Category Archives: Hospital Birth

Exploring Your Options Series – Part 5

Deciding on a place of birth is simple for most women. Most women choose to give birth in a hospital. Women generally feel safe in a hospital. Are there any other safe options? Is it safe to give birth out of the hospital? YES! Studies show that out of hospital options, such as a birth center or at home, are safe for low risk women.

I would encourage you to consider and research the different options and their safety before coming to a conclusion about where to have your baby. The location of your birth will determine what other options are available to you. Some links to help with your research Science and Sensibility “Is Home Birth Reasonable Option?”Science and Sensibility “Birth Outcomes by Birth Location”Science and Sensibility “Flaws In Recent Home Birth Research”, Science and Sensibility – “Obstetricians Claim Homebirth is Unsafe…Again. Where’s The Evidence?”

Part of the decision making process should include weighing the pros and cons of each birth place. Previous decisions (ie: deciding on a care provider) will also have an influence on where you give birth. If you want a physician to attend your birth, having a home birth may not be an option. Not many physicians attend home births, but there are some. I am not sure there are any in Utah, though.

Below are some pros and cons I came up with. Because everyone is different and there is no one right answer for anyone, these things may not apply to your situation. Feel free to make your own pros and cons list to figure out what is the best option for you. Where you feel the most comfortable and safest will be the best place for you to give birth.

Most women in this area plan to have a hospital birth and never consider a birth center or home birth. I would encourage you to consider and research the different options and their safety before coming to a conclusion about where to have your baby. The location of your birth will determine what other options are available to you.

  • Hospital
    • Pros –
      • Specialized care for high-risk pregnancies and births.
      • Pain medication readily available
      • A nurse to take care of you and baby, meals brought to you
    • Cons –
      • Birth is seen as a medical crisis.
      • Mother and baby are often separated
      • Difficulties are often resolved with medications and high-tech procedures
      • Standardized care rather than individualized.
      • Often noisy, lack of privacy, strangers (the nurses are likely people you will not have met prior to your birth. Your particular doctor or midwife may not be the one to attend the birth)
      • Institutional feel.
      • Understaffed.
      • Higher risk of infection.
      • Have to pack and travel to birth place
  • Birth Center
    • Pros –
      • Less infection risk than hospital.
      • Midwifery Care Model
      • More home like than hospital
      • Most problems that arise can be dealt with on location.
      • Baby is never separated from the mother
      • Continuous support
    • Cons –
      • Have to pack and travel to birth place
      • Higher transfer rate than home birth.
      • Fewer pain medication options available
  • Home
    • Pros –
      • Your own space/Familiarity
      • Midwifery Care Model
      • Low-risk treatments used to resolve issues that may arise.
      • One-on-one care with your chosen birth attendant (although this isn’t always the case now. There are some homebirth midwives in the area that have a “practice” much like doctors)
      • Individualized care.
      • Continuous support
    • Cons –
      • Arrange for someone to take care of mom’s needs, the home, and other children.
      • No pain medications available
      • May need to transfer if difficulties arise.

Part 1 | Part 2 | Part 3 | Part 4

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Exploring Your Options Series – Part 3

In my last post I talked about choosing a care provider being an important decision in your childbirth experience. In that article I mentioned interviewing several care providers. Today I would like to talk more about interviewing a care provider.care providers

The first step to choosing a care provider is to become clear about what type of birth you want. Think about the experience you want to have. What does the end result look like? How do you want to feel about your experience? Become really clear about what is important to you and your partner as you begin this life changing event. If you decide you want a medicated birth in a hospital, you can eliminate home birth midwives from your list of care providers to interview.

The next step to choosing a care provider is to find some care providers to research and interview. This can be accomplished in several ways; receive recommendations from friends and acquaintances, ask for recommendations on social media, ask your current care provider for referrals and recommendations, you can search the internet. When asking friends and acquaintances for recommendations on a care provider make sure to ask them about their childbirth experience. You will know their care provider would make a good match for you, if their childbirth experience is similar to the one you hope for. If they had a wonderful medicated birth in the hospital and you would like to have an unmedicated birth without medical interventions, their care provider may not be the right one for you. Ask them how their care provider made them feel. I have heard several women talk about their care providers who say they were really nice, but they didn’t feel like their questions were important or the care provider didn’t spend much time with them. These points are important to know when receiving recommendations from friends and acquaintances. Searching online for a care provider can be very helpful. Several sites online have a rating and feedback system. You can read about other’s experiences with a particular care provider and see their overall rating. This can help you narrow down your list of care providers to interview. Keep in mind when hearing or reading feedback about care providers that birth is an emotionally charged event which creates strong feelings (positive and negative) toward those involved. Many times when things do not go how the birthing family had planned the care provider is seen as responsible and the negative emotion is directed solely toward the care provider. It also happens in reverse, when a birthing family has a positive experience, the positive emotion can become directed at the care provider. This is why many women have strong positive emotions toward their care provider and you may hear many say “I LOVE my OB” or “I LOVE my midwife”. Make sure to ask them why! What did they do to earn such a strong emotion?

The next step to choosing a care provider is to compile a list of care providers to interview. After you have become clear on the childbirth experience you want to have and have asked for recommendations, you are ready to compile a list, narrow it down and setup interviews. Take the recommendations you have received and use the information you gathered to determine which care providers can help you accomplish the type of childbirth experience you want to have. Make a list of these care providers. I suggest having at least 3 different care providers (as well as different types) and not more than 5. If a natural birth in a hospital is part of your ideal childbirth experience, I would suggest speaking with at least one licensed home birth midwife. You may find you can have the best of both worlds with a greater chance of having the childbirth experience you want. Make sure to ask questions about the safety of home birth and what she does in the case of certain emergencies (get specific!).

The next step to choosing a care provider is to setup and conduct interviews. Some women wonder why in the world you would interview a care provider. For most it doesn’t make sense, because it is rarely done. We usually just go to whomever is covered by insurance or whoever our mom or best friend go to. However, the care provider that attends your birth is a very important element to the type of experience you will have. If you want to have a natural birth with few medical interventions in a hospital and the OBGYN you choose is not supportive of natural birth your likelihood of having the experience you want is very low. If you want to reduce the risks of having a cesarean section and your OBGYN has a high c-section rate, your risk of cesarean is increased just by the care provider you chose. Choose carefully! Take your time! And if the one you choose isn’t supportive of the experience you want to have, fire them! Go to a new care provider who is supportive. I have known women you have fired their care provider during labor. They work for you!

The final step is to conduct interviews. Call the care provider’s office and setup a “consult” appointment. Tell the receptionist you would like to discuss different birth options with the care provider. This will help them know how much time to give you for the appointment. On my next post I will discuss how to interview a care provider.

Read the previous posts in this series here: PART 1  PART 2

Image courtesy of photostock / FreeDigitalPhotos.net

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Utah Cesarean Rates

I hosted the Utah Count chapter of ICAN last night at my home. Today I have been thinking about the wonderful women I know who have had c-sections. I’ve been thinking about their stories, both positive and negative. Thinking about their experiences made me wonder about the cesarean rates at the hospitals where most of my moms give birth. It got me wondering what the latest cesarean statistics are for Utah. This information can be found by clicking HERE. Utah’s cesarean rate (23.2%) is lower than the national average (32.8%), which is good. The rates, however, are still higher than the World Health Organization (WHO) recommendation of between 5% and 10%. Their recommendation is supported by the most recent studies. The studies show that c-section rates above 15% do more harm to moms and babies than good. 

Cesarean births are sometimes necessary and are a useful tool for birth. They are being overused. This creates unnecessary risks to moms and babies. Although, I believe it is important for the medical community to make an effort to look at the studies and see how they can improve, I think the biggest changes will come when birthing women are more informed about their options. When women know what options they have and start asking questions about their care, they become empowered to make informed choices. I found a helpful, informative online booklet from Childbirth Connection. In it they answer the questions:

  • Which is safer, vaginal birth or c-section?
  • What are the possible benefits and harms of vaginal birth and c-section?
  • What is it like to have a c-section?
  • If my doctor or midwife suggests a c-section, how should I decide if it is right for me?
  • Is it possible to safely prevent a c-section?
  • What happens if I need a c-section?

To view this booklet click HERE.

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Planning to Have an Epidural? Bring Some Extra Tools

I learned something new at a birth yesterday. If you have low blood platelets, you cannot get an epidural. I don’t think low blood platelets is common, but what I learned was that sometimes a woman may not know she won’t have pain medication as an option until she goes into labor.

I believe it is important for all birthing women to be educated in the normal process of birth, basic comfort measures, and have trained birth support (and don’t count on the L&D nurse being able to provide this, they are busy and many of them do not have a lot of training or experience in natural birth). You never know when you won’t be able to have an epidural, they don’t always work, and sometimes you have to wait a significant amount of time before you can get one.

Epidurals can be a positive tool used during birth, just make sure you have other tools as well.

A doula has many tools, if you hire one it can make your birthing experience more positive, no matter what happens.

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Delayed Cord Clamping

Delayed Cord ClamingA common routine practice within hospitals is to immediately clamp and cut the umbilical cord following the birth of the baby. Although care providers (doctors and midwives) give many excuses for this practice there is no evidence to support it. In fact, there is much evidence to support delaying clamping of the cord.

Below is some of the evidence I’ve collected that shows the benefits of delayed cord clamping. As you read through and view this information you can learn about the benefits for yourself and make the best choice for you and your baby.

Science and Sensibility, a blog by Lamaze International, has gathered a plethora of information on delayed cord clamping. Here is a post in which they refute, with evidence, some of the common objections care providers use in regards to delayed cord clamping.

“In some cases this continued practice is due to a misunderstanding of placental physiology in the first few minutes after birth. In others, human nature plays a role: We are often reluctant to change the way we were taught to do things, even in the face of clear evidence that contradicts that teaching.”

Click HERE to read the full article.

To view all the articles they have on the subject of delayed cord clamping, click HERE. They have a really informative video series about delayed cord clamping given by Dr. Nicholas Fogelson, MD A.P. Department Obstetrics and Gynecology USC School of Medicine. To watch this series click HERE.

Dr. Judith Mercer, PhD, CNM, FACNM, a member of the faculty at the University Rhode Island, is the Principal Investigator on a randomized controlled trial at Women & Infants Hospital examining the effects of delayed cord clamping on outcomes of preterm, very low birth weight babies. She was interviewed over at Science and Sensibility blog. She relates an amazing experience she had at a homebirth in 1979 that helped to influence her decision to research delayed cord clamping.

“I had an epiphany at a home birth in 1979. An infant was born very rapidly with the cord 2 and 1/2 times around his neck. He was as pale as the white sheet his mother had on her bed and limp and breathless. I was very afraid that I would not be able to resuscitate him.  I placed him on the bed and immediately unwrapped the cord from around his neck and dried and stimulated him with no response. His heart rate was well over 100 and the cord was pulsating vigorously.  I noticed that his color was changing from the pale white to pink as his body gained the blood back into it. His heart rate was always over 100. In about 1 and 1/2 minutes, he flexed his extremities, opened his eyes and took a gentle breath.  He looked at us like “What is the fuss?” and never cried.  I tried as hard as I could to get him to cry as I believed at that time that he should do but I could not get him to.  He nursed very well and was a normal child at one year of age when I last saw him.

I knew that I had seen a miracle and one that I would never have seen in the hospital.  In the hospital, we would have cut the cord and taken the infant to a warmer to resuscitate him. In doing so, we would have denied him exactly what he needed – the opportunity for the blood squeezed out of him in the birth process due to the tight cord around his neck to flow back into his body.  This event marked the beginning of my research career.  I vowed that at some point in my life I would research what I had seen but did not fully understand.”

To read the rest of her interview, click HERE.

Below is a video where Penny Simkin talks about the amount of blood lost when we practice immediate cord clamping. She talks about the benefits of delayed cord clamping in a visual way that really helped me understand the way it works. Watch the video, it’s a really great way to spend 5 minutes and you’ll walk away with some beneficial information on this important birth option.

Along with all of the clinical benefits and researched evidence noted in the above links, a benefit that I have seen is the way delayed cord clamping slows down the birthing process. Sometimes in the hospital there is so much routine that is practiced by the doctor/midwife and nurses everything happens so quickly. I believe it is important to slow this process down. When the birth of a baby is slowed down the mother and her partner have the chance to savor the moment and the experience is etched into their memory. Slowing down the birth process is one way to improve and protect the memory of the birth.

As you consider your birth options and preferences, I hope you will research the information available on delayed cord clamping to make the best choice for you, your baby and your situation.

The midwives that I know of who attend home births regularly practice delayed cord clamping. It is important to talk to your care provider to find out their regular practices.

Picture above take by OpieFoto. Taken at the home birth of my 3rd child.

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Birth Declaration by Babies & Bellies

I thought this declaration was wonderful. It describes much of how I feel about how I feel about birth.  CLICK HERE to read the entire declaration

excerpt from declaration:

“Birth, more than any other experience, has the potential to transform the world. It is time that we support women in experiencing birth as a peaceful, positive, and powerful event.

Birth has the potential to be the most powerful driving force on the planet. The healing of birth will surely change the world.

We must reframe the way we conceptualize birth. We must share this wisdom with the world.

Birth is something to be embraced—not controlled.

Birth is something to be welcomed—not dreaded.

Birth is something to be loved—not feared.”

 

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