Obstetrics - Low risk maternity services

 

How are birth centers different?

Birth centers were designed for healthy, low risk mothers and healthy babies. It's a very relaxed atmosphere in a birth center. It feels more like a nice country inn, or somebody's really well kept home, than a hospital. It looks like a house with wallpaper, bathrooms with showers, and Jacuzzis for women to relax in labor. There are kitchens where people can bring their own food and cook in the birth center. In fact, that's how you often know a baby is coming - you can smell some good food being cooked in the birth center kitchen.

 

There is also a lot of privacy at the birth center because of its low volume. We don't have 15 or 20 women giving birth at the same time. One, or maybe two, women will be in the birth center at the same time. And, because it's the place where mothers have come for all their prenatal care, they are very familiar with it. They know the staff who work there. They know the birth rooms since they have looked at them several times and shown them to their parents, friends and their other children.

 

Through the educational program that goes on throughout the pregnancy, parents know what to expect once the mother goes into labor. A mother knows that she can wear her own clothes and that she can eat and drink in labor. She will be encouraged to get out of bed and walk around. She is able to choose her support people - whether it's her own mother, her sister or friend. The father of the baby is almost always there, unless there is some special reason for him not be. It's up to the mother to decide how she wants this to go. This is her labor and whatever makes her feel good is what the staff wants to do for her. The mother can labor in any position that is comfortable for her. She can push on her hands and knees. She can squat, lay on her side or sit in the bed--anything that makes it easier for her to get the baby out. We know that babies come out better when the mother is relaxed, so we try to provide an atmosphere where she feels confident and comfortable so that she will use her body well.

 

Birth centers promote breastfeeding. In fact, because we know that a baby is alert and will nurse well in the first hour after birth, breastfeeding is encouraged immediately. In this way, breastfeeding and the education and support of the mother in the breastfeeding process is established early on.

 

There are no routines in a birth center. There is no routine prep or enema or IV. We do not do the continuous electronic fetal monitoring that keeps a mother tethered to a machine. The baby's heartbeat is monitored, but it is monitored intermittently with a handheld doppler. Also, birth center care reflects a difference in philosophy about episiotomies. We don't cut routine episiotomies. Instead, we use warm compresses to ease the passage of the baby so the mother won't tear. The episiotomy rate in birth centers is about 12 percent while it is well over 90 percent in most hospitals.

 

The most important difference you will find in birth centers, (and a common reason that many people choose a birth center) is that there is no separation of mother and baby. Anything that is done for the baby - treatment or exam - is always done in front of the parents so that they may learn about their baby. The same staff takes care of the mother and baby together. The nurse-midwife, the nurse or the physician in the birth center care for them as a unit.

 

Now, what about problems? We know that people are going to have problems, so there are systems set up to deal with transfers to the hospital. We know that we are going to transfer about 12 percent of the women in labor and that the vast majority of these transfers are not emergencies. Only about two percent of women go to the hospital as emergency transports.

 

The birth center is part of the medical care system and linked to the acute care level of hospitals which insures that, if the mother or the baby develops a problem, we can get them the level of care that they need.

 

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