Choosing an Obstetric Provider and Birth Facility (Hint: Birth Centers offer increased VALUE!!)
Each pregnancy and birth is a unique experience, and choosing your obstetric provider will have a profound effect upon that experience.
Many people spend a lot of time looking for a provider who shares their philosophies about pregnancy, labor, birth, and the postpartum period.
And while this is important, in most cases, it may be EVEN MORE important to know the philosophies of your provider’s partners and the birthing facility.
Most providers work in a group practice – the reality of 24/7 call is harsh – working in a group practice allows providers to also be humans and see their families every now and then!
In a hospital based practice, you may see the same provider during your office visits (typically 5-15 minute visits every month until the third trimester, every 2 weeks until 36 weeks, then weekly until birth), however, this does NOT mean that provider will be at your labor and birth in most cases.
Depending upon the model, either the provider on call for the group or the OB hospitalist will care for you when you go into the hospital in labor. In some practices, you could choose a scheduled induction on the call day of your provider. But if your birth plan/vision does not include induction, in most cases, your clinic provider will not be the same provider who cares for you in the hospital.
This is why it is important to know if your provider’s practice partners share the same philosophies in support of your birth vision.
It is also important to know if the hospital that you are choosing has policies in place in support of your birth vision. According to Dr. Neel Shah of Harvard Medical School, “The biggest risk factor for the most common surgery performed on earth is not a woman’s preferences or her medical risks, but literally which door she walks through” . (https://www.ariadnelabs.org/resources/articles/keynote-to-american-ob-gyns-c-section-rates-linked-to-hospital-complexities/) Cesarean section rates vary widely among practices and hospitals. The comfort level of nursing staff with physiologic birth varies widely between locations. When nurses are only accustomed to birth with interventions, they often feel unprepared to care for a family who is seeking an unmedicated birth without unnecessary interventions.
When you are laboring in a hospital, your bedside nurse is the person who is with you throughout labor and birth. Depending on the provider practice and hospital, your provider may not even be present in the hospital. Your bedside nurse may be doing all cervical exams, giving prescribed medications and interventions, and calling your provider when your baby is near birth. In other practices, particularly those with hospitalist models, the OB hospitalist is present in the facility – the OB nurse does all of the direct patient care updating the hospitalist as needed. Hospitalists typically round into the labor room every few hours – they are generally responsible for all of the patients on the floor.
In most cases, nurses will be at the bedside while you push, and the provider will be called into the room just in time to catch the baby. After the placenta is delivered and any tear is repaired, the provider then leaves the room and you are back in the care of the nursing staff. Vitals for you and baby will be checked frequently in the first couple of hours after you deliver. Offering of immediate skin to skin and the “Golden Hour” (no interruption of mother/baby dyad) varies by hospital. Then vitals typically move to every shift if you and your baby are stable. If you have needs or concerns, you will use your call light to reach your nurse. A provider will round on you each morning until you go home.
In most cases, your next visit will be your 15 minute six week postpartum visit in your provider’s office.
So let’s compare the differences of the medical birth model to the birth center model!
At Sacred Roots, our entire team is committed to your family’s safety and experience.
Our nurse midwives share a call schedule which ensures that there is always a well-rested nurse midwife ready to care for you.
Our prenatal care visits last 30-60 minutes allowing ample time to answer questions and make sure that you have all of the information that you need for decision-making. We follow the same visit schedule as typical medical practices, and we do our absolute best to ensure that you see each nurse midwife in our practice to develop a relationship prior to your birthing time.
Throughout your care (and particularly at your 36 week visit!), we will talk with you about your preferences for your labor and birth and make sure these are included in your chart. Many of our Registered Nurse birth assistants also work in our clinic, so they are also included in this planning!
Our nurse midwives and RN birth assistants are highly skilled at supporting physiologic birth, and our resulting cesarean section rate is 8%! We are genuinely excited and honored to support your birth vision, and hydrotherapy/waterbirth is always available in the birth center.
When you go into labor, you will be speaking with the nurse midwife on call who will then meet you at the birth center when it is time for you to be admitted. Your nurse midwife will complete your admission evaluation and admit you to the birth center. She will remain at the birth center throughout your labor. Your nurse midwife and your RN birth assistant will work together throughout your labor and birth to provide direct care for you. Cervical exams and interventions are done only as needed and only with your consent.
Your provider will be in the room with you during advanced labor, pushing, and as you birth your baby. Your baby will go into your arms immediately following the birth and remain skin to skin with you. After the cord stops pulsating and you deliver your placenta, the midwife will examine for any perineal tears. With exception of severe tears (tears that go to or through the rectum), the nurse midwife will repair any tears as needed. (And yes, of course we use numbing medication!)
Your nurse will then assume care checking vitals for you and baby frequently in the first couple of hours, then hourly until you go home. Your nurse midwife will be present in the birth center during your immediate recovery time. She will be cleaning, charting, and preparing your birth certificate.
After approximately 1.5-2 hours following birth, your nurse midwife and RN birth assistant will assist you to get up to the bathroom. This will likely be the first time that you have been separated from your baby – we love for babies to remain skin to skin and get breastfeeding off to a great start! This is also the time that your nurse midwife will typically do your baby’s full newborn exam including weight and measurements. (Fun fact – Nurse midwives are trained and certified to care for newborns up to 28 days!). If your postpartum recovery has been normal, then this is the time that your nurse midwife may leave the birth center. The remainder of your recovery will then be completed by the RN birth assistant who will discharge you to home at 4-6 hours following birth. (You WILL be ready to go home! Between our childbirth education classes and long review visits, you will have the skills and tools that you need to feel confident going home to recover in your own bed!)
Your nurse-midwives are then available to you 24/7 by phone for any questions or concerns. We will call you to check in on your first postpartum day – we want to know how your new little family is doing! On day 2 or 3, one of our RN birth assistants will come to your house for a home visit. She will assess both you and your baby, talk through any concerns, and assist with breastfeeding. State newborn screening requirements are also included at this visit.
We will schedule you back in the clinic for a one hour 1-2 week postpartum visit. We find this one week visit to be especially helpful for our first-time families! Your final 60 minute postpartum visit is then scheduled at 5-6 weeks postpartum. During these postpartum visits, we have ample time to review your birth, talk through normal postpartum recovery, discuss/assist with any feeding concerns, evaluate for any perinatal mood disorders, review family planning options as desired, complete a physical exam, and address any other needs that may arise.
At Sacred Roots, we offer time, attention, and individualized care. This is one of the ways that birth centers offer exceptionally safe care and have equal and in most cases BETTER outcomes than hospitals. Our small staff of nurse midwives and nurses create a genuine relationship with you.