Thursday, May 26, 2011

Pregnancy Care and Birth Options

With my first child I didn't know much about my options for pregnancy and birth. Actually, I knew next to nothing. I thought everyone gave birth at the hospital (or en route there!). I thought everyone went to an OB for prenatal care.

Then I watched a short snippet of The Business of Being Born during my last trimester. It was bittersweet. It was great knowing there isn't just one way of giving birth, but I was a little upset that I already made my decisions and didn't want the hassle of changing plans. What I took out of it at the time is that I can be just fine giving birth without drugs or interventions, that my body was made to do this. I always wanted a natural birth, I just didn't know that I would have to fight for it so hard. Going against what is 'normal' was not easy. We came out of it stronger and more sure of what we want the next time around.

Before I even found out I was pregnant with #2, I was already looking at my options. As much as I would love to have a planned home birth and feel completely safe with one, it just wasn't in our budget since insurance is unlikely to cover it. The next best thing - care and birth with a midwife at a small birthing center. I am so lucky to have found the North Shore Birth Center! Not only does my insurance cover their services (since they are affiliated with a hospital), but I felt the difference the instant I walked in the door. A completely different atmosphere ensued, where natural birth choices of a mom are respected and supported - not questioned and ridiculed. Even after just one appointment it feels so right to be there - immediately. That's the feeling I longed for but never got at the OB's office and the hospital where I gave birth. This birth center is really one of its kind in our area and was on the verge of closing in 2008 because of 'red tape' issues. Thankfully it is still there! I wish there were more options like this for healthy women who want a non-interventionist birth that's covered by insurance.

These are things I wish I knew three years ago when I found out I was pregnant with our first child:
  • Obstetrician (OB): OBs are trained to manage low risk pregnancies and deliveries, but are especially skilled at handling complications. An OB may be great if you are over 40, have some sort of disease or illness, or otherwise be high risk. But I would say even many so called 'high risk' pregnancies can have a perfectly natural birth if they are allowed to do so. With an OB you are more likely to be constantly asked (sometimes even not asked for consent) about interventions of all sorts because they have become routine within the medical system. Induction, epidural, other drugs, and more interventions that can stall labor or make it more painful than it has to be (not to mention risks and side effects). Many OB attended hospital births end up with cesareans not out of necessity, but out of a cascade of unnecessary interventions that interfere with the natural order of birth or put so much stress on the mother that she stops progressing. I also thought that the care with an OB was quite impersonal. The man is a nice person, but his outlook on birth did not match mine at all, and though he was generally respectful, we always butted heads about interventions. I also thought that the routine visits were a joke, for my healthy pregnancy it would have been less stressful not to have been there at all.

  • Certified Nurse Midwife (CNM): Not all CNMs are equal, that's for sure. Many that work at hospitals may have a more 'medical/interventionist' approach. In my experience, midwives usually offer more unbiased and accurate information when it comes to tests and interventions. I find that they are very hands off and supportive of the choices of the mother. They are also more likely to let the natural course of labor rule and only use interventions when absolutely necessary. A CNM is ideal for a healthy, low-risk pregnancy. I felt right at home with the first CNM I met, I actually felt like I have known her for years. Not to mention I am more comfortable with a female checking me out down there!

  • Doula: I found out about doulas really late in pregnancy. I couldn't afford one and couldn't find one that wasn't certified yet in time for the birth. Doulas are not responsible for any medical aspect of the birth, but rather the emotional and physical support for the mother. They by no means replace the partner/father, but they advocate on behalf of the mom for the birth she wants and help her through labor. Turns out my husband was a great 'doula', I don't know what I would have done without him! But I admit, it would have been easier on him to have another person 'on our side' - especially giving birth at the hospital. At the tiny birth center with midwives I don't feel like it will be as necessary. Plus I now feel so much more comfortable giving birth the second time around.

  • Hospital Birth: The most common way to birth in this country, but not everywhere. A hospital birth may be the safest for high risk or older women, but not for healthy pregnancies and birth. Of course for pre-term labor (which has become painfully common) this is just the place. Just the fact that interventions are so available and near can and often does turn a healthy, normally progressing birth into the opposite. Doctors want to make dinner time, they do not want to wait. Nurses are constantly changing shifts. Changing care takers and mis-communication are common. Ideally you are in and out of there, but birth has its own timing. Moreover, one out of every twenty hospital patients contracts hospital-acquired infections (about 90,000). That is more than all accidental deaths combined (70,000)! Not comforting that approximately an additional 98,000 die from general medical mistakes.

  • Natural Hospital Birth: By 'natural' I mean no interventions, none. We're physically there but I do not want the drugs or anything to do with their 'instruments'. This was our choice with our first baby, and let me tell you - it wasn't easy. It was a steep hill to climb when you are going against everything that is considered 'normal' at a hospital. Thankfully my husband and I are very persistent and we got what we wanted, but in my opinion it wasn't worth the stress - i.e. a hospital birth is not for us. I was very fortunate to have a labor nurse that supported natural birth and applauded our decisions. That was perhaps the only encouraging thing. Yes, it is possible to give an intervention free birth at a hospital and we're living proof.

  • Birth Center Birth: A place between a hospital and home birth. Not to be confused with an in-hospital 'birthing center'. Usually these are free standing cottages or homes outfitted in a cozy home-like fashion but at the same time with emergency equipment in case anything goes wrong. In our case the birth center is affiliated with a hospital, which has its pros and cons. Most birth centers are independent. Generally they only accept low-risk, healthy women and sometimes VBACs. Most births are attended by CNMs and are very low on intervention, they have the lowest rates of c-sections. Many offer water births, which I am excited to try with our second child! A friend of mine has had a water birth twice and loved it, as do most women who try it.

  • Home Birth: A planned home birth is a completely safe option and one I would feel very comfortable with if price wasn't an issue. I would love to labor and give birth at home without having to think of packing and driving somewhere. Just being in a hospital automatically increases your risk of infection or catching a disease. In many developed countries home birth is widely practiced and very common.

  • Unassisted Birth: I don't personally feel comfortable enough to go for an unassisted birth, but I understand those that do. Some people feel that the only people that should be present for birth are those that were there for conceiving the baby. Also, birth is not a disease, or sickness, it is just the course of nature taking place. Just like you don't need a medical professional to die, so you shouldn't need one to be born. Makes sense, but not the route I would choose, especially not for a firstborn.
No matter what you choose, go with your instincts and your gut feeling. I knew the hospital wasn't right for us during the tour, but I didn't follow what I felt - I wish I did. At least now with the second baby I can go with what just feels so right.

Photo 1: Sundeip Arora
Photo 2: Lisa Sentrini-Espinoza


  1. Interesting info, well i gotta find out because most likely i will be giving birth in the hospital, because of the insurance but i will most deff do water birth which is available, don't know all the details i have to ask.
    Even though i am going to regular doctor, but i feel no presure from anyone to do anything i don't want to do.

    The only difference i guess is once you know more you have more options to speak about it.

  2. I have to say that it is totally worth looking in to a home birth-- they are not all expensive. My midwives have made it their priority to be about the cost of the usual insurance deductible so that people can afford the choice! I so appreciate them in that effort!


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