Childbirth Options Explored
Research published in the Journal of Perinatal Education shows that mothers and children benefit from informed decision-making, yet the authors of the study wrote that the "paternalistic model of care is still routine within today's health-care decision making."
These factors make it important for women to consider their expectations for childbirth and to let those expectations guide their decisions. They should fully consider who will provide care and where that care will take place.
Who Provides Care?
Women have different options for caregivers, who often collaborate on a course of care. Health care practices can employ both obstetricians and midwives, and doulas and other specialists can be added to the team as well. Finding out what each care provider considers "routine practices" is the first step women can take to determine if a caregiver is a good fit. Some questions to consider include anticipated medical intervention, potential high-risks aspects of the birth, and the location of the birth.
When building your caregiving team, it's important to understand the role each health care professional will play and gauge the provider's style of care, including her or his willingness to discuss and follow through with your wishes as the patient.
Certified nurse-midwives(CNMs)/Certified midwives (CMs)
- Attend about 12 percent of vaginal births and 8 percent of all births in the United States.
- Can work in any location. More than 94 percent of their deliveries take place in a hospital, but the rest occur at freestanding birth centers and in the home.
- Serve as primary care providers, prescribe medications, and order tests, but they cannot perform major surgery, such as C-section births.
Obstetricians or gynecologists:
- Are doctors who can perform surgery if it becomes necessary. In the United States, 32.2 percent of births end with a C-section.
- May work in a practice, independently, or for a hospital, and will have an MD or Doctor of Osteopathic Medicine (DO).
- Will often have hospital privileges and work in concert with labor and delivery nurses and anesthetists to coordinate and manage care before, during, and after childbirth.
- Assist in providing emotional support and comfort to mothers during labor.
- Cannot provide medical care, but serve as advocates for a mother's birth plan.
- Can reduce risk of C-section birth and complications.
Where Do Births Occur?
The three most popular options for women in the United States are hospitals, birthing centers, and home births. Frequently a mother's choice of caregivers and location are interdependent, as physicians may only practice at certain facilities. Moreover, the location may be determined by the mother's health. For example, premature labor may require hospitalization and the use of the neonatal intensive care unit (NICU) even if a mother planned to deliver at a birthing center.
Hospitals are the most common choice in the United States.
- As of 2012, only 1.36 percent of U.S. births occurred outside of hospitals — including .89 percent at home and .39 percent at birthing centers.
- If women have choices for their hospital birth, they might want to consider whether the facility has a NICU, a surgical suite in the labor wing, or equipment for a water birth.
Birthing centers focus all of their efforts on ensuring that birth meets the mother's expectations through a family-centered approach.
- They are a less-expensive option, which may help families save money.
- Research shows they produce a C-section birth rate that is much lower than hospitals. This is due in part to the fact that birthing centers practice a "wellness-based model of care" and because they typically only deliver low-risk pregnancies.
- Since this option is less likely to result in surgical interventions and avoids the inherent risks of home birth, many women decide that a birth center is the safest place to deliver.
Home births offer women a lower risk of contracting illnesses through the hospital; lower costs; and more personalization, autonomy, and privacy.
- Midwives are known for attending births. According to the American College of Nurse-Midwives, in 2014, "94.2% of CNM/CM-attended births occurred in hospitals, 3% occurred in freestanding birth centers, and 2.7% occurred in homes." They carry life-saving medications to ensure the safety of mothers and newborns.
- Home births are not recommended for high-risk deliveries, like pre-term labor (labor that occurs at less than 37 weeks), where the baby might need assistance. In these situations, having access to equipment and personnel that are able to provide life-saving interventions is essential.
- Among those planning home births between 2004 and 2009, according to The Midwives Alliance of North America Statistics Project, 89.1 percent gave birth at home. Of those transported to a hospital, most were transported for "failure to progress."
Although having a birth plan in place can be helpful, childbirth is not without risk or surprises, so preparation and flexibility are key to ensuring the safety and comfort of mothers and their newborns. Expectant mothers may want to spend time with care providers, even before pregnancy, to build a relationship and understand that person's unique style of care. Pay attention to attitude as much as to what they say to find a partner you can trust to be a key player in this important moment in your family's life story.
Please note that this post is for informational purposes only. Individuals should consult their health care professionals before following any of the information provided. Nursing@Georgetown does not endorse any organizations or websites contained in this post.
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