A Natural Alternative: Birthing centers and home births: SouthFlorida.com

Throughout history and across the majority of the world, pregnancy and birth have been viewed as natural, rather than medical, processes.

It is not doctors, but midwives, who attend the vast majority of births worldwide today.

In this country, midwives delivered almost all babies at home until the 18th century. A scientific revolution and the creation of medical schools that did not admit women as students brought about the virtual replacement of midwives with medical doctors attending births.

In 1820, the first obstetrics professor of Harvard University, Walter Channing, wrote: "Midwifery has been in the hands of women. It was one of the first and happiest fruits of improved medical education in America, that [women] were excluded from practice." But now, the pendulum is swinging back, as more women are choosing to use midwives as their primary birth attendants, rather than doctors, and having babies in non-hospital settings, such as a birthing center or at home.

Generally, Certified Nurse-Midwives have a bachelor's degree in nursing and graduate training in midwifery. Licensed midwives have at least three years of classroom and clinical training. Birth centers generally are staffed with certified nurse midwives along with licensed midwives and birth assistants - often students training to be midwives. Obstetricians and perinatologists are on-call and often available to assist if needed.

There are five birthing centers in Miami-Dade and Broward counties and strong midwife practices in Palm Beach County as well as Broward and Miami-Dade. Most midwives will attend home or hospital births. Florida law mandates that insurance companies pay for care received from a midwife through her office or birthing center, just as they would for a doctor's office or hospital care.

The director of the International School of Midwifery, Shari Daniels, has delivered more than 11,000 babies since 1970 and is the founder of the recently expanded Miami Maternity Center. Daniels, a nationally renowned expert in midwifery and natural birth, explains a fundamental difference between giving birth in a hospital and a birth center: "At the hospital, you fit into the hospital's routine as opposed to the hospital serving you. At the hospital you have to register first - whether you're bleeding or in pain, you have to register - then go to your floor and answer questions ... what my mother's maiden name had to do with my care I never figured out."

At a birthing center, however, the staff already knows you. "You've been coming for nine months. We know who you are," says Alan Huber, administrator of Daniels' Miami Center. The unique birthing center experience starts the first time a mother and her partner come in. "You get a hug and a kiss on the first visit," Huber says.

Unlike doctors' offices, many birthing centers are staffed 24 hours a day. Women do not have to fear waking their doctor with a middle-of-the-night symptom or question. Additionally, birthing centers may be better able to accommodate people with unusual working hours.

Another difference between birth centers and hospitals, Daniels says, is that birthing centers have been traditionally run by women. Women may be more likely to manage the birth process differently - listening to the wishes of the mother in labor, rather than adhering to strict policies.

Andrea Mass of Sunrise had her third child in a birthing center after having a cesarean to deliver twins in the hospital. When she got pregnant again, she returned to her original obstetrician. She says she knew after that first visit that she would handle her second pregnancy differently. "I waited an hour for a 10-minute appointment. [My doctor] said we could try for a VBAC (vaginal birth after cesarean) but I knew that attempt wouldn't really happen."

Concerned that her wish to deliver naturally wouldn't be taken seriously at a hospital, Mass set out to find a midwife. She soon found one with whom she made "an incredible connection. And I never waited an hour to see her. Instead, she spent an hour with me. She never had to look at my chart to see who I was."

The difference between her birth experiences was vast, she says. "For my cesarean, my hands were restrained, everything was bright lights and scary. It was too loud, there were too many people." At her next birth, however, "Everything was the way I wanted it."

Even something seemingly small, like announcement of the baby's sex, was to Mass' request. "Everything was on my terms. I didn't want to be told the sex, so I got to see for myself. It was wonderful; It was wonderful. It showed me that birth can be wonderful rather than medical and frightening."

A Birth in Water

"I gave birth in a tub," Mass says. "There were very few exams, very little touching - because that was how I wanted it. If I'd wanted massage they would have done that too."

Water birth is an option for women who choose a birthing center or decide to give birth in their own home. Connie Mullen, a nationally certified professional midwife based in Delray Beach, estimates that 35-40 percent of her home-birth clients choose to give birth in a tub. She and other midwives say that many women experience a pain-relieving effect from the water, and the buoyancy can make uterine contractions more efficient. Clients can give birth in their own bathtub or inflatable pool, or reserve one from Mullen's practice if she's their midwife.

The Comfort of Home For some, the comfort of a birthing center is surpassed by the familiarity and privacy of a home birth - whether in a tub or a bed. Having babies at home is an intimate option that allows parents to experience the birth of a child in the most comfortable environment possible. Young siblings will also be more at ease by being spared the stress of separation from their parents.

Janice Rozanski of Coral Springs had her second baby at home after having her first in a hospital, "because it was tons easier," she says. "My 2-year-old had no separation issues. He was away from me for maybe two hours [during the birth]. For me it was a lot easier and I felt it was completely safe."

Women who choose to have their babies at home experience the same type of prenatal care as other moms to be, coming in for office visits every four weeks at first, growing more frequent as the pregnancy progresses. Mullen says each visit with her is usually about an hour, and much of that is spent talking, asking and answering questions. The point is to get to know each other. "Pregnancy and birth are an intimate part of your life. You don't want just anybody at the birth of your baby," Mullen says.

Just as in birthing centers, home-birth midwives must determine if the mother-to-be is a good candidate for a home birth. Factors such as high blood pressure, gestational diabetes, or prior uterine surgery may mean a home birth is not a good idea. There are also factors that may not arise until labor begins that mean the mother has to go to the hospital to give birth. If the baby is not coping well with labor or if there is meconium (the baby's bowel movement) in the amniotic fluid, a trip to the hospital may be required. "It's based on the individual circumstance," Mullen says.

"You have to be totally safe for them to continue," Rozanski says. She felt good knowing her midwife had brought medical supplies like emergency drugs, oxygen, and IV tubing to her home. Mothers-to-be can purchase a "home-birth kit" online. Such kits typically include items such as cord clamps, gauze pads, gloves, cotton balls, infant caps and even commemorative birth certificates and footprint sets. "Beyond that, I bring all the medical supplies with me," Mullen says.

Even if the baby is eventually born in a hospital, the mother still is able to experience labor at home in familiar surroundings, and her midwife will probably be able to accompany her and act as her advocate in the hospital. By 36 weeks of pregnancy, Mullen and other home-birth midwives make a visit to the mother's home, and encourage family and friends who will be present at the birth to be there as well. Among other things, it's a visit to ensure things go smoothly once the mother goes into labor. "I assess the environment to make sure there is a clean labor area, that Mom has privacy, and that there are basic things like water and electricity," Mullen says.

For Rozanski, the experience was less burdensome than the one she had in the hospital with her first child. She felt better not having to be strapped to a monitor and have her cervix checked according to the hospital's schedule. "Home birth allows you to go on about the work of your life. I was watching Oprah and making my bed at 4 p.m. and the baby was born at 6:15 p.m."

Not for Everyone

Even though home birth and birthing centers are providing more options, most women still deliver in hospitals, where medical care is immediate in case anything goes wrong. Hospitals work to make the experience more home-like, with labor-delivery-recovery rooms that are decorated with all the comforts of home and options for water birth, walking labor and even delivery by midwife.

Not all women who wish to deliver at a birthing center or at home will be able to. Only healthy, "low-risk" women can safely deliver outside a hospital. Birthing centers routinely screen women on the initial visit to make sure they are good candidates for birth centers, where there is less reliance on medical technology. Many centers will not accept women who smoke or use alcohol or recreational drugs. Another important consideration is that most birth centers do not have available pain medications. If after many hours of contractions a woman decides she would like an epidural, she will have to go to the hospital.

Many of the accommodations made at birth centers can be made at hospitals as well, but it may require the mother to be proactive. While hospital policies may be in place for certain things such as fetal heart monitoring or videotaping, others may be negotiable, such as labor position and walking. Some hospitals are also beginning to offer water births - in some parts of the country as many as half of hospital births are achieved in the water.

Regardless of where the birth will be taking place, all expectant mothers can make a "birth plan" stating their preferences about pain relief, cervical exams, walking and other aspects of labor and delivery - and share it with their provider.

Whether a woman chooses a hospital birth, a birthing center or to have her baby at home, the choice needs to be a safe as well as comfortable one. As the number of birthing centers grows in South Florida and more women have their babies delivered (or "caught," as they prefer to say) by midwives, the nature of birthing is being transformed for many.

Daniels, who like some midwives chooses to live on her birth center campus, says: "Birth centers are family. We can argue like family, scold you like your mother, and love you like your closest, dearest friend."

Veronica Cruz is a freelance writer, mother of two and a South Florida native. She lives in Virginia.