Tuesday, November 17, 2009

Birth Centers, Past, Present, and Home Birth

Yesterday, I explored the traditional one family house, versus homebirth and agreed there was not much difference.

But what about the model of birth center I have been involved in for many years? This is the larger birth center, with a volume of 25 or 40 or even 100 births a month, depending on which space we had.

Before someone comments about large birth centers can't give one-on-one care, the fact is the model that we had, gave fantastic one-on-one care. In fact, our outcomes in any of our facilities whether in the first world or the developing world exceeded the outcomes in the Netherlands, which is known for the best stats in the world. (Outcomes do not equal one-to-one care, we still gave one-to-one care).

Let's compare this type of birth center to the homebirth arguments (I'm not trying to take anything away from homebirth, just giving a different side to the debate).

Remember, the basic precepts that: “There's nothing you can do in a birth center that cannot be done at home.” This statement will continue to remain true in this blog posting, but you may not now see a difference.

Experience of Staff: Busy birth center staff is generally much more experienced. In Jamaica, our three senior midwives had over 25,000 out of hospital births between them (and only 73 episiotomies). Contrast this with a homebirth midwife, that does only three or four births per month.

Less Experienced Midwife Can Yell "Help”: When a less experienced midwife on staff ran into problem, she would call upon senior midwives, who had over. 5000 out of hospital birth experience to guide them.

No Shortage of Supplies: we were fanatical in making sure we had more than enough oxygen, IVs, sterile gloves, anti-hemorrhage drugs, vitamins, etc. This was a function of the admin staff and not the overworked midwifery staff.

Amazing Students: American and Canadian midwives would visit our facilities and could not believe our students were not experienced midwives. Keep in mind, when you are at 200-400 births in your first year as a student. you get pretty good, really quick.

Consistent Transport Relationships: unlike homebirth, where the nearest hospital changes pending on where a home is located, in a birth center, we usually go to the same hospital over and over. This can make for better communications and relationships between hospital and birth center staff.

Back-up Obstetrician: With our volume, obstetricians would find it financially viable to work with us. This helps in collaborative care or transport situations.

Ability to Integrate Other Healthcare Providers: since the birth center is in one place and quite busy, providers such as pediatricians, chiropractors as well as alternative providers would find it worth their while to keep regular appointments at the birth center or to give birth center moms top priority.

I could go on and on, but I believe, you get the point. There are many advantages to this birth center model over homebirth. This does not mean every mom will choose this birth center model. But now, there are is benefits that families can weigh when making the decision.

Most importantly, the vast majority of women are not going to choose homebirth, but they will consider this type of birth center.

Tomorrow-comparing the hybrid birth facility to these other models.



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