Birth Centers 101

Birth Centers 101 1If you are pregnant, you are probably aware that you have three options when it comes to the location of your impending birth: a hospital, a birth center, or your home. Today we'll focus on the birth center option.

I had the distinct pleasure of interviewing Cynthia Flynn, the newly elected President of the American Association of Birth Centers (AABC), for this segment about birth centers. In addition to her presidency, Flynn is a a certified nurse-midwife, a PhD, and a professor in the College of Nursing at Seattle University. She also previously owned and operated Columbia Birth Center in Kenniwick, WA. Needless to say, she is very well-qualified to speak on this topic.

ME: What are the benefits of giving birth at a birth center?

  • Hospitals are essentially public places; you have no idea who is walking outside your door and you are attended by nurses that you don't know. In a birth center, you are likely to know everyone that is there, the care is *very* personalized, and typically your family is truly welcome to participate.
  • Birth centers have been shown to be at least as safe as hospital births (if not more so!) for low risk women because they do not do those things we know increase your risk of complications.
  • Birth centers are not for sick people, like hospitals are. Typically, they do not have the problems with infectious diseases that hospitals do. And birth centers do not separate you from your baby and they do help you breast feed right away.
  • If you have had a baby before and want to be able to go home with your baby so you can sleep in your own bed, that can usually be arranged in a birth center. For early discharge, the midwife will check on you after you have had some sleep.
  • Birth centers offer a time and education intensive program of care. This begins with your first visit during your pregnancy and continues through your six week postpartum visit. At the birth center, the providers take time to answer your questions and educate you about your pregnancy and birth - not only what is happening physically but emotionally and socially as well.
  • A birth center is a maxi-home rather than a mini-hospital. In a birth center you can walk, talk, rock, dance, play, eat, cry: be all of who you are. You have the use of the whole facility - not just just your room. The birth center offers a safe, private oasis for birth. In the birth center you are a partner in your health care. You are educated to the risks and benefits of procedures/tests so that you can make informed decisions regarding your pregnancy and birth.

ME: What happens if an emergency occurs during labor & delivery?
FLYNN: Because your midwife knows you, and you are much less likely to be left alone during labor, most problems can be identified well before they become an emergency. Sometimes, the problem can be solved at the birth center; sometimes everyone agrees that it would be better to move to the hospital. The AABC National Standards for Birth Centers require birth centers to have approved transport plans that describe how the transport happens in a safe way. Occasionally, emergencies do happen, no matter where the labor occurs. In that case, staff are trained and drilled on emergency procedures to keep you safe until additional resources become available. Proximity to the hospital varies by birth center.

ME: Are there any statistics about newborn/mother mortality rates at hospitals compared to birth centers?
FLYNN: Yes, several scientific studies have been done, which show that birth centers are at least as safe as hospitals for low risk women. The landmark "National Birth Center Study" (NEJM, 12/28/89) is one such study.

ME: I'm afraid that the birth center will be unsanitary since it's more "homey." Is the environment sterile and how can I be sure that it is clean?
FLYNN: The AABC National Standards for Birth Centers require that birth centers maintain a safe home-like environment including compliance with federal, state and local regulations. Birth centers follow strict procedures to maintain sanitary conditions. Moms and babies who deliver at birth centers acquire far fewer infections after the birth than moms who deliver in the hospital. Some of the more famous "bugs" commonly found in annual hospital infection reports are yet to be found in birth centers at all.

ME: I'm afraid that the birth center will be "weird" or "earthy." Will I have to mediate or do any strange rituals?
FLYNN: The beauty of the birth center is that you can do your birth however you like--loud or quiet, awake or asleep (yes, women do sleep through labor!), still or active, concentrating or distracting yourself--you are in charge. If you want to meditate or do strange rituals, go for it! But it is not required.

ME: Will I still have to be hooked up to IV's and monitors at a birth center?
FLYNN: Birth centers do zero "routine" interventions. Any interventions will be discussed with you in advance, unless it is a true emergency where time is of the essence. Electronic fetal monitors are not even allowed. However, should you require IV medication, it is available in most birth centers. Often, the IV can be disconnected between medication administrations so you can move around more easily.

ME: Are "drugs" available at birth centers and, if so, what are my options?
FLYNN: All birth centers offer pain management for labor. Pain can be managed through walking, different positions, water therapy, massage, aromatherapy, and/or hypnobirthing. Some centers also offer pain medication, although if you want an epidural the best place for you to be is in the hospital. Check with your local birth center for more information.

ME: Does the birth center provide "toiletry" items for recovery like the hospital does? If not, what should I pack in my "birth bag?"
FLYNN: Most birth centers supply you with what you will need until you go home. Each center will advise you about what might be helpful to bring.
Birth Centers 101 2
You can find a birth center near you on the AABC website. You can also find answers to other questions you may have on the FAQ page. Hey, if you're really ambitious, you can even learn how to open a birth center of your own!

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3 comments on “Birth Centers 101”

  1. I would have loved to give birth at a birth center. Unfortunately the closest one is 2 hours away. Our city is not what you would call natural birth friendly (the epi rate is somewhere around 90%). This was really great to read though!

  2. Thanks for this post. I will be delivering my second child at a birth center in July, and I was quite nervous about this in the beginning. But, after meeting with the midwives and touring the center, (and reading up on birth centers!), I'm feeling much better about the whole issue. :)

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