Monday, June 7, 2010

Birth Centers

As some of our readers know, I have had my last two babies in a free-standing birth center. I just received their local newsletter in the mail, and, as always, I was extremely impressed with the great work they are doing for women and babies in our community. While I have a pretty negative relationship with labor and delivery, overall, I love the birth center experience, and I think the choice to birth in a birth center, as opposed to a hospital, it a great decision for many couples. It isn't for everyone--most particularly those that are high risk!--but for many women it is a great option.

My birth center offers several birthing suits, complete with queen size beds, jacuzzi tubs, natural lighting, relaxing music, and kitchen areas. Nurse midwives attend to all births at the center, and if an emergency arises, you are just a few steps away from the local hospital. Last year, the midwives at the birth center delivered 504 babies. Only 8% of those babies were delivered via a c-section (compared to the almost 40% rate at most hospitals!).* Their episiotomy rate was a mere 5%, AND what I find the most impressive statistic, they had a 99% rate of initiating breastfeeding, and a 90% rate of continued breastfeeding at 6 weeks. Talk about baby centered care!

In general, birth centers are strong promoters of the health of women and babies, and they give many families a safe and wonderful option for a natural delivery in a home like setting with emergency medical care just steps away. If you desire to deliver naturally, I think it is really important to feel comfortable and relaxed at your delivery location. For some women this means a home birth, for others a hospital setting, and for me, it means a combination of the two at our local birth center.

I first sought out the birth center after two less than stellar hospital births. Don't get me wrong, I am very grateful for the healthy delivery of my first two children, but my desire to birth my babies naturally, without unnecessary interventions, was very difficult for me in a hospital setting. For starters, I just couldn't relax in the hospital. We lost our first baby at birth back in November 2002, and as soon as I walk into a hospital labor and delivery room, with all those machines and beeps and monitors, I am immediately brought back to my labor with Therese. My stress level increases and I just desperately want to go home. Stress increases pain, and I know I will ask for pain meds as soon as labor really starts to intensify.

Second, hospitals are set up to deal with medical situations--mainly emergencies and illnesses. In an uncomplicated birth, the process is natural. Mentally I find all the "math" of the hospital draining. The constant monitoring, measuring, timing, and statistics are stressful and prolong my labor. Sure it's my fault that I let all the numbers get to me, but I'm very vulnerable when in labor! I don't like to be put on a timetable and told that I'm taking too long!

In addition, I am a wimp. Plain and simple, if pain medication is available, I will ask for it! If I want to go naturally, I need to move myself away from the temptation of easily available pain medication. The birth center is great because when I ask for pain meds, and believe me I do so frequently at the end of each of my labors, they simply tell me that it is unavailable and will necessitate a transfer. This line usually buys enough time to get me through the most difficult part of labor. I really admire all you natural birthing hospital women--please tell me, and B-Mama who is about to go this route, how you do it?!? A doula? A fantastic husband? Delaying your arrival at the hospital until the last minute?

But I basic point here is that most birth centers are great places, so do check out your local options!

*I realize that hospitals will have higher c-section rates because of the self selection factor in repeat c-sections. The birth center, however, does take repeat clients attempting a v-bac, and so their numbers are higher in this area as well. My overall point is that the natural techniques of the birth center are much more likely to end in a vaginal delivery.


Molly said...

This is such an interesting topic. I have so much respect for you natural mamas. I had planned to try to avoid painkillers with my one birth so far, but after being in labor for so long, I wanted to be able to rest and got the epidural (and thought it was a lifesaver). I plan to rethink this for the next birth, so I'll be interested in the responses to this.

Not to stir the pot, but do the builders have any thoughts on this related article, that's been a bit controversial?

What are your thoughts on husbands witnessing the birth/feeding process?

Kate said...

Rabbi Schmuly is full of culturally-induced crap on this one.

Here's the clearest he gets, the thesis of the piece: "When a husband ceases to see his wife as a woman, and begins to see her as "the mother of his children," a negative trend has begun in his mind that can only subvert his erotic interest. "

While this may be true for some men and some couples, the answer is to do our best not to marry those men and definitely not to raise our sons to be those men!!

I thank God I married a man for whom seeing me as a potential mother was the beginning of eros, and actual motherhood has only been a deeply entwined continuation of that passion.

Right Said Red said...


I just read that article. I think the example she cites is a bit extreme, but overall I do agree that couples tend to struggle with the transition into parenthood and the sacrifices of breastfeeding. Women are usually naturally infertile during this time, so they tend to be less attracted to their spouse and less open to intimacy. They are usually very focused on the baby. This changes gradually as the child ages.

I think the article highlights some of the extremes of the Attachment parenting philosophy. Most women are not "obsessed" with breastfeeding. I do think, however, that having children in your bed for long periods of time can negatively impact your marriage. If your husband is sleeping in another room or on the sofa for months at a time this is not good for your marriage!

I am a HUGE promoter of breastfeeding, but I do not sleep with my babies, they go into their own crib and room when only a few weeks old. I do this for the good of my marriage and for my own sleep! Each couple obviously has to work these things out, but I do think the co-sleeping, nursing round the clock mentality of attachment parenting can lead to problems in a marriage--which is why I have avoided this parenting method. (I also posted on this previously).

I think extended breastfeeding can also complicate NFP and child spacing, and can definitely impact a marriage. This is a topic for another post, but I should write about this because I have counseled numerous women with crazy cycles trying to nurse children at 18 months of age. Their cycles are causing LONG periods of abstinence. I tend to think weaning a child in that circumstance is best for their marriage.

Right Said Red said...

Opps, I meant he cites!!! haha

Anyway, I would like to add that all men are different. Some can watch a birth, others can't. Some can sleep in bed with a baby, others can't. I tend to think it a bigger problem that women gain weight and don't lose it, than that their husband watched them breastfeed or watched the delivery too closely.

Blair said...

Thanks for sharing. I am a c-section mom, but am glad there are so many options for childbirth today! Unfortunately our local birth center, one of the few in our big city, doesn't allow v-bac patients. Many OBs don't anymore either! But many of my friends have had wonderful experiences there, while so many of us have had a very difficult time finding OBs that we like and trust.

And I'll just add my own little comment about extending breastfeeding and co-sleeping since it was mentioned in a comment above. It has been a very positive thing in our family and has spaced our children fairly well (2.5-3yrs). I don't feel it has negatively affected our marriage. My husband is fine with sleeping with the baby and watching him/her nurse. On the other hand, he has no interest in watching childbirth! Especially since mine is a major surgery.

But different strokes for different folks! That's one thing I've learned in my years of motherhood, that every family makes different choices and we should embrace that for what it is instead of try to convince others to try our method of parenting/childbirth/discipline/schooling, etc.

Anonymous said...

I just wanted to comment on Red's comment about the "bigger problem" in marriages being women gaining, but not losing weight. Before I leave my comment, full disclosure: I'm pregnant now, so I admit I'm a bit sensitive to the topic. :) I gained just under 40 pounds in my first pregnancy and had a 9 and a half pound baby. As someone who had been overweight as a teen, but managed to stay a healthy weight until pregnancy, this was difficult for me. It was made even more painful when I struggled to lose the baby weight for months. I mean nothing I did worked. I finally started to slowly shed the weight around 6 months....only to become pregnant at 7 months :) Oh well. (My new OB later told me she suspected a thyroid issue....which I now know for when this baby is born).

Anyway, my point is that while I am a BIG proponent of husbands and wives making an effort to look good for one another (weight, grooming, etc.) the difficulty in losing weight during that six months STRESSED me out. I was constantly worried that my husband wouldn't find me attractive (fortunately he never let me doubt that he did find me very attractive, extra weight or not, and that his love was not conditioned on my physical appearance).

I just think we should be careful what we say on the weight issue - certainly there are times we all could and should be more disciplined, especially for our own health and the sake of our husbands and children. But the post-partum body can be tricky and a wife should never be made to feel that her husband loves or desires her less if she is genuinely struggling to lose the pregnancy weight as fast as some women.

Anonymous said...

A birth center sounds like a great experience. Sadly, there isn't one within an hour and a half drive of where I am! I pray one day all women will have access to this same kind of care, if they so desire. I guess I will have to make the best of a hospital birth! :)


"Eliza" said...

I agree, the weight issue is so tricky and fraught. Not every woman has the same experience with weight and it's much harder for some than others.

This is also linked, albeit tenuously, to the extreme attitude of some women, "I don't ever want to give birth because it would ruin my body." There's an excessive reliance on physical appearance for self-worth and identity there-- nothing can put your body at risk, not even the amazing gift of a child.

I am not criticizing Right Said Red, and agree with her that weight is often a bigger issue than "did he see you in labor". So I am just emphasizing that once people become parents, they have to accept that things will not be what they once were. Mom's body may not be the same, Dad probably won't have time to visit the gym for two hours a day anymore, or what have you. They are parents now. And couples should assure each other that they're beautiful no matter what! As the wrinkles come and the skin starts to sag!

Kerry said...

whoo hoo!!! Loved my birth center experience in Wilmington, Delaware. THE BEST! A great option for low risk mamas, and if you want to go natural, not having that to resort to was perfect for me. If the drugs were there, I know I would have probably taken them. Instead, other natural support eased my pain.

Thanks, Red!

Catholic Girl said...

Wonderful article by Mary Alice--

Right Said Red said...

Just to clarify, I'm not saying that women should loose all their weight immediately, or that we can even loose all the weight! What I'm saying is that our changed physical appearance after childbirth is probably a far bigger adjustment in the intimacy department than the husband having seen us in labor, or seeing us nursing a baby! I'm just trying to be realistic about the issues at play. And I agree completely with Eliza that once people become parents, things are just different.

I should have been more sensitive as I realize that weight is a bigger issue for some women than others. All we can do is try our best with the genes God gave us. My apologies to those I have offended.

Oh--and I just want to add that I don't think it is healthy to want to start losing weight as soon as you give birth! We do need some extra pounds on us to nurse and care for our babies. Nine months to put it on, Nine months to take it off...or longer in some cases ;-)

Anonymous said...

Sadly, there are no longer ANY free standing birth centers in NJ. There are only 2 certified nurse midwives in NJ who perform homebirths. You must pay out of pocket for them but, in my opinion, it's so worth it! And in progressive NY, they are no longer allowing homebirths. THIS is the healthcare change we need!

Rabbi Shmuley is a pathetic victim to our culture in agreeing that a woman's body is an object. I am a full out attachment parent AND so is my husband. To be honest, any man who doesn't want to be an active participant in his child's birth and an excellent supporter of extending breastfeeding (as 2 years or as long as mutually agreable is recommended NAP) has a dilusioned perspective to how God intenioned things to be. You can have a family bed, practice child-led weaning, have your husband be your biggest hero at your baby's birth AND have an awesome marriage. ALL of these things have only added to the passon and the intimacy in my own marriage.

JMB said...

You're lucky you live in an insurance friendly state which allows birthing centers. We here in NJ don't have that choice. That said, I had 2 natural childbirths in the hospital and it was fine.

AWOL Mommy said...

In Europe, the hospital experience is way closer to a birthing center - they definitely have it figured out in a lot of ways.

In reference to Rabbi Schmuley's article, I had a few thoughts. First of all, I think it is good he wrote the piece. As a real hippie breast-feeder, co-sleeper type, it is good for me to be reminded that the husb is priority number one. HOWEVER, my goodness. I feel for this man's wife. Why in the world should we have to cover a part of our own body in the privacy of our bedroom while nourishing our progeny in the most wholesome, nutrition-rich, selfless way possible? Also, I take a lot of my cues on happiness from traditional societies and/or America's more wholesome past. I would like the Rabbi to tell me what is the alternative to breast-milk in the first year? Packages of powder manufactured and marketed by Nestle have only existed for 75 years or so, and you can't give a baby animal's milk until 1. If Dad can't handle the de-eroticization that comes with us feeding our young, what does he propose? I would challenge him as to why this is a new problem for men, since there were no alternatives for most of history, and still much higher marital fidelity rates.

B-Mama said...

The extra weight from having a baby CAN be a good thing, making us rounder, fuller, and more womanly. We are at the essence of our womanhood when we labor and then provide for our newborn. I'm grateful for a husband who appreciates and even welcomes my postpartum body!

I also wish birth centers were an option in our area, but have just enlisted the help of a doula! I'm stoked about this fortune, as she's signing on with only 2 weeks to go 'til my due date and is FREE because she's in training. When I learned of her, it was as if the heavens parted and Glory shone down on me! Praise God!!

Kyra said...

Just wanted to mention that per the recent healthcare reform, Medicaid will now cover the costs of births at freestanding birth centers. This is big! Not only do I think this is good news for low-income women and their babies, but I think it bodes well for taxpayers and even for women with private insurance. The article I read (at mentioned that private insurers often follow Medicaid's lead, meaning that more services may now be covered for women with private insurance who want to choose this option.

Also, as someone who gave birth at a local hospital while on Medicaid, I'm well aware of the tremendous cost of hospital births and the various interventions that often result. In my case, Medicaid covered the FULL $14,000 cost of a mere three-hour labor w/an episiotomy that (imo) wasn't necessary, and the "observation" of at least two doctors who did nothing. Let's not forget the two Motrin pills at $48.00 a pop. Ouch. Doesn't that make you want to give birth at home in your bathtub? :)

While "birth centers" often sound like a fancy and expensive option, with these new reforms I'm hoping that they will make such options affordable to all women and actually cut costs for the Medicaid program in the long run. I think it is not the simple act of giving birth, but rather the hospital cost structure and string of interventions that lead to the astronomical labor and delivery bills we see in this country.

Sara said...

I think the original post on birthing centers touches on the important topic of how much of what doctors and hospitals do during labor can lead to c-sections. The process of birth, after all, was created by God and thus should work most of the time. Things do go wrong and thank God there are wonderful doctors to intervene. However, I don't think God's work has a 50% failure rate (not that it should be considered a failure if a baby came out via c-section only that God intended them to come out another way and if 1/2 aren't coming out that way something is wrong). C-sections are major surgery and are dangerous. Such high rates seem to be saying that well meaning doctors are doing something that is interfering with the natural process causing it to go wrong.
I do believe birth centers have lower c-section rates for many reasons but I think the most influential factor is the lack of medical interference. I had a natural birth in a hospital but I also had a wonderful midwife and I was fully prepared and confident. I was not high risk so I had no medical intervention. No IV's, no monitors, no nurses coming in to check my cervix or ask my pain level, no pitocin when I was late. I was free to do whatever I wanted. I walked, showered, went to sleep, ate, drank, PRAYED, wore my own clothes, etc. Mentally, I also never gave myself the option of drugs. I just went though it but I also think that is part of my personality. Now that i live in a new area and will no longer have access to my midwife I will probably choose a birth center because , for me, it is the next best thing to home.

Erin said...

I just had a natural v-bac in a hospital setting. The beeps and monitors and statistics didn't bother me, but Red, with your sad loss in your first hospital birth, i can definitely see how those noises and setting would trigger such an emotional (and hence physical) response. Unfortunately, I am too high-risk to ever go to a birth center, but we have good friends who love the new birth center in Charelston, SC. She works as a nurse at ours and will give birth there in november.

Rikki Lake's documentary "The Business of Being Born" and her book "Your Best Birth" give a good historical perspective on hospital-setting births vs. midwife attended (home or birth center) births. Even though I am not a candidate for a homebirth after reading and watching these pieces I was secretly wishing I could do it! Birth is natural, and i imagine it is a much better experience in a natural setting.

REd, I had the same reaction knowing drugs were just down the hall. I was begging for drugs at the end of my labor, but the entire time it was a mental battle telling myself I don't need drugs, but knowing all I had to do was say the word and I could have them. I think it would be a much different game if I never knew they were available. Luckily, by the time the "drugs are just down the hall" side won, it was too late to have them and I delivered naturally....and, it was amazing.

Julie P said...

If you haven't read this already, a great article on "how childbirth went industrial" in The New Yorker.

Kate E. said...

Just want to comment that having had one hospital and one home birth...I loved the home birth! The hospital birth was with the same midwives though (the 2 in NJ who preform homebirths that were mentioned by anon) and I have to say that having the proper support makes all the difference. I also STRONGLY suggest having a pleasantly worded, bullet-pointed, one-page birth plan. The nurse took one look at mine and just removed a bunch of things from the room so I wouldn't be asked about them later on!
My midwives were serious "mama bears" and just stepped up and confidently took charge. Then nursing staff at the hospital was used to dealing with them and worked well with them. So it was a really "hands off" labor (no numbers, beeping, etc like Red mentioned).

Having said ALL that, I love love loved my home birth. Not even for the labor itself but for the joy of being in my own: bathroom, shower, bed afterward. Bliss.
And I swear I'm not crazy crunchy,alternative medicine, super attachmenty (although I'm a bit).

Good luck all you soon to be birthing mamas!

Kat said...

Red, thanks for this post - great points, and very interesting!

Juris Mater said...

Red, I think birth centers like Bryn Mawr are as good as it gets--out of hospital completely, so you just walk in from the parking lot and continue labor in a lovely bedroom; connected via underground tunnel to the operating room at the premier NICU hospital in the area; extremely well-trained and professional midwives. And they are SO holistic--it's a family experience, woman directed. It's truly the best of all worlds.

The only sticking point for me in this otherwise-no-brainer-birthing-center-option is that I haven't found midwives who are, on principle, pro-life. Most areas have a pro-life/NFP-only OBGYN somewhere nearby. But most of the time, along with their mission of "empowering women" and a holistic reproductive experience, the midwives have jumped on the "choice" train. Sure enough, the birth center is WAY tamer than most doctors with accepting that we practice NFP and leaving it alone. But still, do you think there's any problem on principle with hiring medical professionals who prescribe contraceptive and would advise an abortion? I tend to think that's a little too particular, not material cooperation, and that a natural, wonderful birthing experience is itself sanctifying and pro-life. But it definitely gave me pause when I found out (after the delivery) that my last midwife had previously worked at a "women's reproductive health clinic" in a neighboring city that was up to no good. But she was a fabulous labor and delivery midwife for me.

Right Said Red said...


Great point! It's funny because we went to the same birth center, and the two midwives who delivered my babies were both professed Christians (one was a former homeschooling mother!) and the other referred me NFP clients!

I don't think it is material cooperation either, and in my case, there isn't a pro-life obgyn option in the area. I do think, however, if you have that option, it might be a more difficult decision. If this is the case, B-Mama's route of a hospital birth with a doula might be the answer.

Great points!