I’ve often wondered what was best for a first-time mom who has never known the experience of childbirth. Should she choose to birth in the hospital the first time around so that she can test herself? Or should she jump right in to an ‘out-of-hospital’ birth? I used to think that being at the hospital was a good plan. Now I think the opposite is true and here is why.
Labor may be easier due to the watchful care of a midwife
When a first time mom becomes pregnant, most often she is in perfect health and would be considered low-risk. At this point she could be cared for by either an obstetrician or a midwife. She would receive essentially the same prenatal care except that in the case of the midwifery model of care she will be watched over more closely on the issue of the position of the baby. This is very pertinent information when she is in her last month of pregnancy because if the baby is not in the most ideal position for labor, things can still be done about it. In the case of the obstetrician, this information is not so concerning because whatever is not right when the mother goes into labor, can be ‘fixed’ for the delivery (which might include forceps or a cesarean delivery). Since the midwife is being watchful and advising the first-time mom on things she can do to encourage a better position for the baby, her likelihood of having an easier labor and an uncomplicated vaginal delivery are greatly increased.
Cost is Lower
One first-time mom came to a birth center for her prenatal care. It was in my early training to become a midwife. I was stunned that she was planning to do her birth un-medicated and out of the hospital when she didn’t even know what birth feels like. Women like this are rare. “What gives you the courage to make such a bold move?” I asked. She replied that it boiled down to cost. They did their shopping. They learned what an obstetrician charges, and what the charges are if he/she does a cesarean delivery (it is higher). Then they shopped the hospitals to learn what their fees were. She was choosing to go with midwives and a birth center because she could save money by two-thirds. They were poor college students and every dollar mattered. She explained that these potential high costs with an obstetrician and hospital would set them back for years. “I told my husband that I can stand anything for that price.” I admired her resolve. She hadn’t taken any classes yet to learn of all the things she’d be able to do to minimize the discomfort of childbirth. Of course, this route would also open up her options for waterbirth therapy. She had faith and she knew she could do it.
How the Labor is Managed
The management of labor really sets out-of-hospital midwives and obstetricians apart. These midwives believe in the natural process of birth. They trust the woman’s body that it knows how to get the job done and doesn’t need much help. Meddling with the process is not necessary in the majority of cases. The midwife’s mantra is to be watchful and allow the mother to do her work. They call it labor for a reason. It is work!
Since the mother is allowed to birth naturally, without added drugs, the contractions are at a pace and strength that she can work with. Her own hormones are stimulating the contractions. They are not overridden by synthetic hormones. The natural oxytocin hormones are endorphins which give off feelings of peace and joy.
Trying to do a birth naturally is so much easier when a mom is in an environment that she is familiar with, surrounded by people she knows and trusts. There is no need to feel anxiety from the get-go.
Contrast this with having her labor managed by an obstetrician. Having the hospital tool box, they can fix anything. If the labor is too slow, it can be sped up with drugs. If the baby is in a poor position, it can be fixed by assisting the mother to push by ‘pulling it out’ with forceps or even a surgical delivery. No harm done. We have a healthy baby and that is what everyone wanted, right? Well, yes, but not at that price. We wanted a healthy baby and a joyful, calm birth. Quite often the hopeful expectations of the couple are not realized satisfactorily because of the way the labor was managed.
Her First Birth Ending in a Cesarean Delivery
Choosing the hospital for the first birth significantly increases her chances of ending up with a cesarean delivery. The ramifications of having had a cesarean delivery on her first birth are huge. She’ll ever after be considered a potentially high-risk mom. She can still choose an out-of-hospital scenario for the next pregnancy but if it also must finish as a cesarean delivery, then the state of Utah will not allow midwives to be the caretaker for pregnancy of that mom anymore. She’ll need to be overseen by an obstetrician ever after. Most obstetricians will advise a repeat cesarean mother to have the rest of her babies in this fashion and to consider curtailing their family size to four children. That is a bitter pill for parents who want to have a larger family.
Since 1 out of 4 obstetrician-managed labors end in cesarean delivery in Utah, my hearty recommendation for a first-time mom is to choose an out-of-hospital birth first. That is, unless she wants a cesarean delivery. Then, that is a different story.