According to Harding (2003), advancements in technology and increased knowledge have broadened the choices expectant mothers have for delivering their babies. These choices affect the level of care provided, where the birth takes place, how the baby is delivered, who is involved, and emergency care options. The chosen care model will impact the emotional, social, spiritual, and physical well-being of both mother and child.
The purpose of this paper is to assess the pros and cons of birth centers, particularly in relation to group practice midwifery, and analyze how they affect the overall well-being of pregnant women and their infants. Birth centers that prioritize midwifery through group practices provide several advantages including consistent care, shared decision-making, and affordability. Nevertheless, concerns arise regarding the availability of pain medication and the safety of birthing centers for both mother and child.
Other models of care, such as obstetric models, give less importance to continuity of care, thus marginalizing the overall health of the mother. For instance, in public obstetric care, the mother receives antenatal care but may encounter different obstetricians during each check-up. As a consequence, there is no establishment of a relationship with the team responsible for delivering her baby, which negatively impacts the social and emotional health factors of the mothers.
Birthing centers differ from shared maternity care by assigning the same team of midwives for the duration of the pregnancy. This approach increases the mother’s trust in her team and ensures that all team members are familiar with the mother’s choices, eliminating the need to repeat information. The first birthing center, named “La Casita,” was established in 1945 in rural New Mexico. Its purpose was to offer a birthing facility for mothers residing far from hospitals (Sibbold and Ping, 2010).
In the late 1980s, birth centers gained popularity for providing affordable and high-quality care to low-risk women. The National Birth Center Study in 1989 found that birth centers offered safety, satisfaction, and cost savings comparable to other settings for giving birth. These centers strive to create a comfortable and homelike atmosphere for labor and delivery by setting up rooms in a natural bedroom style. According to Page (2003), birth centers prioritize the family and implement a specific ethos to ensure excellent care and support for the mother, child, and the entire family.
Birthing Centers cater to low-risk women and offer interventions like episiotomies, forceps, or ventouse deliveries. These centers can be privately funded or connected to a hospital and funded through the hospital, which affects their safety as standalone practices. Birthing centers are typically small in size, fostering an intimate environment that allows families to become acquainted with the entire staff. This level of familiarity is lacking in public midwifery or obstetric settings where different staff members may attend to a mother’s care each time she seeks assistance during her pregnancy. The most significant factor for childbearing women is feeling that the midwives are competent and caring towards them (Green et al., 1998). Continuity of care is crucial for pregnant mothers and midwives alike. It refers to the consistency of care provided by midwives throughout the antenatal checks, labor, and postnatal period. Having familiar caregivers alleviates stress and puts women at ease during delivery as well as antenatal and postnatal checkups (Garcia et al., 1998). This is highlighted by Garcia’s account of receiving continuity of care for her second child, in contrast to her experience with her first child.The author emphasizes the importance of receiving continuity of care through a personal anecdote. Having a midwife present throughout the entire birthing process made a positive impact, contrasting with a previous experience that lacked such continuity. This highlights the significance of this approach in improving the overall birthing experience. Birthing centers adhere to a specific philosophy that prioritizes patient care.
The advantages offered by birthing centers typically include well-trained and empathetic midwives who are familiar to pregnant women (Green et al., 1998). The concept of women-centered midwifery has gained widespread popularity and encourages collaborative decision-making between an engaged patient and the midwifery team (Harding, 2003). Additionally, it is proposed that involving mothers in the decision-making process empowers them and can lead to improved health outcomes (England and Evans, 1992).
Birthing centers have a skilled team of midwives who possess advanced knowledge and expertise. Unlike practitioners, these midwives work without constant supervision, allowing them to enhance their skills. As a result, they can provide patients with reliable and trustworthy information, enabling them to make informed decisions in partnership with the experienced midwifery team. It is important to note that birthing centers prioritize empowering mothers to have natural births; therefore, they do not offer a wide variety of pain relief options (Pregnancy and Children 2008).
Pain medication for pregnant mothers, especially first-time mothers, can be difficult to provide. If patients need strong pain relief or a cesarean section, they will be sent to a hospital. This raises concerns about the safety of birthing centers. However, recent data from Henderson et al. (2007) shows that women who planned to give birth in birthing centers had lower rates of certain interventions compared to those who gave birth in hospitals. These interventions include labor induction (1.4%-5.5% vs 23.6%), continuous electronic fetal monitoring (7.5%-21.8% vs 42%), epidural use (11.3% vs 49.1%), cesarean section (3%-6% vs 4.6%-13.2%), and operative vaginal delivery (5%-7-8% vs 11%-43%). In Page’s study in 2003, the Edgware Birth Center—an independent birth center located five miles away from any acute maternity unit—was discussed.
An evaluation was conducted on low-risk patients at this center which revealed that women planning to give birth there were less likely to need pain medication.However, among these women, 19% were transferred to a hospital before giving birth and 12% during labor.These transfers were done by ambulance to the nearest hospital which may pose potential problems.
According to qualitative data, women who received care at the Edgware birthing center were satisfied with their experience. The center had a breastfeeding rate of 85% and shorter labors by an average of 15%. In addition, costs were 30% cheaper compared to local consultant led units. Overall, Birth Centers seem to be as safe, if not safer, than hospital births.
A study conducted by Henderson et al. (2007) found that fewer neonates needed admission to the Neonatal Intensive Care Unit (NICU) when born in a birth center (3.7%-4.7%) compared to hospital births (15%-19.7%). According to Laws et al., (2009), with 81% of birth centers connected to hospitals and another 12.5% located on a hospital campus, there is no real reason for mothers to worry about pregnancy-related problems.
The aforementioned intervention statistics also support the idea that birth centers are not risky and empower women during natural childbirth experiences. Benefits such as continuity of care, continuity of carers, shared decision-making, and cost effectiveness are easily noticeable in Birth Centers, especially for healthy mothers with healthy babies; however, drawbacks include limited pain medication options and the transfer rate of women.
Statistics show that birthing centers are advantageous for the well-being of both the mother and baby. Qualitative data reveals that 98% of women who have utilized birth centers would recommend them to others (Rooks, Weatherby et al., 1992). In summary, birth centers that employ a team midwifery approach provide a dependable, secure, and more comfortable childbirth experience. This is supported by studies like Garcia J, Redshaw M, Fitzimmons B, Keene J’s “First class delivery: A national survey of woman’s views on maternity care” (Audit Commission, London) and Green J M, Curtis P, Price H, Renefrew M J’s “Continuing to care” (1998).
The text provides information about various books and publications related to midwifery services in the UK. The sources include “The organisation of midwifery services in the UK: a structured review of the evidence” by Books for Midwives Press, Hale. Another book mentioned is “Making choices in childbirth” by D. Harding, which discusses the new midwifery practices and their scientific and sensitive aspects. “Myles textbook for midwives” by L. Page is also mentioned, highlighting the importance of woman-centered and midwifery-friendly care principles, patterns, and culture of practice.
Page, L., Cooke, P., & Percival, P. (2003). The new midwifery: science and sensitivity in practice. Providing on-to-one practice and enjoying it. Edingburgh: Churchvill Livingstone
Ping, E. (2013) Academia. Historical Development of Nurse Midwives and BirthCenters in America. Retrieved from: http://www.academia.edu/365880/Historical_Development_of_Nurse_Midwives_and_Birth_Centers_in_America
Rooks, J. P., Weatherby, N. L., and Ernst, E. K. M. (1992a) The National Birth Center Study. Part 1 – Methodology and prenatal care and referrals. Journal of Nurse-Midwifery 37(4): 222-253.
