Now that we have talked about how to find the provider that is right for you lets talk a little bit about WHERE you will birth. Most doctors and midwives work at a specific hospital or birth center so this topic goes hand in hand with choosing your birth medical provider. While you can often stay with a location and get a different doctor or midwife, you cannot typically keep your medical provider and change locations. That means if you find an amazing location that supports all of your birth preferences but are not so sure about the provider you are with you can likely change to a different OB or midwife and stay at the same location. Another doula once described it as the location being the ship and the medical provider being the sailor. While there are some variations in limitations, policies, and options that each location has the way that the provider will be steering that ship is also very important to consider.
What should you consider when looking at your birth location? First, you need to know the basic differences between types of locations:
- Hospitals may be in closer proximity to your home since there are more of them than free standing birth centers. In a hospital they have access to almost any intervention that you or your baby could possibly need and a lot of knowledgeable and experienced professionals that can assist if needed. Because there is access to all of these potentially lifesaving interventions in a hospital they can be recommended more freely even if not medically necessary. Hospitals have a lot of blanket policies regarding IVs, fetal monitoring, labor time frames, etc. that may not make sense for you and your baby and can mean that you have to advocate more for certain aspects of your birth plan. Often, these policies mean that the nurses are in and out of your labor room regularly asking questions, filling out charts, and checking vitals which can be disrupting to the rhythm of labor.
- Birth centers typically have midwives on staff with an OB at a local hospital available as back up should the need arise for interventions. There is usually a specific protocol in place for transfers to the hospital if needed and it is almost always a very smooth transition. Of course this does mean that there is a chance, though very slim, that you may have to change locations mid labor which can be stressful. Since there are not as many options for interventions being performed in a birth center they usually are not recommended unless they are truly medically necessary or the mother requests it. The midwives and nurses in a birth center tend to be more hands-off and do not disrupt the mother and support persons very often. The midwifery model of care means that there are very few blanket policies in a birth center and each labor is seen as unique with potentially different needs than the last. Most states have strict laws in affect to govern what type of situations a birth center can not support so risking out is a possibility for things such as breech baby, preeclampsia, VBAC, etc. You will want to check with your local birth center to determine what your state says.
- Birthing at home has many differences from a hospital or birth center. On the plus side you are surrounded by your own things in a space that you are completely comfortable in. Everyone will come to you so there is no deciding when the right time to leave is and no riding in the car while you are contracting which many women describe as extremely unpleasant. Like birth centers, there is very little intervention available at home so it will only be recommended if medically necessary or if you request it. Also like a birth center, this means that if intervention is needed you will need to change locations. Depending on your area that transfer can be very smooth or it can be quite dicey as some hospitals do not look kindly on homebirthers and the midwives that support them. The homebirth midwives in your area should have plenty of knowledge to offer about the homebirth transfer climate for your area. Homebirth midwives are also limited, sometimes by state laws and sometimes by their personal discretion, as to what constitutes as too “high risk” for home. If you are choosing a homebirth you will want to talk with midwives that you interview about what scenarios would “risk you out” of their care.
Looking at your ideas for birth and your overall birth plan can help you to determine the type of location that is right for you. You can also look at other factors such as your health and previous birth history and the history of this specific pregnancy. In general, free standing birth centers are not as common in the US. If there is not one near you that may not be an option that you can entertain.
Perhaps the most important thing to consider is your own comfort level. Some women get very stressed just thinking about being in a hospital so a birth center or homebirth might be a better choice for them. Other women are scared of the many unknowns in labor and birth and for those women being in a hospital with access to more interventions is comforting. There is no right or wrong place to birth a baby but there is usually a place that is better for you personally.
As with finding an OB or midwife, you can ask around on social media. Local mom groups are often very happy to share their experiences at various facilities. However, as I said in my last blog, you do have to remember that each mom and baby have different circumstances. What is a horrible location for one mom might be perfect for another and what is just right for one might be completely wrong for another.
Once you have decided on the type of location then you can look at the options that brings you. In many cities and towns there are multiple hospitals and sometimes multiple birth centers to choose from. It is never too early in pregnancy to tour those locations. In fact, touring each location more than once can sometimes give you a better feel for the nurses and other employees as well as the overall attitude of the doctors and/or midwives while there. You may also find that you get different answers to the same questions. This may lead you to investigate their policies and other moms’ experiences further. Some questions that you may wish to ask while on these tours are listed below.
- What is the policy on fetal monitoring?
- Do you have wireless monitors available?
- What are the “rules” for eating and drinking while in labor?
- Are IVs considered mandatory for all laboring women or only as needed?
- Are water labors/births supported?
- If tub labors/births are not supported can I be in the shower during labor as a comfort measure?
- What props do you have available (birth balls, peanut balls, squat bars, etc.)?
- Are there policies governing how long a woman is “allowed” to labor?
- Are there policies governing how long your amniotic sac is “allowed” to be broken?
- What is the procedure if I wish to refuse a procedure, test, or medication for me or my baby that is typically considered hospital policy?
- For what reasons would my baby be taken to the nursery for observation other than a medical emergency?
- If my baby is taken to the nursery or NICU will my partner be allowed to accompany him/her?
- What is the typical procedure once baby is born, assuming no immediate issues with mom or baby? (Do they “allow” immediate skin to skin or is baby taken for immediate assessment?)
- What is the procedure if I wish to keep my placenta?
- During my postpartum stay will baby be taken to the nursery for pediatrician assessments or will those visits be done in my room?
- What resources do you have on site for lactation support and what days and hours are they available to patients?
- How long is the typical stay after a vaginal birth? After a cesarean birth?
When touring a birth center you may also want to ask:
- Who do you refer to for further testing in pregnancy if needed?
- Who is your back-up OB for labor/birth interventions?
- What hospital do you transfer to?
- What is the transfer process like?
- What will “risk me out” of a birth center birth both during pregnancy and labor?
I want to reemphasize that any policies cannot be forced upon you if you wish to decline anything which is why I put the word ‘allow’ in quotes in some of the above questions. However, if there are things that you wish to decline and you know in advance that the hospital policy “mandates” that every mother or baby has that procedure then that should be taken into consideration. It can be quite a fight to go against policy depending on your nurse and your medical provider. Sometimes those policies and wanting to avoid conflict are enough reason to make a change in your birth location. Other times it is not enough to outweigh the positives that particular location offers you. However, it is important to understand that labor and postpartum is often a time when women feel very vulnerable and unable to advocate for themselves or their baby. Having your partner educated on your birth plan and ready to advocate for you in those situations is very important.
A doula can also be an excellent resource for helping you to know more about hospital and birth center policies and what to expect. She can even make recommendations of facilities to consider touring based on your birth plan. Doulas can also help you and your partner to learn how to advocate for you and your baby during labor. She can also help during labor to remind your partner of your birth plan and give ideas for additional questions to ask for anything that is recommended. In the next blog we will talk about some things to consider and questions to ask when interviewing doulas so that you find one that is right for you.