Choosing Where To Give Birth Is Not One Size Fits All

Who will you choose to care for you?

As with most options and choices in pregnancy, childbirth, and parenting, the choice of where to give birth is a tough one for many to make and is subjected to your own anxieties and others criticisms. Tell family that you are having a home birth and you can receive a reaction of mouth hanging open and disbelief to outright animosity and threats they will not attend your birth or call the authorities on you. Mention elsewhere that you are birthing in a hospital and inevitably someone will pipe up that you should watch a popular DVD about the birth business and warn you everyone and anyone who steps in the hospital will end up with an unnecessary cesarean section (and wear a gown someone died in the day before). Unassisted birth? That’s not something you can discuss unemotionally at your local playgroup.  These reactions can be bewildering, stressful, and even hurtful. Couples may find themselves arguing over the pros and cons of where to give birth.

I’m not going to tell you which is better. I trust you. I trust you to make the best choice for yourself. I trust that with the wealth of evidence based information available these days that you can think for yourself and calculate the risks and benefits. There is a lot of misinformation out there as well as rabid opinions on both sides so be careful when you’re on your search and rely on trusted sources and your own thinking ability and intuition.

The fact is, there is no OSFA (one size fits all) answer. If everyone had to have a hospital birth or everyone had to have a home birth we wouldn’t have any choice at all. There are women who feel going to a hospital will subject themselves to unnecessary interventions or inhibit the natural birth process (and that’s okay to come to that decision). There are women who feel giving birth at home is unsafe or anxiety producing (and that’s okay to come to that decision). There will be women who plan for one or the other and end up unexpectedly birthing their baby in their bathroom before ever getting to the hospital and there will be women who painstakingly plan for a home birth or birth center birth and risk out beforehand or are transferred during labor. There will be women who feel disappointed if their birth plan and place of birth go according to plan and decide to do it differently the next time and there will be women who have nothing go according to their plan and adjust their choices accordingly.

But Kimberly, “I hear some people saying, “what about rogue midwives with no real training and greedy obstetricians who can’t wait to slice women open to get to their round of golf?” Those are absolutely valid points but that in actuality comes down to who you are choosing as your provider. One surgery happy obstetrician does not mean the entire hospital is that way (but it could). One irresponsible midwife with no accountability does not mean there aren’t very well trained and competent midwives (but it could). Do your research. I say this over and over. Choosing a provider in line with your childbirth wishes is one of the most important things you can do. I cannot stress this enough. When you have a good provider you can have confidence in the suggestions and care they give you, as well as any backup plan or transfer of care that may come along. If your provider cannot find the time to sit down and have a real conversation with you without just giving canned answers (‘I never have to transfer to a hospital”, “so long as everything is ok”, “let’s just play it by ear”) that may be a red flag that you need and deserve to find a new provider who can make the time to answer the hard questions. Listing all the important questions will have to wait for another blog but a starting point would be to ask if they follow the advice of their own certifying organizations (ACOG — American College of Obstetricians and Gynecologists or MANA (Midwives Association of North America) for example) as well as complying with any state or local laws.

Sadly, not all areas like the one I live in have a multitude of hospitals, midwives, midwives in a hospital setting, home birth providers, freestanding birth centers, etc. to choose from. For those of you in such a difficult circumstance, I feel for you. Planning your birth may be choosing between two less than optimal choices. Until we have more collaboration between hospital providers and home birth/freestanding birth center providers some of us will struggle with gaps in care. In that situation hiring a doula is even more important to ensure a smoother and happier experience.

In some ways it can seem unfair that expectant parents have to put so much work into researching providers, hospitals, out of hospital options, cesarean rates in the area, laws and policies instead of just joyfully preparing for their new little one. Ultimately though, all the research and knowledge leads to a greater involvement in yourself and a sense of empowerment and pride in your choices.

I wish you the best birth possible, wherever you give birth.


All Rights Reserved, Knoxville Doula, Kimberly Sebeck, 2014

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