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What Now?
It is a question not enough of us ask. What now? You've read the statistics and the advice and you are starting
to wonder if you are doing everything you can to have a healthy delivery in the way which you want to. If you go
to a restaurant and don't like the menu or the service or you see throngs of people leaving and claiming it tastes
bad you'd likely turn right around and leave. But for one reason or another, the decision about where not to
birth rarely appears as easy to make as one about where not to eat.
That's OK. It can be overwhelming. You want the best. You want the safest.
Most likely, you have developed a relationship with your provider that you do not want to give up.
Read this birth story from a woman who decided to change providers and location of delivery 7 1/2 months into
her pregnancy. I have recently worked with several women who changed providers less than a month before
their due dates. They were so relieved and at peace with their decisions to follow their instincts, and felt so
proud to "stick up" for themselves and their babies. The lesson we learn from these women is to go towards
what makes you feel right and good about your upcoming birth.
You may have arrived at this page because your provider started to talk with you about planning an
induction or cesarean section and you are not sure what to do. There is one answer--pretend your car is
broken and you drove it to the shop and they told you that it needs a whole new transmission. What would you
do? Go get a second opinion! You can get one for yourself too! You are not broken, you do not need fixing.
You are a woman who is capable of birthing your child. Make sure you are making informed, educated
decisions and don't give that status away. Get a second opinon from a midwife or OB outside your current
provider's practice. Don't settle for less than you feeling 100% comfortable with the actions you are going to
take to birth your child. Click Here for a list of the most common reasons women are told they can't have the
birth they were expecting to have. It is written from a homebirth perspective but it applies to every pregnant
woman. There is research which talks about the benefits and risks associated with a particular issue and there
are birth stories from women who have already faced what you are facing.
Here is the information most expectant mothers and couples usually ask for that actually seems to make a
difference to them in this decision making process:
1. Most importantly--the connection and relationship with a provider (your OBGYN or Midwife) feels like a
defining factor in who you are as an expectant mother. We love and adore our providers when they're great. If
this is you, here's what you need to find out: will my provider deliver my child? Many of the larger practices
have the doctors sharing a schedule and they work "on call" on certain days or weeks of each month. If you go
into labor on a day when your doctor is not on call, another doctor will deliver you. I have worked with a lot of
couples who use these doctors and have yet to work with the doctor that the couple saw throughout pregnancy,
and often with one who the couple had not ever met. That said, the most important piece of information and
often the most surprising one to couples is that your doctor will not be there for your labor. The doctor on call
will know you are in labor and will be called to come in when it is time to push. Often, they will come in and watch
you in your first few pushes and then leave again until the nurses call them and tell them you are close to your
final few pushes. They will return and catch your baby, do any repair work that is needed and then leave. This
is not because they don't like you and don't want to spend time with you so don't take it personally! This is
simply the way that Obstetrics is practiced today by 99.99% of our local doctors. Which is why where you
deliver is so monumentally important. The nursing staff will be the driving force behind the medical
management of your labor and delivery. The Birthing statistics from each hospital much more accurately reflect
the work of the nurses and residents then of your individual provider! And this is also why I am so supportive of
the midwifery model of care which provides for continuity of care and location. Go visit one of our local birth
centers and see the difference. It is astounding--the time and care you will receive from a midwife in our area is
also dramatically different than what you get with an OB. It's not for everyone, but everyone should make the
decision to use a provider based on meeting both types! If you choose not to know what your choices are, you
are choosing not to have a choice.
2. You are a consumer with consumer rights! Just like at the restaurant you can turn around and leave.
Don't worry about making what feels like a last minute decision or middle of the road decision or what might
upset your current provider--this is one of your first acts of parenting. Just like you will advocate for your
child to have a safe environment to grow in, you can advocate to give your child a safe environment to be born
in. No one is saying that you can't use medications or be in a place that should you want them, you can't have
access to them. No one is saying that your provider is bad or cruel. The simple truth is that in Seattle the
options that used to exist for birthing no longer do--and many of the providers which at one time were happily
credentialed at 3 different hospitals only have the choice of one now.
3. If you are open to discussion, then here's how to have that discussion:
a. Call up a local doula and ask if she can take some time to talk to you about birthing outside the
hospital setting. What is a birth center birth like? What is a homebirth like?
b. Call up some local birth centers and talk with the midwives. Be honest--tell them you are thinking
hard about all of this and want to hear their thoughts. You would be surprised at how amazing an out of
hospital birth can be. It is safe and comfortable. You and your baby will be well cared for by
professionals who understand the process of birthing and can support you in a very complete, whole
woman way.
c. If you would like to stay at a hospital find a group that will allow you to develop a connection with the
provider who will be there when you birth. Dr. Richard Agress at The Polyclinic does this.
If you know other practices like his, please email me and I will post them).
d. Find a way to connect with moms who have birthed in a variety of ways and hear their birth stories!
You can do this online or by calling a local doula and asking her if she can set you up with two or
three moms who have recently birthed. Hearing what it is really like can have a huge impact.
4. Learn about the real difference between Out-of-hospital care compared to normative hospital
care.
The (U.S.) National Birth Center Study (Rooks and colleagues 1989, 1992a, 1992b, 1992c; Fullerton and
Severino 1992) of nearly 12,000 women receiving care in 84 out-of-hospital birth centers, is the largest and
most complete source of information about this type of care. As with many smaller studies, the national study
found that the birth center group experienced low rates of invasive procedures and restrictions, when compared
to similar women in hospitals. One woman in six transferred to hospital care after beginning labor, but just one
woman in 42 transferred to hospital care under emergency circumstances. No mothers died.
When compared with large studies of low-risk women in hospitals, the birth center group:
--was half as likely to have a cesarean section
--had a similar rate of death of babies after 20 weeks of pregnancy or in the first four weeks after birth.
The National Survey of Women's Health Centers, conducted in 1994, provides an opportunity to compare 37
non-hospital birth centers with 32 hospital-sponsored birth centers in the U.S. (Khoury and colleagues 1997).
Most hospital-sponsored centers were physically located in the hospital. Compared to the hospital-sponsored
centers, non-hospital centers were more likely to:
--be led by a midwife
--employ midwives and emphasize woman-provided care
--provide a broader range of services
--be accredited by the National Association of Childbearing Centers
--emphasize shared decision-making between women and caregivers
--emphasize women's empowerment and express a feminist ideology.
The non-hospital centers were less likely to view the center as a way to attract women to the sponsoring
organization and to aggressively market their services. This national survey did not examine specific maternity
practices and health outcomes.
Click Here to read more about where to birth from the evidence-based Maternity Center
Click Here for Statistics on the safety of homebirth and birth center births
Click Here for further discussion about how to evaluate and visit different birthing hospitals and centers
Is Homebirth Safe?
What Now?
It is a question not enough of us ask. What now? You've read the statistics and the advice and you are starting
to wonder if you are doing everything you can to have a healthy delivery in the way which you want to. If you go
to a restaurant and don't like the menu or the service or you see throngs of people leaving and claiming it tastes
bad you'd likely turn right around and leave. But for one reason or another, the decision about where not to
birth rarely appears as easy to make as one about where not to eat.
That's OK. It can be overwhelming. You want the best. You want the safest.
Most likely, you have developed a relationship with your provider that you do not want to give up.
Read this birth story from a woman who decided to change providers and location of delivery 7 1/2 months into
her pregnancy. I have recently worked with several women who changed providers less than a month before
their due dates. They were so relieved and at peace with their decisions to follow their instincts, and felt so
proud to "stick up" for themselves and their babies. The lesson we learn from these women is to go towards
what makes you feel right and good about your upcoming birth.
You may have arrived at this page because your provider started to talk with you about planning an
induction or cesarean section and you are not sure what to do. There is one answer--pretend your car is
broken and you drove it to the shop and they told you that it needs a whole new transmission. What would you
do? Go get a second opinion! You can get one for yourself too! You are not broken, you do not need fixing.
You are a woman who is capable of birthing your child. Make sure you are making informed, educated
decisions and don't give that status away. Get a second opinon from a midwife or OB outside your current
provider's practice. Don't settle for less than you feeling 100% comfortable with the actions you are going to
take to birth your child. Click Here for a list of the most common reasons women are told they can't have the
birth they were expecting to have. It is written from a homebirth perspective but it applies to every pregnant
woman. There is research which talks about the benefits and risks associated with a particular issue and there
are birth stories from women who have already faced what you are facing.
Here is the information most expectant mothers and couples usually ask for that actually seems to make a
difference to them in this decision making process:
1. Most importantly--the connection and relationship with a provider (your OBGYN or Midwife) feels like a
defining factor in who you are as an expectant mother. We love and adore our providers when they're great. If
this is you, here's what you need to find out: will my provider deliver my child? Many of the larger practices
have the doctors sharing a schedule and they work "on call" on certain days or weeks of each month. If you go
into labor on a day when your doctor is not on call, another doctor will deliver you. I have worked with a lot of
couples who use these doctors and have yet to work with the doctor that the couple saw throughout pregnancy,
and often with one who the couple had not ever met. That said, the most important piece of information and
often the most surprising one to couples is that your doctor will not be there for your labor. The doctor on call
will know you are in labor and will be called to come in when it is time to push. Often, they will come in and watch
you in your first few pushes and then leave again until the nurses call them and tell them you are close to your
final few pushes. They will return and catch your baby, do any repair work that is needed and then leave. This
is not because they don't like you and don't want to spend time with you so don't take it personally! This is
simply the way that Obstetrics is practiced today by 99.99% of our local doctors. Which is why where you
deliver is so monumentally important. The nursing staff will be the driving force behind the medical
management of your labor and delivery. The Birthing statistics from each hospital much more accurately reflect
the work of the nurses and residents then of your individual provider! And this is also why I am so supportive of
the midwifery model of care which provides for continuity of care and location. Go visit one of our local birth
centers and see the difference. It is astounding--the time and care you will receive from a midwife in our area is
also dramatically different than what you get with an OB. It's not for everyone, but everyone should make the
decision to use a provider based on meeting both types! If you choose not to know what your choices are, you
are choosing not to have a choice.
2. You are a consumer with consumer rights! Just like at the restaurant you can turn around and leave.
Don't worry about making what feels like a last minute decision or middle of the road decision or what might
upset your current provider--this is one of your first acts of parenting. Just like you will advocate for your
child to have a safe environment to grow in, you can advocate to give your child a safe environment to be born
in. No one is saying that you can't use medications or be in a place that should you want them, you can't have
access to them. No one is saying that your provider is bad or cruel. The simple truth is that in Seattle the
options that used to exist for birthing no longer do--and many of the providers which at one time were happily
credentialed at 3 different hospitals only have the choice of one now.
3. If you are open to discussion, then here's how to have that discussion:
a. Call up a local doula and ask if she can take some time to talk to you about birthing outside the
hospital setting. What is a birth center birth like? What is a homebirth like?
b. Call up some local birth centers and talk with the midwives. Be honest--tell them you are thinking
hard about all of this and want to hear their thoughts. You would be surprised at how amazing an out of
hospital birth can be. It is safe and comfortable. You and your baby will be well cared for by
professionals who understand the process of birthing and can support you in a very complete, whole
woman way.
c. If you would like to stay at a hospital find a group that will allow you to develop a connection with the
provider who will be there when you birth. Dr. Richard Agress at The Polyclinic does this.
If you know other practices like his, please email me and I will post them).
d. Find a way to connect with moms who have birthed in a variety of ways and hear their birth stories!
You can do this online or by calling a local doula and asking her if she can set you up with two or
three moms who have recently birthed. Hearing what it is really like can have a huge impact.
4. Learn about the real difference between Out-of-hospital care compared to normative hospital
care.
The (U.S.) National Birth Center Study (Rooks and colleagues 1989, 1992a, 1992b, 1992c; Fullerton and
Severino 1992) of nearly 12,000 women receiving care in 84 out-of-hospital birth centers, is the largest and
most complete source of information about this type of care. As with many smaller studies, the national study
found that the birth center group experienced low rates of invasive procedures and restrictions, when compared
to similar women in hospitals. One woman in six transferred to hospital care after beginning labor, but just one
woman in 42 transferred to hospital care under emergency circumstances. No mothers died.
When compared with large studies of low-risk women in hospitals, the birth center group:
--was half as likely to have a cesarean section
--had a similar rate of death of babies after 20 weeks of pregnancy or in the first four weeks after birth.
The National Survey of Women's Health Centers, conducted in 1994, provides an opportunity to compare 37
non-hospital birth centers with 32 hospital-sponsored birth centers in the U.S. (Khoury and colleagues 1997).
Most hospital-sponsored centers were physically located in the hospital. Compared to the hospital-sponsored
centers, non-hospital centers were more likely to:
--be led by a midwife
--employ midwives and emphasize woman-provided care
--provide a broader range of services
--be accredited by the National Association of Childbearing Centers
--emphasize shared decision-making between women and caregivers
--emphasize women's empowerment and express a feminist ideology.
The non-hospital centers were less likely to view the center as a way to attract women to the sponsoring
organization and to aggressively market their services. This national survey did not examine specific maternity
practices and health outcomes.
Click Here to read more about where to birth from the evidence-based Maternity Center
Click Here for Statistics on the safety of homebirth and birth center births
Click Here for further discussion about how to evaluate and visit different birthing hospitals and centers
Is Homebirth Safe?
