Thursday, November 12, 2009

Home Birth vs. Birth Center

Last night Ren and I were chatting a little about hospital vs. home birth vs. birth center.  We were wondering if a birth center was a bit better than birthing at home but meant we didn't have to birth in a hospital either.

Rixa at Stand and Deliver wrote a post in response to a woman's query regarding the possibility of a birth center being built right across the street from a hospital. I liked her response so I'm reposting it below:

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 (her 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).
So, is a Birth Center the best of both worlds? Rixa argues no, and her blogpost addresses many of the issues that Ren and I brought up. From a previous post she wrote this:

Freestanding Birth Centers offer no technological or pharmacological advantages over home births. Midwives in both settings carry nearly identical equipment. It might vary slightly from midwife to midwife, of course, but there is no additional technology available in FSBC's compared to midwife-attended home births. In both settings, women will likely have access to:
- anti-hemorrhagic treatments and equipment (ranging from herbal tinctures to Pitocin, Methergine, Cytotec, IVs to replace fluid loss and/or stablize in case of transport)
- maternal and neonatal resuscitation equipment and skills (bag & masks, oxygen tanks, suctioning equipment, possibly meds & intubation supplies)
- suturing equipment and local anesthetic
- fetoscopes/dopplers for listening to baby's heart beat during labor
- other equipment for monitoring vital signs (BP cuff, stethoscope, thermometer, etc)

Women in both settings will need to transfer to a hospital for interventions such as:
- operative deliveries (vacuum extraction, forceps, cesarean section)
- analgesia (except in rare cases where some birth centers supply IM narcotics)
- anesthesia (spinal, epidural, etc)
- continuous Electronic Fetal Monitoring (external or internal)
- blood banks if a transfusion is needed

There are valid reasons to go with a Birth Center instead of a home birth, which she touched on above... for instance I wouldn't want to give birth in my apartment building if that were my pregnancy situation. Also, you may not want to rent your own birthing tub or worry about covering your bed or floor with plastic. Of course if you decided to go with a birth center instead of a hospital or at home you'd have to make sure you do your research well, just as you would when picking a hospital, OB, or midwife, because Birth Centers have their own policies just like hospitals do. You may not agree with their philosophies or rules. Its a lot to think about!


I'd also like to point out that we are very lucky and should be thankful that we even have the opportunity to choose our birth setting.  Many poor women do not have the luxury of learning their options or giving birth in an ideal setting. Many women end up having un-wanted home births in a home that is messy, loud, crowded, stressful and not at all cozy because they cannot afford medical care or cannot arrange travel to a hospital. Many give birth in a hospital where they have to go along with whatever the doctors want instead of in a comfortable setting such as a birth center where they are fully supported.

I think we're all wishing for a middle ground, but you really have to choose whats best for you. I really liked this comment posted on Rixa's above-mentioned post:
And speaking as someone recently enlightened and trying to "deprogram" and trust birth, if I were planning where to give birth, I wouldn't consider a homebirth, because I'm just not mentally ready yet. And if a mom who didn't trust birth and trust herself fully was guilted into a homebirth, that could be just as impeding as the "discomforts" of a hospital or FSBC for a woman on the other side.

This is getting long, but I'd also like to note that there is such a thing as an in-hospital birth center.  Sometimes these will have different policies regarding drugs and interventions than the L&D ward since it is in a separate part of the hospital, and may have comfy beds, tubs and showers, and so on.

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