Friday, September 18, 2009

Freestanding Birth Center vs. Home

Just one thought, a follow-up tangent from my previous post critiquing the film Orgasmic Birth: One specific thing I did really appreciate from the film was how they made the distinct point that many qualified midwives bring everything TO the home that is available in a freestanding birth center*. I wish more people knew that. So many people who want to be in a birthing center seem to want to be there because of the perception that it’s safer than a home birth, but I think that’s basically an illusion. Not that I have anything AGAINST birth centers, I just think people sometimes want it to be a compromise between home and hospital, and I feel that this logic is a little bit off. The great, prolific Navelgazing Midwife makes this point very well:
When a dad/partner/relative tells me s/he/they would have no problem having a baby in a birth center, but wouldn't be comfortable at home, I let him/them know that I carry the same equipment that is at the NACC-certified birth center downtown (minus the sedatives). The difference is *I* carry the equipment into their house instead of them getting up, in labor, and heading out into the elements, driving to the birth center. It often comforts them to know this. I have even gone so far as to open my kit up to show a skeptical nursing relative. It is very important for everyone (who will be at the birth) to feel 100% comfortable with the parent's choice to have their baby at home.
I've already had one home birth, as you probably know, and would absolutely do it again, so long as my risk level is appropriate. I definitely prefer this to a birth center, even a really wonderful one. But still, I could see myself choosing a birth center for one of two reasons: if it were closer than my home to a good hospital; or if my home at that moment were not a good setting for whatever reason - recent move leaving the place in a shambles, tiny apartment with thin walls, something along those lines.

There's more to discuss on this topic, of course, but I thought it was a salient point to put out there, and it was a positive thing that sprang from seeing the film despite my having a few criticisms of it, so I though it only fair to mention it. Here endeth the tangent.

*Not to be confused with hospital "birth centers", which are typically the same old maternity wards with the same old policies - but sometimes new wallpaper! And maybe a manicurist! Because those are women's top priorities, dont'cha know.

UPDATE 2/05/10: The midwife writing at Birth Sense recently weighed in on this as well, confirming all the key points listed here:

For some of my clients, I did feel the birth center was a safer location. I worked in an area where a number of my clients lived a long distance from the hospital–up to three hours away. If a woman did not have rapid access to a hospital, I would recommend the birth center because of its location only a block from the nearest hospital. Some women did not have a home setting they felt comfortable in–for example, a client who lived with her in-laws and wanted more privacy for birth. But in terms of safety, a birth center birth or a home birth with easy access to a hospital, are equivalent.

I had all of my emergency equipment and birthing supplies in portable bags which I used at either the birth center or at a home birth. I had the same trained support people helping at a birth, regardless of location. There simply is no difference in what happens in a birth center or a home birth. For any serious complication, both settings will require transfer to the hospital. There was nothing I could do for a woman in the birth center that I could not do for her in her own home.

4 comments:

  1. Don't forget the masseuses at some birthing centers!!!

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  2. Had to add that I JUST TODAY discovered this post from La Rixa's archives, saying essentially the same thing, only in a much more PhD-y kind of way. I am pleased.

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  3. Food for thought. Hm. I had assumed that a birthing center would be better equipped, but now I have a decision to make! The birthing center *is* a few minutes closer to the hospital, but... well, we'll see. Thanks for the education!

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  4. For a couple who wants a homebirth but their home isn't an ideal option (distance in case of transfer, privacy, renovation, etc.), a "homebirth" in a hotel (especially a jacuzzi suite) is a good option. This allows the choice of care provider and autonomy, unlike many freestanding birth centers. I don't know how other birth centers operate, but one freestanding birth center near us has quite a few restrictions: 2 hour limit on pushing (even if mom & baby are both faring well and making progress); 12 hour time limit on ROM before labor; 18 hours time limit on ROM before delivery; no clients beyond 42 weeks; otherwise, forced transfer to a very restrictive hospital. They also do not take VBACs. Personally, I'd much rather have a care provider who can look at my individual situation and recommend a course of action based on our true needs, rather than, "Sorry, sweetie, but you're going to have to transfer now because the clock says so."

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