So, you are pregnant...now what?!
A Look at Birthing Options
(This was developed for basic informational purposes only. It is up to YOU to research, research, and research--and ask appropriate questions regarding your birth.)
Birth Place Choices:
Hospitals--The most widely used birthplace in America.
Advantages--For high risk women (multiple pregnancies, preexisting diabetes, etc.) or situations, hospitals have equipment and trained doctors to mediate should interventions, for either the mom or baby, become necessary. For the mother who seeks to have medical pain relief, this is readily available to her.
Disadvantages--Interventions that were once used only when necessary, have now become the normal routine, sometimes policy, even with these posing increased unnecessary risks to the low risk baby and/or mother. There is also an increased risk to the mom, and especially the baby, from germs contained in the hospital environment--increasing the chances of illnesses and infection in the first postpartum week.
Advantages--Birthing centers are a compromise between the hospital setting and home. The policies of birthing centers can widely vary--much depending on whether the center is freestanding or an extension of a local hospital. Freestanding birth centers are independent centers, which usually employ midwives and doctors (not usually affiliated with a major medical corporation--like Carilion). Depending on the center, you might choose a midwife or a doctor to assist with your delivery. Aside from the homey atmosphere, freestanding birth centers are usually very natural and non-interventive. However, if complications were to arise, they have the resources/medical equipment available to them in the next room. Because the birthing center is reserved for births only, the baby will encounter less germs since they aren't in a setting which also cares for the sick.
Disadvantages--If the mother is seeking a more natural birth, there are some birthing centers (especially those which are extensions of hospitals) that might provide a homey atmosphere, but may be just as routine and interventive as the hospital setting. Birthing centers can address many of the complications which could arise; however, a need for a cesarean section (or other high interventions) would necessitate transporting to a hospital.
Home--Home birthing is on the gradual incline in the US.
Advantages-Because the mom is comfortable in her own home, she will be more relaxed, which in turn, usually leads to easier laboring and delivery. For the mother/couple seeking a natural, intervention free birth, this may be a viable option. Research shows that unneeded intervention actually leads to complications, which might otherwise have been avoided. Mothers are free to eat/drink and remain active, if she chooses. The bonding time between baby and mom is uninterrupted and has no time constraints imposed because of "policies". The risk of infection and illness is decreased as the germs in the mother's environment are familiar--the mom has already built up immunities to these germs. These immunities for these specific germs are then passed on to the baby through breastfeeding. (For more information, see Homebirth )
Disadvantages--Should medical intervention be necessary for mom or baby or should she desire pain medication, she and/or the baby will need to be transported to the hospital. Whereas it is an extremely rare occurrence for there to be an emergency, about 5% of births can constitute a true emergency. If an emergency cesarean section is needed, it takes approximately 20 minutes for the hospital and doctors to prepare for this. Whereas the hospital can be notified of a pending emergency transport from home, you will want to take the distance/time from your home to the hospital into consideration (especially if it is beyond the 20 minutes).
Provider Choices:
Obstetrician--These doctors have completed medical school
and were trained according to the ACOG (American College of Obstetrics and
Gynecology) guidelines. Obstetricians are the most common birth attendants
in the US, and in the local area, only deliver in their respective hospital.
Advantages-- They are highly trained to mediate and intervene in medical emergencies whether during pregnancy or delivery. They are also highly trained to provide prenatal care for high risk pregnancies (multiple births, preexisting diabetes, etc.) .
Disadvantages--Obstetricians often work in group practices so there is no guarantee that your primary physician will be on call when your baby should arrive. Because obstetrics has the highest malpractice rates of any medicines, this has caused many doctors to practice "defensive" medicine fearful of lawsuits. This has lead to an increase of attempts to "manage" the birth process through unnecessary interventions and procedures for the low risk woman. Mothers who desire to have a natural birth in the hospital may have a greater challenge achieving a non-interventive birth with obstetricians, in general.
Family Physician--These doctors have completed medical school and extra training in obstetrics. All family doctors do not deliver, but we have several in our area which do (primarily Carilion).
Advantages--They are trained to mediate and intervene in medical emergencies. They are often more natural minded about the birth process, in general. Many of the delivering family physicians, even though they are in a group practice, will be personally on call for you with your birth. If you choose, these doctors can also care for your baby in lieu of finding a third doctor--the pediatrician. They have been trained in family medicine which includes pediatric training as well.
Disadvantages--Should you become a high risk patient, they will more than likely refer you to an obstetrician or specialist. Should you require a cesarean section, most of them do not perform these, so the c-section will probably be performed by the hospital obstetrician.
Midwife--Midwives deliver in hospitals, birthing centers, and at homes in the US. In the local area, however, they only assist at homebirths with the exception of two certified nurse midwives who are in practice with an obstetrics group (in Lynchburg area--see referrals). Locally, midwives are not allowed to practice in the hospital. There are several different types of midwives in our areas--ranging from a Certified Nurse Midwife (a certified nurse who has completed midwifery training), a Certified Professional Midwife (a midwife trained through apprenticeship or other hands on training, licensed by Virginia), and a Direct Entry Midwife (a midwife who has gained her experience through apprenticeship--some of these are working toward licensure currently). Midwife Referrals
Advantages--Midwives follow a more personal care process,
understanding that birth is much more than just a physical process--that it is
also closely tied to us emotionally and spiritually as well. Most midwives
perform prenatal visits just as the doctors do. Yet midwife prenatal visits
are often in your own
home and can last about 1-1 1/2 hours contrary to the typical doctor visit of
about 20 minutes. Midwives recognize that birth is a natural process and that, under most
circumstances, should be left alone and not intervened. However, if
complications should arise, they have been trained to deal with many of these through
natural and/or medical remedies available. Many are trained in herbal
medicines and homeopathy. They provide support and encouragement for the
mother as a whole. They have the lowest c-section rate of all providers,
and are trained to discern and screen which clients would and which
clients wouldn't be a candidate for homebirth.
Disadvantages--Should a true emergency arise which is beyond the midwife's ability to manage, you will require transport to the hospital. In those capacities, the midwife will usually function as a doula then. Unless the midwife is a certified nurse midwife, access to medical procedures, tests (like ultrasounds), and pharmaceuticals are very limited. Because of this, many midwives recommend that you see a doctor a few times during your pregnancy as well. Even in midwives there is a vast varying degree of opinions of what role medicine should play in birth. As with any provider, be sure to interview and find one that has similar beliefs as your own.
Unassisted --Whereas this may or may not be a viable option to you and your partner, there are couples who birth at home without the skill of a midwife or any other trained attendant. As in everything, research, research, research to get the pros and cons....
Advantages--This offers privacy for the couple who want to keep birth a private, intimate experience. Interventions are virtually impossible unless there are complications which require transport.
Disadvantages-- Depending on how the mother copes with the final stage of labor, it could be difficult for the mother to have an objective point of view to be on the lookout for possible complications--even though most births are uneventful and uncomplicated. Having some sort of attendant ensures that presence of an objective view (make sure that his/her beliefs coincide with your own), while some mothers could potentially miss something with their focus being on the hard work they are doing.
Other Helpful Links:
http://www.who.int/en/ World Health Organization
The Coalition for Improving Maternity Services (CIMS)
http://www.cfmidwifery.org/ Citizens for Midwifery