Where Women Give Birth

Last fall, Cindy Meza gave birth to her second daughter, Isabel, under a eucalyptus tree in the parking lot of her birth center. And while it wasn't exactly what she had planned, Meza, who

caught her own baby, says the care and information she had received from her midwives over the course of both of her pregnancies allowed her to stay calm throughout her surprisingly quick labor and delivery.

Cindy tells her story like this, "My labor with Isabel was going very fast. My husband called the birth center and said, 'I think she's going to start pushing.' They said, 'Don't let her do that! Drive her here immediately.' We drove so fast, we beat the midwife there. I managed to get halfway across the parking lot when I felt the baby crowning. I made it to a tree about 5 feet from the center's front door."

Her husband was busy consoling their toddler, since they hadn't had time to get a babysitter, so Cindy was on her own. "But," she recounts, "because of the confidence instilled in me by my midwives, Sharon Milan and Janice Rodenberg, I knew exactly what to do and was never afraid. I knew how to support the head. I knew to stop pushing at the crowning. I remembered to wipe down her nose for mucus. Actually, she was born with the sac over her head, so, first, I had to pull it back off her face. I rubbed up her back, because that was something Sharon had told me would induce her to breathe. I trusted my body and my instincts, and delivered a perfect nine pound baby." Now, she reports, "I trust myself much more in all aspects of my life. I am proud to be a woman, and I owe so much to the two midwives who helped me achieve this."

While Cindy's story is an inspirational one, her tree-shaded birthing place was one few women would, or could, choose. Cindy herself had not actually chosen the birth center for its back-to-nature charm. In fact, she says, "As a technical writer and Web publisher at a software company, I work in a field of technological advances and, although I wanted my pregnancy and childbirth to be as natural as possible, I was not sure I wanted to give up medical technology. I decided to go to the Birth and Women's Health Center here in Tucson, Arizona, because the birth center is across the street from a hospital, and was a perfect compromise for my desire for natural childbirth and my fear that I might need medical assistance. It was the right choice. I had my first daughter, Astrid, there without medication and it was an incredible, empowering experience."

Most opt for hospital births. More than 95 percent of women will have their babies in a hospital. Most will deliver with a doctor, but more and more women are turning to midwives. Midwife-attended births have doubled in the past 10 years. I had my first baby at Durham Regional Hospital with midwife Kathy Trotter. One of my strongest memories of the birth is of Kathy holding my shoulder, looking straight in my eyes, and saying "You CAN do this." Her firm and loving communication of confidence was just what I needed.

Sally Wong, of Albuquerque New Mexico, gave birth to her son, Luke, two months ago with certified nurse-midwife Nancy Miller of New Mexico Women's Specialists at Presbyterian Hospital. "We went to the hospital because that's what our health plan covered, and we knew they would have all the equipment and staff should we need it," says Sally. "We ended up with midwives because the obstetrician in their practice told me I'd probably be happier with the extra time and attention they offered. We had a positive, positive experience," Sally enthuses. "All of the midwives were so nurturing and flexible, and during the labor, Nancy was so patient. I never felt hurried. Then, some of the other midwives in the practice came to see us after the baby was born. One even came in on her day off. They made us feel so special and supported."

Teri Burdick's pregnancy fell into the "complicated" category; she gave birth in a hospital. Her baby was in a frank breech position her entire pregnancy. She says, "I definitely wanted to be in the hospital. I wanted top medical care." Teri gave birth to a healthy girl through a planned caesarean section in August, 2000 at Cayuga Medical Center, in Ithaca, New York. "I didn't really have a choice about whether or not to go to the hospital. And there is only one hospital here. But, it was really a great experience," she says. "Especially because the staff and the nurses were all very helpful and understanding of my needs." Teri's husband was allowed to be with her for the surgery and that was "wonderful." Teri's advice for women choosing to have birth in a hospital is to "go ahead of time and take tours. We took two tours, so we didn't feel like we were in a very strange place."

Marcelle Karp, co-founder of Bust magazine, who had her baby, Ruby, last fall at St. Luke's-Roosevelt Hospital in New York City also recommends taking tours of potential hospitals, and timing how long it takes to get there. "I did a tour, because I knew it was important to see the lay of the land." Marcelle's obstetrician wasn't covered by her new insurance, so she switched doctors during her pregnancy. "I had just gotten insurance and the idea of spending $8,000 instead of nothing, wasn't really possible. I had no real choice," she says. She knew she wanted a woman doctor and had certain options under her new insurance. And while she found a doctor she liked, at a good hospital nearby, she found, that like most women in the U.S., "So much depends on your insurance. Your insurance really determines your choices."

Regardless of insurance issues, Marcelle says she still would have chosen a hospital. "I had every intention of going the drug route. I suspected that I had no threshold for pain. For me, not knowing what I was in for and," she laughs, "knowing my level of pain tolerance, even tampons are painful for me, I thought I would ask for drugs at 2 centimeters."

 As it turned out, by the time she got to the hospital, Marcelle was 8 centimeters dilated and handling the pain pretty well. "I was immediately taken into the labor room. They asked if I wanted an epidural, and it hurt, but not so bad." So, Marcelle skipped her anticipated epidural. For Marcelle, the most important part of creating a positive birthing atmosphere was her "birth team." In addition to "the doctor, who I trusted, and the two nurses, who were amazing," Marcelle had a doula, her husband, and a friend who acted as a birth partner. Most hospitals, like St. Luke's-Roosevelt, now allow not only husbands in the delivery room, but also doulas, close friends, and family, although there are often restrictions on the number of people and the ages of children.

Birth center options. Some women choose to have their babies at birth centers because they seem to offer the best of both worlds: a home-like atmosphere with access to medical technology should it be needed. Heidi Rinehart, a Board Certified obstetrician who works for the Northern New Mexico Women's Health and Birth Center in rural Taos, New Mexico says that birth centers offer "intimacy, flexibility, and privacy. At the birth center, the woman is the center of what is happening, not the staff, not the equipment, not the routine, just the woman." Rinehart also says that the birth center where she works is a good choice for "women in our practice who may not need the hospital and live far from it. If something unexpected did come up in their labor, it would be hard to reach the hospital from home, so the birth center is a good option."

When it comes to birth places, Rinehart knows what she's talking about, not only does she work for a practice that offers women the full range of choices, she has had two children herself, one at home and one at a birth center. She says, "At the birth center where I gave birth to my first child, hundreds and hundreds of women had given birth naturally there. It gave me confidence."

As to what she recommends for her own clients, "We feel very strongly that the safest place for a healthy woman to give birth is the place she feels the safest." Rinehart says where women feel safe has a lot to do with their personal confidence level. "Women who are not very confident that they can give birth without pain medication, or that their bodies can give birth safely, feel more safe in the hospital," she explains. "They believe that the staff, facilities, or equipment will help them, and if they believe it, it will be true for them. But statistics show that birth center births and home births are safe. In a healthy woman, medical technology does not improve on her physiology. In fact, those medical technologies can introduce side effects and risks of their own."

Home birth choices. The ease of having older siblings attend the birth is one reason some women choose to give birth at home. A home birth midwife for 25 years, Maggie Bennett, of Monterey, California, says, "Children will follow the adults' lead. But, if it is too much for them, they'll go play. I was with one mother whose 13-year old daughter cut the umbilical cord once, and then the next year, she caught the baby. That was great, but I always recommend parents have someone assigned to take care of the child, someone who can take them away if they are a distraction. As for other guests, I believe most women do better with fewer rather than more. The only rule I have is that only people who are supportive should be there."

Some women choose to give birth at home based on a strong desire for natural childbirth and a belief that their home is the most comfortable place to give birth. Bennett says "Home birth is a good choice for any healthy woman. It provides an atmosphere that the woman is familiar with where she can play out her labor at her own pace, with her own instincts, surrounded by the people she chooses. The difference between how we feel in our space as opposed to someone else's is so important. Birth is birth wherever it is. The baby's position has to play out wherever the mom is. That is the work that has to be done. Being in your own space eliminates any barriers to getting that work done. You don't have to adjust to a new environment, physical and social. That can make it a lot easier."

Wherever you choose to give birth, keep in mind your own personal perceptions, and preferences. As Rinehart points out, "What is important is a feeling of safety, security, and privacy, and to have continuous support and encouragement. And different people will define that safety and security differently."

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*taken from "Where Women Give Birth" by Catherine Taylor, Every Baby magazine, Issue One.