Tuesday, September 24, 2013

Birth Location Location Location

Please check out the link here, it's an info-graphic by The Institute of Medicine, demonstrating  the "who, what, when, where, why and how" people are giving birth in the United States in the year 2013.

Kind Birth Editorial:
Graphic 1; How many birth centers are there in the U.S. 
Well, truth is, NOT MANY.  But, I am thrilled to see that the number has approximately doubled since my first pregnancy in 1995-1996.  The midwives I chose were in the process of opening the Puget Sound Birth Center while I was expecting, and though it wasn't open by the time I gave birth, I was planning a home-birth anyway so it didn't matter to me. For those families wanting an out of hospital birth, but aren't close enough, or comfortable with the idea of a home birth, check around.  Call your local midwifery practices.  Even if there isn't a birth center in you area, there may be one that you could travel to, stay with a family member or a friend, or be a part of the conversation that sparks the drive to open one!  As midwives become more and more common, their interest in opening a birthing center will be driven by the interest in the community.  

Graphic 2: Pregnancy complications
The list on the left is thorough, though there is controversy regarding some of these factors increasing risks.  I have read posts by midwives citing that both twins and IVF may or may not indicate the need for in hospital care depending on specific factors and should not be subject to blanket policies, but instead evaluated on an individual basis with care and caution...of course.

There absolutely are risk factors that require, for the safety of mom and/or baby for your pre-natal care and the birth/delivery to take place in a hospital, and of course even the OR.  I am incredibly grateful to live in time and in a place where mom's and babies can be rescued from what would otherwise have been life threatening complications.  It would be unfair though, not to mention that intervening in "normal" pregnancies/labors can introduce risks that would otherwise not have been present.  The risks listed on the right of the info-graphic can happen without cause or warning, but can also sometimes be linked to obstetric procedures that may fall into the category of routine, even if the governing bodies like ACOG don't condone or recommend it.
For example:
  • "Cord prolapse" may result if bag of waters is ruptured prematurely, to try to induce labor for example, before the baby has engaged.
  • "Lack of progress in delivery" may be caused by the impatient interpretation of the care provider, stress, pressure to make progress/perform, pain medications, excessive monitoring, lack of mobility due to being strapped to too many machines, too many cervical exams, unreasonable timelines, distractions, etc.
  • "Fetal Distress" can be caused by (usually prolonged exposure to) both epidural and spinal anesthesia as well as Pitocin.  There is a reason why we are required to have the external or internal fetal monitor on at all times once these medications are on board.
  • "Postpartum Hemorrhage" has been cited in several large studies to be twice as common in women who have had an epidural: see Sarah J Buckley MD 
  • "Umbilical cord wrapped around the baby's neck" can be normal and only rarely causes a problem. With the ability to monitor the fetal heart rate as he or she descends down into the birth canal, Doctors and Midwives can keep track of the baby's well being in or out of the hospital and are trained in resuscitation using the same tools.  For safety in general, I would recommend only considering a home or out of hospital birth if you have access to 911 with a quick response time and are in close proximity to hospital equipped for obstetric care.
Graphic 3: Why do people choose out of hospital births?
That pretty much says it all.  If I could change one thing in Obstetrics today, I would want to have it be required for OB's to attend whole labors/births with midwives on (at least) an annual basis, so they could have the opportunity to see, and hopefully learn from, their ability to bear witness to a woman.  To help them to understand the emotional side of giving birth. When birth is normal, to be there in her circle is a sort of communing, in or out of hospital.  No time constraints, no (obvious) spreadsheets of statistics, just music, time, support, quiet, confidence, patience, and yes of course, medical expertise...but applied with humility, not the arrogance I too often (but not always) see in hospitals today.  We may only be 1.2%, but we're growing and it would be wise for hospitals to learn how to compete.  In fact they must change to prevent the exodus that will continue to happen if hospital practices can't be flexible enough to accommodate no/low/lower-intervention, lower cost, family centered, holistic birthing.  I love working in hospitals, with nurses and doctors who get it.  
Graphic 4: Who delivers babies
I don't have a lot to say about this one.  What I know for sure is that in order to have a beautiful birth experience, whatever that means for you, you must feel safe in your chosen birth location and with your chosen provider.  Because "high risk" factors can limit your options, make sure you have prenatal care to keep you healthy and assess any risk factors you may have.  You might still be able take action to eliminate certain risks. To make informed choices you need to understand the birth process,  and form your own opinions about the options that you have available to you during the birth process.  Don't just take anyones word (midwife/doctor/family/friends/doula/educator) as fact or truth, research the way you would if you were undertaking any other physical event of this magnitude.

Location Location Location is absolutely right.
Click this link for a photographic/video collage of a beautiful birth at an out of hospital birth center for your inspiration or consideration.  I can honestly say that this is a lovely example of what I see most often.  I do acknowledge that I generally work with low risk clients, in an area with amazing pre-natal care and 5 of the nations roughly 225 free standing birth centers within easy driving distance. 
It is still my truth.

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