You'll make plenty of decisions during pregnancy, and choosing where to give birth — whether in a hospital or in a birth center setting — is one of the most important.
Hospitals
Many women fear that a hospital setting will be cold and clinical, but that's not necessarily true. A hospital setting can accommodate a variety of birth experiences.
Traditional hospital births (in which the mother-to-be moves from a labor room to a delivery room and then, after the birth, to a semiprivate room) are still the most common option. Doctors "manage" the delivery with their patients. In many cases, women in labor are not allowed to eat or drink (possibly due to anesthesia or for other medical reasons), and they may be required to deliver in a certain position.
Pain medications are available during labor and delivery (if the woman chooses); labor may be induced, if necessary; and the fetus is usually electronically monitored throughout the labor. A birth plan can help a woman communicate her preferences about these issues, and doctors will abide by these as much possible.
In response to a push for more "natural" birth events, many hospitals now offer more modern options for low-risk births, often known as family-centered care. These may include private rooms with baths (birthing suites) where women can labor, deliver, and recover in one place without having to be moved.
Although a doctor and medical staff are still present, the rooms are usually set up to create a nurturing environment, with warm, soothing colors and features that try to simulate a home-like atmosphere that can be very comforting for new moms. Rooming in — when the baby stays with the mother most of the time instead of in the infant nursery — also may be available.
In addition, many hospitals offer a variety of childbirth and prenatal education classes to prepare parents for the birth experience and parenting classes after birth.
The number of people allowed to attend the birth varies from hospital to hospital. In more traditional settings, as many as three support people are permitted to be with the mother during a vaginal birth. In a family-centered approach, more family members, friends, and sometimes even kids may be allowed. During a routine or nonemergency C-section, usually just one support person allowed.
If you decide to give birth in a hospital, you will encounter a variety of health professionals:
Obstetrician/gynecologists (OB/GYNs) are doctors with at least 4 additional years of training after medical school in women's health and reproduction, including both surgical and medical care. They can handle complicated pregnancies and also perform C-sections.
Look for obstetricians who are board-certified, meaning they have passed an examination by the American Board of Obstetrics and Gynecology (ACOG). Board-certified obstetricians who go on to receive further training in high-risk pregnancies are called maternal-fetal specialists or perinatologists.
If you deliver in a hospital, you also might be able to use a certified nurse-midwife (CNM). CNMs are registered nurses who have a graduate degree in midwifery, meaning they're trained to handle normal, low-risk pregnancies and deliveries. Most CNMs deliver babies in hospitals or birth centers, although some do home births.
In addition to obstetricians and CNMs, registered nurses (RNs) attend births to take care of the mother and baby. If you give birth in a teaching hospital, medical students or residents might be present during the birth. Some family doctors also offer prenatal care and deliver babies.
While you're in the hospital, if you choose or if it's necessary for you to receive anesthesia, it will be administered by a trained anesthesiologist. A variety of pain-control measures, including pain medication and local, epidural, and general anesthesia, are available in the hospital setting.
Birth Centers
Women who experience delivery in a birth center are usually those who have already given birth without any problems and whose current pregnancies are considered low risk (meaning they are in good health and are the least likely to develop complications).
Women giving birth to multiples, have certain medical conditions (such as gestational diabetes or high blood pressure), or whose baby is in the breech position are considered higher risk and should not deliver in a birth center. Women are carefully screened early in pregnancy and given prenatal care at the birth center to monitor their health throughout their pregnancy.
Natural childbirth is the focus in a birth center. Since epidural anesthesia usually isn't offered, women are free to move around in labor, get in the positions most comfortable to them, spend time in the jacuzzi, etc. The baby is monitored frequently in labor typically with a handheld Doppler. Comfort measures such as hydrotherapy, massage, warm and cold compresses, and visualization and relaxation techniques are often used. The woman is free to eat and drink as she chooses.
A variety of health care professionals operate in the birth center setting. A birth center may employ registered nurses, CNMs, and doulas (professionally trained providers of labor support and/or postpartum care). Although a doctor is seldom present and medical interventions are rarely done, birth centers may work with a variety of obstetric and pediatric consultants. The professionals affiliated with a birth center work closely together as a team, with the nurse-midwives present and the OB/GYN consultants available if a woman develops a complication during pregnancy or labor that puts her into a higher risk category.
Birth centers do have medical equipment available, including intravenous (IV) lines and fluids, oxygen for the mother and the infant, infant resuscitators, infant warmers, local anesthesia to repair tears and episiotomies (although these are seldom performed), and oxytocin to control postpartum bleeding.
A birth center can provide natural pain control and pain control with mild narcotic medications, but if a woman decides she wants an epidural, or if complications develop, she must be taken to a hospital.
Birth centers often provide a homey birth experience for the mother, baby, and extended family. In most cases, birth centers are freestanding buildings, although they may be attached to a hospital. Birth centers may be located in residential areas and generally include amenities such as private rooms with soft lighting, showers, and whirlpool tubs. A kitchen may be available for the family to use.
Look for a birth center that is accredited by the Commission for the Accreditation of Birth Centers (CABC). Some states regulate birth centers, so find out if the birth center you choose has all the proper credentials.
Showing posts with label hospital. Show all posts
Showing posts with label hospital. Show all posts
Wednesday, March 17, 2010
Wednesday, March 3, 2010
Birth Plans
In the happy haze of early pregnancy, you're probably already thinking of baby names and planning to shop for baby clothes. The reality of labor and birth may seem extremely far off — which makes this the perfect time to start planning for the arrival of your baby by creating a birth plan that details your wishes.
What's a Birth Plan?
The term birth plan can actually be misleading — it's less an exact plan than a list of preferences. In fact, the goal of a birth plan isn't for you and your partner to determine exactly how the birth of your child will occur — because labor involves so many variables, you can't predict exactly what will happen. A birth plan does, however, help you to realize what's most important to you in the birth of your baby.
While completing a birth plan, you'll be learning about, exploring, and understanding your labor and birthing options well before the birth of your child. Not only will this improve your communication with the people who'll be helping during your delivery, it also means you won't have to explain your preferences right at the moment when you're least in the mood for conversation — during labor itself.
A birth plan isn't a binding agreement — it's just a guideline. Your doctor or health care provider may know, from having seen you throughout the pregnancy, what you do and don't want. Also, if you go into labor when there's an on-call doctor who you don't know well, a well thought-out birth plan can help you communicate your goals and wishes to the people helping you with the labor and delivery.
What Questions Does a Birth Plan Answer?
A birth plan typically covers three major areas:
1. What are your wishes during a normal labor and delivery?
These range from how you want to handle pain relief to enemas and fetal monitoring. Think about the environment in which you want to have your baby, who you want to have there, and what birthing positions you plan to use.
2. How are you hoping for your baby to be treated immediately after and for the first few days after birth?
Do you want the baby's cord to be cut by your partner? If possible, do you want your baby placed on your stomach immediately after birth? Do you want to feed the baby immediately? Will you breastfeed or bottle-feed? Where will the baby sleep — next to you or in the nursery? Hospitals have widely varying policies for the care of newborns — if you choose to have your baby in a hospital, you'll want to know what these are and how they match what you're looking for.
3. What do you want to happen in the case of unexpected events?
No one wants to think about something going wrong, but if it does, it's better to have thought about your options in advance. Since some women need cesarean sections (C-sections), your birth plan should probably cover your wishes in the event that your labor takes an unexpected turn. You might also want to think about other possible complications, such as premature birth.
Factors to Consider
Before you make decisions about each of your birthing options, you'll want to talk with your health care provider and tour the hospital or birthing center where you plan to have your baby.
You may find that your obstetrician, nurse-midwife, or the facility where they admit patients already has birth-plan forms that you can fill out. If this is the case, you can use the form as a guideline for asking questions about how women in their care are routinely treated. If their responses are not what you're hoping for, you might want to look for a health provider or facility that better matches your goals.
And it's important to be flexible — if you know one aspect of your birthing plan won't be met, be sure to weigh that aspect against your other wishes. If your options are limited because of insurance, cost, or geography, focus on one or two areas that are really important to you. In the areas where your thinking doesn't agree with that of your doctor or nurse-midwife, ask why he or she usually does things a certain way and listen to the answers before you make up your mind. There may be important reasons why a doctor believes some birth options are better than others.
Finally, you should find out if there are things about your pregnancy that might prevent certain choices. For example, if your pregnancy is considered high risk because of your age, health, or problems during previous pregnancies, your health care provider may advise against some of your birthing wishes. You'll want to discuss, and consider, this information when thinking about your options.
What's a Birth Plan?
The term birth plan can actually be misleading — it's less an exact plan than a list of preferences. In fact, the goal of a birth plan isn't for you and your partner to determine exactly how the birth of your child will occur — because labor involves so many variables, you can't predict exactly what will happen. A birth plan does, however, help you to realize what's most important to you in the birth of your baby.
While completing a birth plan, you'll be learning about, exploring, and understanding your labor and birthing options well before the birth of your child. Not only will this improve your communication with the people who'll be helping during your delivery, it also means you won't have to explain your preferences right at the moment when you're least in the mood for conversation — during labor itself.
A birth plan isn't a binding agreement — it's just a guideline. Your doctor or health care provider may know, from having seen you throughout the pregnancy, what you do and don't want. Also, if you go into labor when there's an on-call doctor who you don't know well, a well thought-out birth plan can help you communicate your goals and wishes to the people helping you with the labor and delivery.
What Questions Does a Birth Plan Answer?
A birth plan typically covers three major areas:
1. What are your wishes during a normal labor and delivery?
These range from how you want to handle pain relief to enemas and fetal monitoring. Think about the environment in which you want to have your baby, who you want to have there, and what birthing positions you plan to use.
2. How are you hoping for your baby to be treated immediately after and for the first few days after birth?
Do you want the baby's cord to be cut by your partner? If possible, do you want your baby placed on your stomach immediately after birth? Do you want to feed the baby immediately? Will you breastfeed or bottle-feed? Where will the baby sleep — next to you or in the nursery? Hospitals have widely varying policies for the care of newborns — if you choose to have your baby in a hospital, you'll want to know what these are and how they match what you're looking for.
3. What do you want to happen in the case of unexpected events?
No one wants to think about something going wrong, but if it does, it's better to have thought about your options in advance. Since some women need cesarean sections (C-sections), your birth plan should probably cover your wishes in the event that your labor takes an unexpected turn. You might also want to think about other possible complications, such as premature birth.
Factors to Consider
Before you make decisions about each of your birthing options, you'll want to talk with your health care provider and tour the hospital or birthing center where you plan to have your baby.
You may find that your obstetrician, nurse-midwife, or the facility where they admit patients already has birth-plan forms that you can fill out. If this is the case, you can use the form as a guideline for asking questions about how women in their care are routinely treated. If their responses are not what you're hoping for, you might want to look for a health provider or facility that better matches your goals.
And it's important to be flexible — if you know one aspect of your birthing plan won't be met, be sure to weigh that aspect against your other wishes. If your options are limited because of insurance, cost, or geography, focus on one or two areas that are really important to you. In the areas where your thinking doesn't agree with that of your doctor or nurse-midwife, ask why he or she usually does things a certain way and listen to the answers before you make up your mind. There may be important reasons why a doctor believes some birth options are better than others.
Finally, you should find out if there are things about your pregnancy that might prevent certain choices. For example, if your pregnancy is considered high risk because of your age, health, or problems during previous pregnancies, your health care provider may advise against some of your birthing wishes. You'll want to discuss, and consider, this information when thinking about your options.
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