In Bloom Doula Services

Ever since I made the decision to switch from a hospital to a birth center to have my third son, I planned on writing a blog comparing the experiences. The pros and cons of each. How they are different and how they compare. To briefly recap: I had my first two sons at a hospital (both with a hospital midwife) and both were great experiences. I had always wanted to have an unmedicated birth, so I got a midwife, hired a doula, took birth classes and had Holden. A wonderful birth. So when I got pregnant with Waylon I had the same midwife and doula, at the same hospital and had another great experience. This time though, I questioned what I was doing at a hospital at all?

The first time I wanted the comfort of staying over night with the guidance of nurses, and extra help I may need, which was my only real reason for being in a hospital at all. I knew I wanted to avoid an induction, and avoid most interventions and medications, but I really wanted that overnight stay. And I did really appreciate that, but when I had Waylon I almost resented it. I wanted to go home and be with Holden. I refused vaginal checks, refused and IV hep-lock. I felt confident caring for my baby and breastfeeding. I just wanted to go home.

I had to go to great lengths to ensure I had the birth I wanted in the hospital setting. I had to have a midwife and doula willing to press against hospital policy with me. I had to advocate my preferences and needs to nursing staff who had just met me. I had to track my breastfeeding to be overseen by nurses, was woken up repeatedly to be monitored, couldn’t co-sleep, missed my first baby. Suddenly the comfort of nursing staff being close by and being able to stay the night under their care wasn’t as appealing as it had been when I had Holden. I thought to myself why am I here? I decided next time I’d go to a birth center. A birth center seemed fitting for someone like me who wanted an intervention free labor/birth and could go home hours after the birth.

When Waylon was about 6/7 months old I saw pictures of a new birth center opening up near me, Bliss Birth Center. I was practically sold on the pictures alone because it’s BEAUTIFUL! But when I attended the grand opening that spring, and talked with the midwife, Trish Perkins, I was sold. She got teary-eyed explaining how they handle the births and postpartum process there. I knew I wanted that kind of care. Additionally it was close to my childhood home, so I had a familiar feel, horse trails I could walk if I chose, and rave reviews from doulas I knew and trusted.

Bliss was the birth center for me.

My family knew about my “weird” ways prior to going to a birth center. Having a midwife and a doula, becoming a doula, co-sleeping, breastfeeding, etc. but a birth center threw them for a loop.

Yes, a free standing birth center. Yes, I’ll have him in a tub. Yes, it’ll be fine.

It can be hard to explain these differences to non-birthing people. Many women, despite having had babies before, don’t understand much about the birth processes. They still have a lot of fear when it comes to birth, and assume a hospital is safer because it is the societal norm. They are from the generation of “listen to your doctor.” I am from the generation of “ask all the questions.” And I’ve benefited from it. My babies have benefited from it.

SAFETY

The first thing that comes up is inevitably: “is it safe?” The truth is babies die and mom die at hospitals too. Maternal mortality in the U.S. is a major problem. In fact, today women are twice as likely to die from pregnancy and birth complications than our mothers were a generation ago. The majority of women have babies in a hospital setting. And over half of the maternal deaths that occur in America are preventable. It makes me wonder about the care women are receiving in a hospital. Questioning the safety of midwives and birth centers seems to be barking up the wrong tree if you ask me. Hospitals are not necessarily “unsafe,” but they haven’t proved themselves safer than alternatives. Midwives and birth centers have amazing statistics proving they are safe options for low-risk mothers. There was no fear on my part. I knew I made a great choice. Here is why:

• The U.S. average rate for caesareans is 27% in a hospital, but only 6% at a birth center
• Limited interventions: the majority of issues during labor are iatrogenic, meaning they are caused by a medical intervention. A premature induction, the use of synthetic oxytocin – pitocin, the use of drugs like an epidural could change the course of labor
• Midwives only accept “low-risk” patience. I myself am low-risk, but any mother with specific conditions who would be safer at a hospital setting would not be laboring at a birth center in the first place
• Midwives are trained to handle medical emergencies that could arise. They have shots of pitocin on hand, oxygen, antibiotics and IVs. They can address many and most issues that could arise such as antibiotics for being GBS+, or needing stitches for a tear. Midwives are very cautious when it comes to emergencies that would require transfer. They know what to look for when it comes to emergency situations.

Prenatal Care

The basic model of prenatal care at a hospital and birth center are the same. Monthly appointments until week 28, bi-weekly appointments until week 36, and then weekly appointments until birth. There are still routine ultrasounds (an initial ultrasound, a 20 week anatomy scan, and possibly a third trimester ultrasound if needed) and the needed blood panels and testing. Midwives can diagnose and prescribe, and properly address any issue that may arise.

The differences lie in the way the appointments go. At the hospital, even with a midwife, my appointments were quick and to the point. I waited in the waiting room for a while, in the exam room for a while and then spent maybe 15-20 minuets with my midwife. At the birth center it was warm and welcoming. I developed deeper relationships with the entire staff there because it is a intimate setting, with longer appointments. These appointments aren’t rushed and it honestly felt like visiting friends.

Freedom of Choice

Hospitals have much more strict policies. This can be as minor as “prohibiting” eating in labor, or can be as strict as “requiring” specific monitoring, pushing positions, caesareans, etc. At a birth center you are free to do what you want. Don’t want an cervical check? Don’t want to be pressured to induce? Don’t want to push on your back? You don’t have to do anything you don’t want to do. You don’t have to do anything you don’t want to do in the hospital either, but you may face backlash for it. I have seen negligent care, abuse, and have witnessed fear mongering to pressure women to make specific choices threatening the health of their baby unfoundedly.

On the flip side, in the birth center you can pretty much do anything you want to do. Birth in the tub, shower, standing. Eat and drink. Bring who ever you want- children included. You are free to move as much as you’d like. Labor isn’t on a schedule or time table, so a slow progressing labor is just another variation of normal. There won’t be talk of intervention unless the midwife really feels it is for the best interest of mom and baby. Postpartum you are supported in your choices of refusing erythromycin or vaccines if you so choose. Skin to skin and breastfeeding are encouraged, and not interfered with.

Continuous Care

Typically in a hospital there with be a certain amount of nurses working a shift, and depending on if it is very busy or slow in labor and delivery you could get very attentive or more rushed care. If the nurses are busy charting and taking care of many patient and many other tasks they have at hand, you could be laboring in your room alone the majority of the time. Doctors, and hospital midwives may pop in and check in with patients, or address specific issues, but they will not remain with the laboring mother throughout labor. You may benefit greatly from a doula in situations like this. A doula can provide the continuous care that nurses and OB’s may not be able to provide, and work in conjunction with your doctor or nurses to ensure well rounded care.

At the birth center you will most likely be the only laboring woman there. The midwife and her staff that assist with births will be there to make sure all of your needs are met, and remain there throughout the entire labor. If you have a doula, even better.  You will have a full team taking care of your needs, supporting you emotionally and physically, supporting your partner, and helping postpartum. Which leads me to my next point…

Postpartum Care

Postpartum care is another huge difference when it comes to hospital and birth center procedures, but it appears that some hospitals are making improvements on this front. In a hospital you will deliver in labor and delivery and then move to a postpartum room where postpartum nurses will check your bleeding, blood pressure, get you things you need, help with breastfeeding and infant care. The following day a doctor will check up on you. Usually after 24 hours you will be discharged, but this depends on many factors concerning both mom and baby. Once you are discharged you will go home, only to be seen again 6 weeks later for a postpartum follow up. And then… thats it.

Midwifery care at the birth center is much different. After baby is born, and immediate postpartum care has been done, and mom and baby are doing well…. you go home! This was intimidating to me at first. I really loved having the nurses to help, but I also really wanted to go home. But it felt very comfortable once we were doing it. Throughout the next three days there were check in and a 24/48 hour visit at my house from my midwife. This also included infant care. Then there was another 2 week check up. This appointment was another hour long appointment that included mood check ins, breastfeeding support, and more infant care. All appointments are about an hour long and lend itself to building a strong relationship and rapport with the midwife and staff. Then, at 6 weeks there is a final postpartum check up, which you are “allowed” to bring your baby to. Lately, many hospitals are restricting newborns from attending the mother’s 6 week postpartum check up because covid. *insert eye roll for a million reasons*

Payment

I can not speak for everyone when it comes to hospital payments because I know cost of prenatal care a births depend on so many things. Hospital costs, insurance coverage, different procedures done etc. For my first hospital experience I was insured, but still ended up paying over $8,000 out of pocket after the birth, after insurance. I was not a happy camper. So, in addition to insurance, I was paying for the more stuff to cover the birth costs, and I was left wondering what my insurance even did. When I had Waylon I had a health share plan, Samaritan Ministries, instead and they covered the costs of maternity care 100%. The hospital, however, was not a fan, and do not have any policies or payment plans to accommodate patients with a health share. This was a major headache for me, and I detail it more in my blog: Why I Canceled My Insurance to Have Another Baby.

Some insurances do cover birth center births. I think that us becoming more and more common place, but some insurances will not cover a birth center birth. However, most birth centers (in my area) cost about $7,000 total for all prenatal care, labor and delivery, and postpartum care. With or without insurance the birth center was still cheaper. Also, Samaritan will cover a birth center 100%, and my birth center was very flexible with payments and accepting of health shares!

Benefits of Hospitals 

I have nothing negative to say about birth centers, obviously. I realized this blog comes off quite biased. I have visited many in this area now, and feel confident about the care pregnant women can receive at all of them. I also believe women can have really great experiences in the hospital- I did! There are obviously some things that hospitals provide that birth centers do not:

• Most importantly – epidurals! You can’t get an epidural at a birth center because it requires an anesthesiologist to administer it. Many women don’t want an unmedicated birth and know they want to epidural for their ideal birth experience. A hospital is a better choice for them
• Overnight stays. This was something I really loved about the hospital initially. You get a longer stay with 24 hour care from postpartum nurses. This can be very helpful and reassuring to new moms.
• Safety for high risk mothers- mothers who would be in need of an induction for medical reasons, have specific conditions that could lead to complications in labor, or moms in need of a caesarean are safer in a hospital setting

Hospitals aren’t bad, but variety is good. And women having as many choices and options available as possible is always a good thing. More options to choose from will allow women the opportunity to make sure her desires for labor and birth will be met. Obviously there are many differences in hospital and birth center settings, but with more information available mothers can make the best choices for them and their family.

If you have any other questions about birth centers or hospital births please send them my way! I am happy to discuss all things birthy 🙂 I also have open availability for doula services throughout 2021 for any mommas to be.

Birth photography by the incredible Stephanie Shirley Photography