Last week we talked about choosing or switching care providers and how it will be one of the most important decisions you'll make for your pregnancy. However, equally important is choosing the setting for your birth and one that you may want to do prior to choosing your care provider.
Why Should You Evaluate Your Birth Place First?
Environment is important.
Our senses, not logic, are what help us perceive safety vs. threats in an environment. Many times an environment may logically be safer but when you get into the actual situation the sights, sounds, smells, and unfamiliar faces can throw your body off. I experience this every time I go for a shot. Logically I know I’m safer getting the flu shot at the doctors office but my body shuts down and I faint when that needle pricks my arm. The smell of the antiseptic, seeing the nurse come in, the silence of the examination room, hearing the tissue paper I’m sitting on… all of those environmental factors contribute to my body predicting what is coming and getting ready to faint to protect myself.
Your body reacts separately from you in times of stress or fear.
Humans naturally feel better when we feel safe. If we feel harmed, threatened, judged, or controlled we tend to tense up, release adrenaline and be prepared to fight, flee or disengage entirely. Hormones are released or stopped, blood is redirected, your breathing becomes primal…You might experience increased anxiety, discomfort, or confusion because of these unfamiliar sensations, perceived lack of control, or inability to escape.
How Does This Relate to Childbirth?
Imagine that you have three boxes.
Box One: You can fit into if you squish down in a certain position.
Box Two: You can easily sit in, and
Box Three: You can stand and walk around in.
Each of these boxes has four sides to them that limit what you can do when you are in them. The bigger the box the further apart the barriers and the more freedom to move and choose your position, location, and scenery.
You can put anything into each of these boxes but the barriers remain the same.
Now imagine these boxes are your options for places of birth. The small box may be a very rigid and routine labor and delivery hospital that manages many high-risk births and premature babies. What you can do within this hospital is the same as in the small box. The barriers to options and positions are very limited. There are only one or two ways to fit give birth in this “box”.
The second box may be another hospital that is more flexible about routines and values mother's birthing choices. There are many ways to fit into the box but the sides are still there and your limits are easily visible.
The third box may represent a birth center or your home. The barriers are spread out. There are still limits but you can make more movements and choices without running into the sides of the box and can push up against the sides instead of them pushing up against you.
Bigger Box = More Environment Options = More Perceived Safety
Let’s go back to that shot. I wonder if I would have the same reaction if I was in the dark, at home under my covers, smelling my fresh sheets and someone came up and pricked me. Would I faint, or would those other feelings of comfort keep my body calm?
When choosing a place of birth, you want to create the same opportunity to stay calm, relaxed and safe. But you need room to do that. So, finding a birthplace that will give you the room you need to engage your senses in a way that will encourage feelings of comfort, safety, and control are critically important.
This isn’t to say that a box representing a hospital won’t get the job done. In fact, it may be the only type of environment that is considered safe to birth your twins, triplets or higher order multiples. However, different hospitals have different barriers so it will be important to establish which hospital is going to give you the room you need to have a comfortable, safe, and secure birth.
But Doesn’t My Care Provider Decide How Much Control I Have and How Safe I Feel?
No matter what care provider you choose, if you put them in the smallest box, they will be limited by the same barriers as any other care provider.
There are usually more care providers than "boxes". Hospitals and birth centers contract with many care providers to supply residency to your hospital. So finding your place of birth and then a care provider who contracts with that location, or works there exclusively, is an ideal way of sequencing your decisions. That way you can test out multiple caregivers within the size of your box that feels right to you.
How To Evaluate Places of Birth
First of all, it will be important to know the general state of your pregnancy. Are you high-risk for preterm labor, bleeding, or another complication? Is there an issue with one or both babies where they will need additional care after birth? After knowing answers to these questions you can better assess the type of place you give birth.
Asking questions related to each location’s birth philosophy, routines, restrictions, supplies, neonatal care experience, physical location, and insurance coverage are important to your evaluation. You can customize the below based on the restrictions you know already exist:
- Can I freely move/walk within the room and on labor and delivery floor?
- What types of pain relief do you provide (is it just medication or do you encourage birth balls, showers/baths, position change, massage, etc.)?
- If I need a caesarian, what is the experience like? How do you encourage me bonding with my babies?
- How often are parents expecting twins, triplets or more given a cesarean?
- What are the routine birth practices I can expect to receive (IV, Fetal Monitoring, etc.)?
- Are there routine birth practices that are non-negotiable?
- What options do I have to eat and drink?
- What type of support systems are allowed and to what point? (Doula, partner, family, photographer etc.)
- What options do I have for where I deliver (do you have to deliver in an operating room)?
- How is your NICU rated, how many pre-term births do you manage, and what are you not capable of managing (some won't perform heart surgery, etc.)?
- How will you help me breastfeed?
- What are standard routines after the baby is born and how do you get my consent to perform procedures?
- How does insurance and billing work? What will I need to provide when I am getting admitted?
After you have answers to these questions it is time to evaluate your care provider. Do they know the barriers to their box? Do they know how to push up against them to give you more flexibility and space? Have they been in larger and smaller boxes to experience different types of practices so they can make decisions based on experience and not routine?
Put your care provider in the box and test them out. Ask them questions about the barriers and see how they respond. Do these answers sit well with you? Do you feel like you are going to have adequate support while in that box? If yes, then you have your place and care provider. If not, keep looking! These two pieces to your birth puzzle are important and deserve time and consideration.
What other questions would you want to ask a possible place of birth before making a decision?