Risks & Benefits of Hospital Birth vs. Birthing Center

[chanelagonzalez]

I would like to hear more opinions on the matter of hospital deliveries vs home births or birthing centers. As a L&D RN, I believe hospitals are the safest place to deliver since the staff and facility are well prepared to deal with emergent situations. Am I biased since I am a L&D nurse? I am also a new nurse and rather young, and truely do not know exactly what birthing centers have to offer. Any opinions on the matter?

[kythe, LPN]

A birthing center inside of a hospital. Now that is an idea. Where is this located? Again, thanks everyone for the opinions. I have done a small amount of research on the subjects of inductions vs natural labor and hospital deliveries vs out of hospital and I do like to hear what others think. I appreciate the stories !

One issue with hospital-attached birth centers is that they must conform to the hospital's standards rather than truly setting their own that are separate from a regular L&D unit. What these standards are can vary per hospital, but often hospital-attached birth centers still have a higher intervention rates than free-standing centers.

Some hospitals have been known to call their L&D unit a "birth center" because it is good marketing and puts a different picture into people's heads, not because it really relates to a true birth center philosophy. We have a local hospital that does this, but they have more in common with other hospitals (including the same c-section rate), than they do with the local free-standing birth center.

[JenniferSews]

We have in hospital birthing centers the only difference between other OB units and the "birthing center" is the name. I gave birth in one with my third and it was with a midwife who was NOT naturally oriented in spite of the promises she made otherwise. She performed interventions without my consent because she frankly thought I wouldn't know what was happening. Having given birth at home I was very knowledgable about the birth process and although I wasn't able to stop her (because it was too sudden and the pain was too great) I did know what she was trying to do despite my protests. I feel bad for her other patients.

We are fortunate in my city that the amazing midwife who delivered my second child at home opened an independent birthing center across the street from a major hospital. If anything were to go wrong it's a quick trip across the street. It has been a positive symbiotic relationship for the last 4 years that will hopefully continue to offer a real choice (instead of just a different name on the same interventions) for many years to come.

I chose homebirth after a dear friend lost her perfectly healthy full term baby during labor in a hospital. Maybe it would have ended in the same result at home, or maybe not. But it showed me that being in the hospital isn't the be all and end all solution. I suspect that pushing pitocin beyond the point of the baby's tolerance, despite the constant fetal monitoring, was more of an issue than a natural birth may have been. We all have annectodotal stories, and an OB nurse is bound to have more than the average person. But the solid scientific evidence is there that hospitals are not safer for the low risk mom/baby.

ETA- The result of constant fetal monitoring is to allow less actual monitoring of the mother and fetus by a real person. People at a desk watch the monitor, or someone walks in and glances at the strip periodically. It's not the same as actual one on one monitoring the entire labor by a true professional.

[Elvish, BSN, DNP, RN, NP]

If you like to read I suggest starting with Spiritual Midwifery by Ina May Gaskin. Be aware that she's quite earthy in her usage of language and that many of her early clients were hippies. It is however a most informative book about birth in general and home-birth in particular.

I love Ina May!! Spiritual Midwifery is a good place to start. There are parts (like you said) that are a little out there, but her practice is sound and her numbers - though they are old at this point - speak for themselves.

Ina May's Guide to Childbirth is also a great resource, for both nurses and non-nurses. I learned a lot from it when I read it a couple years ago, and recommend it to all my pregnant friends as well.

[JeanettePNP, MSN, RN, NP]

I had one birth center birth. While I preferred it to a hospital, it is nothing like the comfort and freedom of birthing in your own home. The biggest problem with the birthing center is, as others pointed out, that they need to follow the affiliated hospital's policies. In my case that meant breathing down my back to finish up labor and deliver within 24 hours or we'd have to transfer. Also because my labor passed the 12 hour mark there was a mandatory IV inserted.

[CEG]

"Pushed" by Jennifer Block is also a great read-- it's very well organized and has a lot of evidence to support the statements. Anything Ina May has written is also wonderful.

[RadBSN]

Some hospitals have been known to call their L&D unit a "birth center" because it is good marketing and puts a different picture into people's heads, not because it really relates to a true birth center philosophy. We have a local hospital that does this, but they have more in common with other hospitals (including the same c-section rate), than they do with the local free-standing birth center.

Yeah, the hospital in our area that calls its L&D a "Birth Center" has the highest c-section rate in the area and just got scolded for it because they don't actually do enough high risk deliveries to justify a c/s rate that high.

[klone, MSN, RN]

I had one birth center birth. While I preferred it to a hospital, it is nothing like the comfort and freedom of birthing in your own home. The biggest problem with the birthing center is, as others pointed out, that they need to follow the affiliated hospital's policies. In my case that meant breathing down my back to finish up labor and deliver within 24 hours or we'd have to transfer. Also because my labor passed the 12 hour mark there was a mandatory IV inserted.

Just to be clear, the bolded portion is true for "birth centers" that are part of a hospital. It's not true for free-standing birth centers.

[JeanettePNP, MSN, RN, NP]

Just to be clear, the bolded portion is true for "birth centers" that are part of a hospital. It's not true for free-standing birth centers.

This WAS a free-standing birth center but it had to follow the policies of the hospital it used for backup. In the end it closed because it could not maintain that relationship with any area hospital.

[klone, MSN, RN]

But by definition, "free standing" means free of any hospital P&Ps as well as not being inside a hospital. So while it may have not been located IN the hospital, it was not a true FSBC.

[AOX4RN, MSN, RN, NP]

The American Association of Birth Centers really missed the mark by not trademarking the use of the term "birth center". Had they done it, the definition, guidelines/recommendations/protocols, and goals would be clear and not confused with hospital-based labor and delivery wards masquerading as an alternative place to give birth.