January 3, 2015

It’s finally time to answer the big question - hospital birth or midwife? Now I don’t mean to overlook the pregnancy itself, but this topic is important to mention. Whether you go the midwife or hospital route, it’s a decision you’ll have to make early on in the pregnancy and get regular visits scheduled. And the short answer is, the midwife-led care model  leads to more successful pregnancies and better birth outcomes than hospital births for women who don’t have a high-risk pregnancy. According to Cochrane (which by the way is viewed as the final word on medical research studies), in a large, recent study, women under the midwife model gained the following benefits:

• Less likely to lose their baby in the first 24 weeks of gestation
• Less likely to have a pre-term birth
• Reduced epidurals
• Reduced episiotomies
• Reduced instrumental births
• Better chances for an un-induced natural birth
• Received care during labor from providers (midwives) whom she got to know
• Less expensive than hospital birth

To read the full research study, visit the direct link to The Cochrane Library.

Other advantages include improved bonding between mother and baby. Baby isn’t separated from you for excessive cleaning, shots, or other unnecessary reasons. It’s such a critical time to be in contact with baby. Also, midwives support delayed cord clamping (a technique that delivers the most blood possible to baby so they don’t have blue limbs or other issues).

So what is a midwife birthing center exactly? Most people think of water births when they hear of it. While many birth centers accommodate that, it’s simply a center that supports a natural, drug-free, un-induced labor experience that is guided by the mother’s own instincts. That means no epidurals, narcotics, or Pitocin which are all drugs that can harm baby … and you! I’ve heard of several stories where women had “unexplainable” health issues after getting an epidural. Be mindful of the risks and do your own research if you choose to include any of these things. Additionally, the administration of epidurals and Pitocin creates this vicious cycle of intense contractions, which causes more pain, which requires another round of epidural. Or sometimes you’re too numbed up to push. These factors are often what lead to unplanned C-sections despite a mother’s best intentions and what she included in the birth plan. C-sections are best avoided, as they require the most healing time, produce worse allergies for your child, and anecdotally some clinicians observe lower resistance to stress. Not to ‘belabor’ the point, but did you know that most C-sections happen around 6pm and 10pm? (i.e., just before the obstetrician is ready for dinner or to go home for the night). I would gather most women didn’t put in all that hard work into their pregnancy and labor to leave the outcome of the birth to someone’s convenient schedule.

Also in a natural child birth, the pushing isn’t rushed. Your body knows what to do as the cervix dilates, your contractions get stronger, and as baby works with you. Midwives and doulas are there to support you and monitor your status, typically sticking with you throughout the whole birthing process. This is in stark contrast to a hospital setting where there are multiple shift changes … you’re never given the chance to get comfortable with the staff that’s helping you during this very momentous occasion. If you choose a birth center, select 1 that is accredited by the Commission for the Accreditation of Birth Centers. This ensures they operate to the accepted set of standards. Ideally the 1 you choose will also be located in close proximity to a hospital in the event of an emergency. However, you can expect a low transfer rate – only 13% in a local birth center I visited.

To reiterate, a midwife birth center is appropriate when the pregnancy isn’t high risk. Any major complications warrant the care that hospitals have to offer. And it’s not for everyone, particularly if you’re very sensitive to pain. Women are built to have a high pain tolerance, although there will likely be points where you’ll feel the pain and might wish you had an epidural. Regardless, most mothers who went this route and also experienced a hospital birth prefer the midwife route. it's more rewarding, results in a stronger bond with baby, and gives your child lots of health benefits - both physically and mentally - which they will reap throughout life.

An excellent online resource for childbirth is Evidence Based Birth, also conveniently located on our Health Links page under the Natural Parenting section.