You, The Consumer.

You are a mother. You are also a patient, or a client, depending on your care provider’s terminology. But, primarily, you are a consumer.

Photo Credit

Most of us don’t think of maternity care in this way- deciding to pay a specific birthplace and provider, rather than just going to the place that’s cheapest or where your friends went. But primarily, you are purchasing a service, not merely sitting under nonnegotiable care.

I am not writing this to undermine trust in your provider, or to encourage being a “bad” patient who is never satisfied. However, I think that there is enough variance in opinions, management styles, and routines among qualified providers to say that it’s fair to search for one who jives the most with your ideals. Let’s look at some examples.

Hospitals & Birthing Centers- First, look at the time limitations of  your hospital or birthing center. For example, our local hospital is the only one in about a 30-45 minute radius that provides maternity care, and only has 16 OB/GYNS who practice there, delivering around 3000 babies a year (at a 36.9% c-section rate). This means that this place is, in the words of several women I know who have birthed there, “a baby factory.” There is nothing wrong with choosing to have a baby there, but the implications of doing so must be considered. When there are literally not enough beds in the mother/baby unit and new moms are being made to share rooms with elderly men in the general sick patient area, you know that the hospital might be too busy. You know you won’t be receiving care from newborn nurses. You know there’s a possibility of  exposing your newborn to strange germs. You know you will lack privacy. You know you will lack sufficient one-on-one care. Yes, this hospital has a good NICU, round-the-clock anesthesiologist and cesarean availability, and a history of generally good outcomes (by American hospital standards), but does the high number of healthy babies at the end justify the means of care in helping them arrive?

Let it be known that not all hospitals are like this. I attended one about 2 hours from me that was much less busy, had only a 21.6% c-section rate, was quiet and calm, and had enough staff that the nurses could pop in whenever mom wanted them. Which of these two hospitals would I rather pay for their services? Certainly the latter.

One must also consider monetary influences on practices. (Before I write this, you must know that I don’t think all doctors/hospitals only want more money! I really do believe that they DO care about their patient’s well being!) It is worth noting that c-section rates are notably higher at for-profit hospitals than at non-profit institutions. Check out this news story for one example of this disturbing trend.

Home Birth Midwives

Time and money are also considerations for your midwife, though not as frequently as a big organization. How much does she charge? Does this correspond to her training and experience? How many clients does she take on a month? What is her back-up plan if she has two women in labor at once? You must know the answers to these questions before you hire her for your birth.

When hiring a home birth midwife, I think the most important consideration is finding out if you are paying for a qualified provider. As much as I support home birth midwifery,you  must remember that there are different breeds of midwife (CNM, CPM, and DEM), and there is currently no standard of certification for direct entry midwives. I’m not saying you shouldn’t hire one (my own midwife was direct entry), but you should make darn well sure that she is qualified to attend your birth before doing so. Find out her training and experience. Where and with whom did she complete her apprenticeship? Does she have references? Does she have a back-up doc?What is her hospital transfer rate, and what percentage is emergencies? What is her relationship to local hospitals? What are her maternal/infant/perinatal mortality rates, and for what reasons? How would she handle a hemorrhage? What equipment does she bring to a birth? Does she practice with legal integrity? I am not trying to scare anyone out of a home birth, but the safety of a home birth has been shown to depend upon the presence of a qualified attendant. Make sure that yours is.

Birth Philosophies– Remember, you are consuming services. Would you pay for a protestant pastoral education at a local college where the professors are Buddhist? Would you go to McDonald’s to purchase an organic beef hamburger? Would you go to the chiropractor’s office for heavy painkillers? No! Of course these are silly propositions.

Yet we do this over and over again when purchasing birth services. You might want a VBAC, but your provider’s successful VBAC rate is only 15%. “Too bad,” you say. “This is where our insurance takes us. I guess we’ll just work with it.” You have to think through how important your birth preferences are to you, and then choose (and sometimes actually pay for) a provider with a similar birth philosophy as you. You, the consumer, are responsible for picking a provider and birth place that support your desires. If you do not, then it shouldn’t be a surprise when things go differently than you’d hoped. Of course there are always aspects beyond your control, but you can make every effort within your power to ensure that you have purchased like-minded maternity care.

It has been said before that most people put more research into choosing a car or a stereo system than they do in choosing a care provider or birth place. Don’t let this statement be true of you. Make every effort to be an informed consumer.

Middle Ground on the Birth Place Debate

As I research and read more and more, I think I am becoming more balanced on my view of the birth place debate.

Last fall, I had a homebirth. I loved having my baby at home. I am a supporter of competent midwife-attended homebirths for low-risk women with a good emergency plan set into place. I felt safe, supported, and never under pressure.  While I am very friendly and outgoing, I still  prefer to have the most intimate moments of my life occur in private. I think that feeling comfortable and relaxed, as well as having freedom to eat, drink, and move really helped me to progress at a good rate.

I knew that most complications for low-risk women came up slowly (e.g. baby’s poor toleration of labor, true lack of progress, etc.). I honestly wasn’t too concerned for the rare complications that could happen quickly, as not even all hospitals are equipped to handle immediate emergencies in a flash. I actually felt that a complication would be caught more quickly at home than in the hospital, because I had a midwife and her assistant completely focused on me, rather than one nurse divided between four to five laboring mothers.

All that to say, that I am not anti-hospital. It’s every woman’s individual choice as to where she wants to birth. Some women might feel safer birthing in the hospital for the “just in case” emergency. Like I said above, feeling safe and comfortable is probably the best thing you can do for yourself during labor. If a hospital does that for you but a homebirth scares you out of your mind, then by all means, go to the hospital.

Some women may know right from the outset that they want pain medication, and that is absolutely their choice to take it. There are some women who need to be in a hospital for high-risk factors in labor. I am very glad that we have hospitals for women who want to birth there.

For the mother who wants a natural childbirth, birthing at  home or in a birth center are probably the options most conducive to that goal. I only say this because natural birth is not the norm in the hospital. I don’t think that most doctors are directly against natural childbirth itself, but it’s not what they are used to seeing, nor what they are used to “doing” (because a natural birth doesn’t really require much “doing” on the doctor’s part) . However, I have heard of many women who have had successful natural births in the hospital and were treated with kindness and respect.

As far as the accusations that often get thrown on each side, I do believe that the stereotypes exist. For example, I’m sure that there are doctors who get fed up with waiting around for a mom to finish laboring and order up a c-section so they can go home for dinner. I’m also sure that there are midwives who are so “trust birth” oriented that they forget that things can and sometimes do go wrong, and might ignore the warning signs. Both of these situations are tragedies that disregard the needs of mom and baby.

 Each mom has very important decisions to make regarding her birth place. She should first research her caregiver thoughtfully, as Enjoy Birth so aptly discussed. Your choice of caregiver is probably the choice which most affects how your birth will go. Make sure you agree with his or her birth philosophy and practices, and make sure that he or she knows what is important to you in a birth.

After choosing your caregiver, then you can work on choosing your birth place. I believe that if you have a competent, sensible, supportive, and qualified caregiver with plans in place for the unexpected (in any setting), you can have a safe birth where ever you please. For those who point fingers at homebirthers for being irresponsible or hospital workers for being malicious and filled with ill-intent, please see Birth Sense’s article Hurt by ___ (Home, Hospital, Unassisted) Birth?. She writes an admirable blog post that makes us realize that antecdotes from either side of the debate don’t prove the safety of either place. She instead urges us to ask the right questions: How can we make homebirth safer? How can we make hospital birth more welcoming? I must quote her:

“Instead of asking, ‘How can we eliminate home birth?’ or ‘How can we convince women that giving birth in the hospital is dangerous?’, let’s ask, ‘How can I help the woman who chooses to give birth in that setting, to have the safest birth possible within the boundaries of her choices?'”

Exactly. Well said. Each choice has its advantages and disadvantages, and things could go seriously wrong or blissfully right in any birth setting. Many studies have shown that under the proper circumstances, each birth place has similar safety levels. Let’s stop arguing and encourage women to know the pros and cons of each place, then make her own decision.

Sunday Stories: The Baby Place Birthing and Midwifery Center

Gorgeous, gorgeous natural birth video from a birthing center. I love her older son’s involvement in cutting the cord. This is a shortie but goodie!

*Warning: This is what I call a “full-on” birth video. You get a full view of pushing and the baby’s exit. Great for those preparing for birth, but be warned if it makes you squeamish. 🙂

Birthplace Debate Continued…

I had another post in the works, but I have to pause to share this blog. The Midwife Next Door has, once again, done an excellent job of giving a sensible breakdown of what evidence actually shows regarding homebirth. Check out Tripled Risk of Newborn Death at Home Birth? A new study claims that homebirth triples newborn death rates- however, there are serious issues with the study; specifically, it includes accidental and unassisted homebirths in the count. Homebirth for low risk women with a qualified attendant is still shown to be just as safe as hospital birth. Please link The Midwife’s blog everywhere so that we can clear up some of the fog surrounding this issue.

And, finally, another great blog from The Midwife: The Safest Place to Give Birth. This excellent blog talks about how, as of right now, there is no 100% perfectly safe place for giving birth, but dreams of a place where it could be done. Excellent thoughts.