InteliHealth:

As a mother-to-be in this day and age, you have such a wide array of birth options that there is sure to be one that's ideal for you and your partner. Among the most common considerations:

Your first childbirth decision should be choosing the kind of birth attendant you'd prefer. Because medical doctors and midwives — who might be nurses or licensed lay people — differ considerably in their philosophies, training and approach to labor management, you'll want to educate yourself about what each has to offer, so you can feel completely confident in the choice you make.

If you have any chronic medical conditions, are carrying more than one baby, or have any reason to believe your pregnancy may be classified as high-risk, it would be advisable to consult either an obstetrician-gynecologist familiar with your disease or a perinatologist, an obstetrician who has specialized training in dealing with high-risk pregnancy.

Depending on the specific circumstances of your case, these specialists may care for you throughout your pregnancy or act as a consultant to your regular obstetrician. Most midwives will not accept high-risk patients, because their training focuses on normal pregnancy.

An obstetrician-gynecologist is either an M.D. (medical doctor) or D.O. (doctor of osteopathy). Both degrees are accepted as valid by the American Medical Association. These physicians have completed a minimum of four years of specialized training in obstetric and gynecologic medicine. If they have passed examinations conducted by the American Board of Obstetrics and Gynecology, they are board-certified specialists in obstetrics and gynecology.

Meanwhile, there are three categories of midwives: A certified nurse midwife has a nursing degree, has hands-on experience as a labor and delivery nurse and has demonstrated competence through at least one year of midwifery training. Certified nurse midwives also must pass a certification exam given by the American College of Nurse Midwives and have a license from the state in which they practice. When they attend a birth (which may be in a hospital, birthing center or, if permitted by state law, the expectant mother's home), they must have a medical doctor on call to back them up, in case complications develop. They're the most highly trained midwives.

Licensed midwives, also known as lay midwives, are trained in midwifery, but do not have nursing degrees. Their training varies from state to state; as does the examination required by the state licensing board (although some states do not license midwives who are not nurses). There are enormous differences in training and skills among lay midwives, because they've usually learned their craft through apprenticing with another midwife. If you're considering this type of midwife, keep in mind that not all midwives have backup from doctors. Not all lay midwives are licensed. Check to be sure that the midwife you choose has licensure that indicates some baseline training, experience and continuing education.

Professional labor assistants, can be midwives, nurses, childbirth educators or other trained people who assist women during delivery. They don't make medical decisions but work as part of an obstetric team with doctors to support you while in labor. They may also visit you after you've returned home to help with breast-feeding or other aspects of infant care, as well as postpartum recovery.

Hospitals have become increasingly sensitive to the physical and emotional comfort of laboring and postpartum women. Along with an obstetric facility that's mother-friendly, what else should you look for in a hospital? Here are some points to keep in mind:

Credentials: Accreditation by The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), an independent, nonprofit monitoring group, assesses the quality of participating hospitals — roughly 80% of all American hospitals. JCAHO accreditation is reviewed every three years and is voluntary. The group has several levels of accreditation: Most hospitals receive simple accreditation, indicating that they deliver acceptable medical care; a small percentage are awarded accreditation with commendation, a ranking of overall excellence. Conditional accreditation means the institution has deficiencies that must be cleared up in the next six months to maintain accreditation. The public is entitled to know the JCAHO rating of any hospital. Ask the facility's director of quality assurance or quality management for this information. If you aren't able to get the rating directly from the hospital, you can also contact the JCAHO at (630) 792-5800. You also can order a detailed report on any surveyed hospital from the group. Call first to check if a report is available on your hospital.
Routine vs. high-risk services: If your physician considers your pregnancy to be low risk and there are no anticipated health problems with the baby, then an accredited community hospital or any accredited teaching hospital that has an obstetric department should be adequate for your delivery. However, if your physician or midwife practices at more than one area medical facility, you should inquire about which facility would be best for your delivery. If your pregnancy is viewed as high-risk or you anticipate that your newborn may need intensive care, then you should make sure the hospital, can provide a more extensive range of obstetric and neonatal services. If you have any questions or special concerns about the hospital, ask your obstetrician.
Birthing rooms: Many hospitals now offer a labor delivery room, where mothers can labor, deliver and recover in the same room. Previously called an ABC (alternative birth concept), this birthing environment can minimize medical disruptions while you're in labor, while still keeping the high-tech services and highly trained staff of a traditional obstetrical suite close at hand in case of an emergency. Some hospitals even permit other family members, along with your partner, to be in the labor delivery room for the birth.
Rooming in: Another option that most hospitals offer is "rooming in" with your baby. Usually the infant stays in the newborn nursery and is brought to you at regular intervals. With "rooming in," you can choose to keep your newborn with you. You should, however, inquire as to the flexibility of this arrangement. For example, can you have your baby with you all day, but send him or her back to the nursery at night if you're exhausted? Or does the hospital permit only 24-hour rooming in? Also, if you plan to be in a private room after the birth, check whether your partner can room in with you and the baby.

Birthing centers are generally freestanding units that are not part of a hospital, although they may be located within the facility. These family-friendly centers must be licensed by the Commission for the Accreditation of Freestanding Birth Centers and primarily are staffed by certified nurse midwives, with back-up from obstetricians.

Because birthing centers do not have all the high-tech equipment or services available at a regular hospital obstetric unit, the American College of Obstetricians and Gynecologists considers them to be less safe than a hospital for giving birth. Proponents of birthing centers, however, point out that there are now national standards for these facilities, devised by the National Association of Childbearing Centers, that specify staff credentials and other criteria for safe operation. A study of 12,000 women who had delivered at birthing centers, published by The New England Journal of Medicine, concluded that such facilities are a safe alternative to hospital birth for low-risk mothers — especially for those women who have had a previous vaginal delivery.

If you or your unborn baby have any risk factors that could complicate pregnancy, a freestanding birth center may not be the best option for you. Remember that even low-risk pregnancies are subject to unpredictable emergencies during labor that can affect both mother and baby. A hospital that is well equipped for complex deliveries and newborn intensive care may prove to be a better site for your delivery. Even if your pregnancy is considered low risk, check the center's contingency plans for a possible emergency before making a final decision about delivering in a birthing center. Questions to ask include:

Are you accredited by the Commission for the Accreditation of Freestanding Birth Centers?
What arrangements exist to transport me to a hospital in case of an emergency?
How quickly can you get me to a hospital?
Which hospital do you use?
How quickly can you get an obstetrician or pediatrician if needed?

For more information, send a self-addressed stamped envelope to the National Association of Childbearing Centers, RD 1, Box 1, Perkiomenville, PA 18074.

Home is another option for some women. The principle advantage of giving birth at home is the privacy and comfort of having your family with you. And you'll be able to labor at your own pace, make all decisions about your health care, invite anyone you want to the birth and bond with your newborn without intrusive medical intervention.

However, there are significant risks to consider. You may experience difficulty in locating a doctor or licensed midwife who is willing to attend a home delivery. Some insurance plans may refuse to pay for a home birth. Most critical of all, however, is the lack of immediate access to emergency assistance in the event of a potentially life-threatening complication, such as placenta previa or a prolapsed cord, in which part of the umbilical cord is delivered before the infant's head, cutting off oxygen to the baby. For these safety reasons, both the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics advise against home birth.

Choosing A Caregiver And Birthing Site