Interview Ques 4, 5 and 6 

4 & 5

Pros (What are the advantages to this method/technique? What are its best features? Who is it best suited to? What are the limitations of this method/technique?  Who is this method/technique not suited for?  and

Cons: What kinds of problems might one encounter with this method/technique? In what cases are additional help or intervention needed? Etc.)

Hospital: Hospital care by an obstetrician is the best (usually only) choice for childbearing women who have serious medical problems or complications of pregnancy. This includes multiple gestations, fetal abnormalities, premature labor, abnormal bleeding, etc. However, having a planned hospital labor doesn’t mean that you can’t benefit from the supportive services of a midwife during the pregnancy and professional labor support by either a midwife or a ‘doula’.

Con: The down side of elective obstetrical care in a hospital is the greatly increased rate of medical interventions. According to the “Listening to Mothers” survey by the Maternity Center Association of NYC in 2002 (Google on title to read), every women laboring in a hospital was subjected to an average of 7 medical or surgical interventions. This would include induction of labor or speeding up of labor with synthetic hormones, being required to stay in bed due to IV tubes, electronic fetal monitoring leads, etc., and surgical interventions such as use of forceps, vacuum extraction or Cesarean section.

Hospital-based Midwifery: In areas where midwifery care in hospitals or hospital birth centers is available, it is a good option for women who do not feel comfortable with home-based or independent birth centers. Certified nurse midwives (CNMs) provide care in conjunction with an obstetrician and should the mother need or want more medical intervention, the obstetrician can authorize the CNM to provide labor stimulating drugs, pain medication or order an epidural.

Con: Hospital-based nurse midwives are still providing care in a medical system, so they are not usually able to provide the same hands-off, laid back time frame as community-based midwives.  

Community-based Midwifery:    

The only reliable circumstance that permits a woman to have her labor managed physiologically is home-based care with a professional midwife. The outcome statistics for both mother and baby are excellent (the rate of interventions is far less than hospital-based obstetrics with perinatal mortality rate is equal or better (see citation below). There is privacy, no time pressure, women can walk around their house, yard, even neighborhood, eat and drink and use a non-drug variety of strategies to manage the pain of labor. That’s the good news.

Con: The bad news is that laboring at home does not allow for the use of pain meds or epidural anesthesia. However, it is OK to change one’s mind and transfer to hospital care anytime a mother decides that she doesn’t want to continue with an unmedicated labor.  The other aspect of home-based birth services is that if the labor doesn’t progress on its own or there is any kind of emergency, you will have to transfer to the hospital either by your own care or in an emergency, an ambulance. This is very rare but none the less real limitation associated with community-based midwifery care.

 BMJ  2005;330:1416 (18 June), doi:10.1136/bmj.330.7505.1416 “Outcomes of planned home births with certified professional midwives: large prospective study in North America Kenneth C Johnson, senior epidemiologist1, Betty-Anne Daviss, project manager)

6) What exactly is a Birthing Center?  What is different about this process if one birth’s in a BIRTHING CENTER rather than at home?

The words “birth center” can be used to describe very different circumstances. Many hospitals now call their labor and delivery unit a “Birthing Center”. However, except for very rare exceptions, the policies will still be obstetrical, which is to say, medical interventions will be used very liberally. Don’t be fooled.

The kind of birth center that permit the midwives and physicians to use physiological management are known as “free-standing” or independent birth centers. The type of care is very similar to home-based midwifery except for whatever protocols are required by either their malpractice carriers or the state. For example, some state laws will not allow a patient to stay in an “outpatient” facility (the legal category) for longer than 23 hours and 59 minutes. That may mean getting discharged and driving around for an hour and then coming back to be admitted for a different 24 hours period.

Pro: The up side is that birth centers usually are specially designed for the purpose and have comfortable rooms with great big deep water tubs. The care is excellent and a lot of women find that their relative are “OK” with the idea of a birth center birth but would freak out if they were planning home-based care. In many instances, the midwives who own or run the birth center provide care in both places and so the care is very similar.

Con: The down side is that it isn’t your home, you can’t control your space and your activities like you would be able to at home. You may also find your self being transferred into the hospital simply because your time ran out.

7) Are there any common or occasional “criticisms” of this method/ technique/ practice that you have heard other types of practitioners make that you would like to respond to directly here?  If so, please list the criticism first – then your response.

NO

8) Are there any other pieces of information, concerns, thoughts to consider, and/or criticisms that you have about any other specific birth method (or type of practitioner) that you feel women must know about and/or research further to be fully informed?

Helpful web sites ~ www.ScienceBasedBirth.com,  and   www.collegeofmidwives.org  // subdirectory “Safety Issues”

Visit the Maternity Association Center web site  <www.maternity-wise.org> to download HTML files for “What Every Pregnant Women Should Know About Cesarean Section” and “Listening to Mothers” Survey

Or click on the MCA links directly from the list below:


What pregnant women want to know:
  Hot Topics and Downloads:
  Routine Episiotomy Harms Mothers
  Cesarean Section Booklet
Maternity Center Association's cesarean section booklet measures the risks of cesarean birth vs vaginal birth. The accompanying chart "Cesarean Birth and Vaginal Birth: How do the risks compare?" complimentary with purchase. Click here to access the booklet.

Concerns About Early Epidurals:
Maternity Center Association responds to NEJM study on the effect of labor pain medication timing on c-section:
 

Order from the Maternity Center Association Bookstore:
 

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