Women have been giving birth for thousands of years. The processes of labor and birth have remained the same, but the ways women give birth have changed dramatically over the past 100 years (just ask your mother and grandmother). Fortunately, women giving birth today have more choices in childbearing than ever before. One option growing in popularity is the freestanding birth center.

If you chose to work with a freestanding birth center, you would have your prenatal visits in the office at the birth center, you would see your care provider on the same schedule as you would if attending any other clinic, you would have the option for the same prenatal screenings and tests as you would in another clinic setting. You would go to the birth center when you are in labor, just as you would go to the hospital.

So what makes a
freestanding birth center different?

One benefit is that freestanding birth centers are independently run, which means that your care provider is able to make decisions about how to manage your birth based on you and your baby’s health and safety. In the hospital setting, care providers’ decisions are often affected by policies determined by insurance companies and administrators who are disconnected from birth, but make policies based on profit and liability, over health. Care providers working in those settings must follow the policies, even if they lead to unnecessary interventions.

Secondly, freestanding birth centers are usually run by midwives, either direct-entry midwives (often certified professional midwives (CPMs) or licensed midwives (LMs)), or certified nurse midwives (CNMs). While there are differences between types of midwives, all are trained within the midwifery model of care, which promotes the childbearing year as a normal life event, and birth as a normal, healthy process*. Midwives work with healthy women having healthy pregnancies (which are most women). They do not see pregnancy as a disease, and treat their clients like the healthy women they are. They believe in the power and strength of women’s bodies, and the brilliantly designed process of birthing as nature intended.

Another benefit of birth centers is in the continuity of care. You would work with the same midwife throughout your pregnancy. Your prenatal visits would often last forty-five minutes to an hour; you and your midwife would get to know each other very well over the course of your pregnancy. She would expect you to be an active participant in your prenatal care and your birth. You would be presented with options in your care, rather than being told what to do. You would learn a lot, and gain confidence in your body and knowledge. Your midwife would provide the majority of your prenatal care, and would be on call for your birth; there is no rotating call schedule where you get whoever is working the night you go into labor. In addition, she would stay with you throughout your labor, and for several hours after the birth of your baby. After the birth, you would have two or more home visits, as well as an additional office visit before the final six-week visit.

The number and type of interventions you might encounter at a freestanding birth center are much lower than in the hospital. First consider the setting. It’s like being at someone’s home. Where do you stay if you are healthy? Home! Hospitals are mostly for sick people, and going to a hospital often evokes the feeling of illness and helplessness. Pregnant women are not sick. At the birth center, you would eat your own food. You would wear your own clothing, not a drafty gown. Your partner and family are welcomed into your care and encouraged to participate and support you. Your birth would be entirely private – the only people participating would be your birth team, and those you have invited. You may not have considered these interventions in the past, but they can subtly shift your perception of yourself and your well-being.

In addition, there is no routine use of IVs. No medications are used for induction or augmentation of labor. Your midwives use a hand-held Doppler to listen to the baby several times each hour, rather than strapping an external fetal monitor to your belly. You can be free to walk, to move, to dance. The midwives are skilled in comfort measures for labor and birth, and would help you to find natural pain relief and ways of moving your labor along. Narcotics and epidurals are not available to numb you to your birth. Waterbirth is truly available; no one else would be in the tub, nor would it be missing or broken, and you generally would not need to get out to give birth. There is no use of routine episiotomy. You would receive your baby immediately after birth, and may even catch her yourself! Breastfeeding is highly encouraged and assistance readily available. Most mothers and babies nurse in the first hour after birth.

But what about safety?

Out-of-hospital birth is safe for women with healthy pregnancies! Birth in birth centers or at home has been studied extensively and shown to be as safe as a similar low-risk population in the hospital setting. The real difference has been found in the higher rates of intervention (induction, vacuum extraction, episiotomy) and cesarean section rates in the hospital group. A 2003 study in the American Journal of Public Health comparing women birthing in birth centers to similar women birthing in hospitals found that birth centers had a 10.7% rate of cesarean sections, while the hospital rate was 19.1%. In 2005, the British Medical Journal published the largest controlled study comparing out-of-hospital birth to hospital birth, which found cesarean rates of 3.7% at home or at a birth center, compared to 33% in the hospital.

And if a complication should arise? If you should need medications or treatments that the midwives do not perform, your midwives would accompany you to the hospital and stay with you throughout, acting as your labor support and advocate. Remember that true emergencies in birth are rare, and that your midwives are trained to prevent complications by promoting a healthy pregnancy, recognizing early signs of developing complications, and perform emergency measures when complications arise unforeseen.

If you desire a natural birth, freestanding birth centers are a great option. The nature of your care at a birth center supports you and promotes the natural birth process more than in almost any other setting. Do some exploration and determine what your wants and needs are, where your comfort zone is, and what you can do in order to have an optimal pregnancy and birth.

Remember: you are healthy. Your baby is healthy. Live and birth in good health.

* The major difference between these types of midwives is the type of training. Direct-entry midwives are trained in the midwifery model of pregnancy care. They are not nurses, but learn the nursing skills necessary for their best practice, like phlebotomy, giving injections, setting IVs, and suturing. They generally complete their training in home birth practices or in free-standing birth centers, and do not work in hospitals. CNMs are trained first as nurses in the medical model, and then complete their midwifery training in the midwifery model. They generally complete the majority of their training in hospitals, and most CNMs work in hospitals. In addition, they often do much more work in women’s health outside the childbearing year.

AnnMarie can be reached at the Birth House, 28 South High Street, Bridgton, ME 04009 (207) 647-5919, www.birthhouseme.com.