife (at the hospital, actually) asked me a very good question: which do you fear more: being in a hospital or having something go wrong. I did lots of research about risk and realized (I am 99% sure) that it is former. So, if we are able to get pregnant again we will opt for homebirth. If you go that route (either homebirth or a birth center unattached to a hospital) I think it just helps to make sure your midwives are VERY experienced and can recognize early warning signs for uterine rupture. I did EONS of research, and it is a bit blow out of proportion in terms of how often it happens. BUT, if if happens to you, you want to feel safe that it can be caught early and you adn baby can both be safe. I am confident that with a skilled midwife this is possible. If you can’t find someone you are confident with, then I would go to a hospital.
It sounds like it would be really good for you to talk about emergency hospital transfer protocol with the midwives at the birth center. Just hearing that they have a plan for a situation like the one you’re worried about may put your mind at ease. It would also be good to discuss your previous experience with the midwives at the center, both your feelings of violation and disappointment and your desire for a healthy, safe VBAC now. Even if you do end up having a hospital transfer, the prenatal care you receive at a birth center is, in my experience, unparalleled.
I was lucky enough to birth at a great birth center that happened to be located on the campus of a hospital – so I got to labor in big, quiet room with a homey bed, a birthing tub, a rocking chair, and a birth ball with no monitors or IVs, knowing that if something went wrong, I would just be wheeled across the parking lot on a gurney to the hospital (which, incidentally, is just what happened when my midwife detected some meconium staining).
You are 100% right about needing to talk with midwives. So far I’ve only spoken with the head of the birth center, who was awesome but not the woman who’d deliver my baby. I also get the impression from others that a midwife would probably be more open to me asking lots of questions even if it’s not at an appointment, which is something a girl like me needs!
Absolutely. One of the very first questions I asked my midwife was about what her past emergency transfers have looked like. It felt a little awkward to start right off with that, but I knew if she had brushed it off or said, “Oh, we can worry about that if it happens” or even worse “I never transfer!” I would not have been comfortable in her care. But she was very reassuring, told me that there were several hospitals minutes away if there was a true emergency, and that she’d had good experiences transferring to several local hospitals and was able to continue working with her clients as a doula, in a non-medical role.
I loved giving birth at a birth center. It felt magical in a way I’m not sure I could have relaxed enough to feel at a hospital. And part of the reason I was able to relax was because I knew if there were any signs of something going wrong I trusted my midwife to see it and transfer whenever necessary. Go with your gut–if you talk to a midwife and don’t feel reassured, give birth where you’ll feel safe.
First off, I applaud you for giving this decision plenty of thought. Leaving the hospital is a tough conclusion to come to for lots of women. But lots of women are able to have VBACs. Birth outside of a hospital can be such an empowering experience!
I mainly wanted to address your first concern, namely defending your decision to other people. Just remember it is YOUR body and YOUR baby – not anyone else’s. Whatever decision you come to is perfectly legitimate and you can rest assured that you gave the matter plenty of thought. Most of the time, fear is the main driver of those who look down on birth outside of a hospital.
Something I reflect on from time to time is that I’ve never really felt judged with my parenting decisions. I mean, I’ve stood there and witnessed others actually judge me to my face, but I’ve always felt like, “hey, you’re not me, so it’s cool to have your own opinions, but my mind’s made up on this issue.” But then I start talking to my husband about doing something different for babytoo and I get completely defensive to someone who was right there with me last time. not cool. Anyway, that led me to do some searching and I realized that the very same birth center I’m considering hosts ICAN meetings – a support group for women who’ve had c-sections and, like me, need to talk it out.
Because you’re right – fear feels like my main driver right now, too.
Have you lloked into nurse midwives groups in hospitals? some hospitals have separate floors and birthing centers inside. And Nurse Midwives are very skilled, plus is something goes wrong you are already i the hospital. It is a hard decision to make, we are planing to get pregnant at the end of the year after we get married and i would really want to have a home birth, assisted by midwives at home in Puerto Rico. Now who knows what happens in the process. I have been seeing nurse midwives for my well women care for the last three years and i couldn’t be happier, i can’t imagine going back to an OBGYN unless i had a serious health issue, or the doctor was trained by midwives. I would suggest that if you haven’t take a look at The Business of being born documentary and do some research on the Farm midwives and Ina May Gaskin if you haven’t already, you probably have but just in case. Good luck in your search and Have a very healthy and happy birth!
Perhaps in hindsight, yes, your c-section was unnecessary, but your midwife probably went the “better to be safe then sorry” route. I think that researching the protocols for a birth center transferring you to a hospital is an excellent idea, it would let you feel more empowered and knowledgeable, as well as make decisions, about what is a worthwhile risk and what isn’t.
another thing that I intend to do this time: understand more about cesarean delivery. I pretty much assumed it wouldn’t heppen to me (which is kind of dull of me given that I knew the USA has a 33% cesarean rate) and was very afraid of the possibility. This time, I’m going to approach the fear head on. I saw the c-section coming last time (because I was doing some great puching but wasn’t progressing, which led to one intervention after another and so on), but refused to believe that’s where we’d end up. This time I plan on being more prepared on how to create an attitude of empowerment even if things feel like they’re slipping out of my control.
Honestly, your comment about putting your birth experience over the safety of your baby is why I’m personally not comfortable with the idea of having a baby outside of the hospital. Then again, I’m in Canada, and after having 3 hospital births, understand that protocol is different here. Still, though, as much as your birth is YOUR birth, it’s also your baby’s, and the possibility of endangering his/her life in the name of having the experience you want just doesn’t sit right with me. That’s probably an unpopular view around here, but I think that choosing a doctor or midwife (since alot of them attend hospital births) that you trust could really be the key. Find one that agrees with however you want to have your baby: drugs vs no drugs, asking for a second opinion if there’s time before reverting to an emergency procedure, etc. I think that that way you’re ensuring as much as you can that you’ll be able to give birth how you want to, while also having IMMEDIATE access to the hospital’s resources should you need them. It just makes me uneasy thinking that if something were to go wrong at a center, no matter how good the emergency transfer to hospital plan was, I would still have to wait for an ambulance to be called, for it to arrive, for me to get there, etc, and even if it’s only 15 minutes, that’s 15 minutes that I wouldn’t have had to wait if I was already in the hospital. No matter what you decide, though, if you’re 100% happy and certain on the decision, then it’s the right one for you. Good luck!
But you have an assumption that a birth center birth is automatically less safe than a hospital birth, which is statistically untrue. Outcomes for mothers and babies in planned, out of hospital births with trained attendants are identical in terms of morbidity and mortality to hospital births, with far fewer interventions. For a low risk pregnancy in a healthy mother, there is nothing extra dangerous about being out of hospital. Midwives are trained to identify problems as they arise and keep mother and baby stable. They are professionals with equipment and training. You don’t just sit there panicking until an ambulance shows up to save the day.
Bree, I would grill the midwives at the birth center. When we would transfer? Why? How? Talk about your feelings. Talk to mothers who have done both. Talk to your local ICAN chapter about your concerns. And then ask yourself what you want, in your gut. Go with your guts.
My babies were both born at home with a professional midwife and the experiences were wonderful, empowering, amazing, safe, and healthy. I didn’t endanger my children to get the birth experience we all deserved.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447883/
Here’s some research!
You’re welcome 😀
I have one child and I had a homebirth because there is not currently a birth center in my city. (Sad! But one is in the works!) I had similar concerns, and for me, it helped to talk through EVERY scary scenario with my midwife and know what might happen. I had an exceptionally skilled midwife who has been attending births for over 20 years and has handled postpartum hemorrhage, breech births, fetal distress, etc. Once we talked through every single scenario, I realized that, due to her skill and her reliance not on technology to monitor my health and my baby’s, but on actual in-person observation, the chance of a really crazy, life-threatening, last-minute crisis was exceptionally slim. The risk is ALWAYS there, yes. But given my healthy pregnancy and my experienced birth team, it was actually LESS risky for me to give birth at home than in a hospital. I had an amazing, empowering, beautiful birth and a strong, healthy son. I felt safe and confident in my birth team and knew my midwife would tell me transfer to the hospital if needed, and would make that call in enough time to avoid some crazy, TV-drama scenario. I also knew she could handle a number of emergency situations on her own, with her own arsenal of medicine – and herbs and physical techniques that most OBs don’t even know about! This enabled me to birth without the fears and doubts hanging over me, and I think it greatly helped me to have an easy labor and delivery. Fear is powerful, but it CAN be overcome! Figure out what YOU need to quiet those voices and find the birth option that is best for you and your child, whether that is gathering information, watching birth videos, talking to other parents, or just going within and listening to your own intuition. I needed all of that. But I was able to transition from a timid, frightening position to a confident, empowered one, and it has had an enormous and positive ripple effect in my life! I wish you all the best in your journey!
Yes yes, this comment. I just had a home vbac a week and a half ago and my confidence in the skill of my caregivers, plus my own research suggesting that the risks of VBAC were lower than the risks of a repeat surgery, convinced me. I asked lots of questions early in my pregnancy and picked a midwifery practice with LOTS of home VBAC experience and talked through everything with them. It was so the right decision for me and once I talk talk talked it out I felt 100% safe. (if you want to read my story it’s in the two most recent posts on my blog at http://www.jessbot.com)
“I was able to transition from a timid, frightening position to a confident, empowered one, and it has had an enormous and positive ripple effect in my life!”
THIS is exactly what I want and didn’t get last time. I’m still processing my feelings, but I was left feeling like my baby was taken from me rather than delivered into this world by me. I wasn’t prepared for the outcome I got and am certain it’s what led to depression and uncertainty after the delivery.
I’m also trying to keep a comment from Ariel’s post about her delivery in my mind at all times: some thing along the lines that she didn’t get the delivery she wanted but she got the experience she wanted. I think that’s the most wise way to approach this, regardless of what I ultimately choose.
I’m so glad I’m not the only one who worries about coming across as defensive about my choices! I find that once I come to the place in my own head where I know that I’m making the right decision for me, and that others will make the right decision for them, then I’m not that way anymore. It just sort of melts away.
I also find that an antidote to defensiveness in the “considering” phase is genuine listening and curiosity.
Finally, I’m not sure who “people” are, but lots of people don’t really need to know what your birth plan is, and whole bunch more don’t need to know your reasons (just say your plan with a confident smile).
I am currently in my last few weeks of pregnancy with my first child and I chose a birth center over a hospital. Your situation is of course a little being you’re hoping for a vbac (vaginal birth after c-section). But I think is the process in making the decision is the same.
1. Sit down and write out what your and your partner’s concerns are.
2. Write down or google a list of interview questions that will answer those concerns.
3. Interview your potential care providers at the hospital, obgyn office or birth center.
The offsite birth center I chose answered all my questions without hesitation, understood my concerns about my family history of difficult births and had no issue telling me what would prompt a hospital transfer. And the icing on the cake is that the location is less then a ten minute drive to one of the best hospitals in the area including a children’s hospital.
As for explaining to friends and family in my case I explained that I interviewed my care providers, toured the facility, saw the emergency equipment they have on hand and also looked into how far the local hospitals were from the birth center. So I felt that I made the best choice for my care and that of my unborn child.
The most important thing is that you feel safe, secure in the fact that you and the child will get the best care possible, that you can try for the birth you want and that all interventions are medically necessary. And those goals can be achieved in whatever birth venue you chose by asking the tough questions.
In people considering out-of-hospital birth it seems pretty common that they have seen The Business of Being Born, but just in case you haven’t seen it I would recommend giving it a look. There is also a sequel called More Business of Being Born (both available on Netflix) which has a whole section on VBAC which may be very helpful to you.
I just want to make sure this info is out there. In my state, midwives have to work under a supervising ob/gyn by law so there are no independent birth centers. This means that being attended by a midwife is either in a home birth or a hospital birth.
As a policy wonk, I have lots of opinions on these laws but the really good (probably unintended) outcome is that I gave birth to my first child and am preparing for a second in a hospital that is used to the philosophy of care of midwives in addition to the philosophy of care of doctors.
My practice has office on the hospital campus and there are 8 midwives on staff. I never had to meet with the supervising ob and they almost completely autonomous from the client end of things. I have met all during my check-ups and any one of them could be on-call when I go into labor. Since it took 4 days to have my baby, I interacted with at least three during that time. But no one pushed me to speed things along.
At the end, my blood pressure spiked so they called in the ob on call but it was totally non-intrusive and my midwife and I still made all the decisions together. The “supervision” is kind of a technicality and, again, the midwives chose to work with the partners because of how open they are to that style of care.
Post-partum, the hospital had all sorts of family-friendly policies in place -as policies- like preferring that babies stay in the room with parents and how soon they do routine testing. This is the kind of thing that a hospital would be trumpeting on its website, which could help someone make a first cut for finding a compromise between birthing center and hostile hospital. You could grill a hospital practitioner in the same way you would a birth center practitioner and then go with your gut regarding how comfortable you feel. There are also some web forums if you google the hospital that will give insight to people’s experiences of how well policies were implemented.
Bree, this may not help you in your state but it might help others.
It didn’t say so above, but my first birth was with midwives at a hospital. I originally felt incredibly lucky to have found them (a pair of midwives who were able to deliver most of their own patients) and loved the idea that I’d still be in a hospital if there were a need. But my take-away was different: in the end, reflecting on all my prenatal appointments and the delivery, I felt that they were too immersed in the hospital culture. For example, they were both certified to assist with c-sections. I originally thought that was a bonus… until I had one of my own and wondered if *maybe* that was a little too prepared of them. Like it made a cesarean delivery just one more option available to them, but pulled focus away from some of the things they could have done to help prevent the need for surgery at all. I hope that makes sense.
It sounds like you had a wonderful, best-of-both-worlds experience. You also raise a really good point – for whatever reason, I feel naggingly uncomfortable about grilling a doctor in a way I don’t think I feel about grilling a midwife. Doctors are still people who have to convince us they will provide the care we hope to receive, and I can’t let their white coats and antiseptic hospital smells intimidate me, right?!? Since I sent this question in to OBF, I was able to make a meet-and-greet appointment with a doctor who openly advertises his belief in VBAC and unmedicated birth, but I need to remember to take my inquisitiveness/ suspension of disbelief with me to that meeting. thanks for opening my eyes to that.
Before getting pregnant, I researched hospitals and birth centers, both in general, and specifically those near me. I watched The Business of Being Born (not recommended). Between all of that and the horrible hospital experiences I had in my past, I was sold on a local birth center. We toured it, attended an orientation, and I loved it. I had a few months of pregnancy with Kaiser and the rest at the birth center (insurance change) and I was surprised to find that my visits weren’t very different. There were some things I liked better about the birth center visits and others (suprisingly) that I liked better about the hospital. During the orientation we learned that a large number of patients didn’t actually give birth at the birth center. Just like you with the c-section, I was like “Oh, but surely that won’t happen to me!”
I imagine that every birth center is different, but my birth center would send you away to a hospital for any little thing that seemed worrisome. They did not take risks. So I agree completely that first order of business is asking them what guidelines they follow in this regard.
So during labor, I was sent to a hospital I had never even heard of (so much for research) and had a fabulous experience there. I don’t want to give my whole birth story, but suffice to say that they were totally on board with my view of childbirth and they let me insist on getting the kid out my vag when other hospitals probably would have feigned the need for a c-section. Meanwhile, I felt cast away and unsupported by the midwives from the birth center.
If I had to do it over again, I’d research more hospitals instead of rejecting them on the basis of their hospitalness. Specifically, I’d look for c-section rates, whether they have midwives, their feelings on birth plans, and how pleasant the environment seems. (Lol to my birth plan, btw. I still remember the doctor at the hospital holding it and asking me if I was sure I wanted an epidural as it said in my plan that I did not. “YES, SIR, I DO!”)
I am personally opting for a homebirth, but I did a lot of research of different options before making that choice. I looked at hospitals with high rates of unmedicated vaginal births, a birth center, and homebirth. I have a hospital picked out in case something is to change, and I picked them because 50% of their births fit the aforementioned criteria. In fact, they let a friend of mine bring her dog to her delivery.
I also found the birth center in my state had a lot of options for medical interventions and was a lot less “homebirthy” than I expected. I could definitely see it being a really comfortable place for someone with a lot of concerns about homebirth.
If you feel really anxious about the choice you make, you might have a more challenging labor. No matter what you decide, be vocal about your fears because they are all important and legitimate.
“No matter what you decide, be vocal about your fears because they are all important and legitimate.”
heck yes to this! I have so many, “that should have been a red flag,” thoughts about my prenatal care from last time. I put them aside because… well, I don’t know everything, and such and such proably IS scary, and every other excuse I could think of – when in fact I should have said, “I think my midwife is trying to scare me into behaving a certain way and I’m not sure how I feel about it.”
Great advice.
I was planning a homebirth because I trust my body and the midwife & doula I had lined up… then my midwife was no longer available for several reasons that I won’t divulge.
I am struggling between the place where we do things for our children out of fear (early vaccinations, hospital births, etc.) and the place where I believe I am right even thought my belief may not be “conventional.”
I chose my local birth center because home was not an option for me any longer and because it is a place for HAVING BABIES. And for me anyway, yes, not being in a hospital for SICK people when I am merely PREGNANT is more important to ME.
just a note to say thank you to all commenters and OBF for providing a really wonderful space to be able to ask and answer questions without feeling foolish or judged. It’s really awesome to hear everyone’s experiences and advice and I know I’m going to refer to this page frequently in the coming weeks as I come to terms with whatever it is I decide. this is a very unique community and I’m grateful to have found you.
I think a truly good midwife will be concerned about this too. I chose to have my son at a birth center, because it seemed a good compromise between the home birth I’d always envisioned and proximity to the hospital (I lived half an hour away from the hospital and that made me nervous). But my midwives were constantly making sure I remained a good candidate for midwifery care and out-of-hospital birth. They were very open about it, too, saying they needed to do such-and-such test to determine whether I could remain in their care or whether I should transfer to the care of an OB. In the end, I had a complications-free birth center birth that was wonderful. But I had awesome midwives that I completely trusted to make the call on whether or not I needed to be in the hospital. I know, had I gotten close to needing more intensive care, they would have told me. I hope that any good midwife would do the same. (Also, if you want midwifery care but are uncomfortable with an out-of-hospital setting, check your local hospital; many have midwives that practice within the hospital!)
One other thought is that in some ways you are choosing two different variables: 1) provider, and 2) setting. There is a wonderful midwife practice in the area that delivers at a hospital. That could be best of both worlds, but there are also hospital regulations that limit what htey can do (ie. mandatory monitoring for VBACs, time limits based upon financial considerations, etc.). So, perhaps it is helpful to both interview the a) provider, and find out about how the b) setting would impact your labor and birth experience.
Best of luck!
I live in a small place in Canada where your birthing options consist of a hospital – end of options. We do not have ‘legal’ midwives yet and while many of you are probably going ‘Gasp!’ I would like to say that I had 2 births at my hospital and survived 🙂 In my province the OB basically just handles the ‘catching’ of the baby or the C section, if necessary but they are very pro choice. Their outlook is your labour is YOUR labour and all the decisions are up to you. The labour and delivery nurses are wonderful as well – their job is to make you as comfortable as possible – and they are very good at it. We have whirlpool tubs (love them!) and all the birthing equipment you could possibly want. Babies stay in the room with their mommies, we actually don’t even have a nursery and the only time the DR will intervene is if they feel there is a risk to you or the baby, otherwise you are left to labour as you desire. From other stories I have read I know that other hospitals are not so comfortable but I just really felt the need to share that birthing in a hospital can be a positive experience as well. Regardless of where you decide to deliver your new bundle of joy, my advice to you would be to make your wishes known. My first birth experience and my second birth experience are completely different, not in the quality of care that I received but in that I was a nervous girl that didn’t share what I wanted the first time and a confident woman the second time that didn’t hesitate to say what I wanted to happen. The staff was very open to whatever I suggested as long as I wasn’t putting myself or the baby at risk. I even got to labour and deliver almost in the complete dark because I found it to be more calming and tranquil that way. They only used minimal lighting during the actual delivery and to check the baby then off the lights went again until I was ready to have them back on (I actually waited for the sunlight to naturally light up the room – quite the experience). I am a strong believer in this experience will be what you make it – so claim it as yours and do what you want. Good Luck!
I haven’t made it through all of the comments, so please forgive me if this is redundant. I was lucky enough to have a free standing birth center ONLY a 45 minute drive (sigh). 5 minutes from a major hospital. we did all prenatal care and LOVED it. they were lacking in breastfeeding support but the birth experience was superb. I actually believe it IS safer for a baby born out of a hospital. At least in the US. If you would like more information about this, I highly recommend reading Jennifer Block’s Pushed. And have your husband read it! As a nurse who works in the hospital, I was rather terrified of the prospect of birthing in the hospital. Perhaps a little too much. My midwife informed me later that if I had been in the hospital I would’ve most certainly received pitocin. I highly HIGHLY recommend the birth center if you have access to it. But only if you can get comfortable with it as the safest thing for mother AND baby. and find one that will do VBAC. Good luck!
It’s always a tough decision about where to birth. I am a labor and delivery nurse who opted for a home birth the first time around, but am birthing at my hospital of employment this time around. I felt very comfortable with my decision to birth at home, but live 7 minutes from a high level hospital, and so I met the “30minute decision to incision” time that hospitals have to meet for emergency cesareans. I also think that you have to be comfortable with the knowledge that there ARE a few obstetrical events that could happen that may be handled more quickly in a hospital setting. Uterine rupture, cord prolapse, and fetal distress are some of them. Unfortunately I have also seen babies have poor outcomes with all three of those events, even in my wonderful hospital, with obs and anesthesia in house. The chance of those are all extremely rare, but I really think you have to acknowledge those before committing to an out of hospital birth. For me, the skill of the midwives (at both midwifery and fetal resuscitation), the protocols for transfers, the proximity to an excellent hospital with at least a level 2 nicu and in house anesthesia and obs, and your own health and pregnancy history would all be what would help me make the decision.
This is a tough decision, but what cinched it for me was finding a midwife-run/hospital-connected birth center. I got the low lighting, the jacuzzi labor, zero intervention, and peaceful waterbirth I was aiming for; but across the way were hospital staff and equipment for the “just in case” scenarios.
I’m pregnant again and considering a freestanding birth center, but I am looking for one in reasonable proximity to a hospital, just in case.
Seconding this. As a Canadian living in the UK, it took me a little while to get my head around the idea of midwives and birthing centres at all. I really liked the idea of a less medicalised environment (I’m pregnant, not sick!!), but wanted to be in proximity to emergency help if something went wrong mid-labour.
The birthing centre attached to the hospital gave me the low-intervention labour I wanted, but also peace of mind as I was only a hallway or two away from lots and lots of intervention if it was needed. It had the added bonus of giving my (Canadian) parents peace of mind, too. As they said more than once during my pregnancy, I am THEIR baby and they wanted me to be safe!
I’m not sure if this is an option for the original poster, but it is certainly the approach that worked for me.
Forgive me for not reading all the comments (I read most and skimmed the rest and possibly repeating something) but I second the research idea. I would research the hell out of every option you have and then some. Grill the midwives and anyone who might be involved. But be prepared for what you might here – I hate to be Debbie Downer but I live in coastal Georgia and in this state midwives are prohibited by law from delivering VBAC. At least in a birth center (lucky for me I live 15 minutes from the only free standing birth center in Georgia). Your state laws may vary. That being said, to “qualify” as a birth center patient (read: no complications) we all had to go through sort of a screening and during that process, issues like “what would happen if I needed medical intervention? What are you qualified to do? What happens if it’s beyond what you’re capable of here?” were addressed. That being said, I can’t stress ownership and asking questions enough. I didn’t ask many questions, assuming I’d started with no complicatibs a
We decided on our birth center based on transfer rates to the hospital (which happens to be across the street). Transfer was very low, but was reassuring that a transfer to a hospital was available IF medically necessary. Just because you plan on birthing in a birth center doesn’t mean that a medically necessary hospital birth is out of the picture. Birth centers will transfer you if your delivery is too unsafe for their hands.
I’ve been thinking about you, Bree, and how much thought you are putting into this.
If you can’t find a solution that makes you 100% comfortable, I would suggest that you look into hiring a doula to labor with you wherever you labor. Our birth instructor told us that research shows that just having another woman in the room with you reduces c-section rates. She’ll help you step back and make your decisions about care during labor in a more objective way to hopefully help you steer yourself away from unnecessary interventions, regardless of the preferences of your attendants.
Having had a doula, it’s an amazing assist for self-advocacy.
I’m not sure how it’s done elsewhere but births at midwife run birthing centers are referred there by a gynae. This is because birthing centers (and home births) are meant primarily for low risk pregnancies.
Essentially, the option is open for you to ask for delivery at a birthing center but the final decision is not yours, but is rather determined by the progress of your pregnancy, your and baby’s health risks etc etc.
the ‘right’ to have a delivery at a BC may be revoked or lost if the course of your pregnancy changes at any time and yours becomes anything but low risk.
In addition, BC’s are usually fully equipped with an operating theater and are situated near hospitals with ICU facilities so should there be any eventualities, the appropriate teams (paediatrician, anaesthetist, obgyn etc) can be contacted and have recourse to escalate your & babies care.