Childbirth Options, Explored

Isolated decision-making during child labor continues to put women at risk. A report from Obstetrics and Gynecology highlights data from 2000-2014 that describes a steady reduction of maternal mortality in most developed countries, with an outstanding exception: the United States. 

In addition to the many reasons cited by the CDC for why childbirth continues to be the sixth leading cause of death in America for women ages 20 to 34, miscommunication between women and their providers is perhaps the most preventable. Research published in the Journal of Perinatal Education shows that mothers and children benefit from shared decision-making informed by evidence-based practice. Yet the authors of the study cautioned that the “paternalistic model of care is still routine within today’s health-care decision making,” thus creating unrealistic notions around a woman’s labor and her postpartum experience. 

These factors make it important for expectant mothers to engage with their perinatal providers in a collaborative and transparent way, setting expectations and allowing those recommendations, rather than anecdotal hearsay or Hollywood portrayals to guide their decisions about delivery. Fully considering who will provide care and where that care will take place can dispel myths around impending motherhood, as women prepare to give birth to healthy newborns.

Who Provides Care?

Women have different options for caregivers, who often collaborate on a course of care. Health care practices can employ obstetricians, nurse-midwives, doulas and other specialists. 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 a patient.

Midwives:

  • Provide various services, depending on their certifications. Whether a certified nurse-midwife (CNM), a certified midwife (CM) or certified professional midwife (CPM), midwives provide care to women “during pregnancy, labor, birth, and the postpartum period.”
  • 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 happen in birth center and home settings.
  • Will often have hospital privileges similar to physicians, if they are CNM or CMs, meaning they work collaboratively with labor and delivery nurses and anesthetists to coordinate and manage care before, during, and after childbirth.
  • Serve as primary care providers, prescribe medications, and order tests once they attain credentialing, but they cannot perform major surgery, such as C-section births.
  • Cite reproductive care and primary care as main responsibilities in their full-time positions. Examples include “annual exams, writing prescriptions, basic nutrition counseling, parenting education, patient education, and reproductive health visits,” according to the website for American College of Nurse-Midwives (ACNM).
  • Have “improved primary health care services for women in rural and inner city areas and on Medicaid,” according to published reports

Obstetricians or gynecologists:

Doulas:

  • Assist in providing emotional support and comfort to mothers during labor.
  • Cannot offer medical care, but may advocate for a woman’s birth plan.
  • Can reduce risk of C-section birth and complications, and reduce the use of pitocin when present at birth.

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.

  • Although the rate of women choosing to give birth outside of the hospital setting has increased in recent years, only .89 percent of births are planned to occur at home or at a freestanding birth center, according to the New England Journal of Medicine.
  • 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 birthing centers 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, 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 ACNM, in 2014, “94.2 percent of CNM/CM-attended births occurred in hospitals, 3 percent occurred in freestanding birth centers, and 2.7 percent 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), because 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, 89.1 percent gave birth at home, according to The Midwives Alliance of North America Statistics Project. Of those transported to a hospital, most were transported for “failure to progress.”

Although having a birth plan is helpful, labor 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 provider’s unique style of care. 

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.