Embracing Change: Tips and Websites for Finding and Using a Birth Center

Ash tree 1 Change Is Hard


On Tuesday, a new nanny started taking care of the Darling Boys. Our Beloved Nanny graduated a few weeks ago and has moved on leaving an indelible mark on our family. She started taking care of Darling 1 when he was 22 months old. Darling 2 was not even born yet. Beloved Nanny stayed with Darling 1 when we went to the hospital for Darling 2 to be born. Even when Beloved Nanny went to Spain for a semester, we Skyped, emailed and sent mail regularly, eagerly awaiting her return. I admire her patience and calm demeanor in the face of catastrophe, drama and chaos, which occurs on a daily basis around here. The Darling Boys adore her. She truly loves the Darling Boys. Darling 2 calls me and Beloved Nanny "mama", which I take as a great fortune that my Darling Boys had someone who truly loves them to take care of them during the times that Dear Husband and I were working. She will be missed, but not forgotten. We will continue to count her as family.


Also on Tuesday, our massive, beautiful, very much alive, Ash tree had to be cut down. This tree shaded our house and yard from the sun, and was one of the first features I noticed about the house when we saw it for the first time. It was one of the tallest trees in the neighborhood, and was over 50 years old. The Ash tree was struck by lightning 5 years ago during a terrible electrical storm, at which time a quarter of the tree was severed, barely missing our house. I mourned losing that part then, but was so thankful to still have the rest of the tree. Then, just a week or so ago, I noticed the long, thin scar left by the lightning that runs the length of the trunk, disappearing into the ground, had turned into a crack. This weekend, the crack turned into a wide chasm, which popped and groaned in a light breeze. On Tuesday, the City Forester (who knew there was such a person with this title) deemed it a safety hazard, warned us to stay out of the room directly beneath the large creaking branch, and the tree removal people began cutting it down. I hate to see majestic old trees go down. It takes a tree so long to grow to such proportions. In honor of our great tree, the City will plant a little sampling in our yard next spring. The Ash will be missed.


The Darling Boys will get to know the new nanny, and she will get to know them. One day soon they will sit on the couch, impatiently and excitedly watching out the window for the new nanny to arrive for the day, as they did so many times anticipating the Beloved Nanny's arrival. Our new tree will grow and grow, and one day will provide shade to the house and beauty to the yard. But right now, we have empty places at our home, some literal and some figurative. Change is never easy, but that doesn't mean that change is bad.


New Options


Not long ago, a woman having a baby could choose to stay home and deliver her baby with a midwife or go to a hospital with all modern medicine had to offer with a doctor. Now, women can choose a birth center where there are minimal medical interventions, yet some medical devices and methods are still available for use by the midwife and mom-to-be. In order to be licensed by the state, birth centers are required to be within close proximity to hospitals and have back up plans for any emergency situations. While this change in birthing options may sound minimal to some, for others this is a welcome change.


Questions to Ask


As with any childbirth option, it is important to be well informed about what the birth center can offer you; what its policies are; whether the facility is licensed and/or accredited, as well as the licensure requirements of its midwives, etc. Here are two lists of relevant questions to ask a prospective birth center:

Questions to Ask a Birth Center:

  • What is the transfer rate of women from the center to the hospital (a rate of 7-12% is reasonable)
  • In what situations would you induce labor with Pitocin (oxytocin) or breaking of the amniotic sac (amniotomy)?
  • Is electronic fetal monitoring used? If so, in what situations and in what form: Doppler ultrasound, scalp clips or abdominal belts?
  • Is intravenous glucose given? If so, in what situations and can it be refused?
  • Are analgesic drugs used?
  • Do you offer epidural anesthesia?
  • Is there a time limit on the second stage of labor?
  • What percentage of women have episiotomies? (Less than 10% is normal)
  • Do you ever provide assisted deliveries with forceps or suction? In what situations?
  • Can I walk around during labor?
  • Can I give birth on the floor if I wish?
  • Can I give birth standing up?
  • How do you help a woman who is having back labor?
  • Can I take a bath or shower during labor?
  • Can my other children be present?
  • Can I eat and drink during labor?
  • Will there be a midwife with me throughout the first stage?
  • Is there a birth pool?

From http://www.americanpregnancy.org/labornbirth/birthingcenter.html


  • Is this center licensed by the state? Is it accredited by the National Association for Childbearing Centers (NACC)? (Accreditation shows that the center has met a set of national standards for birth centers.)
  • Are the birth center midwives certified? Licensed? How many years of birth center and other experience do they have?
  • Would I be able to meet and get to know all of the midwives who might attend my birth?
  • Does the birth center offer classes in childbirth education? Newborn care? Breastfeeding? Postpartum adjustment?
  • Does the birth center refer to community resources for childbirth education, breastfeeding support, and other concerns of mothers?
  • How much do services of the birth center cost? Are there possible extra costs that I should know about?
  • Does the birth center participate in [my insurance plan]? Note: you should check with your insurer to confirm coverage.
  • Does the birth center accept alternate payment arrangements, such as sliding scale or time payments?
  • During pregnancy, what conditions would require me to transfer to the care of another provider?
  • During labor, what situations would require me to transfer to a hospital?
  • If transfer becomes necessary, what is the back-up hospital and who are the back-up physicians? How can I arrange to tour the site and meet the physicians?
    Would my midwife be able to remain active in my care if I need to transfer to a hospital?
  • Could you give me some examples of emergencies that might arise during labor and birth and how you would handle them?
  • Under what circumstances would my baby need to be transferred to a hospital? Which hospital would it be? How would I arrange to see the facilities and meet the staff?

From http://www.childbirthconnection.org/article.asp?ck=10358


Websites for Moms-To-Be Considering a Birth Center


  1. American Association of Birth Centers: http://www.birthcenters.org/ There is a wealth of general information regarding birth centers on this site.
  2. Commission for the Accreditation of Birth Centers: http://www.birthcenteraccreditation.org/ The information on this site is more technical regarding the requirements and processes for accreditation. You can also find a list of accredited birth centers.


The Scoop

I had both Darling Boys in a hospital, happily hooked up to an IV with an epidural, attended to by amazing nurses and lovely OB/GYNs. Considering how much I feared and dreaded childbirth I really can't complain and don't have any regrets, and would choose a hospital and the same Women's Clinic again. However, I know many moms who had midwives and doulas helping with their deliveries in hospitals, who would have jumped at the chance to deliver at a birth center. It is so nice that more and more women have this choice. On Friday, I will post a bit of Motherly Advice. Over and out…






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