Our blog today is written by one of our Certified Nurse Midwives, Stephanie Curtis, CNM, DNP
“If I don’t know my options, I don’t have any.” – Diana Korte
Every woman deserves the right to choose where and how she will birth her children. She may wish to introduce her child to the world in the comfort of her own home. She may desire the benefits of epidural anesthesia. She may opt for a midwife or a physician as her prenatal care provider.
But at the end of the day, with the appropriate education, I believe every woman would choose the safest option for herself and her baby.
The safety concern usually has to do with her medical history and development of her pregnancy. There are important questions which should be asked at the onset and throughout prenatal care to help determine the best “where” and “how” for every woman. Most of us have heard the phrase “high-risk pregnancy” too often. While there are many mothers out there who have endured those difficult circumstances, there are at least twice as many whose experiences have been relatively uncomplicated. The University of California San Francisco (an internationally recognized leader in women’s health care) reports, “High-risk complications occur in only 6 percent to 8 percent of all pregnancies.”
That means, many women are good candidates for out-of-hospital birth. Here, at The Midwife Group and Birth Center, we complete an initial screening via phone to confirm this is the case. Our role in the health care system is to exclusively support physiologic birth. We recognize there are conditions which are more likely to cause the process of pregnancy to depart from its normal course. Let’s explore some of those pre-pregnancy factors further.
One of the first questions we ask is about previous uterine surgeries, primarily, cesarean sections. When it comes to vaginal birth after cesarean (VBAC), uterine rupture is the complication which is most often mentioned. Research shows the absolute risk of uterine rupture to be less than 1% in both women who choose an elective repeat c-section and in those who choose a trial of labor after c-section (TOLAC). We are huge proponents of VBACs, but the state of Georgia’s regulations will not allow us to attend those deliveries at the birth center.
Next, we’ll ask about your health history. Chronic issues such as hypertension and diabetes often affect pregnancy and labor in such a way that a hospital birth is needed. If you are taking medications which are not recommended while pregnant, in many cases, we can help you find an appropriate alternative. We will use your height and pre-pregnancy weight to calculate a body-mass-index (BMI). If your BMI is 40 or above, an out-of-hospital birth could be potentially unsafe. You can calculate your BMI here https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html. The great news about BMI is that it can change! If you are planning to become pregnant and hoping to be a birth center client, we would be happy to see you for an annual exam or preconception visit where we could help you identify goals and plan to optimize yours and your future newborn’s well-being.
Lastly, there are a few misconceptions about what makes someone “high-risk”. For example, having had first trimester pregnancy losses or being 35 years of age or older when you become pregnant DOES NOT make you a “high-risk” patient. The same goes for couples who have had assistance with conception via medications or procedures such as in vitro fertilization (IVF) or intrauterine insemination (IUI). We would much rather have a conversation with you about these subjects than to have you rule yourself out. Here are some examples of truly high-risk conditions: carrying twins, a baby who remains breech after unsuccessful attempts to turn, bleeding disorders, pre-eclampsia or high blood pressure in pregnancy, and having too much or too little amniotic fluid.
A birth center, while a wonderful option, is not the safest option for every woman. You may be unable to choose a birth center but may still be able to choose a midwife depending on where you live. Many hospitals and physician practices work closely with midwives who provide prenatal care and who attend births on your local facility’s labor and delivery floor. You can search for a midwife here http://www.midwife.org/find-a-midwife.