Choosing the Best Birth Environment
Your choice of birth environment is the first decision you make that determines your pain-relief options. If you know you want to use modern medical pain-relief methods, you will need to select a birth environment that can accommodate these preferences. If you are leaning more toward a natural childbirth, but would like to keep your options open, you may want to be in a birth environment that offers not only nonmedical forms of pain relief but also allows accessibility to medical pain relief, should you change your mind during labor. If you are committed to using no medical pain-relief options and do not want to be in an environment where they are frequently used, you will need to choose a birth environment that has both the physical amenities and supportive caregivers you will need to successfully give birth free of any medications, using complementary and alternative pain-management techniques.
The staff of caregivers available to you during labor and birth can also directly impact your pain-relief options. For instance, if you think you prefer to use an epidural but are in a hospital where the only anesthesiologist is on another unit at the time when you are in need of pain relief, this can significantly impact your birth experience. Conversely, if you prefer to delay or avoid the use of medications, a busy hospital with a high percentage of epidural usage may not be the ideal environment for you to achieve this goal.
Pharmacologic methods (medications) should never replace personal attention and tender loving care of the woman in labor.1
Your birth environment and the people caring for you during your labor and delivery can dramatically impact how you will perceive your childbirth experience. By choosing the type of birth environment best for you, you are more likely to feel relaxed and comfortable when you arrive and throughout the rest of your labor and birth. If you are giving birth in the setting you desire, surrounded by people who are able to meet your needs, including your pain-management needs, you are more likely to have a satisfying “birth day.”
In this chapter we:
Reasons You May Want to Have Your Baby in a Hospital
Size of Hospital Maternity Unit and Their Epidural and Combined Spinal-Epidural Rates:
Two more factors may also determine where you ultimately give birth: your insurance coverage, which may or may not cover your care at your preferred hospital, and your obstetrician’s hospital affiliation. The hospital in which your obste- trician or midwife works will be the hospital where you will have your baby. If you like your obstetrician or midwife, but do not like the hospital with which he or she is affiliated, you may find you will need to switch to a doctor or midwife who works in the hospital where you want to have your baby.
Are Women Who Have Their Babies in Hospitals Satisfied with Their Experience?
According to a survey of sixteen hundred women across the country:
Ninety-six percent said they were satisfied with the health care they received.
Ninety-four percent felt they were treated with kindness and understanding.
Eighty-seven percent said they were free to make their own decisions.
The Birth Center
Birth centers grew popular in the 1970s as an alternative to the hospital birth experience. Birth centers may also be called alternative birth centers (ABCs) or childbearing centers. According to the National Association of Childbearing Centers, “birth centers are guided by principles of prevention, sensitivity, safety, appropriate medical intervention, and cost effectiveness.”4 Birth centers, unlike hospitals, do not exist in many communities across the country and, depending on where you live, may not be an option available to you.
Reasons You May Want to Have Your Baby in a Birth Center
If you choose to have your baby in a birth center, a certified nurse-midwife (CNM) will most likely be your primary caregiver. Although in birth centers midwives and obstetricians work together, it is the midwife who will likely attend to the birth of your baby, unless the obstetrician is needed due to a complication. Your health care provider must determine that you are healthy a woman with a low-risk pregnancy in order for you to give birth to your baby in a birth center. Birth centers provide care to women throughout their pregnancy, labor and birth, and postpartum.
The birth center itself is characterized by a homelike atmosphere that is less high tech in appearance than a typical hospital maternity unit. If you are laboring in a birth center and at some point need emergency medical intervention, you will be transferred to a hospital.
Around 15 percent of women who begin their labor in a birth center need to transfer to a hospital. Of these women, only 2 percent transfer due to an emergency. The remainder are transported to the hospital primarily due to slow progress or because the mom requests anesthesia.
Birth centers promote a relaxed, privte, nonclinical environment in which a variety of nonmedical pain-mainagement approached can be accommodated. Birth centers do not offer epidurals, and they ususally (although not always) do not offer narcotic injections. Birth centers are ot equipped to perform cesarean section deliveries. In fact, the cesarian section rate for women who began their labor in birth centers is around 4 percent.
About the Article
Excerpted from Easy Labor by William Camann, M.D., and Kathryn J. Alexander, M.A.. Excerpted by permission of Ballantine Books, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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