You're pregnant. Congrats! Next step: Where am I going to give birth? This is a decision you don't want to make lightly, as your environment and care provider can make a huge difference in birth outcomes for maternal satisfaction, pain medication use, and the necessity of routine interventions. To help you decide, we’re breaking down the main differences between birth centers and labor & delivery floors of hospitals (interested in a homebirth? That will be covered in another post). Start planning now -- the earlier you decide, the more likely you are able to be accepted into a practice that delivers where you want to give birth. (In NYC, some practices need you signed up by eight weeks of pregnancy! But don’t worry, there are others who will take late transfers, as well.)
Here’s the lowdown on finding the best spot to suit your needs for your little one’s big debut.
Birth Center: Typically a more home-like setting. Rooms provide a double bed, which a partner can easily fit into with mom, along with a Jacuzzi tub, which provides very effective pain relief. There is typically no restriction on the number of people you can have in the room, and there is no separation of mother and healthy baby after the birth. Geared toward women who wish to give birth without medication and who prefer lower use of routine medical interventions.
Labor & Delivery: Typically a more clinical setting. Rooms have a hospital bed which moves into a variety of positions to assist with birthing (ask about the squatting bar for pushing). There is usually a two-person limit in the room with mom. Some rooms may have showers and occasionally baths. Geared toward women who are higher-risk and women who want easier access to pain medications.
MONITORING YOUR BABY'S HEARTBEAT
Birth Center: A handheld monitor will be used intermittently to listen to the baby's heartbeat. Since it is wireless, it does not restrict movement and can be submerged in water. It is recommended for low-risk women.
Labor & Delivery: Electronic Fetal Monitoring will be used. It involves two sensors on a mother's belly connected to the bedside monitor by about six feet of cord. Wireless is very occasionally available in some hospitals. The American College of Obstetricians & Gynecologists (ACOG) state that low-risk women should be monitored intermittently (20 minutes of monitoring per hour), but many hospitals prefer to do it continuously. Risks to continuous monitoring for low-risk women include increased cesareans. Limits freedom of movement which can increase pain. Women can be monitored on the birth ball, standing up, laying on their side, and in other positions, but a mother typically needs to ask the nurse or doctor to try to different positions, as many practitioners prefer a mother to be laying on her back for this.
EATING & DRINKING
Birth Center: Typically women in labor are allowed to eat and drink as they please. I.V.'s are not required unless a woman is dehydrated or requires some type of medication.
Labor & Delivery: Typically women in labor are not allowed to eat and drink, and continuous I.V. fluid is fairly standard. These policies are different depending on the hospital, with some allowing clear liquids like broth and popsicles and others allowing nothing at all. We also find that many practitioners will allow their patients to eat and drink, even if hospital policy technically doesn't, so be sure to ask your care provider.
PAIN MEDICATION CONSIDERATIONS
Birth Center: Birth centers are for low-risk women who prefer to give birth without an epidural. Freedom of movement and non-pharmacological pain-management methods (massage, acupressure, hydrotherapy, visualization, etc.) will be offered and encouraged. I.V. medications may be available. If you ultimately need an epidural, cesarean section or any other medical technology, you will be transferred to labor & delivery. All midwives who deliver in the birthing centers will work with a backup OB who will take care of you if your delivery becomes more medical.
Labor & Delivery: Epidurals are fully available and widely used and offered. This is great for women who know they want to have an epidural. If you are on the fence or know you don't want one, be prepared to tell the hospital staff not to offer the epidural, and that you will ask for it, if you need it.
CESAREAN BIRTH RATE
Birth Center: Only low-risk women will be accepted. Of these low-risk women, there is about a six percent overall cesarean birth rate. See the recent National Birth Center Study II of over 15,000 women here.
Labor & Delivery: Best-suited to high-risk women. Hospital cesarean birth rates in the NYC area range from 20 to 45 percent. Be sure to ask your doctor or midwife about their cesarean birth rate to help you make a decision about care provider; the provider's rate matters much more than the hospital's rate.
The bottom line? Each environment has its benefits. We'll give you the classic childbirth-ed example: When you are hungry for pizza, would you ever go to a Chinese restaurant? Do you want to have the option of laboring in a big tub of warm water? Then you need to pick a birth center or a hospital that provides a tub. Do you want to have an epidural available when you arrive? Then you must pick hospital with labor & delivery. Try to select the best environment and best care provider for your needs and desires, and then step back and let your birth unfold.
Learn more about Birth Day Presence.
Photo from here.