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Choose Your Birth Environment

By Joanne Goldbort, PhD, RN

Choose Your Birth Environment

You have choices when it comes to birthing your baby—consider the options and decide what’s best for you!

As soon as you become pregnant (or even before you conceive), explore your options and decide what type of care provider you want to guide and support your pregnancy journey. Find providers you can connect with and trust, who will be there to assist in the labor and birth processes. Don’t be afraid to ask questions and arrange facility tours as you explore the best place to safely birth your baby.

98% of women in the US birth in a hospital even though there are birthing center and home birth options. In choosing your provider, you’re also inadvertently choosing where you will birth by where your provider practices. For example, if you choose a certified nurse midwife (CNM) for your pregnancy care, typically midwives can care for you at a hospital or a birthing center—and some do home births as well. Most physicians are primarily hospital-based.

Hospitals

Most American women’s birth environment is in a hospital, attended by either a board-certified physician or a certified nurse midwife and usually 2 registered nurses: 1 caring for you and 1 for your baby. If you have a high-risk pregnancy, a NICU team may also be there for support.

You’ll be able to have your partner or other support people, including a doula, with you. Typically, you would labor in a hospital room on what’s called an LDR (labor, delivery, recovery) unit; once baby is born, you would move to the mother/baby unit—sometimes called the postpartum area until you’re ready to go home. For normal birth, you would stay in the hospital up to 48 hours, and up to 72 hours for cesarean.

Expect baby to room in with you; newborn testing or screening can typically be done at your bedside. If baby has to go to a different part of the hospital, ask anyone preparing to move your newborn for their hospital photo ID. You can also have your partner or a support person accompany baby for any procedures or screens apart from you.

Birth Centers

Birth centers are typically operated by either certified nurse midwives or certified professional midwives. Research shows this is a great choice if your pregnancy is progressing normally and without any elevated risks; it’s your best choice if you’re having a healthy pregnancy and want a natural birth without electronic fetal monitoring, intravenous fluids or pain relief drugs.

CNMs are trained to identify any risks during your pregnancy and refer you to an obstetrician or perinatal specialist, if necessary. Birthing centers aren’t typically options for moms carrying multiple babies or who are experiencing high-risk complications such as high blood pressure, which could lead to a condition called preeclampsia. If at any time there is an emergency during labor and birth, you would be transferred from the birth center to the nearest hospital via ambulance.

In a freestanding birth center, you’ll find a more home-like environment. You’re typically in a private bedroom like you would have at home, you wear your own clothing, can have as many support persons as desired including a doula, and you’re not restricted to bed. You can eat light foods and drink fluids; there may also be options for laboring and birthing in water. Your midwife will use a handheld Doppler to periodically check your baby’s heart rate in lieu of continuous fetal monitoring.

You and your partner will actively participate in the labor and birth processes, supported by your midwife and their assistants. Length of stay in this setting is about 6-8 hours, but that doesn’t mean the care ends there. Your midwife will follow up with you in person and by phone in the coming days.

Some hospitals also operate birth centers for moms who want a more home-like birth; still there may be more medical intervention depending on their policies and procedures. To be considered true birth centers, they must meet certain standards for independence and must be separate from the hospital’s labor and delivery unit. Certified nurse midwives typically staff these centers with a separate nursing staff. Like a freestanding birth center, you’ll need to have a low-risk pregnancy to birth in this environment with plans to forego any drugs for pain.

In either type of birth center, the midwives and nurses are well educated on various birthing options and positions, such as standing or squatting, and can offer many different types of comfort measures such as hydrotherapy, birthing balls and relaxation techniques.

Homes

A small percentage (<1%) of American women have home births, typically attended by a midwife. A home birth for the low-risk woman allows more control over the environment—it is your home, after all! You and your partner create your birthing environment and experience as you desire. Your midwife will help you determine how to set up the room for the birth and will bring all the necessary items to safely bring your baby into the world.

Though a home birth environment is more common in other parts of the world, birth is considered more of a medical event in America. As such, the American Congress of Obstetricians and Gynecologists (ACOG) recommends that births take place in a hospital or birth center that meets required standards.  However, ACOG also states that women have the right to make medically informed decisions about birth, and they support care by certified nurse-midwives.

Joanne Goldbort, PhD, RN, is an assistant professor at Michgian State University and an expert adviser to Healthy Mom&Baby.


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