Not sure where to deliver? Hospital, Home, or Birth Center

I wanted to talk about what to ask your provider or wherever you are going to be delivering your baby on how things are going to work because it varies each place that you go to. I have two kids myself and I delivered them both with nurse midwives, but in different settings.

My Experiences With My First Delivery

For my first child, my daughter, I planned to have her at a birth center as it was 30 minutes from our house and we were going to deliver with a nurse midwife. She worked under an OB and also had hospital privileges. My nurse midwife for my first child started the birth center I was supposed to give birth at and she is a phenomenal birth resource, is super well-versed in midwifery and the clinical-hospital setting, and is involved in an organization that certifies Doulas. My birth plan for my daughter was already perfect because the insurance will cover it. The thing about birth centers though are they have to be within a certain radius of a hospital because if there will be complications, they have to be able to transfer the patient. Two weeks before I was due, my nurse midwife told us they were not able to deliver at the birth center because they had to not renew their lease as they were unsure if the hospital was going to be closing. So, she had to give up her dream, her birth center, and we were given two options – stay with her and deliver at a hospital or we could get transferred to the next closes birth center, which was in Pittsburgh and it was a bit further for us and we never met any of the clinicians. We decided to stay with our nurse midwife and deliver at a hospital as it was going to be almost winter.

I do not have an experience with delivering with an OB-GYN so I cannot talk about how that would work. But for delivering at the hospital with a nurse midwife, I want you to know that the hospital has certain rules. When I got there, I was 7 cm dilated, and my nurse midwife was with us all the time. It was a long process as I was laboring all day at home.

A local lay midwife also went to our house to check on me throughout my labor as I really did not want to go to the hospital early. I did not want to get stuck there or stay there for a long time while waiting for the baby to be delivered. I did not want to be given Pitocin, too. Pitocin helps speed up contractions and labor and I wanted to deliver my child without an epidural or pain medications. I knew Pitocin would make it more painful and I did not want to be that new mom who delivers early, but falls into the cascade of needing intervention after. On the day I found out that there will be changes regarding my delivery, I was at a yoga class and the lady behind me is the lay midwife who checked up on me on the day I was ready to deliver my first child. She agreed to help me labor and send me to the hospital later even if it was not what she actually did with other patients as she would only go to their home to help them deliver. So laboring at my house was lovely, relaxing, and easy for me that I even got to read an entire book. My labor with my daughter was slow and not really painful. The contractions started at 11 at night and we went the whole day the next day at home laboring.

We went to the hospital at around 6 P.M. and when we got there, they insisted on doing an IV and they blew up my hand trying to get a vein. They also had issues with the monitor and the monitor was uncomfortable. I kept looking at my husband and he was the one who insisted on not doing a home birth so he looked like he feared me because I was going to kill him. But it worked out fine because my midwife got there and she was with me the entire time. From what I understand from other people’s experiences, when they gave birth with an OB-GYN, they were mostly in the care of the nurses and the provider will come in only later. I do not have a good idea on how that looks.

I also was not allowed to get on the ground, which may not be that important but I did get on the bathroom floor when I gave birth to my second child. I was not allowed to get on the ground at the hospital because my midwife said it was not sanitary, unlike in the birth center. I ended up delivering my daughter at the hospital with one foot on the ground and one knee up on the bed. This shifts your pelvis a little bit and my arms were also bent over on the bed. This definitely gave my daughter the room she needed so she could descend.

Everybody is different so they might need to shift around slightly as the baby is making its way out. However, if you have an epidural, you might not be able to move the way you want as you will most likely just lie on your back. I know for myself that I would never have delivered my daughter if I laid on my back. They did put me on my back to check my progress and I threw up everywhere as it was too painful. Note, however, that some people will have ease delivering on their back, or on their side. The options are pretty wide on how you can deliver. They put it out there in media and movies that you have to deliver on your back with your legs up, but when you are talking about it from a biomechanics’ perspective, to get the pelvic outlet open, delivering on your back with your leg up is not ideal for some people. It’s best to ask your provider if you are allowed to labor or deliver in different positions, because for me that would be a non-negotiable point.

I delivered my daughter at around 2 A.M. and I labored for 28 hours. What made me more tired was I was in a frenzy to have her because she was already pushing two weeks late. I knew if I hit two weeks they would induce me and that would be pretty painful and I did not like the idea of not being able to do it naturally.

My Experiences With My Second Delivery

For my second delivery, I delivered my son at the birth center I was supposed to be transferred to in Pittsburgh when I had my daughter. I also delivered my son with a nurse midwife and the birth center was such a lovely facility. During the time I gave birth to my son, we were the only people there.

My son was also pushing two weeks late and if you go past two weeks, this birth center will send you to the hospital. I did not want the experience of delivering at the hospital again. On the day we went to the birth center, I felt like I was going into labor. We had the whole 24 hours to deliver the baby and I let them naturally induce me. There are lots of different things you can do to stimulate labor and what they made me do was to drink this horrific drink that had castor oil in it. I was fearful of not delivering my son within the 24-hour period so I drank the drink. The drink basically gives you diarrhea and it kicks things into high gear as your abdomen is contracting with getting rid of the castor oil. They also had me pumped in between and asked me to walk.

My contractions, however, are quite mild so I couldn’t tell if I was already in labor. If I had to do it all over again, I would not have them induce me.

After laboring, I was in their tub and I was able to get on my all fours as I braced and rode the waves of contractions. My contractions, however, were not evenly spaced and did not increase in intensity. I had ones I could ride out and others where I can feel the pressure. If I was not in touch with myself, I would not have known that the contraction I was having was already intense. My labor for my son took around six hours.

Although I delivered my son in all fours, I had to shift my position time and again. He was over ten pounds and he was a big boy so I had to shift around a bit to have his shoulders and chubby little body out. Because I had a doula with me, I was able to find the best position to deliver my son. My midwife also did hernia pressure on me during labor so I did not have any tearing. Massaging that area and keeping pressure on it expanded the outlet so it could accommodate the hundred percentile head of my son.

Another thing I liked about giving birth at the birth center was that I was allowed to be on the ground, I had the tub where I could have the labor, and we were provided a nice king-sized bed where we could just relax afterwards. We were also able to leave four to 12 hours after delivery.

The Three Options You Have As To Who Will Deliver Your Baby And Where

After you find out you are pregnant, you have to start looking into what are your options for what kind of birth care provider you are going to have and where you are going to deliver at. Like what I mentioned above, I delivered my two children under different settings. The three options where you can deliver are at a hospital setting, a birth center, or at home.

Birth centers are run by nurse midwives and they have to follow some guidelines as to where they are located and how close they are to a hospital alongside their ability to deliver babies. As mentioned above, there was a problem with the birth center I was supposed to deliver at for my daughter, so I had to give birth at a hospital setting. When delivering at home, you will be delivering with lay midwives. To my knowledge, nurse midwives cannot deliver babies at home, so you have to work with a lay midwife.

More on the differences between lay midwives and nurse midwives, the first one I want to talk about is their schooling and how they get their qualifications. With lay midwives, they do an apprenticeship and work under another lay midwife. They learn the trade from there. The lay midwife I worked with is a phenomenal resource for education, delivery, and pre- and post-natal care. I did mention that the lay midwife who worked with me when I had my first daughter helped me labor while at home.

A nurse midwife, on the other hand, has their Bachelors in nursing and they later on become a nurse midwife. They typically deliver at a birth center or at the hospital. They work underneath with an OB-GYN.

The other option is working with an OB-GYN. However, I only worked with an OB-GYN with my first daughter. I met her handful of times, but I only got acquainted with her in case something went wrong in case I needed to undergo an emergency C-section.  I am not well-versed delivering with an OB-GYN.

What You Need To Consider Where To Give Birth  

After considering who will deliver your baby, the next thing you need to think about is where you want to give birth. You have to know that when you choose the birth center or home setting, you will not be able to have an epidural or any pain medications based on the birth center I had my son. Nitrous gas or laughing gas was offered at the birth center where I had my son, but I was in the zone so I did not think about asking for it.

Birth centers also do not offer Pitocin, the one I mentioned above which speeds up your contraction. They use it, however, after delivery to help with hemorrhaging because it contracts the uterus. So if you want epidural, pain medications , or Pitocin, you should choose giving birth at the hospital.

When delivering babies at the home of lay midwives, you should know that their homes are already set-up for delivery so there will be less mess for you to think about after giving birth.

Another think to keep in mind is to tour the area or facility you are considering. They are not all identical and it is best to check if they have all the things you would want for your birth. Some hospitals have tubs where you can labor in and you should definitely ask when you are touring it. The birth center where I delivered at, you can deliver at the tub. Some centers allow you to labor in it, but you cannot deliver in it. So you have to know this, too, if you are interested in it.

Checking if the area where you want to give birth at has squat bars is also a good thing to know. Squat bars are great so you can get your pelvis moving and the baby can make the maneuvers to descend even further and get into the best laboring position. If the hospital or facility where you will give birth does not have squat bars, you can use your partner and do the squat position.

You should also ask about the rules on being allowed to walk around during labor, or how you can deliver aside from lying on your back. Just to reiterate, when you are lying on your back, you are not letting gravity do its thing, and you are also not able to open up the back side of the pelvis and let the tailbone back down and open up the pelvic outlet. Note, however, that some people can deliver easily on their back. If you cannot, you have to find the optimal position so your baby can be delivered. Also, usually, midwives will deliver wherever and however position you want to deliver the baby. So, that’s something to consider, too.

Other rules you have to ask about is if you can eat or drink while you are laboring. Birth centers and home births are fine with eating and drinking, but some hospitals have issues with eating. That depends on the provider you have so you have to ask about this beforehand.

I also want to let you know that there are other options aside from epidurals. Like what I mentioned earlier, you can use a laughing gas and some hospital use this so you could ask about it before your delivery. I heard good things about it so it’s a good option to use. You can also look into walking epidural, which allows you to have more movement. It also comes down with the skills of the anesthesiologist and you can also ask about it.

But you have to remember that you have to be flexible with your birth plan even if you already planned everything out. So many things can happen and you just have to be knowledgeable on what to expect.

Getting To Know All The Doctors In Practice

Another tip when giving birth is to know all the doctors in practice as you won’t be working with only one. Doctors are not available 24/7, so make sure that the other providers will align with how you see your ideal birth going. You have to make sure you are all on the same page and let them know about what you want while you give birth.

In line with this, you should also establish a good relationship with your nurses. Most are intuitive as to what people need, but if you have a certain birth in mind, you should let them know ahead of time especially if you are giving birth at a hospital. This is because they are used to the more medically-driven birth process.

Having A Doula During Birth

I did not have a doula with my daughter because that was part of the birth center where we were supposed to deliver at. However, I did have a doula with my second child.

Doulas help you with the birth part and sometimes they do education prior to delivering and they do really in-depth classes and answer all your questions. They are a wealth of resources in that way. In labor, they can give you suggestions on how you change your position and do different pressure points for you to help alleviate the pain naturally.

When I had a doula with the delivery of my son, I did not use the education part as I already knew all of that stuff because I work with pre- and post-partum moms. My husband also already took the Bradley method classes when we had our daughter. It is a style of birth education that is 12 hours long, so it’s a lot of birth education.

You can search online for birth education or ask your doula about it. I believe there is never too much information as you always want to be most prepared and know all the different scenarios as you cannot control how your birth is going to look. Being aware of the possibilities and of what might crop up will help you not be too surprised or blindsided about it. For my first delivery, I planned to have a natural birth, not have any epidural, and give birth at a birth center. However, with the changes I shared above, I was ready with the different possibilities that can happen during my delivery. I knew much about it because I work with moms, but I also read this book that I love gifting to new moms. The book is by Ina May Gaskin, an American midwife who has been described as “the mother of authentic midwifery,” and it is about different birth stories. Even if you want to set your sights on how it is going to look, I strongly advise people to know what it would look like in case it does not go how you planned.

Conclusion

These two examples of different births where both nurse midwives worked with me but in different settings hopefully gave you an idea about your birthing decisions. What is important is you make your decisions from a place of knowledge. You should be well-versed and know all the different facets of it so that you can make the most educated and best decision for you and your family as it will not be the same for each person and family. 

If you have any questions regarding finding the provider who works best for you and your family, resources or birth courses you would take to prepare you for delivery, and more, you can drop it in the comment section or you send me a message through Facebook or Instagram. I’d be happy to put you in the right direction about some great resources. If you are expecting, pregnant, or trying, congratulations and good luck!

You can also check my TikTok account as I use the platform to educate viewers about movement, chiropractic education, yoga, pregnancy, and more! 

Thank you for listening and see you next week!