Choosing a birthing location

You have a choice about where to have your baby. This decision is often closely tied to your choice of a health care provider and where he or she has practicing privileges. Most women in the United States — around 99 percent — have their babies in a hospital. Others choose to give birth at a birthing center or in their own home.

Hospital

Today, hospitals treat childbirth less like a medical procedure and more as a natural process. Many hospitals offer a relaxed setting in which to have your baby, with options such as:

• Birthing rooms. These are suites with a homelike decor, and sometimes a bath, where you can labor and deliver. The father or other labor partner can be an active part of the birthing team. In some cases, you may be able to recover in the same room after having your baby.

• Rooming-in. In this arrangement, the baby stays with you almost all of the time instead of being taken to the nursery. An experienced nurse is available to help you get used to feeding and caring for the baby. Other family members are encouraged to take part in the baby's care.

• Nursery. If you choose to have your baby taken to the nursery, you can still see him or her whenever you want. Having the hospital staff care for your baby for a few hours each day can give you some much-needed rest before you go home.

• Family-centered maternity care. This option combines the advantages of rooming-in and the nursery. A single nurse is assigned to both you and the baby. During the day, the nurse cares for you and the baby at the same time and can teach you how to care for a newborn. At night, the nurse can take your baby to the nursery if you wish.

If you have a vaginal delivery in a hospital, you'll probably stay for 48 hours. That's the time health insurers are required to cover in most states. If you have a Caesarean birth, you may stay up to four or five days. Health insurers are required to cover 96 hours for a post-Caesarean stay.

Possible advantages of delivering in a hospital:

• It provides the people, equipment and blood supplies needed in case of an emergency.

• Pain management options are available if you want them.

• Fetal monitoring is offered to help ensure your baby's safety.

Possible down sides of delivering in a hospital:

• You may have more medical interventions than you want — such as fetal monitoring or episiotomy — and more than you would in a birthing center or at home. However, most of these interventions are for your benefit.

• You may at times be separated from your baby.

Before your due date, you may wish to find out about the kind of maternity services your hospital offers and the flexibility of its policies.

Birthing center

Birthing centers can be free-standing facilities or part of a hospital. The goal of a birthing center is to separate routine pregnancy, labor and delivery care from the more intensive care required for high-risk pregnancies and births. In this way, birthing centers can reduce their costs because of the diminished need for personnel and equipment. They also strive to provide a natural birthing experience and avoid overuse of medical intervention.

Most birthing centers are run by certified nurse-midwives or teams of obstetrical health care providers. Staff often includes an ob-gyn doctor available for consultation and referral of at-risk pregnancies. Birthing centers try to be as much like home as possible.

Possible advantages of delivering in a birthing center:

• You labor and deliver in the same room. Your whole family is invited to be with you, including your children.

• You may be offered amenities such as a whirlpool tub, plenty of room to walk about, and the opportunity to eat and drink as you wish.

• You are encouraged to have input in your delivery.

• You usually go home sooner than if you were in a hospital, although postpartum care is available through office or home visits.

Possible disadvantages of delivering in a birthing center:

• Though many birthing centers have the equipment necessary to initiate an emergency response, if complications arise, you'll likely be transferred to a hospital, and that takes time. If you're considering a birthing center, find out its emergency management policies. Look into whether your midwife or doctor will be able to accompany you to a different facility.

• Your insurance may not cover delivery at a birthing center. Call and check.

• Your opportunity to use a birthing center may be limited. Most states have only a few accredited birthing centers, and some states have none. Still, close to 10,000 women in the United States had their babies at birthing centers in 2001.

Home

Just over 23,000 women had their babies at home in 2001. This trend has been fairly stable among American women, but still remains somewhat controversial. Midwives are almost always the health care providers for home deliveries. You usually rely on your own methods for coping with pain.

Possible advantages of delivering at home:

• You're in a comfortable, familiar environment.

• Anyone you wish can be involved with the delivery.

• Financial costs are kept to a minimum.

Possible disadvantages of delivering at home include:

• If you need medical intervention, you'll have to be moved to a hospital. A review of a number of studies comparing home-like settings for labor and delivery with hospital settings showed that substantial numbers of women — ranging from 19 percent to 67 percent — who started out in home-like settings transferred to standard care before or during labor because they were no longer appropriate for a home-like delivery.

• If you haven't received proper prenatal care, emergency care may be more difficult.

One of the interesting findings of these studies is that the atmosphere and decor of the birthing locations were less important than the quality of support provided by the health care provider throughout the birthing process. Whereas too much focus on risk and technology on the part of the health care provider might lead to unnecessary medical intervention, excessive focus on normality might lead to a delay in recognizing complications and taking action. Although many births would be very safe at home, no one knows that until the birth is over. Selecting home delivery and then having a common complication may result in loss of life.

Pregnancy And Childbirth

Pregnancy And Childbirth

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