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Choosing Your Birthplace

Women labour and birth most successfully in the place they feel the most comfortable. Your choice of caregiver will affect the options available to you. Physicians rarely attend births at home and it depends on where your chosen caregiver has admitting privileges if you choose a hospital birth.

Hospitals

Your choice of hospital will limit your choice of caregivers to those with admitting privileges at that hospital, or vice versa. Hospitals are not all alike. Their styles of care can differ dramatically. Most offer tours to show what facilities they offer and it is worth your while to attend one. But it is even more important to meet the staff and ask them questions. The nurses are the people you will be dealing with and a staff that approaches birth as a normal, natural event rather than a medical crisis makes far more difference than any home-like decor you may be offered. Remember, it doesn't matter how cooperative your doctor is, if hospital policies run counter to your desires, hospital policy generally takes precedence

If choosing a hospital birth, personalizing your birthing room with your own things from home can help relax you as you prepare for the birth of your baby. Including such things as your own pillow, a special ornament for the bedside table, your own nightgown to wear, bring a recording of your favorite music and something to play it with (if the hospital doesn’t have CD/cassette players in each room) can really help. Adrenaline, the hormone responsible for the flight or fight response, is triggered by anxiety or stress and can slow, or even stop, labour. Being relaxed and calm during your labour and delivery are very important for an efficient and progressive labour.

The biggest difference between hospital birth and the other options is the way in which childbirth is approached - the philosophy. Midwives who attend births at home and in birth centers believe in the birth process and instill in their clients a confidence in their body's ability to birth the new baby.

Birth Centers

Birth Centers place that gives you a caring, warm and homelike setting where you are supported and respected as well as safe and secure. It is often proclaimed as the best of both worlds for those unsure about birthing at home, yet not wanting a medicalized birth experience.

Birth centers were designed for healthy, low risk mothers and healthy babies. It's a very relaxed atmosphere in a birth center. It feels more like a nice country inn, or somebody's really well kept home, than a hospital. It looks like a house with wallpaper, bathrooms with showers, and Jacuzzis for women to relax in labor. There are kitchens where people can bring their own food and cook in the birth center. A Birth Center welcomes your children, your parents, and friends so you can decide who will be with you or near you as you give birth.

Homebirth

Keeping in mind the statement that "women labour and birth most successfully in the place they feel the most comfortable," the home seems a logical option when deciding where to give birth.

If you have chosen to birth in your own home, you will need to find a midwife to be your caregiver. It is important to select someone that you feel you can grow to trust with whom you can develop a good relationship. You should feel free to ask your midwife any of the questions that you would have asked your doctor or hospital staff.

If you choose to give birth at home you are not subject to any particular policies or procedures. You alone, with the help of your partner and selected family and friends, create the birth plans ideal for you. For example, you might plan to wear a special nightgown while labouring (or wear nothing at all), you might plan to go for a walk in you neighbourhood with your partner during early labour, you might want to give birth in front of the fireplace, or in the bed where the baby was conceived, or in a warm pool of water.

Fathers find that supporting their partner comes more naturally at home - in the hospital they are more apt to feel like an outside, less competent. Parental and sibling bonding to the newborn is also enhanced in a relaxed home environment.

When the baby is born at home, breastfeeding is often more successful because baby is always close to the mother. This is not only good for the baby, but also helps the mother by releasing the hormone oxytocin into the body to help expel the placenta and prevent hemorrhage. This also gives you the advantage of being able to act spontaneously with him or her and to develop a sense of confidence in your abilities as a new parent. Your midwife and your support people continue to nurture you in the early days following the birth so as you can fulfill the important job of nurturing your new child.

Unassisted Birth

Unassisted birth is when a woman or couple who chooses to give birth without the aid of medical or midwifery care. By choice, thousands of women are making this decision for a variety of reasons. Some believe that it is a spiritual calling, something that they believe in religiously. Others believe that medical or even midwifery care are interventive and will interfere with the natural process.

"Independence of thought is essential for those who choose to give birth without medical assistance," explains Laura Kaplan Shanley, author of Unassisted Childbirth. It also requires thorough knowledge of prenatal assessment, birth knowledge, and newborn assessment and care, including newborn CPR knowledge.

Hospital Questions:

Do women labour and deliver in the same room?
Are partners and welcome to remain during all procedures?
Are siblings welcome at the birth or shortly thereafter?
Are women allowed to eat and drink lightly during labour, should they so desire? May they bring their own food and beverages?
Are other support people allowed for both the labour and birth? Is there a limit? Are women allowed to move about during labour?
Are women allowed to choose to give birth in whatever position they find most comfortable? Does this include kneeling, being on hands and knees and squatting?
Which of the following are done routinely: intravenous drip, electronic fetal monitors, enemas, shave or mini/shave preps, medications, episiotomies? (For more information, refer to Interventions)
Is waterbirth an option?
What percentage of this hospital's patients had a forceps delivery last year?
Is perineal massage and support practiced by the birth attendants (nurses and doctors) here?
What percentage of this hospital's patients had a natural unmedicated birth last year?
What is the cesarean section rate of this hospital?
Are partners welcome to attend cesarean sections?
After birth, is immediate and unrestricted contact for mother and baby allowed, or is the baby required to go to the nursery for examination and/or observation? Do you allow 24 hour rooming-in: for the baby? For the partner?
If the baby requires special care can both parents visit the intensive care unit and touch and hold their baby? Can the mother breastfeed the baby in the intensive care unit?
What sort of postpartum support is provided with early discharge?
Is there breastfeeding support? Does this hospital have a lactation consultant on staff?

Birth Center Questions:

Are other support people allowed for both the labour and birth? Is there a limit? Are women allowed to move about during labour?
Are women allowed to choose to give birth in whatever position they find most comfortable? Does this include kneeling, being on hands and knees and squatting?
Which of the following are done routinely: intravenous drip, electronic fetal monitors, enemas, shave or mini/shave preps, medications, episiotomies? (For more information, refer to Interventions)
Is waterbirth an option?
Is perineal massage and support practiced by the birth attendants here?
What is your transfer rate?
What sort of postpartum support is provided?

Homebirth Questions:

In addition to questions specifically for your caregiver, you might want to ask the following:
When do you come to my home?
What do you bring to the birth?
Will you be the one to come to my home? Do you bring anyone with you? Who? How do your services differ from that of other birth attendants?
How do you handle complications?
How much do you charge? Is there a flexible payment system?
Do you offer water births, and what are their benefits?

"Some women say that since birth is an act of love. Personal and intimate, it should take place in one's own environment, without unnecessary observers, among friends in a loving atmosphere. They want to know that the father of the baby or a close friend can be present throughout, can take an active part, and can give emotional support through the labour… Often a woman would like to ensure that her baby has a "gentle birth" and is welcomed into the world tenderly, without the machinery and bright lights that are almost inevitable in hospitals." Kitzinger, 1989.

wp_choose_birthplace.doc 8/4/2005

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