Why a Birth Center?

I decided many years ago (like probably 13 years ago at this point) that I wanted to have unmedicated births if I could. And when I learned that I didn't have to birth in a hospital, I decided I would find somewhere else instead. 

After doing lots of research and visiting several places and talking to lots of midwives, I decided that we would do our birth through The Birth Center. (We are currently undecided about laboring at home versus the birth center itself, but are leaning toward the latter due to space and condo proximity.) 

As soon as someone hears that, they ask me why. Why a birth center? Why unmedicated? They don't mean it in an attacking way. Many of them are genuinely curious. And it's a valid question. I have SO many reasons for making this choice, that it is a little difficult to answer in the quick way I think they expect; it's a long conversation! So I thought I'd sit and write out some of my reasoning for choosing a birth center, unmedicated birth, and midwives. If you want to skip my own personal reasoning and go straight to an article that sums a lot of it up, please do. (For a TL;DR, skip to the summary and implications.)

I think one of the biggest reasons for me is understanding my options, knowing my rights, and wanting to be in an environment where I don't have to fight for what I want (e.g. no medication/intervention, free movement, water birth, eating, delayed cord clamping, etc.). I have observed that many hospital labors are doctor-centered. Just a couple of examples of this: Stopping pushing until the doctor can come. Having a C-section if a doctor wants to go home for the day. I understand that not all doctors are this way. I just would prefer to birth in an environment that welcomes and facilitates the kind of birth I want to have--knowing they advocate for me and the things I want. 

I want personalized care. The idea of nurses I've never met being a big part of something I consider intimate and sacred is very unappealing to me. It's a gamble what kind of nurse you'll get, and how many you'll get if there are shift changes while you labor. The fact that I have the next five months to get very familiar and comfortable with a few midwives is encouraging to me, and it feels special. I want to build relationships. Even if I know and am familiar with my doctor, knowing she'd come in to "catch," stitch me up if needed, and leave, just sounds too impersonal to me. 

I want a comfortable birth. I want to wear what I want (don't get me started on how much I hate hospital gowns and socks). I want to eat and drink. I want to labor hanging off the edge of the bed. I want to labor in the water. I want to sit on a ball. I want to use ceiling silks. I want to be on all fours. I want to be in a bed with my baby and husband after the birth. I highly doubt at any point that lying on my back will sound comfortable to me. In the most physically challenging moments of my life, I want to move around and do what feels right to me. I don't want to be in a position that's easiest for medical professionals and more likely to tear me; I want to do what's conducive to labor. 

I want to hold and keep and feed my baby after he arrives. I want to hold him immediately, and not have him taken away to be cleaned and weighed and all these other things that can wait. Again, I understand that this can also happen in a hospital. I am choosing a birth center because this is the standard and consistent practice, and not something I have to request or insist on. 

I want fewer interventions (e.g. electronic fetal monitoring, IV, restricted eating/drinking, epidural, Pitocin, membrane stripping, episiotomy, and Cesarean). "The high use of these interventions reflects a system-wide maternity care philosophy of expecting trouble. There is an increasing body of research that suggests that the routine use of each of these interventions, rather than decreasing the risk of trouble in labor and birth, actually increases complications for both women and their babies." Again, I realize you can have a low to no-intervention hospital birth. I am choosing a birth center because that is their natural design; I won't need to have a vocal advocate or an "accommodating doctor."

I want the surprise. I really do want baby to come when he's ready (as much as I might regret saying that in the final weeks). I understand that having a date and time picked out is appealing for many women, but that removes a lot of the excitement for me personally. 

I want to see what I can do. I'm mentally preparing for a level of pain which I've never experienced before. I hope to prepare in all the ways I possibly can, with classes and meditations, and I know it will be the hardest thing I've ever done. But I also know I can do it; my body can do it. Women have done it for centuries (millennia). And I think there's something empowering about a woman coming out on the other side of labor recognizing what she is capable of. I am not at all diminishing the labor that women experience with epidural or C-section! I just want to do it my own way--the way that leaves me feeling my most empowered. 

Doctors are trained in surgery and emergency. Most OB/GYNs have not sat through the duration of a labor. They're usually called in at the end, or called in for an emergency. Experienced midwives have a significant amount of experience in the laboring process. They're familiar with all the stages of labor, potential challenges and obstacles, are highly trained, and are incredibly supportive. I want the labor professionals, not the surgery/emergency professionals. 

Hospitals are for more than just labor. They have to spread their resources among lots of other sick patients and laboring mothers. I want to be in a quiet, private place that has been set aside for the purpose of labor. I don't want to be rushed in any way to free up a room. And I don't want to be concerned about a doctor's schedule or planned vacations. 

Other downsides of hospital labors (from friends who have had several hospital births): 
- Unnecessary and frequent vaginal checks
- Being unable to sleep (due to said checks, etc.)
- Not being allowed to have anyone there (in the COVID era)
- General additional interventions as mentioned above

Basically, I just want to do this old school. It feels right for me. 

Something I feel passionate about is female choice (whether it's to end a pregnancy, breast feed or not, birth at home, etc.). I personally know several women who didn't even know they had options for their labor. They thought hospital birth with an OB/GYN was just the way we do things--the only way. I think in our culture and country we need to start talking more openly about birth and labor as a common and normal experience, not a horrific scary process that is expected to be an emergency (although it can of course always become one). By not having the conversations, women are left in the dark about what happens during labor (especially physiologically), about what their bodies are capable of, and about what their choices for birth even are. I also know that some women have complicated and high-risk pregnancies, and the safest and best (and even only) option for them is the hospital. But for the women who do have options, I want them to know what they are!

I strongly believe in making informed choices. And I wish alternative birthing wasn't viewed with fear and negativity, but rather as the method that provides the most support and that results in more favorable outcomes for mothers and babies. If even after learning about options, a mother still feels safer and better about birthing in a hospital, that's awesome! I just want all women to know their options and feel empowered to make informed choices that feel best for them and their baby. 

While I have a method and location in mind for my first birth, I understand that things can go wrong, even to the healthiest of us (e.g. pre-eclampsia, etc.). I know things could change, especially in the third trimester, and risks could go up, despite all my best efforts. And that's fine. I just want to go into this process hoping for the best.

Mostly I wanted to compile this to share my reasons for my choice, since so many people ask. And maybe it'll help a mom who doesn't know what her choices are. I feel blessed and privileged to have the choice, and to have so many options close by! I hope and pray that my pregnancy continues to be healthy and normal, and that my delivery goes as it is supposed to. 

Love to all moms everywhere. You do you!