Wednesday, November 11, 2009

Pinky has a question about birth centers

Pinky, one of my blog readers and a L&D nurse (well, she recently switched and now is working as a psych nurse) and CNM-in-training, is doing a paper on freestanding birth centers. She's like to know why or why not you'd choose a birth center. Here are her questions:
Would folks who want a homebirth because of the restrictive nature of the hospital, come to a freestanding birth center? Is there a demand for Birth Centers? Especially a Birth center across the street from the hospital that has a large staff and 24 hour Ob and anesthesia folks so they can handle anything you throw at them. And a Nicu would be good too. I was thinking, if we did start up a birth center across the street from the hospital I worked at, would it be used? If we build it, will they come?

So for any home birth folks out there, could you please leave me a comment on your thoughts. What would you need in a birth center to make it attractive to birth at?

Here's my response: for me, a birth center is a less appealing option to me than a home birth. There isn't any inherent safety advantage of a freestanding birth center over a home birth, since the same equipment will usually be present in each setting (Doppler for intermittent monitoring, O2, IVs for dehydration/hemorrhage, antihemorrhagic meds, adult and neonatal resuscitation equipment, etc.) I'd much rather be in my own turf, rather than be at the mercy of an institution's rules, restrictions, or protocols. Of course birth center rules/protocols aren't anything like a hospital's, but still, it's not your house and you are the guest in someone else's territory. If I am going to get into a car and go somewhere else during labor, there better be a darn good reason for it--i.e., I need medical attention in a hospital setting.

On the other hand, someone else might choose a birth center over a home birth for a number of different reasons. Perhaps they just feel safer birthing in an institution/going somewhere to give birth, rather than staying in their own house. Perhaps they don't have a nice or safe home environment and the birth center is really awesome and luxurious and has a great labor tub. Perhaps they live too far away from their backup hospital for their own personal comfort (for some women, this might be 30 minutes, for others, 1 hour), but the birth center is right across the street from the hospital (pinky's ideal scenario, which I definitely can see the appeal of; I mean, if you're literally across the street from the hospital, you can't really argue from a safety perspective).

I wrote about this a while back in The Best of Both Worlds? I should note that I don't really feel that birth centers are the "worst of both worlds." It was more a train of thought that I was following at the time. I'd love to see more birth centers, especially ones really close to a hospital, because I think they would attract more women who are not thrilled about birthing in a hospital, but want the proximity to emergency care if needed.

And for a really fascinating idea that has started to gain momentum, read about freestanding maternity centers (my phrase; they don't really have an official name yet). It's basically a freestanding birth center with an OR and 24/7 OB and anesthsia coverage. Not part of a hospital, but instead owned and run by doctors and/or midwives directly.

Alan Huber explains his concept of a physician-owned birthing facility  in Why are pregnant women forced to choose between X and Y? and has more followup explanation in What's my hidden agenda?. Dr. Stuart Fischbein has also been working on this concept and thinks it might be a way to solve our maternity care crisis. Read A new type of birthing facility.


  1. I had my first baby in the hospital with a midwife. I chose that route because it was my first and I wanted to have my bases covered should anything go wrong. Now that I am planning for my second baby, I definitely want a homebirth. I considered a birth center until I realized like you said that there isn't much advantage. I would much rather NOT leave my house and have my midwife come to me.

    That said, I think birth centers close to hospitals are great because it gives women a middle ground. They can be in a more mother/baby friendly environment but have quicker access to medical assistance should that be necessary. Another reason I've heard women say they choose birth centers is so that they don't have to worry about the mess and prep of a homebirth.

    I actually really like the idea of a freestanding maternity center. I think that would appeal to a lot of women. My dad is a surgeon and there are already many freestanding surgery centers around the country. Why not extend that model to maternity centers? Sounds great to me!

  2. I'd come only if I had a high-need or risky labour. but then they would send me to a hospital anyhow b/c I've had a VBAC.

    to me birthing centers aren't what I want. no matter how they dress it up like a home, I have no desire to birth in a home that isn't mine. I want to give birth then crawl into my bed and stay there as long as i want.

    birthing at home isn't at all the same as a birthing center. two different things totally. some people like one and some like the other.

  3. I think birthing centers are vital and needed, and that women as a whole would benefit.. However, as a home-birther, I don't see the appeal much.
    I pretty much agree with the statement 'If I am going to get into a car and go somewhere else during labor, there better be a darn good reason for it' from Rixa.
    Also, I will always be more comfortable in an environment that is my own.

  4. Since I don't want to give birth in a hospital, a birth centre is my only option. I'd love to have the luxury of being able to choose a homebirth, but in the part of Australia that I live, there are no midwives who will attend homebirths (and if the government has its way, come the middle of next year homebirths will effectively be legislated out of existence in Australia, but that's another shameful story). The birth centre in my town is fairly new and just next door to the hospital. It's nice, but I still wish I had the choice.

  5. I would love a homebirth, but hubby is no where close to being on board (he's getting closer though! 2 years ago it was NO WAY AT he's saying, "Those dr's. don't always have YOU in mind do they...." ha!) We have a fantastic birth center next to where I had my 2nd son w/ MW's but they won't take me as a VBAC (unless your c/s is under their care -ie. labor w/ them but have to be transported for a c/s-)...kinda like, "Sorry, you screwed up and made the wrong choice for your first birth..." So my only options are hospital or home...I'm hoping that one day I can claim that homebirth as my own.

    And my argument for those that claim that it's 'my body my birth' and to do it where ever *I* want. Yes, I could, but my hubby was more of a help than my doulas while I labored at home all day and at the hospitals (my doulas were PHENOMENAL and I will never birth w/o one again! But something about my husband's presence/voice/touch made everything amazing). If he isn't comfortable in the situation, neither will I be.

    So glad we have the freedom to choose (sort of, lol) where to birth our babies!

  6. While I myself have homebirths, I realize that homebirth is not for everyone. People may not feel safe, or may not be able to afford it, etc. This is where I think a birth center would be a nice alternative to the hospital.

    However, I do feel that there is a HUGE difference between a free-standing birth center and one that is under the jurisdiction of a hospital. In my state, all the free-standing birth centers were forced to close, and the only two birth centers that remain are associated with hospitals. While these are nice places to give birth, they have VERY strict restrictions on who can give birth there, and a high transfer rate (over 25% at one birth center). Add on to that the fact that you would be transfering to a less than ideal hospital, for non-emergency reasons, and you can see why a lot of women choose not to go there to give birth.

  7. I think a free-standing birth center near a hospital would appeal to many women. It would offer them the opportunity to have fewer interventions, but also bring peace of mind for them and their families should an emergency arise.

    I would be interested if my home was not ideal, too small for a birth tub, not enough hot water, too crowded, etc. And I think it would be nice to have a place to go, with all of the equipment that can make labor more managable, but not be in a hospital with all the sick people and MRSA.

  8. I'm definitely pro-homebirth, but I had a birth center birth for my son. My husband got out of the military when I was 7 mos pregnant, and we moved home and were staying with my mom (who I love dearly but didn't want at my birth because she didn't believe I could do it). Our rental house wasn't ready yet; we signed the lease a couple weeks before my due date, and I was just too pregnant to get much done. And we couldn't find a homebirth midwife at the time anyway. We found a birth center a couple of hours away, and we had a great birth. Afterward, we went home and spent the night in our house surrounded by tons of still-packed boxes!

    I'm so glad that birth centers exist for all the various reasons that women want a birth that isn't in a hospital but not necessarily at home.

  9. Looking back, I wish I had chosen a home birth for both of my kids. But, I didn't know now what I knew then. I didn't know anyone who had had a home birth, and was going out of my comfort zone and culture even using a midwife. I had one hospital birth with a CNM and one birth center birth with an LM.

    My experience in my neck of the woods is that women are more willing to choose a freestanding birth center than a home birth, but that may be specific to here in South Florida. I think the birth centers in the area do a much brisker business than the home birth midwives.

    That may be due to being able to handle more births at a birth center. The one I trained at had 5 labors in 48 hours this past weekend, 4 of them simultaneous. Two midwives on at a time can handle that with several well trained assistants, and they did. That would be very difficult to manage as a home birth midwife team.

    And, the more people who deliver at one of the local birth centers, the more they drive business there, so business begets business.

    But, both local centers offer home birth as an option, and I would have to say the one I trained at may do 4 home births a year, but they do 20 to 40 birth center births a month. Their clientele seems to think the freestanding birth center is the "best of both worlds".

    I think it's a balance of fear and knowledge, with a swish of priorities and framing of risk.

  10. From my perspective, which is decidedly from someone who isn't even pregnant yet with their first but anxiously awaiting the day I can ditch the pills, I would love to have a birth center close by.

    This is because my Husband is dead set against the idea of a home birth. We have had discussions about it and he having never been part of a birth feels much more comfortable being in or much closer (not that we are not 10 minutes away from 2 hospitals) to a hospital. He is afraid of something going wrong.

    Since my Husband is such a vital part of my support system in everything and will be just as much a vital part of my support when the that time comes, I feel it is only appropirate to take his feelings on this into consideration.

    So if there was an option of a freestanding birth center in my city across the street from the hospital I would love it and most likely take complete advantage of it.

  11. If they had a nice, jacuzzi-like birthing pool, and would let my children accompany me, I think I would go to a birth center. The jacuzzi at the hospital made a huge difference with my last labor--the second time I have had back labor, and the first time I found any relief. But it wasn't just the warm water--it was the high power jacuzzi jets, and I don't think I can get that set up at home (someday, when I build my own house). Honestly, it was worth being in a hospital for...

    Another, rather silly, reason for wishing there were a nice birth center nearby: I am a really lousy housekeeper, and it would be nice to not have to worry about the state of my home going into labor--but I would worry with a midwife showing up!

    I'm really on the fence right now over my next birth. I've had three natural hospital births, I like the idea of home birth but there are some logistical challenges (I found a midwife I like but the hospital she goes to for back up is a long way away. I haven't been able to find a backup doctor locally). I could go back to the hospital I was at for my last baby, but I couldn't pull off another water birth there (they don't do water births, I just didn't let them know when the baby was coming last time). And I'd love to have my children with me for this one.
    I think the birth center would be ideal if I could find one close enough!

  12. I birthed in a makeshift "birth center" in my midwife's old house. It was much closer to the hospital than my own - down the street instead of 20 minutes away - and I was able to holler and scream in complete safety, since my downstairs neighbor is a real bitch when it comes to noise (although that wasn't a deciding factor in doing it there, but a nice perk).

    I hear so many women wish they had a birth center to go to because they live so far away from the hospital. Fo this reason alone I think birth centers are great. They are also a nice in-between option for people who are nervous about homebirth - even though, as we all know, a birth center birth is NO DIFFERENT than a hoembirth. Still, if it wins the support of people who matter most, then it's a happy compromise.

  13. I gave birth in a birth center 3 blocks away from a hospital. My reason was because of the location of my house. I was over 30 minutes away from any hospital, and even further away from a hospital I'd want to go to if I needed a c-section or if the baby needed special care. I think it's a great option, and I'm glad such places exist.

  14. Like Rixa, my feeling on freestanding birth centers is that because there is no real difference in equipment or expertise between home birth and a birth center, I would (and did) choose a home birth. The circumstances under which I might choose differently are also identical to Rixa's - if I were further away from a hospital than the birth center, or if my home were really unsuitable for a birth at the moment (as was Jill's situation). I blogged about this recently, with much props to Rixa.

    But I'm not commenting just to ditto her. I have to say, I really, really appreciate the question itself. I get awfully tired of hearing all kinds of invective from people who are opposed to home birth - without offering ANY solutions to the legitimate problems of the current hospital climate. Even if you disagree with the safety of home birth, assuming a "Hospitals! Take 'em or leave - well, okay, don't LEAVE 'em, because that would mean encouraging birth options, so . . . Take 'em or you're a moron!" - well, it's not ever really going to help the situation, is it?

    So I've often wondered what the anti-home birthers would actually suggest in response to the many reasons (policies, environment, continuity of care, and so on) some women are opting out of the hospital. What would their alternative offering be? what would they be willing to change? Would they endorse a different option altogether? Thanks for asking, Pinky.

  15. Before I got pregnant with my second baby, I planned on giving birth in a birth center. When I had a consultation with the midwife, she told me that as far as safety and equipment go, there is no real difference between a home birth and birth center. The birth center I was planning on going to was a few blocks away from a hospital and she was encouraging about the kind of care mothers who have to transfer receive at that hospital. But it made me think that doing it at home would be nice. I knew I wouldn't feel comfortable in my little apartment. It's too small, there are neighbors on both sides and below me, only one bathroom with a small tub, and a little too far from a hospital for my comfort. BUT, my mom lives only 10 minutes away and has everything I wanted in a birth setting. So after talking to her, she and my step-dad said it would be great for me to give birth there. So that's what I did. It was a wonderful experience and I am very glad I had my baby boy there, this past June. It was a combination of birth center and home. It was a home, not my home, but one where I felt very comfortable, had all the amenities of a birth center (except the deep bathtub didn't have jets), was 5 minutes from a hospital if you go the speed limit and obey the traffic lights, was well set up for my 2 1/2 year old daughter to be there, and the best part is that we didn't have to pay a $1500 facility fee (like at a birth center). Also, I didn't feel the pressure to leave at a certain time. We stayed there about 12 hours after the birth, then went home, a family of four. Here's the link to my son's birth story:

    For my next birth, if I am still living in the same place, I would love to do the same thing again. If I have moved to a different area and/or state, and the home birth setting wasn't as good, but there was a birth center, I would absolutely look into it. It's hard to imagine going to a hospital for another birth. So a birth center would be a wonderful option.

  16. Having had one highly interventive induction turned c-section birth, and one super smooth and intense-but-not-difficult home birth, I'd have to agree that for me the only way I'd go to a birth center is if I lived somewhere where I was too far from a hospital for my own comfort. (Which I don't foresee happening, we are not country folk by any stretch)

    I like being fully on my own turf and not having anyone extra there. For all that I labored for about two days, I didn't bring the midwives in until I hit transition, about 45 minutes before my son was born. I liked it being just my chosen family/friends and no one telling me what to do and not do.

  17. I come from Portland, where I think we are like the birthing center capital of the world or something! Seriously, there are so many great ones, and yes, people do come to them.

    Portland has a very large natural birth movement, but for many of the reasons Rixa mentioned, many women do opt for birth centers over homes. People with pets, for instance, will often opt for birth centers where they do not have to worry about sanitation, etc., on their own.

    I find that many women select birth centers for their FIRST child, as they still might have a fair bit of fear and anxiety about birth, but they desire for natural/intervention-free atmospheres, if possible. Many of those women do opt for home births at their second births, as they have grown to feel more comfortable with their bodies, birth, and the process as a whole.

    I do know that in Oregon and Washington, it seems we can't ever have enough of them.

  18. in my state we have one free standing birth center. and they are so strict in their policies that they transfer care so much its not worth even signing up there.

    if they had a birth center where I live that is not associated with the hospital at all, it might appeal to some women. not me. I will not leave my house unless there is a true problem that needs to be transported for. I am not going to labor in the car then get used to a new place when I can do the whole thing at home.

    I think freestanding birth centers are great for women that aren't comfortable at home or the hospital. as long as the birth center is not associated with the hospital then its a great option.

    women do need the choice for something other than home or hospital but with all the laws and enforcements around birth it is really hard to open and keep a birth center open. at home u don't have that problem. ur home is always there.

  19. this may have been said by other commenters already, but i wanted to throw in my 2 cents.

    pros for birthing centers:

    - insurance- some providers are more willing to cover a birthing center than a home birth. BIG advantage.
    - husbands- some husbands aren't comfortable with birthing at home. a birth center can be a good opportunity for the husband to see that unmedicated births are safer and more desirable

    those are probably the 2 biggest that we faced.

    about what i'd like to see in a birth center:
    - low lighting
    -birthing tub
    - a massage therapist
    - a living room for friends and family that want to be near

  20. My choice would be Home, Birth Center, Maternity center, hospital.
    I much prefer the home for the reasons you listed in your blog plus I am already immune to the germs in my own home. That makes anything away from home at least slightly more risky.
    Unfortunately if we hav another (i have had 4 at the hospital and 4 at home), I am now so high risk I don't think my midwife would advise me to birth at home (30 minutes from the hospital). We don't have birth centers here so I will have to go to the hospital. I would love to have either other option.

  21. If there had been a freestanding birth center available to me, I probably would have chosen that option for my firstborn. I knew I didn't want a hospital, but a birth center was appealing for the ostensible "safety" and the simple fact of being set up for it, in a way that my apartment was not. I also know that for some friends/family in rural areas that are 1+ hrs from a hospital, a birth center was appealing.

    But, now having had a homebirth I like being in my own home too much to consider anywhere else.

  22. I'm in Portland, Oregon, also, and have to agree with Rachel Clear. I had my first and so far only in a FSBC, but given my location, my definition of what that is perhaps is not what others are thinking. I had a Midwife, an apprentice and a student who were my team throughout pregnancy and delivery, and the center/midwives I selected were all CPMs, not an officially sanctioned medical professional among them.

    I chose the FSBC because I was confident that I was working with strong proponents of the midwifery model of care, I was fully in charge of and responsible for decisions with regard to my prenatal, labor and post-partum care, and we lived in a crappy apartment with three cats. As an added bonus, the FSBC was only a few blocks away from where we were living at the time, and I half expected to walk there when it seemed necessary. Didn't actually feel like it when the contractions kicked in around three a.m., but I liked the possibility.

    If we have another, we will definitely plan for a homebirth, most likely with the same midwifery group. The biggest appeal at the time was just that their birthing space was more pleasant than our home, not a whit more medical. Coin-op laundry down a couple of flights of stairs immediately after birthing a baby? Not so much.

  23. When my kids were born, I lived in SD - very negative homebirth state. I *really* wanted a homebirth, my husband was very supportive of that as well... but we decided to go the hospital/family practitioner route rather than ask a midwife to possibly get in a heap of legal trouble to help us.

    I had two wonderful, unmedicated, unrushed and non-interventive (I did allow my membranes to be ruptured as I started pushing with my daughter - and she was born 9 minutes later). Great nurses, awesome doctor... but it wasn't where I wanted to be. If a birth center would have been available in a situation like that (we lived in a rural area an hour from the hospitals that did births - in an emergency, and in the winter both times, I would have gotten to the hospital by helicopter), I probably would have gone that route. But in an area where homebirth is legal (for the midwife) and the choice is pretty readily available... I'm not sure that a birth center makes a whole lot of sense. There are other reasons (want to have a hb but live in a crepe paper walls apartment... or with your parents/in-laws and want more freedom). So there would probably still be a market - but maybe not such a big one? I don't know - my two cents for what they're worth =)

  24. Thanks for your help Rixa.

  25. I would love to combine the following;
    Have an unrestricted birth with intermittent fetal monitoring as long as me and baby are not in distress, with a non-interventionist CNM as the primary caregiver, with an ob-gyn anesthetist and operating room available close by if necessary. I would want to travel to the facility earlier in the labour so I wouldn't be rushing to the facility to give birth at the last minute; however, I would not want to be rushed into giving birth once there for resource reasons. Of course the facility should be home-like and not be bound to strict protocols like a traditional hospital birth ward is.

    I had a homebirth because this kind of facility was not available to me, and I lost trust in ob-gyn attended traditional hospital birth. Although my homebirth was great, I'm not completely attached to the idea of birthing exclusively at home, not when I could have a compromise between a home-like setting with my CNM and doula, while also having medical back-up immediately ready in case of emergency.

  26. One benefit that a birth center has over a homebirth that no one has mentioned yet is a sense of camaraderie and community. I loved seeing other pregnant women when I arrived for my prenatal appointments. I am still close with the group of parents we met through our birth center. Choosing the birth center was not a decision based out of discomfort in my own home, fear, or proximity to the hospital--it was based on a desire to connect with other women and families.

  27. After one hospital birth, I have to say I would definitely go with a birth center. More than myself though, I think (hope?) a birth center located close to a hospital would forestall 80% of the most common fears about non-hospital births (quick access to medical care), and still carry many of the rewards of a midwifed/home/natural birth.....

  28. I have been thinking about the maternity center concept the past couple days. At first it seemed appealing. But then as I mulled over it, I wondered how a freestanding maternity center would be different from an L&D unit, other than not being in a hospital.

    One of the biggest problems with maternity care (I believe) is that we have taken interventions meant to be used in cases of medical need/emergency (induction/augmentation of labor, c-sections, episiotomies, epidurals, continuous monitoring, etc) and used them for reasons of convenience and/or defensive medicine. I'd say one of the main advantages of choosing to birth at home or in a birth center is that because most of these interventions are not readily available in those settings, you figure they won't be used on you without a really good reason (both because you often have to be transferred to the hospital first, and that providers who choose to practice in those settings tend to be less intervention-happy.)

    So if you add emergency services back into the birth center picture, what do you get? You'd have to have OBs to do surgery, so now you've got OBs back in the picture; you'd have to have anesthesiologists too, so now you've got epidurals too. It starts to sound an awful lot like a transplanted L&D unit. And if it's a transplanted L&D unit, what's the qualitative difference between the care you'd get in a hospital and the care from this freestanding maternity center? Will it just bring all of the inherent disadvantages of defensively practiced, labor-as-emergency care behind a new, more birth-friendly facade?

    Don't get me wrong - I'm not against the concept of a birth center that includes emergency OB care! But I would be against it if it's just a replica of our current birth-with-emergency-care model, in a new building.

  29. I recently had a homebirth and the only thing that would make me choose a birth center over my home would be if I lived a fair distance from a hospital and emergency care. As it is, I live in NYC and am about 4 blocks from the nearest hospital, so I felt perfectly safe birthing at home, even if faced with an emergency situation.

    The benefits of the homebirth were numerous -- no need to travel in the middle of labor, being on my turf and in my personal space, going to sleep in my bed when all is finished, midwife coming me to for follow-ups in the days after, rather than having to leave the house, etc. A birth center near a hospital would take all of this away.

    People who don't want to worry about the prep or lclean-up of a homebirth confuse me. By the time I had showered, gotten myself into bed, and initiated breastfeeding with the help of my midwife, her assistant and our birth team (2 friends + husband) had cleaned everything up and the apartment looked as it did before labor had begun. What kind of bloodbath do people think homebirth is?

  30. I'd like to respond to Rebecca's comment. I agree that if it was just a transplanted L&D there would be no point. But I think the ideal would be to have a freestanding birth center owned by docs and midwives that had a natural approach to birth. If their method of care was very low intervention and hands-off UNLESS truly needed, than I think it would be great. It would give families who are concerned that peace of mind that there is a backup very close, but still be encourage to have a low intervention natural birth experience. I think it could be done with the right group of care providers.

  31. But Rebecca, emergencies happen and ob-gyns have their place too. I agree with Katrina's last comment.

  32. Unless we have a huge paradigm shift in how medical care is paid for (people pay out of pocket for routine care, and only have insurance cover "catastrophic" costs--like, oh, how car or homeowners insurance works....), I really don't think the average pregnant woman is going to go to a birth center even if it does offer anesthesia and cesarean. They just don't perceive any advantage over going to the "safety" of the hospital.

    I also think a huge barrier to providing anesthesia is the cost of hiring 3-4 anesthesiologists to provide 24/7 coverage. A surgery center, since it can control the time when anesthesia is needed, might only need one anesthesiologist, or even just a part time anesthesiologist.

  33. I think I'd seriously consider a birth center, particularly if I move away from my Dr. Wonderful. My husband has a relative who has some severe complications and very nearly died, and he's firm: no homebirth. I haven't been able to sway him with statistics or education or anything over several years. We've talked about how it's not rational. No homebirth. I respect him enough to respect his fears and limitations. After all, it's my safety he's worried about, even if I do disagree with him. And it's his baby too. So, for me, a birth center would be a likely compromise, should I ever leave my Dr. Wonderful, who you'd swear was a midwife. A birth center would be a welcome option, particularly if I could talk my insurance into it. I'd have to be able to get the insurance on board. Maybe someday we'll be well enough off to do what we want and never mind the cost, but that day is not today, lol!

  34. I am comfortable and think that homebirth is best for the majority of pregnancies. But I would be willing to use a birth center for 2 reasons. 1) my husband is a great deal more comfortable with a birth center than with a homebirth and 2) understanding that sometimes the house where you are currently staying is not the best 'home' (right now we are with inlaws who disagree with homebirth and for our first birth, had our livingroom been any smaller we wouldn't have been able to fit the birth team in there, as was, it was very crowded!)

  35. A few people have commented that birth centers offer nothing different than hospitals. In my experience, this could not be further from the truth.

    Most birth centers in my town (Portland, OR) are actually IN homes. They come complete with all of the amenities of a home, and don't have all of the technology gadgets, bells and (unneccessary) whistles of a hospital.

    If a birth center is like a hospital, they are failing miserably.

    My best advice for Pinky would be to take a look at birth centers that are getting it RIGHT and model after those ones. Our birth centers in Portland are always filled to capacity, year-round, so we're are a testament that people WILL use them if they are offered (and if they aren't merely replicas of hospitals).

  36. Rachel Clear, did you birth at Alma? Either way, Pinky, that is at least one person's idea of an ideal birth center, if you care to look into it.

    Jo, I gave birth to my first at a birth center and had no idea what to expect. As it happened, I think I "ruined" about 4 chux pads. Granted baby boy was born in the water, but I didn't want anyone but husband, me, midwives and baby involved, and I certainly didn't expect anyone to volunteer for whatever clean up might have been involved, let alone being on clean up duty myself immediately before or after the birth. Having the option of a safe, comfortable, surgical suite free environment where laundry/vacuuming of cat hair was not even a consideration was exactly what I needed for the first time. If we'd been living in a house and/or I had witnessed birth before, my preferences might have been different, but I was happy to have found the right setting (the only augmentation I was offered was a mirror between my legs while pushing in the tub, a red popsicle, some oxygen during pushing, if I wished, and my choice of a delivered meal when all was said and done). I brought my own homemade chicken soup, and was almost disappointed that I was back home in less than eight hours and didn't need any of the pampering that I'd prepared for myself. Aside from the clean up crew.

  37. Sorry to come into this late, but I wanted to add something. I don't think a freestanding birth center would be bad, but wouldn't see the point in our case because we had four fine home births, even including 'problems' like hemorrhage and fetal macrosomia (cough eleven pounds cough). But I think all the birth centers around here are physically attached to hospitals and operate with pretty much the same restrictions on the laboring woman. :P

    From the center's point of view, I wonder how they operate re: litigation. I mean, assuming that the women who go to hospitals start going to freestanding birth centers, especially ones with their own emergency care (anesthesia, surgery, etc), how are they do they handle litigation without turning into mini-hospitals with tons of restrictions and liability disclaimers?

    I kind of like the "under the table" approach to home birth when it's not entirely official, because you're expected by your care provider (the midwife) to be proactive, informed, and aware of your risks. When they become part of the mainstream and have to treat their clients like morons who are going to sue, I'm not going to be as happy.


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