Thursday, January 31, 2013

Birth Center Birth...For Safety's Sake

Our practice name and description say it well- Integrated Women's Wellness. "We are an integrated, collaborative Physician-Midwife team, who bring together our individual knowledge and skill to create a beautifully blended model of care."

In our practice, I meet with every newly pregnant mom for her initial appointment. I love to be able to personally welcome every new patient. At this appointment we discuss the patient's medical history, discuss any relevant pregnancy concerns and precautions, obtain labs, and lastly, discuss the practice philosophy and options for care. Patients have the option of midwifery care, physician care, or a blend of both. Depending on their history and risk factors, many also have the option for hospital, birth center, or home birth.

For those who have never heard of or considered midwifery care or Out-Of-Hospital birth, sometimes this is a hard thing to comprehend. Wait a minute. 'Out-Of-Hospital?' Like, as in, have the baby NOT in the hospital? Birth at a birth center? At HOME????? With a what (that would be Mid-wife)? Without a DOCTOR!? Mind.Blowing.Stuff. In today's era, it's not uncommon for women and their partners to have never been exposed to what a midwife is. You get pregnant. You go see the doctor. You have your baby at the hospital. (And, if you're lucky, about 67.2% of the time, you end up with a vaginal birth.)

There is an upward trend in more and more new patients coming in who are inquiring about midwifery care and birth options from the get go (before I even have the opportunity to mention it). {On a side note: Interestingly, included in this upward trend of women inquiring and choosing Out-Of-Hospital birth, within my clientele I have a physician, Registered Nurse, and the wife of a physician.} But still, for every one of those, there are still others that say things like "No way, I want to be in the hospital, in case there's a complication," or, "I want to be at the hospital, where it's safest." And lastly, with the first-time moms I often hear, "I very much want midwifery care and a birth center birth, but I think for my first baby, I'll go to the hospital to be safe. If everything goes well, I'll do an Out-Of-Hospital birth next time." We support women in having options for their birth- that in essence is what we are about- but, it is still hard for my midwife ears to hear (knowing the statistics for hospital birth as well as OOH birth)!

So to those who may speak the same words or think those same thoughts and have apprehension or questions about the safety of birth centers (and Out-Of-Hospital birth in general), Check out the link below to the just-released study, Outcomes of Care in Birth Centers: Demonstration of a Durable Model.

These quotes sum it up and say it well:

"The cesarean birth rate in this cohort study was 6% versus the estimated rate of 25% for similarly low-risk women in a hospital setting. Had this same group of 15,574 low-risk women been cared for in a hospital, an additional 2934 cesarean births could be expected."

"There were no maternal deaths. The intrapartum fetal mortality rate for women admitted to the birth center in labor was 0.47/1000. The neonatal mortality rate was 0.40/1000 excluding anomalies."

"The intrapartum fetal and neonatal mortality rates found in this study are comparable to those reported in many studies of low-risk women."

"This study demonstrates the safety of the midwifery-led birth center model of collaborative care as well as continued low obstetric intervention rates, similar to previous studies of birth center care. These findings are particularly remarkable in an era characterized by increases in obstetric intervention and cesarean birth nationwide."

So for safety's sake, consider this: If you are trying to avoid unnecessary intervention and avoid a cesarean section, planned Out-Of-Hospital birth has been shown to be a safe option. While we continue to support our moms that truly desire to be in the hospital, we will also recognize the growing evidence that Out-Of-Hospital birth is a safe and good option, both for moms and for babies.

The study can be found here:

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