Where you decide to deliver and with whom impacts how likely you are to start the cascade of interventions.
Only you know where you will be most comfortable delivering!
Having a baby should be an empowering and exciting time for moms-to-be. A huge part of the experience is the provider and facility you choose to support you as you bring this new life to this world. Many people do not know about the multitude of options you have available.
When it comes to where you can deliver, there are 3 main choices.
Before you decide, we HIGHLY encourage you to watch The Business of Being Born - Documentary.
Check out the resources on the website Empowered Birth as well.
Why is the location so important?
The provider and facility you choose have a huge impact on the birth process and the likelihood of interventions during delivery.
In other words, the location and staff at that locations are going to heavily influence whether or not you receive an IV, your position, whether you can drink, eat or walk, what drugs you take, if any, what procedures happen to your body to have the baby arrive such as episiotomies and cesarean section surgery.
First is traditional hospital birth. This is the experience most people today are familiar with and picture when having a baby. It is also a fairly recent concept. Up until the early 1900s, most women gave birth at home with a midwife or their sister and mother, and that was that—just something to consider.
When in a hospital setting, it is customary to be told what time to come in for an induction or cesarean. Upon admission, you will have an IV put in your arm. Depending on the situation, you may be given IV fluids or medications, or the IV might be "locked" and used only if needed.
You will likely be tethered to within several feet of the bed by fetal monitors (one monitoring the baby's heart rate and monitoring your contraction pattern). You can always ask about intermittent monitoring if you and the baby won't have any overt medical situations present.
Epidurals and IV narcotics are offered to almost all laboring women. If you choose to get an epidural or narcotics for pain control, you won't be able to get out of bed.
The most common way to deliver in the hospital is in the traditional lithotomy position (laying on your back with legs up) for delivery. However, there are many creative positions available to you, even with an epidural. If you have a savvy labor nurse, she will guide you through them, depending on your situation. Check out "Spinning Babies" to get some ideas of what positions and why.
Many are told that if they do not dilate a certain amount every hour, they will be given Pitocin. Pitocin is the synthetic version of the natural Oxytocin you make in your body. Oxytocin helps cause your uterus to contract to help deliver the baby and clamp down the uterus after delivery, so you don't bleed too much. It is also responsible for helping you bond with your baby after you deliver. Most women in the hospital are given Pitocin. This medication's job is to increase the contractions in both consistency and frequency. This can make it harder to cope with the pain than medication-free labor and lead to the mother asking for an epidural or cesarean when that was not her plan. Prolonged use of Pitocin greatly increases a woman's risk of postpartum hemorrhage, one of the highest causes of maternal mortality.
Because hospitals know you have a choice about where to deliver and because pregnant women have spoken so loudly, hospitals are starting to bring back midwives as an alternative provider option to an obstetrician. Things like delaying the baby's bath in order to not interfere with natural scents of both mom and baby to promote breastfeeding and delayed cord clamping to help prevent jaundice are becoming standards of care in both large and small hospital settings. "Rooming-in" where the baby doesn't leave you the entire stay is also becoming the norm as "newborn nurseries" disappear.
Once an epidural is started, you are at a higher risk of having a cesarean section. A cesarean diminishes the exposure to the beneficial bacteria in the vagina that is crucial for the baby's microbiome and immune system. A c-section is a serious surgery, which can be life-threatening, and not something we suggest choosing simply for convenience or fear that "your vagina will get stretched out." If you and your partner choose to have more than three children, you should know that it is not recommended that you have more than three c-sections because of the risk of your uterine scar opening up, which can lead to the death of your baby and you. There is a time and a place for everything, including a c-section; we want to empower you with knowledge so you can discern the risks and benefits for yourself!
If you do find yourself in an emergency and need a cesarean, you can ask the nurse to swab your vagina beforehand and rub the fluids after the birth on the baby's nose and face to inoculate the baby with the beneficial bacteria. It sounds gross, but the preliminary research shows it may make a positive difference, and your baby's immune system can benefit! The exception to this might be if you develop an infection during labor (called chorioamnionitis).
Additionally, anesthesia, IV fluids, pain medication, and a cesarean (or just epidural for vaginal birth) can hinder breastfeeding initiation. Many say pain medication leaves them feeling "spaced out" or difficulty moving after a c-section can delay breastfeeding. The longer a woman is in the hospital, especially those being induced, wind up receiving more IV fluids during their stay, which can cause greater edema or swelling in their breast tissue, hindering breastfeeding. All of these things can make bonding with the baby more challenging. Birth experts assert that the hormones that normally are released in natural births can be blocked the epidural. This can lead to formula supplementation, which permanently alters a baby's gut microbiome (yes, even one bottle) and can negatively impact a mother's milk supply and confidence.
People can have wonderful and safe hospital births, and they are essential for high-risk births. Hospital care has saved lives. And it is important to us that you make an informed choice and know that you have other options as well. If you choose to go to the hospital, know that you have a choice in every decision! You are the customer and, therefore, the boss of your and your baby's medical care. If you are uncomfortable with a recommendation, trust your gut and say no. Or ask for more information. Or ask for more time to decide. If a provider is not okay with that in any way, ask for a new provider.
The second option is a freestanding birth center. These facilities are typically close to major hospitals but work independently of the hospital and offer more of an “at home” feel with the many of the options a hospital offers.
At a birth center, many of the safety options of the hospital are still in place, but the setting is customized to make you feel like you are at home. Regular furniture, birthing balls, bathtubs, dim lighting, and music are all your choice. Providers try to be very inconspicuous in your care and cater their timing to what is best for you. Epidurals are not an option at a birth center, so the likelihood of entering the cascade of intervention is much lower.
There is far less risk of intervention at a birth center. From MamaNatural: A recent study found that giving birth at a birthing center is far safer for women experiencing low-risk pregnancies than at the hospital. The national C-section rate for low-risk women is an astounding 32.7%, while the C-section rate for women who intend to birth at a center is 6%.
Birth Center Information: https://www.birthcenters.org/page/NBCSII#outcomes
Homebirth with Midwife and/or Doula or
The third option is home birth. This is when the providers go to your home when you are in labor and support you in your delivery in the comfort of your own home. It is important that a hospital is close by in case there are complications. All options offer pros and cons, but one should definitely research appropriate options and choose what they feel is best for their situation.
Home births offer the most relaxing environment for many, and the intervention rate from providers is low!
You can have music and candlelight if you prefer, move around, and have your familiar comforts.
Midwives and Doulas are available for many levels of care. They may come for your home birth, for your hospital birth, or even stay with you at home after the baby arrives. They are key in supporting you through the fear of the unknown during labor and birth. They can provide a myriad of things, including essential oil massage, positional direction, partner-anxiety management, or just simply being quiet support to you during this time. Like many times in life, you may not know what you'll want or who you'll be until you are in the moment. You have never done this before! Take a breath and go with what you need and feel is right at the moment.
Homebirth safety article with studies cited: https://mana.org/blog/new-studies-confirm-safety-of-home-birth-with-midwives-in-the-us
Your provider is there to support YOU...aka it is OKAY to Fire Your Provider.
There are 4 major providers you can choose from:
First, you have your conventional Obstetrician. These providers mainly deliver in hospitals with a very conventional model of care. To learn more about the conventional model, read our article on birth plans.
On a personal note, our Director Zen Honeycutt wants to share that after watching The Business of Being Born and pregnant with her third, she asked her OBGYN about interventions. Her OBGYN said. "I will be honest. If you do not dilate a centimeter and a half every hour, I will give you Pitocin."
Zen said, "Well, that's not going to work for me." She never went back. After two previous hospital births, she gave birth at home in the water with her husband, a midwife, and a doula, to candlelight and Andre Boteccelli playing Beso Me Mucho. Drug free, free to move around, walk, get in and out of the water, minimal vaginal exams, and the comfort of home. It was the most physically empowering experience of her life. Ten months later, her son's first word was "Yes." She says the birth empowered her and her husband to create a world of YES for their family.
Whatever you decide, make sure that you feel supported and safe with your OBGYN or other provider.
Second, there are midwives. Midwives can work in hospitals, birth centers, or offer home births. The tricky thing about Midwives is whether you can get your insurance to cover them. At first request, most insurance representatives will give you the run-around and slyly say, "No, we do not cover the home birth." Upon further inspection of your coverage, what you will likely find is that insurance does not cover the room and board for your home birth (of course, why would you charge insurance for your own home!?) They mostly likely DO cover the service of a midwife for you to deliver at home. It makes sense for them to do so too. An average hospital delivery with prenatal OBGYN appointments in the office when Zen's son was born in 2003 cost $17,000. Her third baby's home birth cost $3000 with prenatal Casa visits by the Midwife. The insurance companies save THOUSANDS when we give birth at home. It's a wonder they don't make it easier to get it covered.
NATUROPATHIC OR CHIROPRACTIC DOCTORS
Third, are unconventional providers like a Naturopathic Doctor or a Chiropractor. These options are state-dependent as the provider's scope of practice is defined by the state they live in. Experienced Naturopathic Doctors or Chiropractors can monitor the baby's progress and mother's health without invasive vaginal exams. We highly recommend that even if they are not your primary providers, you do consider consistent care from Naturopathic or chiropractors. They support the body to heal itself naturally without medications that come with serious side effects.
Lastly is the option of unassisted home birth. While the safety profile of the options is not necessarily even, it is important to know all of your options. We suggest that even if you do not choose this option, you watch a few videos online of unassisted home birth, just so that you can be aware of how capable women are of giving birth naturally. On the off chance that an unassisted birth ends up choosing you...in a taxi or elevator, it will give you more confidence that you can do it.
Have anxiety about what to choose?
Keep in mind, in the end, the most important result is a healthy mom, a healthy baby! We want to empower you with knowledge and choice because your interventions or lack of them during labor can alter your outcome both positively or negatively. At the end of the day, you have to live with your birth experience, and we want you to look back at it with joy for the rest of your life because that's how long you will remember it! For some, watching baby videos on YouTube helps moms-to-be to sleep at night. They love hearing happy baby sounds. Try it!