A Supplement to "In Defense of the Birth Center"

At my last appointment I was tasked to write up my birth plan (which I will share once I have written it!) So I went through the birthing class packet and the folder that the birth center provided me from the get go which has all sorts of useful information from what not to eat to insurance coverage. That's when I came upon this informative section which would have been good to include in my "In Defense of the Birth Center" post. So here it is several days later as a supplement to that initial post:



"What Is A Nurse Midwife?
A Certified Nurse Midwife (CNM) is educated in the two professions of nursing and midwifery. Completion of a nursing program and state licensure as a registered nurse (RN) are prerequisites for entrance into a university affiliated nurse midwifery program. There are more than 40 such programs throughout the United States today. A CNM in North Carolina has received national certification by the American College of Nurse Midwives and is licensed by the State Board of Nursing. All the nurse midwives on staff at WBWC have the appropriate credentials to practice midwifery, are certified in Neonatal Advanced Life Support and CPR, and meet continuing education requirements of their profession. All providers are covered with malpractice insurance.

Nurse midwives care for women during pregnancy, labor and birth. Care is also provided for newborns and mothers following birth. Well-woman gynecology is another aspect of nurse midwifery practice. (I did my yearly "lady-exams" there prior to becoming pregnant.)

Nurse midwives work in a collaborative relationship with physicians and other health care providers so that medical consultation and assistance is always available at UNC Hospitals should it be required. 

How Is A Birth Center Different From A Hospital? 
The Birth Center is a safe, comfortable, homelike setting where women are offered choices in the manner in which they give birth. The staff encourages family participation and women themselves choose who will share in their birth experience. We believe that education is an integral and essential part of a satisfying pregnancy and birth experience. It allows women to make informed choices throughout the process. Laboring women will be continually assessed and monitored by the nurse midwife and the RN to assure both mother and baby are doing well. 

Each private birthing room contains a bathtub where mothers can spend time in the warm water to help them relax. Mothers are encouraged to eat, drink and move around in order to be as comfortable as possible during the labor and birth. Careful follow-up is provided after discharge from the center via telephone, home visits and office visits. These are only some of the special attributes of the midwifery/birth center model of care.  

How Is The Birth Center Accredited?
WBWC is accredited by the Commission for the Accreditation of Birth Centers. Accreditation is a voluntary procedure and is based on carefully defined national standards. This accreditation process occurs every 3 years. 

What Complications Can Be Handled In A Birth Center?
Nurse midwives are prepared to handle the following complications:

• Post-partum hemorrhage/excessive bleeding that can be controlled with the use of medications. If necessary an IV can be started to replace fluids. (The mother can be transferred to the hospital by ambulance if necessary.)
• Infant resuscitation. A nurse midwife and registered nurse who are each certified in Neonatal Advance Life Support will be present at every birth. The training includes resuscitation, suction, and intubation to establish and airway The Birth Center is equipped with suction, oxygen, laryngoscopes, ambu-bags and an infant transport incubator. A neonatal transport team is minutes away at UNC Hospital.      
• Perineal tears. Nurse midwives are trained to repair tears and episiotiomies using a local anesthetic.

What Cannot Be Done In The Birth Center?
If any of the following are needed, a transfer from the Birth Center to the hospital is required. The nature of the situation causing the transfer determines whether the nurse midwife will deliver you at the hospital or whether Family Medicine or OB/GYN physicians will become involved for the delivery.

• Anesthesia. Epidural anesthesia is not available at the Birth Center. Pain medications in labor are used sparingly because they can cause respiratory depression in the newborn. Coaching and support are used routinely. Labor and birth are hard work. It is our goal to help women and their families make labor a positive experience for everyone. 
• Vacuum, Forceps or Cesarean Birth. These procedures are done by our consulting physicians in the hospital when necessary. 
• Pitocin Induction or Augmentation. Because this requires the use of continuous electronic fetal monitoring and immediate access to surgery should it be indicated, delivery is done at the hospital. 
• Fetal Monitoring. If there is a need for electronic fetal monitoring, a transfer is required. (The Birth Center uses a portable Doppler to monitor the baby's heartbeat. That's how we listen to his heart at each appointment.)

Is A Birth Center Safe?
The National Associaton of Childbearing Centers conducted a prospective examination of 11,814 women who received intrapartum care in 84 freestanding birth centers in the United States from 1985-1987. Many different factors were examined including Cesarean deliveries, mortality rates, episiotomies, Apgar scores, electronic fetal heart monitoring, IV administration of fluids, analgesia and anesthesia, and vacumm or forceps assisted deliveries. In a study by Fullerton and Severino comparing the women from the NACC study with a group of 2,000 low-risk women who delivered in a hospital setting in the same time frame, several conclusions were drawn. Women who received their intrapartum care in a hospital were more likely to have used pain medication, anesthesia, continuous fetal monitoring, IV infusions and episiotomies. The birth center clients were more likely to eat solid food during labor, to have portable Doppler used for fetal monitoring and to take a shower or bath during labor. The infant mortality rates, 1.27 per 1,000 live births for the birth center group and 2.1 for the hospital group were similar. The Cesarean section rates were 4.4 for the birth center group and 8.4 for the low-risk hospital group. Of the women who delivered in the birth centers 98.9% said they would recommend the center to their friends. 

Birth Centers around the country are currently keeping data that in the near future will be compiled to provide a current picture of the birth center model of care."