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Thrive Birth Center Blog, Thrive Birth Talk

Where You Birth Matters, Part Three: Are Birth Centers Safe?

With the upcoming screening of the locally produced documentary Why Not Home? The Surprising Birth Choices of Physicians and Nurses, we thought it was a good time to have a community conversation about the importance of birth location. 

In Part Three of this series, Melissa Wiseman, LM, CPM, looks at why the studies show us that birth centers are not only safe but ideal for low risk families. Enjoy! 

Are Birth Center’s Safe? A look at the studies, your choice, and why it works! 

More and more families are seeking the care of midwives for their pregnancy and birth. Some preferring hospital birth with Nurse-Midwives and others choosing home birth or birth center care with Licensed Midwives. The choice of where you give birth is highly personal and is based on your own set of values, ideas and knowledge about birth. We give birth where we feel safe and despite the past century of being told that hospital birth is the safest place for birth to occur, women who give birth in free standing birth centers are experiencing much better outcomes.

A recent article Maternal Outcomes in Birth Centers: an integrative review of the literature presented maternal outcomes from 23 quantitative and 9 qualitative studies of 84,300 births planned to occur in freestanding birth centers throughout the United States and internationally.   The outcomes were certainly favorable for healthy, low-risk women who choose to give birth at a freestanding birth center. These positive outcomes included higher rates of vaginal birth and lower rate of cesarean birth, greater perineal integrity and fewer episiotomies, less use of oxytocin for labor augmentation, and less use of epidural or other pharmacologic pain management. A review of this magnitude is a highly valuable comparison tool, especially if you are pregnant and deciding whether a hospital or birth center or home birth is right for you.

In addition to this study, the American College of Obstetricians and Gynecologists recently released a statement that healthy low-risk women should be supported in their choice to give birth in birth centers. So, what is it about birth centers that promote better outcomes for you and your baby?

Midwifery Care provided in birth centers

Women report greater satisfaction with the comprehensive and individualized care and a more egalitarian relationship with their midwives, where a personal connection helped them to engage and be an active participant in their care. When we provide you with unbiased information, access to high quality clinical care and ample opportunities to make your own choices, then will we really see superior outcomes for both you and baby. professional-bubble

A place where your choices are respected

Women who are respected as the prime decision maker throughout her and her baby’s care feel a greater sense of empowerment. Becoming an empowered voice in your care and in the care of your baby is essential as you transition into parenthood. We encourage you to be engaged and active participants in your care, and in turn your midwives trust and respect the informed choices the you make.

 

IMG_0741-Edit-1200x800It is a home away from home

Birth Centers are home-like environment that is set up specifically to promote uninterrupted, natural birth. Birth suites are often spacious with a large tub, should you choose to labor or birth in the water. The layout is created to ensure safety and privacy during birth, each piece of furniture carefully chosen for both comfort and function, and our cabinets are stocked and organized to hold the necessities for labor and birth.

Baby on a Scale

Out of sight, not out of reach

In birth centers, your midwives give you the room to labor and give birth without pressure to submit to common interventions such as pharmaceutical labor induction, augmentation and epidural pain management. These are still accessible, but do require a short car ride to the hospital to obtain. Because these options are associated with risk of further interventions and cesarean section, they are best used when only absolutely necessary. To promote the most physiologic birth and best possible outcomes, healthy low-risk women should have the opportunity to go into labor when their baby and body is ready. They should also have the space to labor and give birth on her own terms with the watchful guidance of skilled midwives through the process.

 

But what if something goes wrong?

Complications can arise in labor and birth and such is life, we don’t drive with our airbags out just in case they don’t do their job and inflate on impact. And it certainly doesn’t mean a healthy low-risk woman needs to give birth in the hospital “just in case”. Because midwives are experts in normal birth, midwives are especially good at identifying patterns in labor that are not following the normal progression for birth. Remember, there are yellow lights before there are red lights. With the undivided attention your midwife, she can address issues that might arise in a timely and dignified manner. You are the number one priority of your birth team! As midwives, we are readily equipped to treat some of the more common complications that may arise in labor, birth or in the immediate postpartum. If there are more complex or emergent issues, we are able to make a timely transition to the hospital.

 

 

The choice around where to give birth is only for you to make. But the tides are starting to turn as we are seeing our health care system encouraging healthy, low risk women to seek birth center care. And why? Because our mamas, our babies and our outcomes are strong.

~Melissa Wiseman is a licensed midwife practicing at Thrive, Ultimate Frisbee enthusiast, and all around birth nerd. 

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Staff

An Interview with an Apprentice Midwife

At the end of the year, having student midwives at Thrive is bittersweet. They’ve caught babies, they’ve smiled into mamas eyes, they’ve held the hands of partners, they’ve cleaned a few birth rooms. They are trusted team players who are leaving the center to support other communities. Typically, student midwives are new to midwifery. However, this last year, we could not have been luckier to practice along side a student midwife with fifteen years of experience. How can this be, you might ask? You’ll have to read the interview with Serena Russel. Serena, we are sad to see you go, we thank you for your insights and hard work, and we wish you well in building your practice in Grass Valley and Nevada City! You can see Serena’s beautiful website here and please feel free to leave her a note in the comment section. We know she touched many people’s hearts as their families were born.

 

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Kelly:  Tell me about the moment that you absolutely knew you were meant to be a midwife?
Serena: It started out with my ravenous hunger for knowledge and information on natural and normal birth when I became pregnant with my daughter at 18. Once I had her at home, with the guidance of my amazing midwives who continually and unwaveringly trusted and supported me, that knowledge became power and I felt compelled to share and inspire other women with this knowledge. This led me to midwifery.

Kelly: Tell me about your path to becoming a licensed midwife?
Serena: This is a long and winding one! Once I decided midwifery was my path (right after my daughter was born in 93), I started with self study and then attended a midwifery intensive for 3 months. This was in 94/95 before CA had licensing available for midwives, meaning it was a renegade path. The midwife who taught the class was very outspoken and she inspired me to always stay committed to my goal of supporting women. I apprenticed in a home birth setting for a few years. My mentor was trained by a granny midwife in Tennessee and passed on the deep trust and wisdom that comes with knowing your stuff and knowing when to use it~ and when not to use it! I started catching babies for friends in 99, but ultimately decided that I could use some high volume experience. I went to Jamaica to volunteer and train at a high volume birth center run by the well known midwifery mama, Shari Danials. I spent 6 weeks there and came home after 40 births and a plethora of clinicals. Slowly, I started my small practice with the idea that licensing, with all the protocols and requirements, would ultimately hold me back from my ability to truly work for my clients. I practiced for years this way, balancing single motherhood with midwifery, all the while knowing that one wrong step and I could go to jail for a felony. I kept diligent paperwork, wrote informed consents, attended peer review and followed local peer protocol. This was exhausting and it kept my practice very small. In 2013 the midwifery law went up for review and in January 2014 many aspects of it changed. Most importantly,  the concept of a woman’s right to self determination changed. For me, this meant I was no longer covered by my diligent claims of being unlicensed. So, I decided it was time to join the licensed model and through that decision realized it would also offer me an ability to be available to more types of women and families.
I enrolled in NMI and realized that after almost 15 years of primary practice, I had very little documentation I could use to prove my skills. This led me to the frustrating awareness that I would need to apprentice… again. Thats when I found out that Thrive Birth Center was looking for apprentices. Knowing the ladies from peer review, I emailed them and communicated my situation and found them to be surprisingly receptive. I arranged to start in an advanced student role in march 2015. Having been primarily home birth trained and experienced, I found the birth center to be a bit confusing at first. Electronic charting, digital b/p cuffs and an entirely different client load than I was used to was slightly intimidating but Jasmine and Caitlin were patient and friendly and took the time to explain everything. The other student showed me the ropes and quickly my insecurity shifted as I felt very much a part of the team. The collegial nature of my experience at Thrive brought perspective into my own ways of practice and expanded my ability to midwife all types of women in a comfortable and gentle manner.

Kelly: Wow, you really went from student midwife to experienced midwife back to the student roll again. What was the most challenging aspect of being an apprentice?

Serena: I think being on-call all the time while juggling the need to take care of my other responsibilities, like paying bills, making money and household tasks, was the most challenging piece of apprenticing as a midwife. It’s a lot of work and selfless service, and yet its also very rewarding.

Kelly: What was the most rewarding aspect of apprenticeship?
Serena: I loved that every single new mom and baby that comes into this world is gently and well cared for by their providers at Thrive. Also, working with the amazing midwives at the center, not to mention the work we brought to more traditional home settings.

Kelly: Now that your apprenticeship is complete, how do you plan on bringing these skills back into your communities?
Serena: After so many years coming, I feel really great about entering into this new phase of being a licensed midwife. I’ve just relocated to Grass Valley and am really excited to offer midwifery care to home birth mamas in the community. I love the water birth model at Thrive and I am purchasing a birth tub to include in my practice. I’d also like to create educational opportunities for families about the safety of home birth, VBAC, and healthy lifestyles for preconception. In addition, I plan on offering Holistic well woman care, and in- home-fertility support including IUI.

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Thrive Birth Center Blog

Vaginal Birth After Cesarean, a Birthing Midwife’s Perspective

Vaginal Birth After Cesarean; by Jasmine Maes, LM, CPM

I am writing both from the perspective of midwife and from that of a birthing woman. I had been a midwife for eight years when I learned I was pregnant with my first baby. I felt confident and supported. I planned for the homebirth of my dreams. I encountered some complications of pregnancy at 37 weeks and agreed to a hospital induction of labor. After 40 hours, many tears, a whole lot of Pitocin, and very little sleep, I agreed to a cesarean birth. My amazing son was born, and I was relieved and in love, and absolutely heartbroken. How could I, an experienced midwife, allow such a thing to happen to me? I felt harmed and tricked, and sadly my story just sounded cliché, an all too common tale. I spent countless hours deliberating which decision might have allowed me to birth my son the way I had envisioned. My body wasn’t ready. That tub was so shallow. Was I really that sick? Was the induction even necessary? What if I had been able to keep going without an epidural?

With my second pregnancy, I was determined from the start to give birth vaginally. I did not fear labor, uterine rupture, or having another cesarean birth. I just knew that I needed to be left alone. I absolutely needed to be at home. I needed water that was deep and hot. I needed privacy. I needed my husband to believe me and believe in me, and hold me through every contraction. I needed experienced midwives around me to keep the birth room safe and peaceful.

I went into labor several days after my due date. I had mild regular contractions during dinner and went out for a walk with my husband and our son. By the time I reached the bottom of our hill, I called our midwives. Soon after, I was moaning and leaning over the stroller, I still had to make it back up that hill. One of the midwives agreed to come over and listen to our baby and check in. As I reached the driveway, my water broke, and the midwife arrived. She and my husband filled the birth tub and just 5 short hours later, our baby girl was born. Birth works. It is powerful and true, and in my opinion it is as safe as life gets. Even with a previous cesarean scar. Jasmine

Many families are surprised to hear that VBAC is “allowed” or even possible in Sonoma County. Though some hospitals do not allow or support a woman’s decision to birth vaginally after a previous cesarean, the Thrive midwives have had the experience of supporting women through this journey for many years. Midwives have long been the guardians of successful VBAC. Our patience and trust in birth are key elements in any birth, but are crucial for the woman desiring a VBAC. Freedom of movement, emotional and physical support, effective relaxation through hydrotherapy, and choice of birth position are essential in a VBAC experience. So is the ability to allow labor to unfold in its own unique way, free from the confines of time limits and protocols, free from the supervising eye of the surgeon.

Myths and realities abound around the risks of VBAC and uterine rupture. In just a few minutes of research, I found what I was looking for. Lots and lots of numbers. The risk of uterine rupture is higher in women with previous cesarean scars, that fact cannot be argued. And what about the risks of repeat surgery? Increased chance of hemorrhage, infection, organ damage, placental complications in future pregnancies, increased pain and recovery times, and breastfeeding challenges. I encourage you to look, the results are fascinating.

But numbers aside, the overwhelming reality is that vaginal birth after cesarean is considered an acceptable option for women who have access to emergency medical care when necessary, and that is not necessarily defined as birth in the hospital. The National Institutes of Health found inconclusive evidence to support the recommendation that women desiring a vaginal birth, labor in a hospital with 24 hour surgical staffing. With Thrive’s optimal location near two major surgical centers, we have better access to emergency care than many women living in a rural area, or birthing in a lower volume community hospital. Women should have the choice to birth vaginally and be supported in this choice, wherever they feel safest.

Since our opening a year ago, we have had 5 healthy and victorious VBAC deliveries at Thrive! There is something so healing and inspiring about watching a woman discover her own power through birth. Amazement as she reaches down to feel her baby emerging, disbelief that her body knows just how to do this. It reminds me why I love being a midwife, and of my own journey to motherhood. Serving the courageous women and families in our care has helped me to see my son’s cesarean birth as a treasure, an experience of value that has allowed me to connect with so many women on a vulnerable and deeply emotional level. For months after his birth, I wished I could go back and do it all over again. Now, I wouldn’t trade that experience for anything in the world.

 

 

Resources:

 

www.VBACFACTS.com – an awesomely researched and un-biased site with tons of information and studies on VBAC

 

consensus.nih.gov/2010/images/vbac/vbac_statement.pdf –  The National Institutes of Health Consensus Development Conference Statement on Vaginal Birth After Cesarean: New Insights

 

www.ICAN-online.org – International Cesarean Awareness Network

 

www.uptodate.com – widely referenced by physicians