With technology on the rise and an increased experience from the past there is now a confusing array of choices that the pregnant mother has to deliver her baby (Harding, 2003). These models affect the type of care she receives, the location of her birth, the type of birth she endures, the people that surround her and also the care her baby will receive in an emergency. The social, emotional, spiritual and physical health determinants will all be affected relative to the model of care that is chosen.
The purpose of this paper is to provide an insight into the advantages and disadvantages of birth centers, specifically participating in group practice midwifery and analyse how this affects a pregnant mother’s holistic health and the babies. Group practice in birth centers are midwifery-based forms of care and provide many benefits including, continuity of care, excellent shared decision making and cost. However this model of care does pose some problems including the lack of pain medication and whether birthing centers are the safest option for both mother and child.
Other models of care including obstetric models place less emphasis on continuity of care and therefore marginalize the mother’s holistic health. For example public obstetric care still provides the mother with antenatal care but the mother could see a different obstetrician each time she has a check up. This results in no form of relationship with the team who will deliver her baby, which affects the mothers social and emotional health determinants.
Birthing centers contrast this model by providing the same team of midwives throughout the entire pregnancy. This method therefore heightens the mother’s confidence in her team and all members of the team have an understanding of the mother choices rather than duplicating information as seen in shared maternity care. The first birthing center was opened in 1945 and was called “La Casita”. It was located in rural New Mexico to provide a birthing place for mothers who lived to far from the hospitals (Sibbold and Ping, 2010).
People followed suit and birthing centers soon became renowned for giving quality, inexpensive care to low risk women and in 1989 the National Birth Center Study suggested, “Birth centers provide safety, satisfaction and savings comparable to other birth settings”. Birth centers essentially create a homey experience for delivering a child. Rooms are set up in a natural bedroom style environment. Page (2003) explains that these centers place emphasis on family and put a specific ethos into practice to ensure quality care and support for mother, child and family.
Birthing Centers only take low risk women and do perform interventions such as episiotomies, forceps or ventouse deliveries. Centers can be privately funded or can be connected to a hospital and funded through the hospital. These two types of centers create a large margin in whether it is safe to be a stand-alone practice. Birthing centers are also usually small which creates an intimate environment that allows families to become familiar with all the staff, which is something that is not provided in a public midwifery or obstetric setting as different staff could appear each time a mother seeks care during her pregnancy. What probably matters most is that she (the child bearing woman) should feel that they (the midwives) are competent and that they care- about her” (Green et al. , 1998). Continuity of care is crucial for pregnant mothers and also for midwives. Continuity of care refers to the consistency of care given from the midwives; whether it is in antenatal checks, during labour or postnatal. Women value special relationships and when they have carers who they know it puts them at far more ease during delivery and during antenatal and postnatal checkups. Garcia et al. , 1998) gives her account of knowing her midwives and receiving continuity of care for her second child in contrast to how she had her first child. She states “It was wonderful to have a midwife I had met before and who stayed with me the whole time- I just wish this had been the case the first time” This statement gives insight into the benefit of women receiving continuity of care and how this affects the overall birthing experience. Birthing centers employ a specific philosophy that places emphasis on how they care for patients.
The benefits that birthing centers generally provide are well trained, sensitive midwives who are known to child-bearing mothers. (Green et al. , 1998) Women centered midwifery has become very popular and creates collaborative decision making between an active patient and the midwifery team (Harding, 2003). It is also suggested that the input of the mother decision allows them to feel empowered and this can result in better health outcomes (England and Evans 1992).
Birthing centers provide a midwifery team that have enhanced skills because they are in an environment that allows them to improve their knowledge and experience without practitioners watching their every move. Due to enhanced knowledge and experience midwives can provide the patient with valid and reliable information. The patient is then able to make decisions along side the skilled midwifery team. Birthing centers do not provide a full range of pain relief. This reflects the midwives role and a birth centers philosophy on empowering the mothers to give birth in a natural way (Pregnancy and Children 2008).
However not offering pain medication for mothers in pregnancy can be confronting, especially for first time mothers. If patients need strong pain relief or are in need of a cesarean section they will be transferred to a hospital to receive the treatment they need and this is the issue that surfaces the safety issue with birthing centers. However recent statistics from Henderson et al. , (2007) show that women who planned to deliver in birthing centers were less likely to have: * An induction of labour (1. 4%- 5. 5%) Vs. (23. 6%) * Continuous electronic fetal monitoring (7. 5%- 21. 8%) Vs (42%) * An Epidural (11. 3%) Vs (49. 1%) A Cesarean Section (3%-6%) Vs (4. 6%-13. 2%) * An operative Vaginal Delivery (5%-7. 8%) Vs (11%-43%) Page, L (2003) describes the Edgware Birth Center, which is located 5 miles from any acute maternity unit making it a stand-alone birth center. An evaluation was carried out on low risk patients attending the birthing center. Women who intended on delivering their baby at the birthing center were less likely to need pain medication. Of these women 19% were transferred to a hospital antenatally and 12% during labour. These women travelled via ambulance to the nearest hospital and many problems could have occurred because of this.
However it becomes apparent from qualitative data that even these women were satisfied with their care. Out of the women 85% breastfed and labors were an average of 15% shorter in the Edgware birthing center. Costs were also 30% cheaper compared to local consultant led units. Overall, Birth Centers appear just as safe as hospital births, if not safer. A study conducted by Henderson et al. , (2007) showed that fewer neonates were taken to NICU if they were born in a birth center (3. 7%-4. 7%) VS. (15%-19. 7%) in hospital births. With statistics showing that 81% of birth centers are connected to a hospital and another 12. % are on hospital campus, there is no real reason for mothers to be distressed on problems occurring during pregnancy (Laws et al. , 2009). The statistics on interventions previously stated also supports the idea that birth centers are not dangerous and that they empower women to give birth in a natural way. The advantages of Birth Centers are very apparent especially for healthy mothers with healthy babies. The advantages of Birth centers include continuity of care, continuity of carers, shared decision-making and cost effectiveness. The disadvantages include; Lack of pain medication and the transfer rate of women.
Statistics support birthing centers for the health of the mother and child and qualitative data shows that 98% of women who have experienced birth centers would recommend it to their friends (Rooks, Weatherby et al. , 1992). In conclusion, birth centers that employ a team midwifery model of care create a reliable, safe and a more comfortable delivery. Referencing Garcia J, Redshaw M, Fitzimmons B, Keene J 1998 First class delivery: A national survey of woman’s views on maternity care. Audit Commission, London. Green J M, Curtis P, Price, H, Renefrew M J 1998 Continuing to care.
The organisation of midwifery services in the UK: a structured review of the evidence. Books for midwives Press, Hale. Harding, D. (2003). Making choices in childbirth. The New midwifery: science and sensitivity in practice. Edinburgh: Churchvill Livingstone Jennifer Henderson, Janet Hornbuckle or Dorota Doherty , Women and Infants Research Foundation King Edward Memorial Hospital for Women PO Box 134 SUBIACO 6904 WA Page, L. (2003). Myles texbook for midwives. Woman-centres, midwifery-friendly care: principles, patterns and culture of practice. Ediburgh: Churchvill Livingstone.
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