Hospital, Birth Centers or Home: What’s the Right Choice for You?
If you, like the great majority of childbearing women in the U.S. are well and healthy, you can consider the full range of places for giving birth. The Sacramento region has many hospitals, an out-of-hospital birth center, and several highly qualified homebirth midwives who attend births in the mothers’ homes. Click on the following link calhospitalcompare.org and view the ratings under "maternity" of local hospitals. We encourage you to research all your options, and thereby educate and empower yourself to make the decision that is right for you and your family.
How Does One Compare the Options?
Let’s begin with hospital birth: In the United States, the hospital is the most common place for giving birth, with care usually provided by physicians who subscribe to the medical model of care. The philosophy of the medical model of care is that pregnancy and birth are a medical condition, usually requiring intervention, and is “normal” only in retrospect. Caregivers subscribing to this model rely more on the facility’s technology than your body’s physiology to assess your well being and that of your baby.
Hospital birth does have some advantages: A hospital is best equipped to diagnose and treat mothers and babies with serious complications. If a genuine need for medical intervention develops during your labor, a hospital is the place to get it. Also, if you desire medication for pain relief, hospitals are the only place to get it.
In a hospital, you may find that your care is standardized, with various interventions routinely implemented, whether or not you have a clear need. Difficulties – or variations from normal – are typically addressed with medications and high-tech procedures. There is generally not enough staff available to provide the help and support you may desire. That is one of many reasons to have a birth doula, whose only focus is you.
Not all hospitals are alike. They can vary widely in many ways, including rates of induction, cesarean section, and instrumental deliveries. Also, they can have different policies regarding such things as how many people can be in the room with you, whether you can eat or drink during labor, or continuous vs. intermittent electronic fetal monitoring. Some have midwives available; some don’t. Of those that do, some have them available 24 hours a day, others only on weekdays. Similarly, they vary with regard to the availability of lactation consultants.
These are just a few of the things to consider, and a few of the ways hospitals can differ. We encourage you to choose the hospital that best meets your needs from among those available to you. If only one, learn their policies, and where they are willing to “bend” if you want something different.
What You Can Expect at an Out-of-Hospital Birth Center
In the Sacramento region, we only have one out-of-hospital birth center, named (appropriately enough) The Birth Center. It is located in Fair Oaks, very close to Mercy San Juan Hospital, though not affiliated in any way. Three of our doulas, Janet, Amy, and Ruth, work there (on-call) and may be able to answer some of your questions. We encourage you to check it out yourself, possibly take a tour, meet the midwife, to see if this is an option for you.
In general, by choosing to give birth in an out-of-hospital birth center, you will receive the midwifery model of care, with its underlying philosophy that birth is a normal, healthy event, albeit one needing supervision and care. This means that you can expect more emphasis on your individual needs than the standardized care of the hospitals. Also, there is a far lower rate of interventions, less use of technology and more focus on your body’s physiology. You will also find staff available to give you continuous physical, emotional and informational support during your labor and birth, and support for your family members, as well. If the need for medical intervention arises, a transfer would be made to the appropriate hospital.
Home Birth: Do People Really Do That?
Yes, they do – though relatively few make that choice. What you can expect with home birth is similar in some ways to an out-of-hospital birth center experience, in that you will receive the midwifery model of care with its underlying philosophy of the normalcy of birth and respect for individual needs and preferences. Additionally, giving birth at home means there would be no need to figure out when to go to the hospital as your labor progresses, and no changing rooms once the baby is born. Our region has several home birth midwives, all committed to safe, attentive care.
Although pain medications are not an option for home birth, home birth midwives employ many non-pharmacological methods of pain coping/mitigation, thereby keeping your risk status low. And since you may be wondering, they do carry medications and equipment to treat or stabilize emergencies. A competent midwife would inform you of any development in your labor that may call for medical intervention. Together, you would make the decision to transport, if needed, in a timely manner.
Like doctors, not all midwives are the same. They may have different kinds of training, experience or credentials, style of practice and rates of using tests and procedures, or policies and restrictions. If you are considering home birth, we encourage you to interview several and choose the midwife (or midwives, as they usually work in teams) that best meets your needs.
Evidence for the safety of home birth is extensively referenced, and literature summaries provided in the book, The Thinking Woman’s Guide to a Better Birth, by the award-winning medical writer, Henci Goer. You’ll also find more on some of the websites on our links page.
The information here is your starting point – daunting, isn’t it? We’re here to help. We’re not here to steer you in one direction or another. We can provide you with resources and information, and talk with you about your personal priorities and desires for your birth. You’ll only give birth to this baby once. Your time spent researching and planning will be time well spent. We would love to help.