Pharmacologic methods (medications) should
never replace personal attention and tender loving care of
the woman in labor.1
Your birth environment and the people caring
for you during your labor and delivery can dramatically impact
how you will perceive your childbirth experience. By choosing
the type of birth environment best for you, you are more likely
to feel relaxed and comfortable when you arrive and throughout
the rest of your labor and birth. If you are giving birth
in the setting you desire, surrounded by people who are able
to meet your needs, including your pain-management needs,
you are more likely to have a satisfying “birth day.”
In this chapter we:
- List the most common birth environments.
- Describe what each has to offer with
regard to pain-relief options.
- Provide a description of the various
professionals who may (or may not) be with you during
labor and birth.
- Provide an at-a-glance comparison between
hospitals and birth centers.
Most women in the United States (approximately
98 percent) give birth in a hospital. But all hospitals are
not alike, and maternity units vary greatly from hospital
to hospital. In addition, the size of the hospital and its
maternity unit can impact the type of birth experience you
Reasons You May Want to Have Your Baby in
- You want to be in a place where all or most medical
pain-relief options will be available to you.
- You want to give birth in a setting
that has equipment and staff ready to deal with an unlikely
- You feel more confident in a birth environment
surrounded by a variety of medical professionals.
- You want a two- to four-day recovery
period before returning home with your new baby.
Larger hospitals typically offer more medical
pain-management options than are found in smaller (community)
hospitals. Larger hospitals are more likely to have an in-house,
around-the-clock anesthesiology staff readily available if
you are in need of an epidural. Often, these larger hospitals
have anesthesiologists who are assigned specifically to the
maternity unit. This reduces the likelihood of delays for
women in need of pain relief that must be given by the anesthesiologist.
Smaller hospitals may not have as many medical
pain-relief options and may not offer epidurals twenty-four
hours a day, seven days a week. If they have a limited anesthesia
staff, some smaller hospitals may not offer epidurals at all.
On the other hand, many of these small hospitals, as a result
of not having as much “high-tech” pain relief
to offer, often have staff and equipment that can successfully
support the mom who prefers to use fewer or no medications
throughout labor and birth. So, depending upon your own preferences,
either of these settings may be right for you. But, clearly,
if you desire the full-throttle pain relief of an epidural,
you are more likely to find this type of pain management taking
place in larger hospitals with busier maternity units.
Size of Hospital Maternity Unit and Their
Epidural and Combined Spinal-Epidural Rates:
- In hospitals that deliver fifteen hundred or more babies
per year, 69% of women use an epidural or a combined spinal-epidural.
- In hospitals that deliver five hundred
to fifteen hundred babies per year, 50% of women use an
epidural or a combined spinal-epidural.
- In hospitals that deliver less than
five hundred babies per year, 40% of women use an epidural
or combined spinal-epidral.2
Hospitals of all sizes are increasingly responding
to women’s requests for more pain-management options,
including baths, showers, the use of birth balls, and the
promotion of movement and positioning during labor and birth.
More hospitals are encouraging, or at the very least accepting,
women’s choice to use doulas (described in this chapter)
as their primary support people during their labor and birth.
Many hospitals throughout the country have
made their birthing rooms more appealing and homelike, with
the goal of helping women feel relaxed and comfortable in
the unfamiliar and sometimes intimidating surroundings of
a clinical setting. Even with these changes, the hospital
stay (which, for most women, is their very first hospital
stay) can make you feel like, well, like you’re in a
hospital! Many caregivers recommend you bring your own homelike
objects of comfort that will promote a sense of familiarity
and relaxation in an otherwise unfamiliar setting. You may
want to bring your favorite pillow, fragrance, photos, and
a radio or CD player to listen to your favorite music. If
you feel more comfy in your own clothing, let the hospital
staff know you would like to wear your own threads instead
of their hospital gown.
Two more factors may also determine where
you ultimately give birth: your insurance coverage, which
may or may not cover your care at your preferred hospital,
and your obstetrician’s hospital affiliation. The hospital
in which your obste- trician or midwife works will be the
hospital where you will have your baby. If you like your obstetrician
or midwife, but do not like the hospital with which he or
she is affiliated, you may find you will need to switch to
a doctor or midwife who works in the hospital where you want
to have your baby.
Are Women Who Have Their Babies in Hospitals
Satisfied with Their Experience?
According to a survey of sixteen hundred women
across the country:
Ninety-six percent said they were satisfied
with the health care they received.
Ninety-four percent felt they were treated
with kindness and understanding.
Eighty-seven percent said they were free to
make their own decisions.3
The Birth Center
Birth centers grew popular in the 1970s as
an alternative to the hospital birth experience. Birth centers
may also be called alternative birth centers (ABCs) or childbearing
centers. According to the National Association of Childbearing
Centers, “birth centers are guided by principles of
prevention, sensitivity, safety, appropriate medical intervention,
and cost effectiveness.”4 Birth centers, unlike hospitals,
do not exist in many communities across the country and, depending
on where you live, may not be an option available to you.
Reasons You May Want to Have Your Baby in
a Birth Center
- You are committed to giving birth without pain-relief
- You do not feel relaxed in a medical
setting and prefer a nonmedical type of atmosphere.
- You feel more confident in a birth setting
surrounded by your family and being cared for by staff
(and equipment) that is geared toward supporting a labor
experience using coping strategies instead of medical
- You may want to return home as soon
as possible after giving birth.
Birth centers are often operated by midwives,
or midwives and physicians together. The prospect of giving
birth in a birth center is usually most appealing to women
who want a birth environment where there will be as few medical
interventions (including pain-relief interventions) as possible
during labor and birth. The birth center is a good option
for women who do not want to have their baby in a hospital
but also do not want to give birth at home.
There are some in-hospital birth centers that
provide a homey family-centered birth environment; they are
attached to the hospital or are located on their campus. The
in-hospital birth center is a distinct facility, separate
from the hospital’s labor and delivery unit. Typically,
epidurals are not offered in these centers. Depending on your
preferences, this type of environment may also be a perfectly
suitable option for you. A birth center within a hospital,
however, may not operate in the same way an out-of-hospital
birth center does, and its care practices and staffing may
be more like hospital care than birth center care.
If you choose to have your baby in a birth
center, a certified nurse-midwife (CNM) will most likely be
your primary caregiver. Although in birth centers midwives
and obstetricians work together, it is the midwife who will
likely attend to the birth of your baby, unless the obstetrician
is needed due to a complication. Your health care provider
must determine that you are healthy a woman with a low-risk
pregnancy in order for you to give birth to your baby in a
birth center. Birth centers provide care to women throughout
their pregnancy, labor and birth, and postpartum.
The birth center itself is characterized by
a homelike atmosphere that is less high tech in appearance
than a typical hospital maternity unit. If you are laboring
in a birth center and at some point need emergency medical
intervention, you will be transferred to a hospital.
Around 15 percent of women who begin their
labor in a birth center need to transfer to a hospital. Of
these women, only 2 percent transfer due to an emergency.
The remainder are transported to the hospital primarily due
to slow progress or because
the mom requests anesthesia.
Birth centers promote a relaxed, privte, nonclinical
environment in which a variety of nonmedical pain-mainagement
approached can be accommodated. Birth centers do not offer
epidurals, and they ususally (although not always) do not
offer narcoticinjections. Birth centers are ot equipped to
perform cesarean section deliveries. In fact, the cesarian
section rate for women who began their labor in birth centers
is around 4 percent.
Excerpted from Easy
by William Camann, M.D., and Kathryn J. Alexander,
M.A. Copyright © 2006 by William Camann. Excerpted by
permission of Ballantine Books, a division of Random House,
Inc. All rights reserved. No part of this excerpt may be reproduced
or reprinted without permission in writing from the publisher.