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.