Think | Choosing a Place of Birth

The largest study of its kind has found that for low-risk women, giving birth at home is as safe as doing so in hospital with a midwife.

Research from the Netherlands - which has a high rate of home births - found no difference in death rates of either mothers or babies in 530,000 births.

Home births have long been debated amid concerns about their safety.

to read more - http://news.bbc.co.uk/1/hi/health/7998417.stm

Take a deep breath in. Close your eyes. Sit quietly and imagine that you are in labour. At last your journey on the long road of pregnancy is drawing to a close and your labour has begun. Draw a picture in your mind of your ideal labour and birth. Think of who you would like to be with you. The room you are in feels familiar and safe. The light is gentle, the room is quiet. You are supported in your birthing space. There are no interruptions, no loud noises, no unwelcome visitors, this is your space. You will need time to wander through your labour to meet your baby. You will have this time and the people you have chosen will support you on your journey. It feels good to be held by these hands that know this road that you are traveling. It is encouraging, supportive and empowering.

This is homebirth.

This is you and your unborn baby traveling together to the elusive place that is birth. You need to relax into your labour and feel uninhibited enough to go to the birth place. You do not know the way to go, but your body and your baby do. It is an involuntary process that your uterus and baby map out together. Your only work is to relax and let this process unfold. You are able to do so here without interference or external stresses being placed on you. At various times you doubt yourself and feel that you are slipping, but the people that you have chosen carefully to support you, encourage you to regain your balance. They trust in your body’s ability to give birth and so you trust your body. This is an ancient process that has worked for centuries. Now too your body will work.

You have chosen your environment carefully, you do not want to be disturbed or rushed or distracted. By making this careful choice, you have given yourself the gift of space. This allows your body to work at its own unhurried rhythm and pace and gives you time to discover the strength that lies hidden within yourself that you will need to birth your baby.

You are creating your birth story and it will be different from any other. As unique as a thumbprint. This is your story, one that you will recount many times here after. Each woman’s dream childbirth is different, and so each homebirth story is different. It is the role of the midwife to help each dream come true, within the parameters set by the baby’s unique journey into the world. The midwife you have chosen is your guide, mentor, educator, and a professional dedicated to the most modern techniques to guard the safety of you and your baby. For women with low-risk pregnancies, homebirth with a qualified midwife is as safe as hospital birth. In fact, by reducing stress and elevating comfort women that choose to homebirth generally require fewer interventions and report greater satisfaction.
If you are interested in birthing at home with a midwife, click here to find a midwife in your area.

What are the main types of places of birth? What are my options?

What is it like to give birth in a hospital?

What is it like to give birth in an out-of-hospital (or “freestanding”) birth center?

What is it like to give birth in my own home?

How do these options compare to a “birth center” in a hospital?

What are the main types of places of birth? What are my options?

There are several types of places of birth, or birth settings, in South Africa hospitals, out-of-hospital birth centers, and your own home. In addition, it is important to understand the meaning of a “birth center” in a hospital. This page provides information about these places of birth. As you become more aware of your needs, values, and preferences, you will be able to choose a place of birth that is suits you.

The great majority of childbearing women are well and healthy, and can consider the full range of places of birth. If you have a serious medical condition or are at high risk for developing such a condition, you will probably want to plan to give birth in a hospital and be in the care of a doctor who is board-certified in obstetrics. Maternity caregivers understand and can advise you about situations that may call for more specialized care.

What is it like to give birth in a hospital?
In South Africa, the hospital is the most common site for birth. Care in hospital is usually led by physicians, and often reflects what has been called the medical model of care. This can mean that hospital maternity care may:

• give more emphasis to standardized than individualized care
• use various interventions routinely, whether or not birthing women have a clear need
• rely more on the facility’s technology than your body’s physiology
• not have staff available to provide continuous physical, emotional, and informational support during your labour and birth (many women may be in labour at the same time, and the staff’s attention is often drawn to managing technology).

There are several advantages of hospital birth:

• although most childbearing women are well and healthy, a hospital is best equipped to diagnose and treat women and newborns with serious complications or high risk of developing such complications

• if you plan to use a hospital, you will never need to transfer to another facility before, during, or after labour (apart from the rare situation of needing highly specialized care that may not be available in your hospital)
• in the rare instance of an emergency requiring hospital care, you are in the facility and needed personnel may be immediately available
• you may wish to have some interventions, such as pain medications, that may not be available in non-hospital settings.

Not all hospitals are alike. They can vary widely in a number of ways, including:

• rates of using tests, procedures, and drugs (for example, rates of inducing or bringing on labor artificially, artificially rupturing membranes, cutting episiotomies, performing caesareans, and pulling babies out with a vacuum extractor or forceps)
• policies and restrictions (for example: limitations on who can be with you, or requirement that you use electronic fetal monitoring after admission)
• whether or not midwifery care is available
• whether or not they are a “Level 3″ hospital with specialized care for very sick newborns
• whether or not emergency and anesthesia services are available at night and weekends.

Because of this variation, if you choose to give birth in a hospital, you should choose the one that best meets your needs from among those available to you. Tips and Tools for Choosing Your Place of Birth encourages you to visit various settings and offers some possible questions to ask when learning about hospitals and other birth settings.

What is it like to give birth in an out-of-hospital (or “freestanding”) birth center?
Freestanding birth centers are not available in all areas of South Africa, and far more women give birth in hospitals. Nonetheless, a freestanding birth center can be a good choice for women who want more personalized care than in hospitals, yet may not feel comfortable with home birth.

In contrast to the institutional environment in hospitals, most freestanding birth centers have a homelike environment, and many are in fact located in converted homes. Care in birth centers is often provided by midwives and often reflects what has been called the midwifery model of care. This can mean that birth center care may:

• give more emphasis to individualized than standardized care
• provide care in response to your needs and preferences, and avoid the routine use of interventions and their side effects
• rely more on your body’s physiology than the facility’s technology
• have staff available to give you continuous physical, emotional, and informational support during your labor and birth, and to support your companions as well (you may be the only one there in labour, and the staff is less likely to be focused on managing technology than in hospitals).

There are several drawbacks of birth in out-of-hospital birth centers:

• although most women accepted for birth center care do give birth in this setting, a proportion switch to hospital care before, during, or after labour (as a precaution, due to complications, or because they change their plans); a flexible attitude can be helpful
• although freestanding birth centers are situated near hospitals and have established emergency care plans, in the rare instance of an emergency requiring hospital care, the hospital facility and personnel are not immediately available
• although freestanding birth centers offer many “low-tech/high-touch” forms of care, you may wish to have some types of care (such as pain medications) that are not available in freestanding birth centers.

Not all out-of-hospital birth centers are alike. They can vary in a number of ways, including:

• rates of using tests and procedures (for example, rates of cutting episiotomies or transporting to a hospital for a caesarean)
• policies and restrictions (for example: situations that would require that you or your baby to shift to hospital care)
• characteristics of back-up hospital and physicians.

Because of this variation, if you choose to give birth in a freestanding birth center, you should choose the one that best meets your needs from among those available to you (there may not be a choice in your area). Tips and Tools for Choosing Your Place of Birth encourages you to visit various settings and offers some possible questions to ask when learning about freestanding birth centers and other birth settings.

What is it like to give birth in my own home?
Hospitals are the most common birth setting in South Africa, and a much smaller proportion of women give birth at home.

Home birth shares many qualities of birth in freestanding birth centers. In addition, it is your own familiar and private space, and you do not have to relocate during labour or after giving birth. Most home birth caregivers are midwives offering what has been called the midwifery model of care. This means that birth in your own home may:

• be highly tailored to your needs and preferences
• avoid the routine use of interventions and their side effects
• rely more on your body’s physiology than technology
• enable you to receive continuous physical, emotional, and informational support during your labour and birth, and offer important support to others present as well (you will be the only one in labour, and your caregivers are not likely to be focused on managing technology)

There are several drawbacks of home birth:

• a proportion of women planning home birth switch to hospital care before, during, or after labour (as a precaution, due to complications, or because they change their plans); a flexible attitude can be helpful
• although you would want to have back-up medical and hospital arrangements in place for any needed transport, in the rare instance of an emergency requiring hospital care, the facility and personnel are not immediately available
• you may wish to have some types of care, such as pain medications, that are not available in home settings.

Not all providers of home birth services are alike. They can vary in a number of ways, including:

• education, experience, and credentials
• style of practice and rates of using tests and procedures (for example, rates of cutting episiotomies, inductions or transporting to a hospital for a caesarean)
• policies and restrictions (for example: situations that would require that you or your baby to shift to hospital care)
• location and other characteristics of back-up hospital and physicians.

Because of this variation, if you choose to give birth at home, you should choose the home birth caregiver that best meets your needs from among those available to you. Tips and Tools for Choosing Your Place of Birth encourages you to consider various settings and offers some possible questions to ask when learning about providers of home birth services and other birth settings.

How do these options compare to a “birth center” in a hospital?
Many hospitals realize the demand for benefits of a birth center or a homelike environment and offer birth centers within the hospital. This may be a good choice for a woman who appreciates the homelike individualized care of a birth center, and wants emergency care to be available in the same building.

A word of caution: a birth center within a hospital does not necessarily offer the same type of care as a freestanding birth center. Many hospitals call their regular labour and delivery area their “Birth Center” to make it sound appealing. Although this area in a hospital may look more homely than the rest of the hospital (for example, with rocking chairs and wallpaper), patterns of care may more closely resemble routine hospital practices than care in freestanding birth centers.

If you are considering a hospital birth center, you should learn about the type of care that is offered there. It is important to clarify how, if at all, a hospital’s birth center policies and practices differ from regular hospital care, including:

• availability of midwives and of continuous support during labour
• availability of a choice of methods for pain relief
• restrictions: for example on who may be with you, whether you are allowed to eat or drink, and whether you are free to move about
• routine care: for example, electronic fetal monitoring or newborn procedures.

In short, does the staff have a commitment to the birth center concept, or is the name “birth center” used primarily for marketing purposes?

Adapted from www.childbirthconnection.org to suit South African context

July 2007