Birthing Center?

I haven't done any research into the safety of birth centres because there are none around here. But I know that studies have repeatedly shown homebirths to be as safe as hospital births for low-risk births, so I can't imagine birth centres being any less safe.
I would definitely do some research if that's something you're interested in. You could also contact your local centre and ask them for info. It would be great too if they had stats they could provide re: intervention rates.

It might be helpful to think about what you want for this birth and what the best way to accomplish that is.

Hopefully someone else will have some experiences to share!

If it helps, I've heard really good things about the Austin birthing center.

Actually, in most cases of normal births, homebirths are safer because of the unneccessary intervention that occurs with many hospital births, causing complications that otherwise wouldn't occur.

In a birthing center you'd have a better chance of not undergoing a c-section too.

Im pretty sure I've crossed a home birth off my list because I'm, first off, uncomfortable in my own home. We moved here recently and that's issue numero uno. Also I'm not high risk but I still have the fear of "what if something goes wrong?". This is number 3 for us so I probably shouldn't have that concern but for whatever reason, I do.

Do whatever makes you most comfortable cardhousewife, thats what's most important. Hopefully you can visit a birthing center and see if it's right for you. In my understanding birthing centers can potentially be less expensive than some hospital births (depending on if you got insurance how good of insurance you got). 1 out of 3 women these days who are pregnant have a c-section when laboring in a hospital, this number is reduced drastically when laboring in a birthing center and even more with home birthing, so that's one really I'd stray away from a hospital birth if I financially could (I'm on medicaid), especially if I didn't have good insurance or non at all (considering they can end up costing $50,000). A friend of mine wanted to go the whole natural hospital birth route recently but ended up getting a c-section... blah.

"1 out of 3 women these days who are pregnant have a c-section when laboring in a hospital,"

May I ask where you got that statistic from? That seems really high to me.

Yeah, I got it from the book "The Thinking Woman's Guide to a Better Birth" by Henci Goer.

On page 11 the quote goes like this, "In 1970, the U.S. cesarean rate was a stable 5 percent. By 1980, it had more than tripled. By 1983, one in five women was giving birth by major surgery, and the rate has yet to drop below that number. Some hospitals today perform cesareans on more than one-third of their obstetric patients, and a few surgically deliver as many as half."

Goer doesn't directly site where she got those specific numbers, but has a lengthy bibliography at the end of the book. The book's copyrighted for 1999, who knows where the numbers or now, but I doubt they've decreased below 1980s numbers.

I suppose looking at that quote again one could say 1 in 5 instead. 1 in 3 was what I recalled when I made that quote. *shrug*

I have heard only good things about the ABC!

I'm curious about the high number of c-sections at hospitals. What is the implication? Hospitals getting more money? But if that were so it would be necessary to prove that it was medically necessary wouldn't it? If they were to get money from the insurance it would be.

You should watch The Business Of Being Born! I've also heard the book "Pushed: The Painful Truth About Childbirth and Modern Maternity Care" is really good.

They do it because it's quick and convenient, for legal reasons (so if something goes wrong they can say they did all they could), so they can keep their skills up, because often one intervention leads to another so it becomes necessary when it needn't have been, and probably there are a zillion more reasons.

There's an article on why the rate is rising
http://www.childbirthconnection.org/article.asp?ck=10456

As for stats, this one says that as of 2004 the c-section rate in the US was 29.1% which is nearly 1 in 3.
http://www.childbirthconnection.org/article.asp?ClickedLink=389&ck=10285&area=27

Hospitals have the highest rate because they're based on the medical model of pregnancy and childbirth. The midwifery model ends with fewer interventions because it comes from the perspective that pregnancy is a normal and usually healthy part of a person's life, so there is less tendency to try to "fix" things.

Thank you for the links. It's a wonder this is my 3rd baby and I'm new to researching all of this.

Here's an article about rising C-section rates from the CDC's National Center for Health Statistics.

http://www.theunnecesarean.com/blog/2009/3/18/c-section-rate-rises-2007-us-cesarean-rate-hit-318-percent.html

I would certainly opt for a birthing center over the hospital. Essentially, they have all of the equipment you would find at a standard hospital, but without the ability to perform surgeries. In the event of a life-threatening emergency, they would transfer you to the nearest hospital with an OR and call ahead. You would probably arrive there before they had everything prepped. At the birthing hospital near me, decision-to-incision time is 20 minutes. Plenty of time to transfer.

Labouring at a birthing center will statistically lower your chance of undergoing a C-section, being artificially augmented, delivering with forceps or vacuum extraction, and suffering an episiotomy or severe tear. Most birthing centers provide birthing pools and other measures to help you deal with labour without medications and encourage you to be upright and mobile. Labour tends to progress faster and more efficiently if you can move and avoid drugs.

Keep in mind with those stats that part of the reason hospitals have more Cesarean births is because they also tend to have more high-risk patients.

I'm not quite sure where your from MamaCaboose, but here in North Dakota (and most of the US in general) there are hardly any alternative options for women other than hospital births. If ya got money, resources, and support you might be able to find a midwife. So around here, you don't see more high-risk births at hospitals, you see em' all in the hospital. I doubt enough women are going to birthing centers and midwifes to skew the c-sections stats you'd read about that occur in hospitals.

I didn't read any more of this article, besides what I posted here. It is very long, but if you're interestede in reading the rest, it is from http://www.medscape.com/viewarticle/589062. I don't really know how biased it is or in which direction, but I posted it because it has the stats for homebirths in the US. Here in Oregon where I live, I'm pretty sure the percentage of women giving birth at home is slightly higher, but I live in a very liberal town.It does say though, that the percentage of homebirths in the US has remained below 1% since 1960.

Before the mid-20th century, most American women gave birth at home under the care of midwives.[1] As the specialty of medical obstetrics grew, the percentage of hospital-based births increased.[2] In 1940, 40% of births to white women and 73% to nonwhite women in the United States occurred at home.[3] Total hospital births were 56% in 1940.[3] In 1950, the percentage of hospital births soared to 88%, rising to more than 99% by 1969, where it remains today.[3-5] Therefore, the small percentage of the population of women choosing home birth in the United States today comprise a minority culture.

Although the percentage of home births has remained below 1% since 1960, the actual numbers are not trivial. National figures for 2005 show that 24,468 infants were born at home in the United States.[4] The majority of women who chose home birth in the United States were white (n = 19,706) and were attended by midwives (n = 13,118).[4]

Numerous studies have shown equivalent safety rates when comparing home and hospital births.[6-11] A recent integrative review compiled data from 28 studies undertaken between 1969 and 2000.[7] Fullerton et al.[7] concluded that maternal and neonatal outcomes of planned home birth receiving first-level care were favorable when compared to planned hospital or birth center births.[7] A meta-analysis of six studies comparing the birth outcomes of 24,092 low-risk pregnant women found that perinatal mortality was similar between the home and hospital birth groups.[10] Olsen[10] found that the home birth group had a decreased frequency of induction, augmentation, episiotomy, operative vaginal birth, and cesarean delivery.[10]

Despite favorable safety rates, the choice to have a planned home birth is not well supported in the United States by the government, professional organizations, the insurance industry, or society.[1] Government regulations impede practitioners from providing home birth services by limiting licensure. All states license physicians and advanced practice nurses, but only 23 states allow licensure of nonnurse certified midwives who are more likely to attend home births.[12] Recently, the American College of Obstetricians and Gynecologists issued a news release reiterating its opposition to home birth as stated in their 2006 Statement of Policy, which admonished physicians from practicing home birth and from providing back-up support for home birth providers.[13,14] These regulations and policies result in small numbers of home birth providers and great difficulty for women in locating a provider. Some insurance companies do not fully reimburse providers' fees for home birth.[15] In addition, women who choose home birth are often asked questions about the perceived risk they are taking.

Studies from other countries where home birth is more prevalent examined reasons why women chose home birth. Common themes were control, comfort, freedom to move, and fewer interventions.[16-20] In two of the four studies, women stated that they felt safer at home.[16,20] In Turkey, although the main reason for choosing home birth was economic, almost 50% of the women stated that they feel more comfortable at home.[20]

Given that women choosing home birth in the United States are a minority population, and that their choice to birth at home is not well supported, the aim of our study was to describe the reasons why women choose home birth.

In the Canadian study that is most recent, it compares low-risk women in hospital to low-risk women at home, and the outcomes at home are still better.

All of that being said, women need to have their babies where they feel the most safe. I have seen women who are nervous of out-of-hospital birth, plan an out-of-hospital birth for the better stats. They just didn't progress. The stress of not being in hospital had an effect on their natural oxytocin level. Once transferred, they had a baby.

I definitely would not want to discount the importance of the studies, not at all, and I'm totally pro homebirth and am planning one for myself. And when people seem confused when I mention that, I always site the studies.
But to be fair studies cannot control for everything, and since the women involved aren't randomly assigned to give birth at home or hospital (not that they should be LOL) they may be a self-selecting group, different from the hospital birthing group in some way (possibly knowledge about birth, what kind of education, etc,). So what the studies show really is not necessarily that homebirth is safer for all low-risk women, but that it is safer for the women who choose it.

True, they are prospective studies. That is the best we will ever have... I can't see women agreeing to a RCT!!!

I checked out of this thread for a while, so I'm sorry I didn't respond to all this earlier.

Pintsized - I'm not saying there are enough low-risk patients birthing w/ midwives to skew the stats of the hospital C-section rates. Those rates are what they are. What it might skew, however, is the *comparative* rates. What I'm saying is that because those who do choose homebirths or births with midwifes are more likely to be low risk, you can't automatically say that higher hospital intervention rate is entirely *because* doctors are more likely to pursue unnecessary complications (though some, or even all, of it certainly may be).

I guess I'm just a big fan of being cautious with statistics, yk? Taking the information, but taking it with a grain of salt.

Cardhousewife - I'm sorry if my comment drew us away from your original question. Again, I've heard only good things about the Austin birthing center. Beyond that, my best advice is to find a caregiver with whom you are really comfortable.

And I lol'd at Yabinti's comment about pregnant women agreeing to a RCT.

Well, wouldn't happen!
The best we have (Canada) are prospective studies on low-risk women in both settings.

Oh, I totally agree with you, Yabinti. I just thought the idea of it was funny - when I read that I imagined a pregnant woman saying something like, "Well, I was going to interview different care providers, but then I decided it would just be easier to be assigned randomly to someone for the sake of a research project. She won't tell me whether she's a doctor or a midwife or, you know, a hairdresser who just likes pregnant people a lot, because she says my perception of her could bias the study, but I'm not too worried about it." Yeah, somehow I doubt that's ever going to happen.