K.R. asks from Fort Collins, CO on August 26, 2010
Is Delivering at a Birthing Center Reckless?
Hi ladies. I am delivering my 3rd and had settled on a wonderful local birthing center. It has gotten great reviews, and when I toured I felt very much at home.
Well, my mom and mother-in-law think it is reckless. They claim that if emergency strikes, that the transfer time to the hospital will make or break the situation. My MIL is respiratory therapist and attends a lot of high risk births, so of course she sees the worst of it. Theoretically, if I am delivering in a birthing center I will be low-risk and baby will be full-term, obviously. I've had 2 very textbook deliveries with my boys, and am in great shape and very healthy. I am NOT a risky person by any means, and would like to think I have a good head on my shoulders and wouldn't take unnecessary risks.
My theory is that hospital births inherently cause more high-risk situations. Pitocin can be a dangerous drug that causes serious uterine stress, that can lead to epidural (which carries it's own set of risks), and you are MUCH more likely to get a c-section with those two interventions. C-section carries a set of serious risks that vaginal birth does not. So to me, a birthing center is a safer environment, where those interventions aren't pushed on you to "speed things up", etc.
However admittedly, if an unforeseen emergency situation arises for baby or mama, would I rather be in the hospital? SItuations I could think of are shoulder dystocia, baby not breathing at birth, mom bleeding too much, etc. How much does transfer time factor in? I know midwives are trained in infant resuscitation, there is oxygen at the birthing center, and they have anti-hemorrhaging drugs (they went over all of this at my recent tour). They also monitor the baby in the womb, so theoretically if baby is in distress they are going to transfer you before he/she is even born.
Anyway, I am just looking for any information on the safety of birthing centers, and any personal experience that might help me fight a case here and convince two people who I greatly love and respect that this is a safe option, as my gut is telling me it is.
So What Happened?™
I appreciate all the responses!
In response to Dawn - I agree - the way I presented it here is a little one-sided. Let me describe my last birth and you can see where I am coming from in terms of pitocin use. I live in Dallas, and it is used WIDELY here for non-medical induction, sometimes as early as 38 weeks. Moms go in for cervidil the night before, then get their pitocin and epidural immediately in the morning. That is very common here (many of my friends have gone this route).
My personal experience is that I hired a midwife specially NOT to have this scenario played out. I got to 38 weeks and was 5 cm dilated, and at each appointment my midwife encouraged me to just check in at the hospital and get pitocin going and my baby would be here hours later. Each appointment my will got less and less because I was extremely uncomfortable and ready to meet my baby. Each time she suggested non-medical pitocin induction and it was harder to resist.
I held firm and finally went into spontaneous labor on my due date. I got to the hospital at 7 cm, walked the halls a bunch, and after 3 hours was still at 7 cm. ONCE AGAIN she suggested using pitocin. I had only been in the hospital for 3 hours, and in labor for about 6 hours. Baby was in no distress. I had interviewed this woman extensively and told her I did not want unnecessary pitocin use. I held firm again and she ended up breaking my waters instead. Had the baby a few hours later. I had to constantly advocate for myself to NOT be given unnecessary drugs during a perfectly normal, healthy labor. And this is with a midwife!
Now I will totally agree with you that I thank GOD for pitocin for situations where women really need it. For instance, I've always maintained that if my water broke and contractions didn't start spontaneously, that i would be agreeable to using pitocin. Or if a labor has seriously stalled and baby is in distress....etc. Thank god for surgeons and hospitals for emergency situations.
What I am lamenting is non-emergency, non-medical pitocin induction. It is not right for me, and I felt like I constantly had to battle against it during my last labor. I want to avoid that at all costs this time.
EDITED TO ADD
Thank you everyone! What an overwhelming an amazing response. Gives me TONS to think about!
I've gone ahead and scheduled my first prenatal appointment with the birthing center, and I'm bringing my mom to the appiontment with me to get a bunch of our more pressing questions answered. Unfortunately my MIL doesn't live here so she can't come along :( I've confirmed that they have all the same medical equipment to resucitate a non-breathing newborn (they can even intubate), anti-hemorrahage drugs, and are very experienced at dealing with shoulder dystocia. Those were my BIGGIE concerns, and my midwife didn't even hesitate when I asked her over the phone about this stuff. Just very calm and matter of fact, and confident. I'm still not totally clear about transfer time (it's about 4 miles away from a hospital), but they require that you already have your paperwork filed with the hospital and that you've met the backup doc, so that seems pretty good.
My husband is 100% on board, which he has been from the start. It's just my MIL and mom that I'm really feeling opposition from. And a lot of my friends think I am absolutely and totally crazy, but they have not done any research so I tend to take that with a grain of salt.
Thank you again everyone for the thoughtful answers!!
V.S. answers from Dallas on August 27, 2010
I had all of mine (4) at birthing centers and had very positive experiences.
My friend had hers (5) at a birthing center. She used one near Baylor Hospital. When her 4th had issues, they knew how to handle him and got him to the hospital very quickly. She was comfortable enough to have her next one at the birthing center.
If I have another, I will definitely go back. I think you should do it. Birthing centers provide bonding opportunities between husband, mother and baby that a hospital atmosphere will never provide. You will never regret it.
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T.J. answers from Seattle on August 26, 2010
I do billing for a few local birth centers and i can tell you there are far fewer transfers than births. The ones that do are often not true emergencies. One is right in front of a hospital, so that makes transferring much easier. If you've had two good births already you should be low risk and a great candidate for this! The majority of transfers are for slow or prolonged labors or pain relief. Newborn resuscitation, postpartum hemorrhaging, etc happen on average one out of every 30 births and are almost always handled right there with no need for transfer. HTH!
L.S. answers from Tyler on August 27, 2010
I have two things for you to think about:
1. I have a male friend whose wife wanted to deliver at home (I know..different from a birthing center). He was adamently against it and his one comment to his wife was: "If something happens to the baby because of this choice, I will never be able to forgive you." I think that is a very powerful statement and you should discuss your choice/decision with your husband.
2. I have a friend who did decide to have a baby at home. 24 hours after her water broke, she still had not delivered and she ended up being transported to the hosptial for an emergency C section. I asked her - "Who made the decision to transfer you to the hospital?" She said that SHE made the decision. In my opinion, the midwife AND/OR the husband should have made that decision and it should NOT have been left up to my friend. I think if you do go to a birthing center that you ought to have your birthing plan written out and if key things happen (or do not happen), then those are break point decisions to transfer you to a hospital (one example is water breaking and no delivery before 24 hours passes).
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B.M. answers from Dallas on August 27, 2010
I've delivered twice at a birthing center and 3 times at home. Both are safe. The midwives I've used are well-trained in normal birth and they are prepared for emergency situations. When we first decided to use a birth center, my mother was not supportive. And then she got a tour and met the midwives. That helped. Also, I found some studies to show her regarding safety. Mortality rates in hospital and birth centers where the same. Outcomes where different. Better birth experience for the mother and baby. Less unneccessary interventions. The studies I gave to my mother are over 12 years old. I'm sure newer ones exist. I've heard my sisters and friends talk about their hospital births. I wouldn't trade for anything.
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K.C. answers from Dallas on August 27, 2010
Just yesterday another momma was concerned about giving birth at birthing center because you get sent home hours later. I will suggest to you the same thing I suggested to her... just have your baby at the hospital and spend the next two days bonding and being pampered...meals in bed etc..
God only knows it is difficult to get that kinda help at home : )
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P.M. answers from Tampa on August 26, 2010
I think a birthing center is a great idea for Momma and Baby in a low risk birth. The idea that every birth is an emergency waiting to happen is ignorant and hurtful towards women and their children. If taking Mom and MIL along to prenatal visits doesn't change their minds... firmly tell them it is YOU giving birth, not them. They can either support you or leave you alone about it.
CPMs or Certified Professional Midwives are fabulous. They are extensively trained in NORMAL and NATURAL childbirth - and in some states, they can attend breech and twin births. They are also experienced in neonatal CPR, shoulder dystocia, stitching tears, dosing of pitocin to stop hemorrhage, etc.
I am a Nursing student, with the intention of being a CNM (Certified Nursing Midwife)... but then I had my OB rotation and realized most CNMs who practice in hospitals are just as gung ho to drug you up, slit you open and get that paycheck - erm, I mean baby, out of you as soon as possible to open the room for the next Momma. I will be getting my Nurse Practioner License by 2015 and get trained as a Certified Professional Midwife.
Non medicated, non forced and non fear driven birth is what is best for majority of Mommas about to give birth. OBs have a purpose and that is to support, mitigate and do medical interventions for women who have high risk pregnancies... not women who are low risk.
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R.J. answers from Seattle on August 26, 2010
Most birthing centers are closely linked with hospitals AND have medical staff on hand in OUR area.
I (and the majority of nursing and medical schools) agree with you 100% on the pitocin issue... but the problem is that it takes 10 to 20 years for that to filter down into common practice. The "best" hospitals TEND get that info into practice first... because they not only have staff that is teaching, but their staff is constantly and rigorously retraining/ staying up on their edu, and they're also hiring the top % of grads. Some of the "best" don't, but it's because they have to pay off their expensive equipment, and that's done by using it. It's no surprise that when a hospital gets a new surgical building they do more surgeries. Yes, because they can (aka patients have to wait for less of a time who would be getting it anyway), but ALSO because the staff is actively hunting for more patients that need surgeries. (It's called poaching or "marketing"). In birthing centers, at hospitals, it creates quite a large grey area.
There is ONE hospital in our area that spent several hundreds of millions on their new birthing center that focused on c-sects and surgical interventions. Low and behold they do the MOST non-medical-neccessary c-sects in the state. People go their, specifically because they want to be able to schedule a c-sect... and the OBs who practice there tend to specialize in surgical births. Their NICU is set up along similar lines to traditional ICUs/NICUs. Another hospital in our area spent several hundreds of millions on a new birthing center, and it's set up with birthing rooms the size of my downstairs. Complete with a daybed for visitors and a real bed for daddy, and the baby NEVER leaves the room (everything is set up so that your baby stays in your sight from the moment they crown until you check out, unless they need to go to the NICU, which is set up so that parents can sleep IN the NICU with their child. (They are also the overflow NICU for Children's Hospital). Two TOTALLY different emphasis in 2 hospitals that are both cutting edge. But neither practice gratutis use of pitocin. It's ONLY used in either hospital to induce, and never as standard proceedure (like "You're nearing your due date, lets go ahead and do a pitocin push to get things going"). Also never when a patient is already in labor. HOWEVER the majority of hospitals in our area still follow the outdated "pitocin push". It's because they have staff that was trained to do so, and they haven't stayed up (or disagree) with the studies over the past 20 years. In another 10 years or so, they'll change their policy... but not until the new grads ascend into a position of authority.
It's like the use of foreceps. MOST hospitals don't use forceps to pull EVERY baby out anymore (for the huge list of reasons not to). Yes, it is occasionally medically necessary, but it used to be common practice for EVERY baby. Just like pitocin. Gradually the practice fell out, just like pitocin is starting to. Just like yanking on the umbilicle cord (which causes hemmoraghes) used to be common practice and now isn't, and just like "sterilizing" a new mom's nipples used to be common practice and now isn't. It just takes time for the info to filter.
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L.K. answers from Austin on August 26, 2010
I have a BS degree in Respiratory Therapy and I worked in high risk labor and delivery and the NICU for several years. I also did several rotations through Parkland Hospital in Dallas when I was in college so I understand where your MIL is coming from. However, what I also came to understand was that the women and babies I was treating in the hospital were not normal, healthy, low risk pregnanices and births. These were sick people. And that is why they were in the hospital. The hospital is no place for a healthy woman to give birth. I have 3 children. The first was born in the hospital and my next two were born at home, the last one just this past April. I am a healthy, low risk woman. I have healthy children so there was no need for me to be in the hospital. The problem with the hospital is that they cause a lot of the problems with all the interventions they do on healthy mothers that do not need them. Research has proven time and time again that the safest and healthiest place for a healthy woman to give birth is outside of the hospital.
I am now a homebirth midwife. The transfers I have been a part of were not emergencies. Most of the time when we have to transport it is due to maternal exhaustion, or the babies heart rate looks a little funny on the monitor. And transports are very rare. If an "emergency" does come up such as bleeding following birth or the baby is not breathing very well upon birth we have the supplies and the training to deal with those things. The only time I have seen a healthy mother and baby die due to complications from childbirth was at the hospital. And the reason she died was due to the interventions that the hospital did. Most likely if she had been at a birth center or at home she would be a live today.
Please have your MIL read the following books: Pushed by Jennifer Block, The Thinking Womans Guide to Better Birth and Obsteric myths vs. reality both by Henci Goer. These books are full of information and research that proves out of hospital birth is safer for you.
And even if she reads these books and still feels the same way it is your body, your baby and your birth and you need to give birth where your instinct tells you to. At that point you simply tell her you love her but this is your decision and you would appreciate her keeping her scary stories and negativity to herself. And then don't call your MIL or your mother until after the birth, because if they are there they will only bring stress and fear to the energy surrounding you and that is not good for a laboring mom.
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C.P. answers from Dallas on August 27, 2010
I agree with you, the risk seems higher in a hospital. I was 40 years old when I had my baby with a mid-wife in my home and never once did I feel like I made a mistake and my baby was 9lb8oz and had a hard time coming out but she was very experienced. It is your pregnancy, not theirs.
My very best advice is to go buy or rent a documentary called, "The Business of Being Born," it is excellent and will open your eyes to so many things. It compares hospital births to birthing centers. I think it will also put your family at ease. Best of luck to you.
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E.L. answers from Dallas on August 27, 2010
First let me say that this is a very contraversial subject and you are going to get answers from all perspectives. Rather than tell you my opinion, I'm going to share some things that you can do to answer this question for yourself.
You mention you are concerned about transfer time. Ask your birth center what the average transfer time is. Be sure to ask whether this is for emergency or non emergency transfers. In the case of an emergency transfer for a c-section, what is the average time from "Okay, we need to transfer" to "first cut"? Then compare that to the transfer time within the hospital - from "okay you need an emergency c-section" to "first cut". Within the hospital there is still "transfer time" because they have to call the surgeon, prep you and get you to the surgery room.
You mention several scenarios you (or your relatives) are concerned about: shoulder dystocia, infant not breathing at birth, and mom bleeding too much. Ask your midwives how they handle each scenario and what the outcomes usually are. I know that the midwives I have worked with have the same infant recusitation equipment that the hospital does, and they also have pitocin and IV fluids in case of mother hemhorraging. I bled too much with my last baby and a shot of pitocin in my leg fixed it. The next step would have been IV fluids but I didn't need them.
As far as shoulder dystocia, ask your midwives if they've ever encountered it and how they handle it.
Finally, ask your relatives to watch The Business of Being Born. My FIL watched it (on his own, I didn't even ask him) and after that he understood our preference to at least start off in a birth center much better. He even made the comment that he thinks that part of the reason my husband had to be a c-section was because my MIL had an epidural and couldn't move around to open up her pelvis to let his head through.
I"m not against hospitals at all. I think they are very good at what they were designed to do, which is to help people in extreme medical situations. If my midwife decides that we need to transfer to a hospital because any high-risk issues arise during my pregnancy or during labor, I will be grateful that I have that option. I simply choose to start with the least invasive method of care and only do more if and when the need arises. I have had 1 hospital birth and 2 birth center births, btw.
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