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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:
List the most common birth environments.
Describe what each has to offer with regard to pain-relief options.
Provide a description of the various professionals who may (or may
not) be with you during labor and birth.
Provide an at-a-glance comparison between hospitals and birth centers.
Hospitals
Most women in the United States (approximately 98 percent) give birth in
a hospital. But all hospitals are not alike, and maternity units vary
greatly from hospital to hospital. In addition, the size of the hospital
and its maternity unit can impact the type of birth experience you
have.
Reasons You May Want to Have Your Baby in a Hospital
You want to be in a place where all or most medical pain-relief
options will be available to you.
You want to give birth in a setting that has equipment and staff
ready to deal with an unlikely emergency.
You feel more confident in a birth environment surrounded by a
variety of medical professionals.
You want a two-to four-day recovery period before returning home
with your new baby.
Larger hospitals typically offer more medical pain-management options
than are found in smaller (community) hospitals. Larger hospitals are
more likely to have an in-house, around-the-clock anesthesiology staff
readily available if you are in need of an epidural. Often, these
larger hospitals have anesthesiologists who are assigned specifically
to the maternity unit. This reduces the likelihood of delays for women
in need of pain relief that must be given by the anesthesiologist.
Smaller hospitals may not have as many medical pain-relief options and
may not offer epidurals twenty-four hours a day, seven days a week. If
they have a limited anesthesia staff, some smaller hospitals may not
offer epidurals at all. On the other hand, many of these small
hospitals, as a result of not having as much "high-tech" pain relief
to offer, often have staff and equipment that can successfully support
the mom who prefers to use fewer or no medications throughout labor and
birth. So, depending upon your own preferences, either of these
settings may be right for you. But, clearly, if you desire the
full-throttle pain relief of an epidural, you are more likely to find
this type of pain management taking place in larger hospitals with
busier maternity units.
Size of Hospital Maternity Unit and Their Epidural and Combined
Spinal-Epidural Rates:
In hospitals that deliver fifteen hundred or more babies per year,
69% of women use an epidural or a combined spinal-epidural.
In hospitals that deliver five hundred to fifteen hundred babies per
year, 50% of women use an epidural or a combined spinal-epidural.
In hospitals that deliver less than five hundred babies per year,
40% of women use an epidural or combined spinal-epidral.2
Hospitals of all sizes are increasingly responding to women's requests
for more pain-management options, including baths, showers, the use of
birth balls, and the promotion of movement and positioning during labor
and birth. More hospitals are encouraging, or at the very least
accepting, women's choice to use doulas (described in this chapter) as
their primary support people during their labor and birth.
Many hospitals throughout the country have made their birthing rooms
more appealing and homelike, with the goal of helping women feel
relaxed and comfortable in the unfamiliar and sometimes intimidating
surroundings of a clinical setting. Even with these changes, the
hospital stay (which, for most women, is their very first hospital
stay) can make you feel like, well, like you're in a hospital! Many
caregivers recommend you bring your own homelike objects of comfort
that will promote a sense of familiarity and relaxation in an otherwise
unfamiliar setting. You may want to bring your favorite pillow,
fragrance, photos, and a radio or CD player to listen to your favorite
music. If you feel more comfy in your own clothing, let the hospital
staff know you would like to wear your own threads instead of their
hospital gown.
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.3
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
You are committed to giving birth without pain-relief medications.
You do not feel relaxed in a medical setting and prefer a nonmedical
type of atmosphere.
You feel more confident in a birth setting surrounded by your family
and being cared for by staff (and equipment) that is geared toward
supporting a labor experience using coping strategies instead of
medical pain-relief strategies.
You may want to return home as soon as possible after giving birth.
Birth centers are often operated by midwives, or midwives and physicians
together. The prospect of giving birth in a birth center is usually
most appealing to women who want a birth environment where there will
be as few medical interventions (including pain-relief interventions)
as possible during labor and birth. The birth center is a good option
for women who do not want to have their baby in a hospital but also do
not want to give birth at home.
There are some in-hospital birth centers that provide a homey
family-centered birth environment; they are attached to the hospital or
are located on their campus. The in-hospital birth center is a distinct
facility, separate from the hospital's labor and delivery unit.
Typically, epidurals are not offered in these centers. Depending on
your preferences, this type of environment may also be a perfectly
suitable option for you. A birth center within a hospital, however, may
not operate in the same way an out-of-hospital birth center does, and
its care practices and staffing may be more like hospital care than
birth center care.
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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