Birth Centers: Pop 'em out naturally and save $$ in the process

[catccc]

This has been mentioned within other posts about pregnancy and babies, but I thought I'd give it a topic of its own.

I had both of my kids at a midwife run Birth Center instead of a hospital.  Many hours of drug-free, character building, baby birthing badassity!

I think there are tons of benefits, both financial and health related.

I had decent insurance both times, but the even the copays were less at the birth center v. a hospital.  Amazing quality service/care to boot, so a huge value IMO.  And savings are probably even greater if you are paying a portion out of pocket.

[homeymomma]

Birth centers are a great option if you are allowed. There are many conditions/health history criteria that exclude patients from birth centers. Also, both people I know personally who intended to birth in a birth center or at home (and indeed labored for many hours there), ended up being transferred to their local hospital, where they were not only fearful for their babies' health, but in unfamiliar surroundings. Their preferred providers (their midwives) did not have hospital privileges, so they were also handed off to unknown OBs.

One of these friends' babies died. Unknown causes, healthy pregnancy/labor, but baby had no heartbeat or respiratory effort upon delivery. While she is still supportive of home and birth center birth in theory, she wonders if the lack of technological oversight during her labor and the transfer time between home and hospital was a factor.

I've also witnessed first hand (on the heels of CNMs) successful birth center births which were quite amazing, peaceful, and beautiful, including one which required extensive neonatal resussitation (which was successful).

So, I don't land one way or the other, but I do feel VERY strongly that money should not be the motivating factor when choosing a provider or location to birth your baby.

I'm pregnant with my second right now. With my first, I shopped around until about 30 weeks, and looked at birth center/home birth providers. I chose a midwifery practice that delivered in-hospital. I had preeclampsia so I would have been excluded from the birth center/home birth practice eventually anyway... I'm glad I made the switch earlier myself so I knew my providers. I'm going with the same set up this time, midwife in hospital. I feel it has benefits of both worlds. But after severe postpartum complications last time, caused by my midwife, I am going with a different practice this time, and strongly considered going the OB route.

[La Bibliotecaria Feroz]

America's wacky insurance system means this can go either way. My sister, a NICU nurse, felt so strongly about having a home birth that she coughed up $4000 for a home birth that her insurance wouldn't cover.

My giant, sunny-side-up, crooked babies both involved long labors followed by c-section. My total out-of-pocket cost: $0.

[Emilyngh]

I had my daughter with a midwife and had drugs.   I'm all for having a midwife and/or keeping things low cost  and just wanted to remind folks that going this route does not necessarily exclude drugs to ease the "character building" pain.

[rmendpara]

I can't relate to anything in this thread (single male), but just wanted to say that the title made me laugh out loud.

Classic!

[ruthiegirl]

Depends on insurance.  Mine would only cover a hospital birth.  A birth center would have set us back $2,000. 

All four of my kids were delivered drug free in hospitals.  Great deliveries, terrific nurses and $0 out of pocket.  And my husband was more relaxed knowing that we had medical back-up. 

I do love the idea of birth centers, just wish they were more accessible. 

[homeymomma]

Depends on insurance.  Mine would only cover a hospital birth.  A birth center would have set us back $2,000. 

All four of my kids were delivered drug free in hospitals.  Great deliveries, terrific nurses and $0 out of pocket.  And my husband was more relaxed knowing that we had medical back-up. 

I do love the idea of birth centers, just wish they were more accessible.

Our insurance pre-approved a home birth, but not a birth center birth! Lol. Insurance is a tricky game for sure. I'm jealous seeing all these cost=$0 posts. We have individual market insurance and even with the highest level coverage we could afford, delivery of baby #2 is going to cost us about $7500. Yuck.

[ruthiegirl]

Our insurance pre-approved a home birth, but not a birth center birth! Lol. Insurance is a tricky game for sure. I'm jealous seeing all these cost=$0 posts. We have individual market insurance and even with the highest level coverage we could afford, delivery of baby #2 is going to cost us about $7500. Yuck.

Ouch.   That is a lot.  We get insurance though my husband who works for a university.  I know we are really lucky to have such quality insurance and I treasure it. 

Good luck with your new little one!

[catccc]

yeah, a lot to consider.  The birth center I used had a relationship with an OB, so transfers to the hospital could happen smoothly.  Just wanted to put it out there because I know a lot of moms that don't even consider the option at all, they just assume that having your baby in a hospital is the only choice.

[eil]

My understanding was that most hospitals are pretty accommodating these days... and I'm not aware of a doctor who will refuse anyone a "natural" birth at a hospital unless there's a good medical reason not to.

Our most recent child was born at a hospital and we were positively thrilled with the entire process. It was a natural, vaginal birth. No painkillers. Mom and I both preferred hospital births because if something goes wrong before, during, or after delivery, we wanted the ones who know their medical shit right there in the same building with us. Even with insurance, it wasn't terribly cheap but the staff and level of care was excellent. We simply could not have asked for a better way to bring our son into the world.

Contrast with one of our friends... she's a bit of an ultra-hippie. Refused any kind of medical attention at all the whole time she was pregnant. (Cited some kind of bullshit "study" about ultrasounds causing miscarriages on her Facebook.) They were all set up for a home birth with a doula and whatnot. Around the due date she starts getting abnormally sick and hubby finally persuades her to see a doctor. Surprise, she has some kind of serious medical condition that means she has to be in the hospital during the birth and for a good while after. She wasn't too happy about that. Thankfully, everything turned out fine and both she and the baby are doing great.

[Gin1984]

My understanding was that most hospitals are pretty accommodating these days... and I'm not aware of a doctor who will refuse anyone a "natural" birth at a hospital unless there's a good medical reason not to.

Our most recent child was born at a hospital and we were positively thrilled with the entire process. It was a natural, vaginal birth. No painkillers. Mom and I both preferred hospital births because if something goes wrong before, during, or after delivery, we wanted the ones who know their medical shit right there in the same building with us. Even with insurance, it wasn't terribly cheap but the staff and level of care was excellent. We simply could not have asked for a better way to bring our son into the world.

Contrast with one of our friends... she's a bit of an ultra-hippie. Refused any kind of medical attention at all the whole time she was pregnant. (Cited some kind of bullshit "study" about ultrasounds causing miscarriages on her Facebook.) They were all set up for a home birth with a doula and whatnot. Around the due date she starts getting abnormally sick and hubby finally persuades her to see a doctor. Surprise, she has some kind of serious medical condition that means she has to be in the hospital during the birth and for a good while after. She wasn't too happy about that. Thankfully, everything turned out fine and both she and the baby are doing great.

Eh, sometimes they think they get to tell you want to do, but given I was in pain, I was pretty good at being bitchy and getting my way.  Personally I would not go into a hospital without a second person to make sure my wishes are followed.  This is no different than any other medical procedure in my mind.

[Cassie]

I had my 3 babies many decades ago in a hospital.  Kids are now 34, 37 & 41.  I took the Lamaze classes & never took any drugs. The hospital or docs did not care.  Some people were doing it at home with a midwife but I was afraid that if something went wrong we would not get immediate medical care.  A normal birth can go bad quickly.

[Gin1984]

I had my 3 babies many decades ago in a hospital.  Kids are now 34, 37 & 41.  I took the Lamaze classes & never took any drugs. The hospital or docs did not care.  Some people were doing it at home with a midwife but I was afraid that if something went wrong we would not get immediate medical care. A normal birth can go bad quickly.

Agreed.  I started bleeding internally while giving birth and had to go in for emergency surgery. 

[Cassie]

Glad you are okay:))

[Freedom2016]

I'm a big proponent of natural birth (fan of Ina May Gaskin) but also really glad I had a hospital birth. I had a midwife, no meds, and vaginal birth, and I even got to labor in a tub. But I had a "stubborn placenta" after DS was born and had to be anesthetized to remove it; and I bled enough to nearly need a transfusion. I'm just not sure how that all would have gone down in another setting, and it's not worth it to me to find out.

#2 is due in October. We're living in another state but found a midwife practice here that delivers in a great local hospital that has a policy of not doing elective c-sections... and is otherwise very natural-birth friendly. Looking forward to another good experience.

We made sure our midwife and hospital are "in network" on our health insurance, so after we cover our deductible, all birth expenses will be paid.

[bonjourliz]

My understanding was that most hospitals are pretty accommodating these days... and I'm not aware of a doctor who will refuse anyone a "natural" birth at a hospital unless there's a good medical reason not to.

Our most recent child was born at a hospital and we were positively thrilled with the entire process. It was a natural, vaginal birth. No painkillers. Mom and I both preferred hospital births because if something goes wrong before, during, or after delivery, we wanted the ones who know their medical shit right there in the same building with us. Even with insurance, it wasn't terribly cheap but the staff and level of care was excellent. We simply could not have asked for a better way to bring our son into the world.

Contrast with one of our friends... she's a bit of an ultra-hippie. Refused any kind of medical attention at all the whole time she was pregnant. (Cited some kind of bullshit "study" about ultrasounds causing miscarriages on her Facebook.) They were all set up for a home birth with a doula and whatnot. Around the due date she starts getting abnormally sick and hubby finally persuades her to see a doctor. Surprise, she has some kind of serious medical condition that means she has to be in the hospital during the birth and for a good while after. She wasn't too happy about that. Thankfully, everything turned out fine and both she and the baby are doing great.

I absolutely disagree with the first paragraph here.  As an active member of my area's birth community, I have heard countless stories of pregnant/laboring women being disrespected, lied to, patronized, etc. In fact, an upfront, evidence-based model of care is the definite exception to the rule.

A birth is not somewhere I would make decisions based on cost. It's a shame that cost is a deciding factor for so many families; I wish everyone could give birth where they feel most comfortable. if cost doesn't need to be a primary factor for you -- don't let it be. 

Also, for anyone planning a med-free birth (or just wary of navigating the system solo) --- a good doula is worth her weight in gold.  I didn't get one for my first birth, thought it was too expensive.  Had one for my second, and even my DH agrees that she would have been worth 10x what we paid her, for the value of the support she gave us.  A good doula needn't be the most expensive, either -- newer doulas often offer discounts, esp for certifying births. And they may be more eager than their older jaded counterparts.  Yet usually, by the time they are certifying, they have done a ton of training, shadowing, etc, so they aren't totally green.



Sent from my HTC first using Tapatalk

[abhe8]

i WISH it had saved me money. 4 big, perfect, healthy babies born at home with the most lovely midwife (probably in the whole world) and it cost me a very un-mustacian 4k each. oop. insurange paid not a dime. (FWIW, they would have cost about $200 each had we gone the hospital route, as we have pretty good insurance). and of course, it was worth every penny. i would not trade it for all the money in the world.

that said...i'm happy and supportive of every mama and her choice and every baby...and so glad we have the choices on how and when we meet the sweet little ones.

[Amanda]

Just want to pop in and say that this is the greatest community ever. This kind of conversation would have devolved into nasty judgmentalism pretty much anywhere else on the web, and here are a bunch of different perspectives and opinions and experiences calmly and supportively communicated.

I had two separate births in a hospital with a very supportive DO. Both my boys and I needed swift medical intervention during the births and I am glad I was close to the beeping machines and oxygen tanks.

I acted as doula for a close friend's homebirth last year and it was a really unique and positive experience. And, when I was 16 I was the only capable person around and I delivered my baby brother in what was supposed to be a midwife-assisted homebirth, but, because of uniquely short labor, turned into daughter-assisted homebirth. I still try to hold it over both my mom and my now 17-year-old brother.

[GuitarStv]

I had my daughter with a midwife and had drugs.   I'm all for having a midwife and/or keeping things low cost  and just wanted to remind folks that going this route does not necessarily exclude drugs to ease the "character building" pain.

+1

Our birth was in a hospital with a midwife.  Original plan was to go natural.  There were complications (big surprise squeezing a 10 lb baby out of a 100 lb woman), and my wife ended up getting an epidural for the pain.  It was absolutely the right way to go for us.

[sleepyguy]

What I found pretty crazy is C-section cost upwards to $15k in the US?  That correct?  Wow, both our kids my GF had to have it and boy I'm glad we're in Canada where it is 100% covered.

[Dr.Vibrissae]

We're getting ready to have our first, and I'm very comfortable with my OB and the hospital we'll be using.  She is very supportive of natural births (much more so than my spouse FWIW) as are all the labor and delivery staff (from what I could tell on the tour).  The whole thing is set up for co-rooming, and the doctors and nurses are part of unit to see to both mother and child.  Since I like it, and it's covered, I didn't really bother looking at the other hospitals or the birthing center (home birth does not sound like my cup of tea).

I have several friends locally who had midwives and home births.  I considered looking into a midwife, but didn't bother since I like my OB.  There is a midwife in this practice, but I don't like her at all.  I really hate being talked down to, scolded and ignored, especially by someone who has only seen me and my chart for 5 minutes - I guess that's how some women feel with some doctors.

I think it's a shame that there are women out there who feel bullied by their doctors.  Is it because they end up with a provider they aren't familiar with?  I have a hard time thinking you would continue to see a doctor you don't trust for care. 

[bonjourliz]

I don't think its so much that women are being attended by people they don't know... But rather that their ideal is quite different than the provider's norm.  Also, a lot of providers are not following evidence based medicine.  A lot of our standard protocols are not supported by medicine, yet they still happen.  Episiotomies, limiting food and drink in labor, putting time limits on labor/pushing, breaking mom's water, pitocin to distress, inducing for a suspected big baby, not supporting vbac.... All of these happen everyday, but they are not supported by evidence.  And if a mom goes in wanting a natural experience, and ends up on the intervention train... well that is a big change.  But thats the difference btwn what a mom wants and how most providers practice. These differences are not apparent before the big day, and by then there is only so much a mom can do (especially if she did not see a conflict coming).

Sent from my HTC first using Tapatalk

[homeymomma]

I think it's a shame that there are women out there who feel bullied by their doctors.  Is it because they end up with a provider they aren't familiar with?  I have a hard time thinking you would continue to see a doctor you don't trust for care.

Many practices (including most midwife practices) are group practices. So if there's 6-12 providers, you'll barely get a chance to meet all of them during your pregnancy, much less quiz them all on their agreement with every part of your birth plan. Then it hardly matters because you don't get to choose who's on call when you deliver.

[MicroRN]

I think it's a shame that there are women out there who feel bullied by their doctors.  Is it because they end up with a provider they aren't familiar with?  I have a hard time thinking you would continue to see a doctor you don't trust for care.

You don't necessarily have a choice. 

Since I was seen at a military hospital for my first, I saw "my" OB for care (although she deployed halfway through and I got a new one), but I had no expectation of her being at the delivery.  They used a hospitalist model, where the staff was scheduled for regular shifts.  It has some great advantages, including that "your"  OB isn't being called to come in at 2 AM and potentially misses the birth.  On the downside, you have no idea who will be at the birth itself, and it's usually residents, plus they change out every 12 hours.  You could start with someone you liked and end up with someone you didn't.  Most of them are good, but there are a few who are awful.  This hospital delivered about 3000 babies a year.  It was a bit assembly-line, but the quality of care was excellent.  They had a top-ranked NICU, 24 hour anesthesia on site, and they were well-trained in handling complications.  When my baby went into distress, my room was suddenly full of brisk but very calm medical staff who immediately worked their drill, and when it didn't resolve we headed for a c-section, where baby was out in under 20 minutes.     

With the 2nd baby I saw a civilian OB since there was no military hospital. I actually only saw him at a few appointments - most of them I saw the NPs.  Also, while he would try to make it to births, if he couldn't an OB from an entirely different practice that I had never met before would have covered for him.

[oldtoyota]

The bottom line, I've found, is that it looks better in court to have done an invasive procedure like a c-section in the event something horrible happens and everyone goes to court.

C-sections are overused in the US and sometimes for the convenience of the doctor's schedule. Rates for that sort of abdominal surgery are lower in other countries.

Please note that the above is not an attack on anyone who has had a c-section.

Also--and this is truly terrible so sorry to point it out--anesthesiologists are highly paid and need to do work to receive that pay. Hospitals, in the past, have been better compensated when a woman has surgery and that surgery justified the high expense of the anesthesiologist needed to put the mother-to-be to sleep. There are simply more profit points in a c-section than in a regular birth.

Did a lot of reading on this topic back in the day…I also like Ina May.

[La Bibliotecaria Feroz]

Doctors definitely do practice "defensive medicine," which is why my sister--someone who regularly attends c-sections and other intervention births in her capacity as a NICU nurse--chose a home birth. WHO says that a c-section rate of 10-15% is reasonable. Hospitals are often way, way over that.

Ina May probably could have gotten my giant-headed, sunny-side-up, crooked babies to come out, given a few days of labor, but with any lesser midwife, I think I would have wound up with a hospital transfer and CS. I feel good about the way things went because I was educated and knew what was going on.

Birth centers do give you a better chance of avoiding interventions, which can be bad for both your health and your pocketbook! (Depending on your insurance.)

[MicroRN]

What I found pretty crazy is C-section cost upwards to $15k in the US?  That correct?  Wow, both our kids my GF had to have it and boy I'm glad we're in Canada where it is 100% covered.

It entirely depends on your insurance.  Both of my c-sections were $0 out of pocket.  I know a friend paid around $4500 out of pocket for a birth center, since her insurance wouldn't cover it.  The thing that was really bad was that she transferred to the hospital after 30+ hours of labor, including 4 hours of pushing for a forceps delivery.  She ended up still paying the birth center AND having to pay the hospital co pays, which were about $2000.   

[Gin1984]

A normal birth can go bad quickly.

I don't have kids but utterly agree with this. I am thankful that all of my friends had their babies in hospital. Without modern healthcare and interventions, I'd have lost several friends to childbirth, and quite a few of their kids wouldn't have survived. Home birth seems irrationally risky to me.

Me too.  I would have died if I was not at a hospital. 

[bonjourliz]

Actually, studies have shown that, for low risk women, home birth with a qualified attendant is as safe as a hospital birth.

I don't know your unique situations, but in general -- the vast majority of birth "emergencies" have clues before they present.  A HB MW is trained to pick up on those signs.  Also if something unexpected does pop up, she is able to triage most situations until you transfer to a hospital.  Finally, the interventions that come standard in most hospital settings make the complications more common. 

Homebirth is more common outside the US for sure.  But the US does birth differently than everyone else, and our outcomes are worse.  Things need to change.

Sent from my HTC first using Tapatalk

[Gin1984]

Actually, studies have shown that, for low risk women, home birth with a qualified attendant is as safe as a hospital birth.

I don't know your unique situations, but in general -- the vast majority of birth "emergencies" have clues before they present.  A HB MW is trained to pick up on those signs.  Also if something unexpected does pop up, she is able to triage most situations until you transfer to a hospital.  Finally, the interventions that come standard in most hospital settings make the complications more common. 

Homebirth is more common outside the US for sure.  But the US does birth differently than everyone else, and our outcomes are worse.  Things need to change.

Sent from my HTC first using Tapatalk

I had no risk factors, easy birth, no drugs, the whole thing. Then my daughter somehow rip a part of my cervix on her way out.  For me, personally, not have those people there is a risk.  I gave birth at a hospital with a high end NICU not because we had any expected problems but because I like to have the best if something goes wrong.  I just don't get have access to medical care and not availing yourself of it. 
Granted, I do think have a person there to make sure your wishes are followed is a good thing for any procedure so don't think I am just pro-medical people.  Everyone has the right to make their own medical decision, I just don't get this one.  It just is too risky to me.

[bonjourliz]

Actually, studies have shown that, for low risk women, home birth with a qualified attendant is as safe as a hospital birth.

I don't know your unique situations, but in general -- the vast majority of birth "emergencies" have clues before they present.  A HB MW is trained to pick up on those signs.  Also if something unexpected does pop up, she is able to triage most situations until you transfer to a hospital.  Finally, the interventions that come standard in most hospital settings make the complications more common. 

Homebirth is more common outside the US for sure.  But the US does birth differently than everyone else, and our outcomes are worse.  Things need to change.

Sent from my HTC first using Tapatalk

I had no risk factors, easy birth, no drugs, the whole thing. Then my daughter somehow rip a part of my cervix on her way out.  For me, personally, not have those people there is a risk.  I gave birth at a hospital with a high end NICU not because we had any expected problems but because I like to have the best if something goes wrong.  I just don't get have access to medical care and not availing yourself of it. 
Granted, I do think have a person there to make sure your wishes are followed is a good thing for any procedure so don't think I am just pro-medical people.  Everyone has the right to make their own medical decision, I just don't get this one.  It just is too risky to me.

you're right, everyone needs to make the choice they feel most comfortable with. 

I dont mean that HB is better or that women should be forced to HB if they dont want to.  only meant that HB isn't as risky as it seems at first glance.  but of course that's a statistical thing, and statistics only go so far when you are considering the choice for yourself.

Sent from my HTC first using Tapatalk

[ambimammular]

Love Ina May! Those birth stories are empowering, especially when it's your first child and your only knowledge comes from sitcoms/media.

I think most people just don't know there are options.

[Hannah]

I gave birth at the Minnesota Birth Center, and I loved it. My cost was about $4800 out of pocket, but would have been closer to $7000 out of pocket at the Children's Hospital (which was across the street, and to which the midwives had admitting rights). We are on a very high deductible plan ($4500), and only pre-natal care was explicitely covered by my insurance.

Certified birth centers all have some sort of agreements with hospitals, though the specific legal requirements vary by state.

The best part about birth centers is being able to go home after giving birth. I went into the birth center around  3PM and was home with a new baby in tow around 10:30 (we lived four blocks away at the time). They came to our house for the 24 hour appointment to check on our little guy.

Also, giving birth naturally does make you feel like a badass.

That being said, modern medicine has saved my cousin with all 3 of her births, so be sure that if you are high risk, or think you might be high risk that you feel really comfortable with the midwive's views on hospitalization.

[Daleth]

One of these friends' babies died. Unknown causes, healthy pregnancy/labor, but baby had no heartbeat or respiratory effort upon delivery. While she is still supportive of home and birth center birth in theory, she wonders if the lack of technological oversight during her labor and the transfer time between home and hospital was a factor.

Im so sorry for your friend.

Cornell University recently did a study to compare the relative safety in the US of childbirth at home, in birth centers and in hospitals. They restricted the study to low-risk births only (full-term singletons weighing at least 2500g/5.5lbs with no congenital anomalies), and they looked at ALL such births over a three-year period (2007-09), over ten million births.

Here are the death rates they found for babies born (death during or soon after labor), and a link:

Hospital births with midwives: 3.1/10,000
Birth-center births with midwives: 6.3/10,000
Home births with midwives: 13.2/10,000

http://www.ajog.org/article/S0002-9378%2813%2901155-1/fulltext

That to me is pretty sobering. There are European and Canadian studies showing better results for home and birthing-center births, but the thing is, European and Canadian midwives are very different than American ones for at least two reasons:

1- They are all the equivalent of CNM's (certified nurse midwives). No other developed country lets people without medical training practice as midwives--but we do. Look up the requirements to be licensed as a CPM (certified professional midwife) or LDM (licensed direct entry midwives)--it's appalling. US hospital midwives are CNM's. Birthing center or home birth midwives? Only rarely--they're usually just CPM's or LDM's.

2-As CNM equivalents, they are integrated into their countries' health care system--AND they are not allowed to deliver pregnancies that are high risk; they have rules that they must follow re: what patients they can accept and when during labor they have to transfer to the hospital. If they fail to follow those rules they lose their licenses. Here in the US? Not the case.

Even assuming a hospital birth is more expensive, which isn't always true (especially with home birth, for which most midwives charge thousands--and insurance won't typically cover it), this is a situation in which you get what you pay for and it really really matters.

[Daleth]

What I found pretty crazy is C-section cost upwards to $15k in the US?  That correct?  Wow, both our kids my GF had to have it and boy I'm glad we're in Canada where it is 100% covered.

That sounds high to me, and they are covered by insurance just like a vaginal birth is, so their raw cost is in any case orders of magnitude higher than what you would ever pay as a patient.

[hermoninny]

I had both kids at the hospital.  After #2, I said that if we have #3, I'm going to seriously consider a home birth. 

#1 was induced for a variety of reasons, but I wouldn't allow them to break my water, and had no pain meds and a short labor (6 hours).  My OB was very new and fought me the whole way through my pregnancy over certain things (no flu shot, rules of the induction, etc), but after the birth was done she said to the nurse, "Natural births are just so beautiful."

#2 was born in a different state that, while extremely granola, is also very litigious so it's hard to have a natural birth.  I shopped around for an OB for a while, and she was perfect.  We got to the hospital at 6pm and baby was born at 6:50.  No time even for an IV. 

My one complaint is that we weren't "allowed" to leave the hospital until 24 hours after birth after #2 (we stayed the full 48 hours for #1).  We wanted to be home with our toddler, and it's so uncomfortable to be there for so long with people coming in and out of the room all the time.  Hence the serious consideration for a home birth next time (if there is one).  I looked into birthing centers for #2, but the closest one I could find is about 90 minutes away, and that's if there's no traffic (which NEVER happens here).

I'm extremely lucky that I've had limited complications during pregnancy and super-easy births and can consider such alternative methods.  I'm a staunch supporter of every mother getting their perfect birth, from c-section, to pain meds, to birthing center or home birth. 

[oldtoyota]

A normal birth can go bad quickly.

I don't have kids but utterly agree with this. I am thankful that all of my friends had their babies in hospital. Without modern healthcare and interventions, I'd have lost several friends to childbirth, and quite a few of their kids wouldn't have survived. Home birth seems irrationally risky to me.

Hospital births are risky too. One friend caught a super bug in the hospital and was on drugs for years to try and get rid of it. Another friend had the surgery and now has permanent nerve damage. A third had a baby who ended up in the NICU due, mostly, to the hospital not having a delivery room ready.

AFAI have seen, medical staff only allow home births for those who are low risk, and there is always some risk in having a baby.

There's risk to surgery and also to being put to sleep during surgery.

[JoyBlogette]

+1 for Canadian babies where the cost is the same regardless of birth choice. 

Also, in Ontario, midwives are registered and licenced.  Just wondering if that is the same as in the US?  Does anyone know?

[Gin1984]

+1 for Canadian babies where the cost is the same regardless of birth choice. 

Also, in Ontario, midwives are registered and licenced.  Just wondering if that is the same as in the US?  Does anyone know?

There are different types of midwives here, some licensed, some not.  And it depends on your state because licensing is state specific.

[Mt9982]

What I found pretty crazy is C-section cost upwards to $15k in the US?  That correct?  Wow, both our kids my GF had to have it and boy I'm glad we're in Canada where it is 100% covered.
[/quote

It's covered by insurance.  Yes, there are issues with medical care in America but I believe your media distorts this.  The vast majority of US citizens have insurance.  Just look at the Obamacare enrollment figures which also illustrates that fact (20 million out of close to 400 million people signed up?)  If I have a csection, my cost would be most likely 100 percent covered, unless I haven't reached my 600 dollar annual deductible and I go to an out of network doctor. 

While medical costs are much lower in canada you also have to realize that csection aren't cheap either.  While they probably don't cost the government 15k, it still would cost something as it's a surgery. 

[La Bibliotecaria Feroz]

There are two main types of midwives in the US: nurse midwives and direct-entry midwives. The latter have wildly varying educations and skill levels. Not all states license direct entry midwives, who perform mainly home births (some work in birth centers).

My sister's home birth was with a direct entry midwife who was licensed in her state. As a nurse, Sis felt more qualified than a layperson would have been to judge the midwife's skill and--equally important--judgment.

[Daleth]

Hospital births are risky too.

Oh, certainly, nothing is risk-FREE. So the question is, are hospital births AS risky as home births for moms and babies of comparable inherent risks? IOW, is a breech baby or a set of twins or a low-risk full-term head-down singleton as likely to come out of a hospital birth alive and well as they are out of a home birth? And how about the moms?

And the studies, at least in the US, seem to say no, they're not. Hospital births are not without any risk, but they are LESS risky.

AFAI have seen, medical staff only allow home births for those who are low risk, and there is always some risk in having a baby.

What country are you in? In the US medical staff have zero input on whether you do a home birth. If you can find a midwife willing to do a home birth--and there are non-CNM's out there who will agree to home births for 43-week breech babies, monoamniotic twins, and other high-risk births, no problem--you can do a home birth.

Of course, the midwives willing to do this generally have no medical training (they're not CNM's), upping the risk still further ...

There's risk to surgery and also to being put to sleep during surgery.

C-sections are usually not done under general anesthesia--just a heavy epidural or spinal block--so the risk of "being put to sleep" isn't there.

Ironically, the moms who end up needing general anesthesia for their c-sections are typically the natural birth/no drugs/no interventions ones, including the emergency transfers from home births and birth centers. Reason being that:

 (1) they don't have an epidural, even a light "walking epidural," so the option of just upping the dose of meds in their epidural isn't there--it takes 30-40 minutes to get an epidural placed and have to start working, which is time you don't have in an emergency (general anesthesia, in contrast, works almost immediately); and
(2) they are more likely to reject interventions (or not even be at the hospital) until the situation becomes life threatening, so by the time they consent to a c-section there is no time left to wait for an epidural or spinal block.

[Primm]

Ironically, the moms who end up needing general anesthesia for their c-sections are typically the natural birth/no drugs/no interventions ones, including the emergency transfers from home births and birth centers. Reason being that:

 (1) they don't have an epidural, even a light "walking epidural," so the option of just upping the dose of meds in their epidural isn't there--it takes 30-40 minutes to get an epidural placed and have to start working, which is time you don't have in an emergency (general anesthesia, in contrast, works almost immediately); and
(2) they are more likely to reject interventions (or not even be at the hospital) until the situation becomes life threatening, so by the time they consent to a c-section there is no time left to wait for an epidural or spinal block.

Agreed. Of all the mothers who deliver in my hospital, the ones we are the most concerned about baby outcomes for are the ones who come in with a 17 page birth plan, specifying things like no interventions, soothing music, delayed cord clamping etc. All of these are what we do if possible, but the people who ask for them specifically tend to be the hardest to convince to agree to interventions if something does go wrong, by which time it's often too late.

Trust me, I've seen it happen more times than I care to remember.

[Credaholic]

I'm 31 weeks pregnant with my 2nd, planning a home birth with licensed midwives. I'd love any input from those who have been through a home or birthing center delivery on questions to ask, monitoring I should make sure to have during the last trimester/delivery, supplies to make sure are on hand, etc.

I had a non-medicated, totally normal delivery with my son in a hospital. They did not require me to have continuous monitoring, just hooked me up to the heart rate monitor periodically to make sure we were both doing fine. I did have a little extra bleeding after delivering the placenta, and ended up receiving a Pitocin shot (which I was perfectly happy with) to clamp my uterus down and stop the bleeding. That was the only minor hiccup and was easily handled.

Since the first birth went so well and I trust my body in this process, I'm confident that I'm an excellent candidate for a home birth. My midwife and I have discussed doing a shot of Pitocin after the birth just as a precaution, which makes me feel more comfortable about that particular issue. I've had 3 ultrasounds (12 week, 20 week, and 30 week - the last one being to verify no previa) so I'm happy with the amount of monitoring I've had. My midwife is definitely precautionary. Baby has flipped breech a couple of times, and she's said that if there's any question as we get closer to delivery she'll send me for another ultrasound just to be sure. Baby is in good position now though and hopefully will stay that way since she's getting a bit big for flipping. My midwife would not consider an out of hospital breech delivery.

I've had gestational diabetes testing, and am going to ask about Group-B strep at my next appointment. With my doc for my first child I peed in a cup at every appointment (I'm not 100% sure what they were looking for - proteins?) but never do at my midwife appointments. Is this something I should ask for? How much heart rate monitoring should there be during the actual labor? What questions am I not thinking of?

I'm still confident in my choice, but as we get closer to the actual delivery I'm wanting to triple check that all ducks are in a row for this. When you're in a hospital, it's easy to go in totally blind and not really worry about it. I will also have my mom on hand who is a practicing GP and delivered in hospital for many years, so that's also an extra safety that makes me feel more comfortable in this decision, and I'm minutes from several top notch hospitals.

[bonjourliz]

I have had 2 hospital births.  If in have a third, it will likely be a home birth.

The first was an induction for high blood pressure.  Every intervention in the book... lasted 2 days ... and then pushing was ineffective plus I had a fever.  From my main nurse to the anesthesiologist to the OB, I was treated with complete disrespect by virtually everyone but my MW.  The nurse was actually complaining about me during the c-section, after my husband left the room with the baby.  Funny how that stopped when my MW (who was in the OR with me) mentioned that I am an attorney.

My second was a 100% natural birth.  I had a doula, and arrived at the hospital in active labor.  My nurse was just awesome -- she saw that I was in a "zone," and went with it. All my labor and postpartum interactions were respectful and honored the situation -- totally different than my first.  If I was confident that another birth would be like that, I would never consider birthing anywhere else. But I know that's not the case, and although this practice is the best for natural birth, there are still some serious quirks.  (Not all the MWs are stellar, and the hospital has some awful protocols esp re: babies who need antibiotics).

We have excellent home birth options here.... Wonderful, highly trained MWs (CNMs even!) with fully supportive OB back-up and smooth transfer plans.  So it will be a strong possibility if we have another.

The safety net of a hospital is appealing, but that's not all there is to birth.  And the more I learn about homebirth (particularly with the MWs I would like use), the more in realize the difference in safety nets really isn't so big. Especially after you consider the differences in the providers themselves.

Sent from my HTC first using Tapatalk

[Daleth]

WHO says that a c-section rate of 10-15% is reasonable. Hospitals are often way, way over that.

The WHO actually recanted that idea in 2009. It turns out there was (and I’m quoting the WHO here) “no empirical evidence” supporting the conclusion that the optimal c-section rate was between 5% and 15%, and there is still, to this day, no evidence on what the optimal rate is or even if there is such a thing as an optimal c-section rate. The 15% number was just made up out of whole cloth in 1985, and the WHO didn’t get around to clarifying that until almost a quarter century later.
 
Here’s a somewhat sarcastic article on that, but you can find any number of other references to it via google:
http://www.sciencebasedmedicine.org/whats-the-right-c-section-rate-higher-than-you-think/

[La Bibliotecaria Feroz]

WHO says that a c-section rate of 10-15% is reasonable. Hospitals are often way, way over that.

The WHO actually recanted that idea in 2009. It turns out there was (and I’m quoting the WHO here) “no empirical evidence” supporting the conclusion that the optimal c-section rate was between 5% and 15%, and there is still, to this day, no evidence on what the optimal rate is or even if there is such a thing as an optimal c-section rate. The 15% number was just made up out of whole cloth in 1985, and the WHO didn’t get around to clarifying that until almost a quarter century later.
 
Here’s a somewhat sarcastic article on that, but you can find any number of other references to it via google:
http://www.sciencebasedmedicine.org/whats-the-right-c-section-rate-higher-than-you-think/

Fascinating! I stand corrected. It's worth noting, though, that this article discusses only maternal mortality--not other complications that can accrue from a CS, like adhesions (that is, your internal organs sticking together). Or the additional risks that accrue with every additional CS. I follow celebrity news for my job as a trivia writer--Tori Spelling, for instance, almost died after her 4th CS. Controversial subject with a lot of gray areas and a lot of unknowns.

[HSLmom]

I'm 31 weeks pregnant with my 2nd, planning a home birth with licensed midwives. I'd love any input from those who have been through a home or birthing center delivery on questions to ask, monitoring I should make sure to have during the last trimester/delivery, supplies to make sure are on hand, etc.

I had 3 home births, I interviewed like 10 midwives for my last baby and only felt good with two of them. If you feel uncomfortable, I'd keep looking until you find one you like and feel respects your wishes.  I'm pretty against interventions - I had one ultrasound, checked for rh sensitivity (if you're rh neg, you need to do your own research on this, most midwives are underinformed and will mess this up), and used a fetascope/kick counts to check on the baby instead of doppler. I allowed use of the doppler while in labor.

I'm able to tell position of the baby, but you might want to check that he's head down/ anterior. I didn't want my water broken because of risk of prolapse, so I made sure the mw was ok with me refusing vaginal exams in labor. Also research what you're comfortable with regarding how long it takes for the placenta to come out (mine was 30 mins and I'm comfortable with that), ask the mw if she ever uses cord traction (I personally would not allow that outside of a hospital), ask her how she would measure postpartum hemmorhage and what steps she would take to remedy it, and look all those up to make sure you're comfortable with them.

Ask her if she'd transfer with you if you had to transfer.

With home birth, or any medical procedure/birth really, it's super super important that you know what's going on and you are finding someone who respects your wishes and has experience. It's not good enough to just 'feel comfortable'with someone - they can confidently blow hot air and sound really convincing but do lots of stupid stuff that just hasn't caught up with them yet. You need to know what can go wrong, what a variation of normal is, and what low-intervention things can be done to keep problems from getting bigger, when you need to transfer, and what routine procedures you want to do for sure or want to skip for sure.

I'm a total birth junkie :) 

[Credaholic]

With home birth, or any medical procedure/birth really, it's super super important that you know what's going on and you are finding someone who respects your wishes and has experience. It's not good enough to just 'feel comfortable'with someone - they can confidently blow hot air and sound really convincing but do lots of stupid stuff that just hasn't caught up with them yet. You need to know what can go wrong, what a variation of normal is, and what low-intervention things can be done to keep problems from getting bigger, when you need to transfer, and what routine procedures you want to do for sure or want to skip for sure.

I'm a total birth junkie :)

Thanks so much for your thoughtful reply! I have answers to a lot of those questions already, but had never even heard of cord traction, I will definitely be asking about that. I discussed the amount of monitoring at my appointment today, and am happy with the amount of heart rate checking they do, etc. and also discussed a lot of potential reasons for transfer, and at what point they would make that call. I'm feeling really good about everything, and as I said feel like I have cautious midwives (I definitely don't want overly confident midwives, and will transfer without argument if they think I should!)

I'm also planning on getting a birthing tub rental, a birthing ball, and of course need all the home supplies they require/recommend. It will be interesting at the end of this experience to see exactly how much money is spent, but $40 on pads, gloves and a rubber sheet should certainly be much less than a hospital. The one thing I'm finding that I wasn't expecting is that what is supposed to be my more low-key, zen home birth is actually a bit more stressful to prepare for since you can't just show up at the hospital with a spare change of clothes packed in an overnight bag!

[ASquared]

Second the natural delivery, preferably birth center or home birth if you are comfortable. 

Better for you, better for baby.  The financial benefits are just a side perk!! 

And to those commenting about home/birth center costing 2-4k, remember that for most people a hospital delivery will cost this much or more, and put you at increased risk of complications/etc (assuming normal pregnancy).