Place of Birth

HOSPITAL DELIVERY ROOM

ADVANTAGES

·  Widely available, tradition, accepted.

·  Well-staffed by medical doctors.

·  Availability of surgical and emergency equipment and personnel.

·  Equipped to handle high-risk patients and complicated labor and deliveries with fetal monitoring, sonograms, laboratory tests, anesthetics, blood transfusion, and cesareans

·  Resuscitation and infant intensive care available for newborns that are premature or ill.

·  Technical , medical outlook during labor, delivery, and after birth reassures some mothers and makes them feel confident and comfortable.

·  Hospital staff to care for mother and baby after birth can give mother physical help, rest, and support.

·  Visiting hours, when limited, may keep new mother from becoming overtired.

·  Presence of other new mothers and their infants may provide a special social experience.

DISADVANTAGES

·  Greatest likelihood of routine use of medical interventionist techniques such as prepping, 

   fetal monitoring, IV, induced labor, drugs, anesthetics, episiotomy.

·  Mother has least control over environment and is most subject to rules and procedures--

    during labor,  delivery, and after birth.

·  Hospital environment and procedures can be frightening, frustrating, insulting or degrading.

·  Hospital is generally an unfamiliar place with little privacy.

·  Unlikely that mother will know her labor attendants, have them with her continuously, or

    have them throughout the whole labor.

·  Mother most likely will have to remain in bed throughout labor and use a delivery table.

·  Hospital rules often minimize mother’s (and family’s) early contact with the newborn.

·  Most hospitals require the baby to be in the nursery for some period every day.

·  Hospitals births tend to be expensive.

BIRTH ROOMS AND BIRTH CENTERS

ADVANTAGES

·  Combine availability of technical medical service with warmth of nonmedical atmosphere.

·  More likely to be staffed by nurse-midwives.

·  Physicians and nurses staffing birth rooms tend to be less interventionist than those in

   technical hospital settings.

·  Support natural childbirth and bonding.

·  Hospital rules are minimized.

·  Mother can have family members, labor coach, and friends present for labor and delivery.

·  Generally less expensive than a regular hospital delivery.

·  Increasingly available.

DISADVANTAGES

·  Birth centers not close to a hospital have less immediate access to some medical equipment.

·  Still may involve a fair amount of medical rules and intervention- for example, some birth rooms routinely require monitoring, other won’t admit others over 35.

·  Still an unfamiliar environment that a mother must go to.

HOME DELIVERIES

ADVANTAGES

·  Mother is in a familiar, supportive place-does not have to be moved, and has the most

    control over her environment.

·  Mother avoids unfamiliar and/or unsupportive attendants.

·  Nurse-midwife is present for the whole labor.

·  Family and friends can be present at any point and for any amount of time.

·  Less chance of medical intervention and possible ensuing problems.

·  Best environment for bonding; baby need never be separated from mother.

·  Least expensive.

DISADVANTAGES

·  Many women are consciously or unconsciously apprehensive about the unconventionality of

    home deliveries and their possible dangers.

·  Technical and emergency training of medical staff may vary (especially in infant

     resuscitation) and be difficult to assess.

·  Medical procedure and extra personnel not available

·  If problems arise, mother must be transported to the hospital in active labor or after the

    baby is born.

·  Considered less safe than a hospital birth  (although a number of studies indicate

    home delivery is as safe).

·  Not widely available.

Common criteria for home delivery

INITIAL SCREENING

·  Maternal age between 18 and 35 for a first baby, between 18 and 40 for subsequent births

·  Less than 20 minutes travel time to the backup hospital

·  Healthy mother with no preexisting chronic diseases

·  Normal obstetrical history with no previous pregnancy complications for mother or baby

·  No previous cesarean section (generally)

REASONS FOR RULING OUT HOME DELIVERY

·  Development of a medical problem such as high blood pressure, excess amniotic fluid,

    herpes (within 6 weeks of delivery), intrauterine growth retardation, placenta previa, or

    abruptio placenta

·  Determination of inadequate pelvis for this particular baby

·  Breech presentation or twins (generally)

CAUSES FOR TRANSFER TO HOSPITAL

·  Premature labor

·  Premature rupture of membranes (sometimes)

·  Inaccessibility of hospital due to weather conditions

·  Failure of labor to progress

·  Meconium staining of the amniotic fluid

·  Fetal distress during labor

·  Excessive maternal bleeding

·  Retained placenta or deep tear requiring surgery

·  Poor condition of baby, including low birth weight, respiratory distress, low Apgar score, or

   development of neonatal jaundice

When to Call the Birth Care Provider During Pregnancy:

The following symptoms don’t necessarily mean that something is wrong, but it is important for the mother to discuss them with the practitioner both for her own reassurance and to guarantee that if a problem does exist, it can be treated before it progresses.

·  Visual problems: blurred vision, double vision, or spots in from of your eyes

·  Swelling of face or fingers

·  Severe headache

·  Muscle irritability

·  Convulsions

·  Abdominal pain

·  Persistent vomiting after the first trimester

·  Blood or fluid from vagina

·  Chills or fever

·  Burning on urination

·  Unusual change in baby’s movements, especially long absence of movement