I’m not…

…a doctor or a medical expert; I’m not a clinician or midwife. I’m definitely not equipped with the professional experience to describe all that happens inside the female body during childbirth. 

I am…

…a mom of three boys who has done a reasonable amount of research about “birth-day” venues. I discovered that choosing any locale other than a hospital requires discussion with a medical professional. Without a doubt, gauging the appropriateness of each individual’s non-hospital delivery demands investigation and contemplation.

Each pregnancy brings unique labor and delivery questions

Like most mothers, I recognized that planning each of my sons’ (”zero”) birth-days was one of the first steps to lead up to this major life event. It’s not surprising that my first (Ian’s birth) was the most daunting among my deliveries. Most definitely, it set the tone for his subsequent two brothers – Nico and Constantine’s arrivals.

An abundance of first-time, mom-time allowed me the focus, ample consideration and exploration opportunities to make thoughtful decisions. Internally, I felt a lot of apprehension rooted in a fear of the unknown. I’d never given birth before! So I used my time to investigate birthing technique options like Lamaze, the Bradley method and hypnobirthing. (I’ll share more about birth techniques in an upcoming post.) I explored these options as a way to calm myself and to cope with the anxiety that led up to the Big Day.

Two and five years later, I had more opportunities at the “birthing bat” while relinquishing my pregnancies through the births of second and third sons. Prior to their deliveries, I assessed my options in completely different ways. Ian was a toddler when brother, Nico, came along, so a successful, natural hospital birth (sans epidural) was still clearly etched in my mind.

During Nico’s upcoming delivery, and the planning stage prior to it, I became determined not to use an epidural, once again. And on the day when it was offered – at the height of my labor woes – I somehow remained resolute in my decision, despite my labor being packed with pain… and unexpected, episodic vomiting!  I may have grunted something like, “Noooo, $%*#@!” (Sorry Dr. Z and delivery room nurses!) But, yes, I stuck to my predetermined plan! (I’m still not sure how I withstood succumbing to the proffered pain relief.)  For all intents and purposes, I had a “natural” delivery experience, albeit from the confines of a hospital bed. With no complications and an overall positive experience, it’s clear that my commitment to hospital care was bolstered.

When fetal health & safety are in question delivery choices are simplified

A few years after Nico’s birth, we prepared for our beautiful Constantine. But unlike my first two, prenatal testing during this pregnancy indicated my youngest would likely be born with special needs. And with that determination, any consideration of choosing childbirth outside of a hospital was no longer my choice.

For me, while I thought briefly about other options for my first born, I definitely leaned heavily toward a hospital setting because it represented safety to me. To be honest, the “what-ifs” made my decision an easy one. Above all, I wanted access to immediate care if something didn’t go according to plan. Additionally, I liked the straightforwardness of connecting my OB/GYN and my soon-to-arrive sons’ pediatrician inside the same  hospital in which they each associated. It seemed like a seamless, functional meeting of the birthing minds that eased my emotions and simply just made sense.

As individuals, women should evaluate what works for them

As I say this, I realize these were my experiences. I appreciate other women’s outlooks and decisions in preparation for their big “birth-day” event. In fact, that’s what led me to examine different birth possibilities for those interested in exploring choices. Unlike me, maybe an at-home or birth center experience suits your expectations and complements your life-and-or-birthing style. Perhaps a focus on alternative methods to prepare for childbirth is your preferred approach – like pelvic floor physical therapy, that “through breathing techniques, mobility exercises and safe strengthening methods prepare the body for optimal birthing health and decrease chances of complications,” – according to Dr. Jennifer Santamaria of Femme Strong. Whatever you decide, I’m sure many will fall into each category and will explore a variety of pre-birth plans and techniques. Whatever the individual choices, my hope is that readers find this breakdown useful.

Homebirth, birth center or hospital?

There is no one right answer when it comes to deciding the best place to give birth. Some women prefer the hospital setting with its technology and medical professionals standing by. Others feel more at ease giving birth at home with a midwife or doula present. Then there are others who feel a choice nestled in between – at a birth center – may be best suited for them.

There are pros and cons to each setting. It’s important to consider one and all before selecting that special place where you will first come face-to-face with your precious inner occupant. As noted, barring your water breaking and finding yourself in an unplanned delivery locale, moms-to-be typically have three places to consider for their birthing experiences:

• At-home
• At a birth center
• At “the” hospital

At-home birth

Of course, an at-home birth is exactly what it sounds like — giving birth at your place of residence. Home births are becoming more popular in the United States, but they are still relatively rare. According to the National Institutes of Health, fewer than 1% of births in the US take place at home.

However, in 2020, due to the coronavirus pandemic, home births increased more than 20%, according to the CDC. Many women made the choice to abandon hospital births because of virus concerns and the risk of exposure. Hospitals also limited the number of attendees at births during the pandemic with most only allowing one person to be present. Each of these new realities succeeded in etching another check in the “pro” (vs. “con”) column for many soon-to-be moms.

Aside from Covid-19 concerns, for many women, the idea of birthing in their own space during such an intimate and intense experience is appealing and intuitively makes sense. Understandably, some women have sentimental reasons that influence a desire for birth at home.

Elements of an at-home birth

• Personnel and invited guests (if any)
• Equipment and supplies
• Environment

Personnel and invited guests (if any)

At-home births feature a couple of key, hands-on birth attendants: 

• Midwife
• Doula

Midwife

A certified professional midwife (CPM) is the most common type of care provider at a home birth. CPMs are trained and licensed to provide prenatal, birth and postpartum care for low-risk women and their babies. In some states, certified nurse midwives (CNMs) are also able to attend home births. CNMs are registered nurses who have completed a graduate-level program in midwifery. They are able to provide the same care as CPMs, as well as prescribe medications and order tests. In some areas, home births may also be attended by licensed direct-entry midwives (LDMs). LDMs complete a midwifery educational program but are not necessarily registered nurses.

Doula

A doula is a trained birthing professional who provides physical, emotional and informational support to a mother before, during and after childbirth. Doulas are not medical professionals and cannot provide medical care.

Invited guests

Is it important for you and your partner that close family members or friends be present for your child’s birth? If so, a home birth allows you more flexibility. Keep in mind, however, that your midwife may suggest limits to the number of attendees.

Equipment and supplies

An at-home birth requires less equipment than a hospital birth. However, there are several pieces of equipment and medical supplies that are useful, or essential, in a successful home birth delivery. Since the typical home does not warehouse standard hospital-grade supplies, these items will add to the list of pre-planned birthing necessities. The midwife or doula will bring all of the necessary supplies, including:

Equipment

• 

  A stethoscope and Doppler machine to listen to baby’s heart rate     

• A blood pressure cuff to check mom’s blood pressure periodically
• Pads and sheets to protect furniture and surfaces
• Birthing ball, chair or stool for different positions during labor
• Tub for water birth (not always used)

Supplies         

• Gloves
• Gauze and bandages
• Scissors
• Umbilical cord clamps to tie off the cord
• Umbilical cord  knife, scissors or blade to cut the cord
• Plastic sheet to catch the baby
• Soft towels to warm and dry the baby
• Blanket for the mother and baby
• Perineal spray bottle and squirt bottle (to clean up after the birth)
• Mesh underwear (to help with perineal healing)

If you choose to have a home birth, you will need to provide a few things as well, including:

• A clean and comfortable place for the birth
• A bed or mattress for the birthing mother (a birth tub can also be used)
• Several large towels
• Pillows and blankets
• Snacks and drinks for the labor support team

Benefits of at-home births

A home birth has significant benefits. These include:

• Familiar and comfortable environment
• Ability to move around freely during labor
• Reduced medical intervention
• Lower chance of hospital-acquired infections
• Presence of doula or other support person or people
• Shorter labors
• Immediate skin-to-skin bonding and breastfeeding
• Fewer complications overall

Drawbacks of at-home births

Though there are many potential benefits of an at-home birth, there are also some drawbacks to be aware of. These include:

• Less access to pain relief options
• Potential hospital transfer in case of an emergency
• Increased risk of infection if environment not managed correctly
• Increased risk of complications for women with certain medical conditions
• Health insurance preclusions

A home birth is not for everyone. Check with your physician as you discuss your baby’s due date to determine if you are a good candidate for an at-home birth. It’s important to recognize that home births are not recommended for those in the following groups:

• Previous C-section moms
• Pregnancy with multiples
• Babies not positioned for a head-first delivery
• High-risk pregnancies

Clearly, at-home births have both advantages and disadvantages, and for many women it is not a safe option. It’s important to weigh these factors before making a decision about birth locations. For greater insight into at-home birthing, be sure to watch this remarkable video depicting one woman’s home birth experience.

 

Labor and delivery at a birth center

Many people consider birth centers to be a cross between at-home birthing and a hospital delivery. Birth centers are facilities staffed with midwives. Offering an alternative to hospitals, birth centers furnish a more home-like atmosphere than hospitals.

They provide some of the comforts of at-home births, such as the ability to move around during labor, use of a birthing tub or pool, the ability to control the room environment by dimming lights, adjusting noise levels and experiencing labor and birth in different positions. Birth centers are becoming more popular in the US, but they are still not as common as hospital births. According to the American Association of Birth Centers, less than 0.50% of births in the US take place at a birth center.

 

Birth center benefits

The benefits of a birth center delivery in contrast to a hospital birth include:

• Relaxed and home-like atmosphere
• Movement (walking, standing, kneeling, leaning, swaying, etc.) allowed during labor
• Lower rates of interventions, such as epidurals and forceps’ deliveries
• Encouragement of immediate skin-to-skin bonding and breastfeeding
• Shorter labors

Birth center drawbacks

The drawbacks of a birth-center delivery include:

• The need to transfer to a hospital if an emergency arises
• Potential restrictions on the use of medical insurance

The hospital birth

A hospital usually comes to mind when people think about the birth of a baby. About 99% of births in the US take place in a hospital setting – the most common birth locale in the country.

Hospital-birth benefits

• An alliance of medical professionals in instances of labor and delivery complications
• Access to pain relief options, such as epidurals
• Medical insurance acceptance and coverage

Hospital-birth drawbacks

• Increased interventions, like the use of epidurals and forceps during labor and delivery
• Longer labors
• Higher rates of cesarean sections
• Reduced ability to control immediate birth room environment

Birth location considerations

The following are important considerations whether deciding to give birth at home, at a birth center or at the hospital:

• Level of medical intervention 
• Number of people permitted attendance
• Environment offering the most comfort 
• Cost of chosen setting
• Preferences for postnatal care and breastfeeding support

Level of medical intervention

One of the biggest factors when deciding where to give birth is your preferred level of medical intervention. Hospitals offer the most medical assistance, followed by birth centers and then homebirths. If you want, or need, constant monitoring during labor, pain medication or other medical support, a hospital is likely the best setting for you. If you favor as little medical intervention as possible, a homebirth might be preferable.

Number of people permitted attendance

How many people will you want present at the birth?  Well, due to Covid and subsequent restrictions since early 2020, hospitals limited the number of birth attendees to a single participant – sometimes excluding a women’s request to allow a doula (or forcing a choice between her partner or her doula). Recently, as vaccinations have become the norm, hospital rules may be less restrictive in some locales. If guests are an important factor for your delivery, be sure to ask about invitee restrictions.

Generally, and as expected, hospitals have a team of medical professionals present, including doctors and nurses. At a birth center, your collaboration of medical professionals is smaller but will include a midwife. And at a home birth, moms-to-be usually engage a midwife and a doula. For some women, the ability to invite more loved ones to witness or assist with the birth makes at-home delivery optimal.

Environment offering the most comfort 

While hospitals offer the most medical intervention and sterile conditions, they can also be the most impersonal. Birth centers offer a more home-like atmosphere yet unfamiliar surroundings. Home births, of course, offer the most comfortable, intimate and personal setting.

Cost of chosen setting

The cost of your chosen surroundings may also be a factor. Hospitals rank the most expensive, followed by birth centers, while home births rank the least costly. However, the ability to use medical insurance to cover or offset the expense of childbirth is an important consideration. Home births and birth center deliveries are frequently not covered by insurance.

Preferences for postnatal care and breastfeeding support

 

At last, the moment arrives when your baby bundle is nestled in your arms! Postnatal care and breastfeeding support suddenly become top of mind. Voices of knowledge and experience become key during this first blush of motherhood. Instruction that your professional birthing partners offer at this time can help establish techniques that benefit both you and your infant for months (and years) to come.

 

While hospital-delivery nurses are well trained in assisting moms with breastfeeding their newborns, doulas are considered experts in the nursing department. In a hospital setting, the delivery nurse will assist new moms in lactation. Midwife and doula birthing professionals, who attend at-home births or oversee birth center deliveries, receive specialized training. They offer key suggestions as new moms begin their breastfeeding journeys. Increasingly, many women rely on doulas for new motherhood-related support, instruction and advice, no matter where they choose to give birth.

The wrap up

I hope you enjoyed reading this article. If it helped give you a little perspective or sparked a conversation with your partner about “Zero-BirthDay” venues, I’m grateful we met through my words. Keep the conversation going! Remember to consult a trusted medical professional with your questions early along your pregnancy odyssey. Before you know it the day will come when someone [new] gets to call you “Mom!”

Happy birthing!

[Please note: Childbirth and delivery options discussed in this article are meant to inspire discussion only and are not meant to dictate a particular decision. Individual research is important for those considering their birthing choices. Consultation with a medical professional is necessary to obtain detailed knowledge about labor and delivery.]

Choosing Your Ideal “Zero–BirthDay” Venue

Written by Maria Felicia Kelley
The North County Moms