When speaking with people about where they plan to give birth to their first baby, I often hear this, "We're probably going to go with the more 'traditional" route and have the first baby in the hospital with an obstetrician. Next baby, we might try giving birth at the birth center with a midwife." While I respect everyone's decision about where and with whom they should give birth, I think this statement requires a little more analysis.
The "Traditional" Birth
Let's get this straight right off the bat here. Midwives have historically been the traditional birth attendants since the beginning of humanity. It has only been in the past 100 years that doctors have increasingly become birth attendants. No offense intended against doctors, but birth with a midwife is a "traditional birth." Hospital birth with an obstetrician is the new, experimental birth plan. WIth infant mortality and maternal mortality (see graph below) in the US being the worst in the industrialized world, the experiment doesn't seem to be working really well. For African American mothers, the statistics are much worse.
Maternal Mortality Is Rising in the U.S. As It Declines Elsewhere
Notes
"Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015," The Lancet. Only data for 1990, 2000 and 2015 was made available in the journal.
Source: The Lancet
Credit: Rob Weychert/ProPublica
The First Birth is Really Important
How you give birth the first time is critical. Avoiding a cesarean section with the first baby sets you up for the best possible outcomes for all of the rest of your babies. The national average cesarean section rate is 31.9% according to the CDC. For midwife-attended births at birth centers, the average is around 6%.
Having a cesarean birth is much more complicated than having a vaginal birth. Cesarean section is major abdominal surgery and carries with it many risks that all surgeries can have - excessive bleeding, infection, embolism, and death. Also, specific to cesarean, there is an increased risk of unplanned hysterectomy due to hemorrhage and damage to the reproductive and urinary tract. For future pregnancies, that first cesarean increases their risk of uterine rupture and issues with the placenta, like placenta previa. Women who have a cesarean birth are far more likely to have repeat cesarean births, and with each subsequent cesarean birth, the risk of complications increases. Avoiding the FIRST cesarean is so very important.
You're a Medical Consumer
For many first-time moms, giving birth is the first time they've really needed to deal with the medical industry. Yes, industry. Just watch The Business of Being Born and you'll understand. One of the people in the movie says it best,"Medical decisions are made for monetary and legal reasons, not because they're good for the mother and baby." You should be able to make informed medical decisions based on your own specific situation, not based on what's "right" for the medical industry.
You Deserve Time
This is an opportunity for you to research all of your options, and you deserve the opportunity to have in-depth and lengthy discussions with your provider about your needs and desires. A midwife gives you all the time you need to explore all of your options. Our appointments with you are usually about an hour long, compared to most OB visits being 13-16 minutes on average.
At the birth, your midwife and birth assistant are with you throughout. You have the benefit of the continuity of care that comes with having your provider know you so well (after all of those hour long visits). Then, after the birth, your midwife is available to answer your questions and provide the same level of care throughout the postpartum period. They're typically very skilled at lactation support and can be there for you if you need help getting breastfeeding going smoothly. She sees both you and your baby, providing normal newborn care throughout your postpartum care period. Your midwife becomes your trusted resource throughout your pregnancy, birth, and postpartum.
Contrast that with a hospital birth with an obstetrician. Most of your care in the hospital is provided by labor and delivery nurses whom you have never met before. They provide excellent care, but they do not know you like your midwife would. For a hospital birth with an obstetrician, it is very unlikely that your OB will be with you for much of the process. Typically, you will see them for a few minutes periodically during labor, and then they typically are in attendance once the head is visible when you are pushing. They normally stay with you until the placenta delivers and they have finished suturing (if needed), and then they leave you in the care of the nurses. Postpartum care is typically extremely limited with OB care. Most OBs visit you when they do rounds in the hospital, and then they see you again at your 6 week postpartum visit.
Making the Choice
There are a lot of factors to consider when thinking about where you'll give birth. We know an out-of-hospital birth with a midwife is not the answer for every woman, but we also know it is the right choice for many women. Explore your options, talk to a midwife, talk to an obstetrician, watch The Business of Being Born, read books, and make an informed choice about where your first baby should be born..