Actually, Birth Never Needed to be in the Hospital
Evaluating birth choices while pregnant in the time of COVID-19.
Take a deep breath.
If you read that headline and bristled, let me clarify this before I even begin: For people who are high-risk, ill, or who personally feel safest in a hospital setting, then the hospital IS the absolute best place to have your baby.
But for healthy, low-risk people, I’ll say again:
Birth doesn’t – and never did – need to be in the hospital.
Thanks to COVID-19, people are rushing in droves to explore out-of-hospital options. Some common concerns we have heard repeatedly from people planning hospital births:
Concern that they will no longer be able to bring a doula to their birth
Concern that they will no longer be able to bring their partner to their birth
Concern that their partner can be present for the birth, but not allowed in the recovery room afterward
Concern that if a partner is allowed in the hospital, they won’t be able to return if they leave the building for any reason
Concern that they will be exposed to viruses or illnesses and become sick while in the hospital
Concern that they will be separated from their baby if they are showing COVID-19 symptoms or test positive
Concern that they will be subjected to mandatory epidural anesthesia, Cesarean surgery, or other unnecessary interventions
News outlets report on this current trend toward out-of-hospital birth as if pregnant people are trading one risk for another.
And I get it. I know that:
PREGNANT IN A PANDEMIC: “I STARTED TO THINK THAT MAYBE I SHOULD JUST GIVE BIRTH IN MY BATHTUB”
is a far more compelling headline than:
MORE PEOPLE CHOOSING BIRTH CENTERS – AN OPTIMAL AND TOTALLY SAFE PLACE TO HAVE A BABY.
But the reality is that people aren’t trading one risk for another. There is less risk in birthing at a licensed and accredited birth center. And that’s true all the time, not just during a global pandemic. Accredited birth centers repeatedly and consistently demonstrate improved outcomes for moms and babies – outcomes that translate across race and socioeconomic status.
There is less risk in birthing at a licensed and accredited birth center. And that’s true all the time, not just during a global pandemic.
Do we like that fear is driving people to consider birth options outside of the hospital? No. It’s sad that fear has to be any kind of driving factor for pregnant people. But do we like that something, ANYTHING is driving people to consider birth options outside of the hospital? Absolutely.
In the (hopefully near) future, social distancing guidelines will be relaxed. We will return to grocery stores and birthday parties and sporting events and begin to find our new normal. And we hope that a part of that new normal is a paradigm shift in the way we view birth. We hope that new normal includes a greater appreciation for the incredible work doctors and nurses do caring for sick people in the hospital.
And we also hope that more people will begin to realize that pregnancy isn’t a sickness.
Diana Petersen received her journalism degree at the University of Arizona and her Master’s degree in education at Northern Arizona University. She is a DONA-certified doula and Lamaze-certified childbirth educator at Babymoon Inn, an accredited birth center and full-scope midwifery practice in Phoenix, Arizona.
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People often instinctively avoid medications – both prescription and over-the-counter—when pregnant or breastfeeding.
The good news is that that most medications are safe for breastfeeding.The really good news is that you can easily look up medications and even environmental substances to see what’s known and what’s safe.(links below)
The best news of all is that there are dedicated researchers who continue to study the amazing attributes of breastmilk (the human variety in particular) and how some substances get through the mom’s body into the milk and how they affect babies.Dr. Thomas Hale of Texas Tech University is a champion in this field with his Infant Risk Center.You can even help, especially if you or a friend needs a medication that’s on the list of drugs under study and can provide breastmilk samples.
The bad news is that if you ask a medical provider, you may get poor advice!Many doctors, particularly in specialties that don’t see breastfeeding often (like urgent care, emergency and surgery) will advise mothers to stop breastfeeding either temporarily or permanently.The medical field is just starting to improve on its education and advocacy for breastmilk, including the risks to babies who aren’t breastfed.
Here’s where you can go for accurate information when you need it:
www.mothertobaby.org This FREE source is super handy.You can email them, call, text or IM on any substance exposure, including medications.The University of Arizona is part of their team!
https://www.infantrisk.com/appsDr. Hale and the Infant Risk Center have up-to-date apps that are really handy. It summarizes information on medication safety for pregnancy and breastfeeding. This is the one I recommend to professional colleagues – it’s one of the few “paid” apps I keep!
The Arizona Breastfeeding Hotline:1-800-833-4642There’s a lactation consultant always available to answer your question, even in the middle of the night. It’s a FREE call, and the lactation consultant can talk to you about any questions or subjects related to breastfeeding at any stage.
The Babymoon Inn Midwives!Just give us a call, we’ll be happy to chat about your question.
Olga Ryan MS-NL, RN
Director, Babymoon Inn Tucson
Olga has been in Perinatal nursing since 1995 and in birth center nursing since 2006. She has been studying leadership her whole life and recently joined the Babymoon Inn team as director of the Tucson location.
With a growing (and sometimes overwhelming) checklist for a healthy pregnancy, here’s an easy one: Vitamin D supplementation!
New research shows that taking Vitamin D supplements during pregnancy may help protect against asthma and other respiratory infections.
The study showed that women who had received Vitamin D supplementation during pregnancy gave birth to babies with a boosted immune response. This immunity may result in a decreased risk of asthma.
“But I live somewhere sunny… do I need vitamin D?”
Yup. According to Kathy Adams LM, CPM, a midwife at Babymoon Inn, nearly everyone – pregnant or not – could benefit from supplementation.
“No matter how much sun we get, most people are deficient in vitamin D,” she said. “Different people may need different supplementation amounts depending on sex, age, lifestyle, etc. Talk to your doctor or midwife about what vitamin D supplement may be most appropriate for you.”
With one out every three babies currently being born surgically in the United States, health care providers, researchers, and consumers are all beginning to question what can be done to lower the Cesarean rate and consequently the associated risks for moms and babies.
The Journal of Obstetric, Gynecological and Neonatal Nursing published a retrospective cohort study that included 3,031 births and 72 nurses. While the mean nurse Cesarean rate was 26%, nurse’s individual rates ranged from 8.3% to a whopping 48%.
With such a wide variation in Cesarean rates across nurses, the study concluded that “the nurse assigned to a patient may influence the likelihood of cesarean birth.” The authors further suggest that, “Data regarding this outcome could be used to design practice improvement initiatives to improve nurse performance.”
If you’ve seen a Babymoon Inn staff member lately, you’ve probably noticed a shirt that reads, “Evidence-based care with a hug. #birthcenters.” As an accredited birth center, we have a long history of providing holistic and personalized care, but also care that is driven by evidence and what research has shown to lead to the best outcomes for parents and babies.
What that research has demonstrated again and again is that for healthy, low-risk people, accredited birth centers tended by midwives are the safest place to have a baby.
But what makes someone low-risk? New research has identified factors to help determine a person’s risk status and help guide them to the choice of birth location that is appropriate for them.
Cheyney acknowledged that “there is actually very little agreement on what constitutes ‘low-risk” and that the majority of research on risk factors has been limited to a hospital setting, whereas this new study includes nearly 50,000 people seeking planned birth center or home birth.
history of a prior cesarean (with or without a history of also having a vaginal birth)
post-term pregnancy (greater than 42 weeks
advanced maternal age
elevated body mass index.
The study compared the risk factors with the following outcomes:
likelihood of transfer
any genital tract trauma
any postpartum hospitalization for a maternal indication in the first 6 weeks
low 5-minute Apgar score (<7)
very low 5-minute Apgar (<4)
any neonatal hospitalization in the first 6 weeks
any NICU admission in the first 6 weeks
combined fetal and neonatal death
The outcomes of Cheyney’s research showed that:
“Older than average mothers (35 years and older), women with an elevated BMI (30 and over) and women who labored after a cesarean who had also had a vaginal birth all had very little additional risk relative to our comparison group… Women who are older, heavier, or who have had a previous C-section and a vaginal birth who have no other complications actually do quite well in the community setting, and we are hopeful that state regulations will be modified to reflect these findings where needed.”
The research also gives insight into the risks of VBAC (vaginal birth after Cesarean) in an out-of-hospital setting.
“Women who labored after a cesarean who had also had at least one vaginal birth had excellent outcomes in the community setting. In fact, their risk was lower than what we found for women having their first baby. However, we also found that clients laboring after a cesarean who have not had a vaginal birth were at higher risk than anticipated. Their outcomes grouped among the highest risk of the subgroups we analyzed, which included breech and preeclampsia. Women laboring after a cesarean without a previous vaginal birth had a risk of fetal or neonatal death that was ten times higher than the low risk comparison group of healthy multiparous women with no risk factors. Their rate of fetal and neonatal death was 10 out of 1000 compared to a less than one out of 1000 among multiparous women with no risk factors.”
“To complicate matters, among women laboring after a cesarean with no prior vaginal birth, the repeat cesarean rate was just over 22%, which is less than our overall national cesarean rate of 32%. This means that 78% of women in this higher risk group had a vaginal birth! Pregnant people with this risk factor who are considering a community birth are forced to navigate a complex balance of risks and benefits associated with laboring after a cesarean in a community setting.”
Navigating through the research to understand the benefits and risks of any birth setting can be a challenge. Have questions? Ask us.
More than 73% of women prioritized choosing their care provider over choosing the hospital in which they would give birth, according to research published earlier this year. Only 17% chose a hospital first and then sought out a care provider.
The research included more than 6,000 women who answered survey questions through the Ovia Pregnancy app.
In an article for Slate.com, Christina Cauterucci looked at the Ovia survey and also at a recent assessment of 12 childbirth facilities that examined the correlation between the design/layout of the facility and the Cesarean rate. The assessment included both freestanding birth centers and hospitals.
“Neel Shah, a Boston OB/GYN who works at health-care research center Ariadne Labs, was one of the authors of the Ovia Pregnancy survey. He says U.S. hospital C-section rates range from around 7 to 70 percent, often with wide ranges in a single zip code. And though hospital choice can be a woman’s biggest risk factor in the care she receives, including her chances of needing a C-section, few women pick their delivery hospital first. ‘Nobody picks a restaurant based on who the waiter is,’ he told Slate, comparing restaurant service to hospital care. The service might be impeccable, but, if the restaurant has a higher-than-average record of food poisoning, not many customers would want to take that risk.”
Cesarean rates were higher in facilities where delivery rooms were farther apart Cesarean rates were higher in facilities where the call rooms for staff were farther away from the delivery rooms Cesarean rates were higher in rooms that see more than 100 annual deliveries The primary lowrisk Cesarean rate was lowest in the three freestanding birth centers included in the study
So what does this mean for you? It means that while your choice is provider is important, so is the location you choose to have your baby.
For example, the correlation between the design of Babymoon Inn birth center and its Cesarean rate matches the correlation found in the Ariadne Assessment. This freestanding birth center features the following:
Two birthing suites eight feet apart A midwife in the building during the entire labor and birth, no farther away than the next room Birthing rooms that see around 90 births a year A Cesarean rate around 56%, similar to the national birth center Cesarean rate
To make an informed choice about your birthing location, consumers must tour potential birth locations early and ask questions and seek out information that may not otherwise be offered. According to the Slate article:
“Shah recommends that pregnant women and their partners look at the whole ward and the process of delivery care, not just the delivery room, when touring birthing centers. Where will they check in, sit for triage, and recover? Where are the nurses and doctors hanging out—is it near the labor and delivery area or further removed? Prospective patients could also benefit from looking at publicly reported hospital data, like C-section rates and rates of hospital-acquired infections, on internet databases such as the one run by the Leapfrog Group before choosing a facility.”
How early in pregnancy did you tour your birth location? What questions did you ask to help make your decision?
Babymoon Inn is a full-scope midwifery practice and wellness center with locations in Phoenix and Tucson. Our team is committed to improving maternal outcomes and providing personalized, evidence-based care to all people.