Thursday, May 17, 2012

Free standing Birth Centers: Common Myths Revealed

The quotations below are taken from the website of Greenhouse Birth Center, a free standing birth center in Okemos, MI. Many of these statements - or versions of them - inform the philosophies and practices of birth attendants nationwide. They are reassuring and empowering. They are also woefully incomplete and oversimplified.  As with many things, birth cannot (and should not) be summed up in one sentence, one phrase or one mantra. For mothers considering out-of-hospital birth, it is essential to be able to think critically about statements like these. After all, birth is complex and our understanding of it should be equally complex. To that end, we've taken these statements of belief and fleshed them out a bit to paint a more realistic picture of birth and maternal care.

  • "Birth works."  Birth often works, but not always.  Sometimes women and babies need help. 
  • "Just as our bodies know how to grow and nurture our babies, they know how to give birth and how to feed them."  Our bodies are beautifully designed, but they don't magically know how to give birth or how to breastfeed successfully all of the time.  They are not perfect in function.  We have intuition, but we also have experts to help guide us when our bodies need help.  Birth and breastfeeding come with great challenges for most of us.  Many women and many babies have died during childbirth. 
  • "The very things that help you go throughout pregnancy safely and well are the things that will help you give birth safely and well - health, confidence, support, privacy, and tender loving care."  What's missing from this list of what will "help you get thorough birth safely" is careful monitoring by educated, skilled professionals who can and will recognize signs of danger, acting appropriately to keep you and your baby safe.  Another  key factor in determining "safety" is the availability of emergency technology, equipment, medications, and medical personnel.  It's irresponsible and crazy to think if you're confident enough, trust birth enough, and are supported with love that things will turn out fine.  I used to think that, and it cost my baby his life. Safety means you and your baby go home alive, anything less is unsafe. 
  • "The best way to care for a pregnant woman is to educate her, support her, nurture her, and help her watch for problems so that she can avoid them or correct them when possible."  All true statements.  You have to first accept that problems exist in order to appropriately address them.  Then you have to have the skills and knowledge to recognize them when they do appear.  I would add that appropriate transfer of care when the "problems" detected are outside one's scope of practice is critical. "Education" does not mean indoctrination and manipulation of research, data, and truth. 
  • "That if a problem should arise with mother or baby, consultation and collaboration with appropriate health care professionals provides safety and smooth transition of care when needed." Also true statements, but without guidelines this determination of when the transition of care is needed, is very subjective.  There are no rules to follow, and nothing that defines what is high versus low risk.  To many home birth midwives, high risk is "just a variation of normal".
  • "That the presence and assistance of experienced women -the midwives- are useful guides to mothers in their journey of pregnancy, birth, and parenting."  The ideal is there, and likely the intention, but for many of us we felt like we were "unassisted", left to follow our intuition, with no real guidance at all during labor.  "The presence and assistance of experienced women" is great as long as the relationship stays professional in making clinical decisions as oppose to influencing clients with personal agendas.  
  • "That a safe, comfortable space, designed for gentle birth and individualized care is the ideal way to provide our services to the women in our community who want alternatives to the medical model of care but are not comfortable with a home birth."  I think this statement bothers me most.  The insinuated "safety" of a freestanding birth center is such an illusion!  There is nothing safer about giving birth in a different building than your own home when that building (aka freestanding birth center) adheres to no regulation, has no medical equipment for emergencies, has no insurance, has no guidelines for scope of practice, and doesn't report its outcomes.  To insinuate otherwise is fraudulent.  And, I would further add that sometimes birth is rather violent, even in a comfortable space.   

Please visit the Reformed CPM's post entitled, "Just Believing Does Not Make it So" for more on this subject. 

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