Frequently Asked Questions

 

Out-of-Hospital Birth FAQs

 

Why do people choose an out-of-hospital  birth?

Birthing out-of-hospital is not for everyone. In fact only two or three percent of Americans plan to have their babies at home; a higher percentage choose to use free-standing birthing centers. For these select few an out of hospital birth is greatly desired. Following are some of the reasons people choose to give in places other than traditional hospital setting.

  • Out-of-hospital birth is simpler and more intimate—no strangers, and low use of technology.
  • The parents feel more secure and in control in their familiar surroundings, with loved ones helping and no one else’s rules to follow.
  • Labor and birth are treated as normal bodily processes. Hospital birth is pathology-oriented, and perceives labor more like a disease than a normal process. Birth is treated with numerous unnecessary interventions (such as restriction of food and drink, non-medically necessary inductions or cesarean surgery, etc.)1-4, medications, and procedures. Some hospitals have so many routines and regulations that parents feel they have no choices. Convenience for hospital staff sometimes means inconvenience for parents.
  • The same familiar midwife stays throughout labor, while in the hospital, changing shifts of unfamiliar nurses and frequently, unfamiliar doctors provide care in the hospital.
  • Uninterrupted contact with the baby and feeding on demand are possible in at home; there is no need to separate baby from parents for observation or routine care.
  • Parents can eat their own food, wear their own clothes, and welcome whomever they want-- whenever they want.
  • Alternative birth settings cost a fraction of the cost of hospital births.
  • The midwives’ expertise in normal natural birth makes a great difference in the woman’s ability to minimize her use of pain medications without suffering.

How do you ensure safety?

Unfortunately, perfect outcomes cannot be assured all the time, no matter who the caregiver is and where the woman gives birth. Midwives, however, give high-quality care before, during and after birth, and have demonstrated in numerous studies that outcomes are similar for hospital and out-of-hospital births for low-risk women (5-9). How do they do this?

  • By selecting only healthy women with normal pregnancies who want natural childbirth outside the hospital.  Others are safer with hospital care.
  • By obtaining training and continuing education. The Certified Professional Midwife credential (issued by NARM-- North American Registry of Midwives)  is the only midwifery credential that requires experience in out-of-hospital birth, including homebirth.   (http://narm.org/certification/)  Their training may include formal classroom studies or a long term apprenticeship with a reputable, more experienced senior midwife. Their training includes extensive clinical experience in perinatal care, observation and management of births, postpartum care, and newborn care. Certified Professional Midwives are required to be certified in neonatal resuscitation, as well as adult CPR.  During their practice, they are required to accumulate additionalcontinuing education hours--often in the form of classes, seminars, conferences, workshops, and even self study.  Frequent peer review with other midwives is required as well.
  • By providing comprehensive prenatal care to the woman, including education and encouragement toward health maintenance; a close relationship based on familiarity, respect and trust; and screening for problems and appropriate treatments, if necessary.
  • Continuity of care with the same caregivers by arranging consultation and back-up care with doctors and hospitals, so that there is no gap in care if problems arise and transfer to a hospital takes place.

What if problems arise during birth?

In my experience, approximately 15 to 25 percent of clients (first time mothers)  develop problems and are transferred to the hospital during labor OR prior to labor. For second time (or more) mothers, the percentage goes down to 10 to 15 percent. These problems are usually not clinically serious, but will be solved more safely in the hospital by medications or technology. Therefore, parents should be prepared for the possibility of problems requiring transfer. The ability to transfer when needed is a safety feature of birth center and home births. The reasons for transfer are usually non-emergencies like prolonged labor.  (www.cfmidwifery.org) 

On rare occasions, however, true emergencies occur and require immediate action, for example: prolapsed cord (the cord comes out before the baby), excessive bleeding in the mother, shoulder dystocia (the baby’s shoulders get stuck during birth), breathing problems in the baby. Of course, these are emergencies even if they take place in the hospital. The crucial factors with these emergencies, wherever they occur, are immediate recognition and appropriate immediate action. A midwife often provides the same initial treatment in these emergencies, as VA law allows, as a nurse or doctor in the hospital. Because such problems can arise unexpectedly, her training is extensive in the handling of emergencies. She uses appropriate maneuvers with her hands, gives appropriate treatments, uses special emergency equipment, which she carries with her, and calls for the emergency aid vehicle to take mother and/or baby to the hospital, if needed.

Conclusion: A healthy woman, cared for by a good midwife with back-up services, has as good a chance for a good outcome from birthing out of the hospital as from a planned hospital birth. She and her partner also gain the benefits of greater control, intimacy, comfort, convenience and unique equipment for a natural birth. Almost everyone who has births in home or birth center setting find it extremely satisfying. Parents who choose to give birth outside of the hospital should be respected for their decision and supported in it.

Do you assist with water births?

YES!  Water birth is an excellent option when having your baby at home or birth center. Some of the benefits of birthing in the water:

  • Pain relief and relaxation for the mom
  • Higher oxygen levels to both mom and baby
  • Gentle transition to baby from the womb

I have assisted numerous water births and highly encourage them if the mother is interested. For additional information on water birth, I have multiple books about it in my lending library.

Doula Services FAQs

 

Why would I want to have a doula for my birth?

Studies (10) show doula assisted births have a marked decrease in need for:

  • cesarean sections 
  • pain medication 
  • forceps/vacuum assisted vaginal birth 
  • pharmaceutical labor augmentation 

 There are also studies which show a decrease in:

  • the mother's pain
  • length of labor 
  • postpartum depression

When should I hire my doula?

The earlier, the better!  Ideally, it is easiest to hire your doula by your 20th week of pregnancy, but don't despair if you are beyond that point.  Most doulas (including myself) will take clients on in the last trimester--even right before your due date!

1-Whiteman, Honor. "'No reason' to restrict food and drink during childbirth." Medical News Today. MediLexicon, Intl., 26 Aug. 2013. Web.  

2-Caughey AB, Sundaram V, Kaimal AJ, et al. Maternal and Neonatal Outcomes of Elective Induction of Labor. Rockville (MD); Agency for Healthcare Research and Quality (US); 2009 Mar. (Evidence Reports/Technology Assessments, No. 176)

3-Zhang J, Yancey MK, Henderson CE. U.S National Trends in Labor Induction, 1989-1998. J Reprod Med. 2002 Feb: 47(2); 120-4.

4-Grobman WA. Elective Induction: When? Ever?. Clin Obstet Gynecol. 2007 Jun; 50(2); 537-46.

5--Johnson KC,  and Daviss BA.  Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ 2005: 330:1416.

6-Cheyney M, Bovbjerg M, Everson C, et al.  Outcomes of Care for 16, 924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009.  

7-Janssen P, Saxell L, Page L, et al.  Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. CMAJ 2009 Sept 15, vol 181.

8-Hutton, E. K., Reitsma, A. H. and Kauffman, K. (2009), Outcomes Associated with Planned Home and Planned Hospital Births in Low-Risk Women Attended by Midwives in Ontario, Canada, 2003-2006: A Retrospective Cohort Study, Birth, 36: 180-189. doi: 10.1111/j.1523-536X.2009.00322.x

9-de Jonge, A., van der Goes, B., Ravelli, A., Amelink-Verburg, M., Mol, B., Nijhuis, J., Gravenhorst, J. B. and Buitendijk, S (2009), Perinatal Mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births. BJOG: An International Journal of Obstetrics & Gynecology, 116: 1177-1184. doi: 10.1111/j.1471-0528.2009.02175.x

10--Stein M, Kennell JH, Fulcher A.  Benefits of a Doula Present at a Birth of a Child. Pediatrics. 2004: 114: 1488-1491. doi: 10.1542/peds 2004-1721R.