Birth Centers & PhilosophiesSep 07, 2022
The Canadian and American healthcare systems are frequently compared, from either side of the border, with Canada’s often lauded as superior largely due to its publicly funded nature. But that doesn’t mean that there isn’t a lot to learn from other healthcare models around the world. One area where the US can be considered a leader in comparison is the increasing growth of Birth Centers accessible around the states. The United States currently hosts more than 384 freestanding birth centers across 37 states and DC, while Canada has only 18, a relatively low number even factoring in the differential in population. But you may be wondering - what even is a Birth Center and who is it for? Join us on today’s episode as Dr. Sarah chats with certified nurse midwife Sarah Stetina, and Director of Midwifery at the Burr Ridge Birth Center in Burr Ridge, Illinois. They discuss the different practices that have led to the emergence of Birth Centers and philosophies around providing the best maternity care for patients such as yourself!
Models of Care
In Canada and the US, there are currently three main ways a pregnant person can plan to have a delivery:
- In Hospital
- At Home
- In a freestanding Birth Center (depending on where you live)
with support from either one or a combination of: a family doctor, midwife, and/or obstetrician. Many family physicians, such as Dr. Sarah, are not trained in home births and only attend hospital births. They can also provide prenatal and postpartum care, and often do so while caring for mother and baby as a dyad - two interrelated people who’s care and health is viewed as a whole. In the US, babies are most commonly born in hospital with the attendance of an obstetrician. Family physicians are also able to attend births, but it is much less common.
There are also several different types of midwives in the United States who attend births:
- Certified Nurse Midwives: attend nursing school, after which they obtain an advanced practice degree, like nurse practitioners, but specializing in midwifery birth
- Certified Professional Midwives: attend a midwifery program, without necessarily first completing nursing school
- Certified Midwives: similar to certified nurse midwives they’ve completed a midwifery program of study, except without an initial degree in nursing
- Traditional Midwife: may practice more traditional birthing methods
All of the above classifications have different legal statuses in different states, and are also specialized to attend different types of births, whether in hospital, home, or birth center. Certified nurse midwives are legal to practice in all three settings, in all fifty states. In both Canada and the US, some midwives are qualified to provide prenatal and postpartum follow-up care as well, in a clinic or at home.
Obstetricians can provide primary maternal care, and often do in the US and parts of Canada, but they are more specialized and better geared towards supportive care and attending to any complications in birth that may require intervention. They are the problem solvers! However, many obstetricians are not well versed in other types of maternal support, such as newborn care, breastfeeding etc. This is why in some parts of Canada, only family practitioners and midwives provide perinatal care, while obstetricians attend, or are called in to intervene in more complex births, or births undergoing complications.
With obstetricians being the main point of entry for maternal care in the United States, outcomes reflect a model where their methods are not geared toward low intervention. Midwifery can be viewed as a good option for those who wish to birth outside of a hospital setting or for someone that wants a low intervention or unmedicated birth.
Who are Birth Centers for?
A birth center is a freestanding entity, meaning it is completely separate from a hospital. Hospitals themselves may have labour and delivery units called “birth centers” but when we’re discussing Birth Centers as an alternative to hospital births, we are referring to those separate from a hospital - both physically and administratively. In the United States, regulations around Birth Center locations and operations are determined state by state - some states require Birth Centers to have a relationship with a hospital, as is the case in Illinois, which can provide informed support should an emergency situation arise that requires intervention or surgery.
Inside the center, the birthing person is supported by a combination of certified nurse midwives and registered nurses. The pressure of time is often alleviated, so the labour process takes as long (or short!) as it needs, and a low intervention, evidence-based approach is pursued. Epidurals and anesthesia are not available, but there are a lot of other tools to ensure patients are comfortable and coping well with labour!
Birth Centers are a great alternative for those who feel a little uncomfortable with giving birth at home, but would prefer not to be in a hospital setting. However, they are also designated for low risk pregnancies and most Birth Centers follow a pretty strict criteria for who can pursue care at a birth center, and who can actually labour there, to ensure it is the appropriate place for the patient to be.
As with most things, a balanced and informed approach to care often proves best. All types of providers and settings are useful and at times necessary as they are ultimately working toward the same end goal - a healthy birth for both the parent and baby! Providers can learn about the different practices of care from each other to provide you with the best results, and hopefully this post and episode provides a bit more insight into the options available to you!
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