Thursday, October 29, 2009

Hospital, Birth Center, Home,…. Which Is Safest?

In yesterday's blog (scroll down a little and read it first). I asked the question: ”Could anything be done, so that obstetricians become hearty supporters of out-of-hospital birth?”

Before I delve into that question, I want to ask a different question: "Where is the safest place to have a baby? In a hospital with physicians? In a hospital with nurse midwives? In a birth center with nurse midwives? In a birth center, with direct entry midwives? At home with nurse midwives? Or at home, with direct entry midwives?" (Let's assume that we are talking about low risk women).

I believe if you ask an obstetrician that works in hospital, he or she will say "in hospital with physicians." If you ask a Licensed Midwife or Certified Professional Midwife, they would say: "at home with direct entry midwives."A birth center CNM would say, "at a birth center with nurse midwives."

Can they all be right? Are they all wrong? I  know that, each discipline will believe, what they do is the safest and is in the best interest of moms and babies.

Is it possible that the reason that everyone can believe that their way is the best, is because the best method does not exist in this country? Is it possible that women do not have the perfect option? Does every one of these choices cause women to sacrifice some degree of safety?

Let's pretend that there was a rather large birthing facility located inside the hospital that operates autonomously from the hospital? This facility follows the majority of the principles and standards of the American Association of Birth Centers. This facility offered a homelike birth setting, water birth, choice of position and even choice of midwife. That means a woman can choose either a nurse midwife or a direct entry midwife. The hospital’s staff, rules and bureaucracy have no influence on this birthing facility. This means that the facility does not even need nurses; it could utilize birth assistants to help midwives. This facility would give fantastic one-on-one care, yet, it operates at a large profit.

Furthermore, this beautiful birth facility would be connected by a short tunnel to the hospital operating suite, where obstetricians and anesthesiologist and OR Nurses were available around the clock. Likewise, this hospital has a top-of-the-line NICU. Of course, in our fantasy the birth facility even has a low transfer rate to the hospital. Furthermore , for the ultimate fantasy, the birth care professionals and staff at the hospital have a great relationship with the clinicians and staff of the adjacent birth facility.

Do you agree that this would be absolutely wonderful and all things being considered would be the safest model for mother and baby? If you're honest, you will agree!

Of course, this is a fairy tale, and does not exist. So why do I bring it up? Because, in tomorrow's blog posting. I will suggest another model. It will start an interesting discussion. Different sides will start taking different positions. You may see people start arguing that this model will not be as safe as the model they currently work in.

And that is my point! The safest model does not exist. For various reasons, the model that I described above is impossible to achieve. Occasionally, hybrids of this model have been tried and seem to fail, therefore, the fairytale that I described above will not be presented, because it is not workable.

It is important to realize that as we analyze the models. there will be pros and cons. Every model has its own set of risks. Each model has its strengths and weaknesses, and the argument will be made that, it is not as good or better than one of the other existing models.

I ask you keep an open mind, because, no matter what your position., we have just admitted that you are trying to preserve a flawed model.

Check back tomorrow.



  1. As always Alan, you give us different perspective!

    When are you and Robbie coming out????


  2. I think the perfect model would also have to include a few intangibles: a surrounding healthy birth culture. This birth culture would have to include a healthy view of pain and birth. Ideally (for me) it would include the prevailing opinion that natural birth was best without belittling other kinds of birth. This culture would also believe that women's bodies are capable of birth in the natural way, and would teach women that they bodies are strong and trustworthy.

    You're right - it doesn't exist. *sigh*

  3. As a precipitous birther, I have to agree that healthy attitudes are key. In my current area, there is no way for me to have a healthy hospital birth -- the only way they know how to manage it is to induce.

    Therefore, due to attitude, my options become limited. I chose a homebirth for my 15 min labor, and the midwife just made it here. She is closer than the hospital, should I have needed to go there.


    Common sense seems to almost never prevail when childbirth is concerned -- from any of the camps.