More on birth centers and maternity centers

I'm currently reading Birth Territory and Midwifery Guardianship: Theory for practice, education, and research by Kathleen Fahy, Maralyn Foureur, and Carolyn Hastie (Butterworth Heinemann (Elsivier): Books for Midwives, 2008). Just today Science & Sensibility featured a review of the book by guest blogger Dr. Katharine Hikel. The review is worth reading--as is the book--but I wanted to highlight this particular excerpt when she discusses birth environments and brings up the idea of a freestanding maternity center: taking the entire birthing wing outside the hospital.

But what is the best birth environment? In a chapter called “Mindbodyspririt architecture: Creating birth space,” architect Bianca Lepori describes her designs for hospital-based birth rooms that are meant to enhance, not counteract, women’s abilities to give birth. She created suites of rooms with “Space and freedom to move; to be able to move to the dance of labor; to respond to the inner movements of the baby; to walk, kneel, stretch, lie down, lean, squat, stand, and be still.” The rooms have “Soft and yielding surfaces; or firm and supportive surfaces; different textures; the right temperature; soft curves; darkness or dim light.” A birthing woman can be ‘immersed in water, flowing or still; respected, safe, protected, and loved.” Access to the suite is through an antechamber; the bed is farthest away from the lockable door, and not visible from it, so that privacy is respected.

Lepori’s birth architecture reproduces the comforts of home. There is access to the outdoors, and private walking places. There are birth stools, exercise balls, bean bags, hooks for hammocks or ropes for stretching. Tubs and beds are large and accessible from both sides. There are accommodations for families. There are comfortable chairs for nursing. Medical equipment – supplies, oxygen – is tucked behind a screen or put in a closet. A refrigerator and light cooking equipment is available. This ‘birth territory’ certainly outshines the typical hospital OB floor; though it begs the question: Why not just stay home?

The answer, of course, is that, for those four to ten percent of births that truly need intervention, the OR is right there. It’s better not to have to transport a woman who’s labor has turned complicated; it makes sense – for many – to have all the birth territory under one roof.

This birthing-suite design indeed takes into account the all-encompassing, body-mind-spirit event of childbirth. It honors laboring, birthing women and families; it respects the process. It worked well for a designated maternity hospital in New Zealand – a facility already designed for childbearing. But most US hospitals are multi-use facilities; and though obstetrics is among the best money-makers for hospitals, childbirth is the only event that occurs there that is not related to illness or trauma.

The real question is, why not remove birth completely from the pathology-centered hospital model? Why not redesign birth territory to maximize best outcomes, minimize intervention, and replace the present medicalized view of birth as a disaster waiting to happen with the more normative, expectant-management, midwifery view? Move the whole shebang, from the waiting room to the surgical suite, out of the hospital and back into the community where it belongs.

The idea of a freestanding maternity center--one that has an OR and in-house OB and anesthesia, but that is completely separate from a hospital--is new. No one has ever done this before that I know of, and so no one knows how it would/should/could function. Would it be identical to hospital-style maternity care? Would women go there? Would being free from the confines of a hospital and all of its rules and regulations open up a space for a real change in maternity care?

One of the best ways to explore this new idea and offer up your own questions and ideas is to come to the Controversies in Childbirth Conference in Tampa, on February 19-21, 2010. The conference oragnizier, Alan Huber, just wrote more about the concept of freestanding maternity centers today, in a post called Birth Centers Versus Homebirth.