So you just discovered you're pregnant. With that discovery you likely experienced a whirlwind of emotions. From how you feel about being pregnant to the long list of things to do. One important decision to make is the type of prenatal care you desire. With this decision you also must decide on a location and provider. General location options include hospital, freestanding birth center, or home birth. Provider options vary depending on location. Wherever and whomever you choose for your care, it should be a thoughtful decision. You should be aware of your personal views around pregnancy and childbirth, your knowledge of usual procedures and policies, and your desires. Though they come with unique differences, there are notable similarities among options.
What's The Same:
For all location options guidelines from the American College of Obstetrics & Gynecology (ACOG) usually set the tone for standard of care provided. These guidelines include various screenings and test at different points of gestation to accurately assess mama and baby's health status. This includes but is not limited to assessing vitals (blood pressure, heart rate, and breathing), checking blood type, STD/STI testing, screening for gestational diabetes, checking iron levels.
The standard procedure for prenatal visits for a healthy low risk pregnancy are monthly visits up to around 32 weeks gestation then bi-weekly visits and around 36 weeks weekly visits until delivery. For a moderate or high risk pregnancy the number of visits may increase to allow for closer monitoring. An ultrasound for anatomy scan is recommended in the second trimester. The anatomy scan allows a visual assessment of development of baby's organs, limbs, overall size, and gender. For a moderate to high risk pregnancy and any situation where further assessment is recommended, more and/or higher level ultrasounds may be performed.
Each prenatal visit will consist of vital assessment, weight check, assessment of fetal heart tones. Depending on point in pregnancy there will be an additional screening. There is different education provided depending on relevance at time of visit.
During the labor process care givers monitor mama and baby status to ensure both are tolerating the process well and implement medically necessary interventions when appropriate. Monitoring includes: laboring moms vitals; frequency, duration & intensity of contractions; and fetal heart tones.
The differences among the options for providers and birthing location may be the factor in final choice.
What's Different:
Hospital
In the United States care in the hospital is often provided by an OB-GYN who follows a medical model. Some hospitals also have DO's (Doctor of osteopathic medicine) who specializes in well women's and perinatal care, and Certified Nurse Midwives (CNM). DOs and CNMs are trained to have a more holistic approach.
When planning for time of labor travel time is a factor to consider. Distance and travel time to the nearest hospital varies depending on the type of environment you reside in. According to a 2018 review, in an urban area people live an average of 4.4 miles from the nearest hospital, 5.6 miles in suburbs, and 10.5 miles in rural areas.
During the labor process mom is placed on continuous monitoring to track fetal heart tones and contractions. This inhibits ability to move freely. Oral intake is either completely restricted or limited. There are usually limits on number of visitors allowed. For example, there may be a limit of three visitors during labor.
Some hospitals have the option to labor in water but usually prohibit birthing in the tub. ACOG supports immersion in water during labor but recommend birth on land. ACNM, American College of Nurse Midwives, does however support both labor and birth immersed in water for a healthy low-risk mom who has been provided adequate information to make an informed decision.
Freestanding Birth Center
Freestanding birth centers follow a holistic model. This type of facility is its own entity not inside a hospital. Care can be provided by cnm, cpm (certified professional midwife). Freestanding birth centers are not as readily available as hospitals. Throughout the United States there are over 384 freestanding birth centers compared to over 6,000 hospitals. Some families travel as long as an hour to reach the nearest birth center. This is important to consider when preparing for labor.
Monitoring of fetal heart tones during labor process is performed intermittently with a hand held doppler or a fetascope depending on provider and client preference. Contractions are monitored by client report and provider assessment through visualization, touching the abdomen and watching the clock. This method allows for free movement. Moms are encouraged to eat and drink as they desire.
Birth centers tend to be accepting of whatever number of people mom wants in the room during labor as long as safety and progression are not impaired.
Home Birth
holistic model of care. usually provided by a cpm. Visits can take place in an office space, in your home, or another private setting you and provider are comfortable in. You can expect longer, more personalized visits. During labor, since the birth is at home there is no travel time to consider. However, it is good to be aware of distance to the nearest hospital in case during labor or immediate postpartum mom and/or baby require transfer to the hospital. The midwife will educate the family about when to call and have a plan in place so that she may arrive in a timely manner.
Fetal heart tones are monitored intermittently with a doppler or fetascope.
Free movement is encouraged. Moms eat and drink as desired. Option to labor and deliver in water, usually a blow up style pool that can be placed in any spacious, easily accessible place in the home.
What Does All This Mean:
Pregnancy and birth are a personal, special experience. The care you receive is your choice.
Peace & Love From Your Hippie Nurse ♥
Sources:
Comments