As an expectant parent, you have a variety of choices including birth setting, careprovider, birth attendants and support, education and actual labor and birth options. Today, your options are set by both the care provider and those who care for you in your birth setting. Obtaining knowledge about all of your choices will increase your empowerment as an informed consumer of health care.

Consumer? Yes, we consume health care in a wellness setting when pregnant. Pregnancy and birth are one of the few physical activities for which we have real choice on health care. Bound in many cases only by the limitations of insurance, HMOs or PPOs, choice is still there. It may involve touring a birth facility, interviewing a physician or childbirth educator - but you are choosing!

Five Questions to ask your caregiver to ensure you are well informed of your options. What is the proposed treatment or procedure? Make sure you fully understand what is suggested and how it is done. What are the benefits? What are the risks? What are my alternatives? What would happen if I did nothing?

Whether you choose a Labor Delivery Recovery room (LDR), Labor Delivery Recovery Postpartum room, Alternative Birth Center (ABC), freestanding birth center, home birth or birth in a conventional hospital setting, read as much as you can about the pros and cons of each so that you will be making an informed choice.

LDRs and LDRPs: offer comfortable home-like space for birth. Few admission or "at-risk" criteria exist. Women labor, give birth and spend the first bonding time with family and are generally not transferred to a postpartum room until 1-2 hours for LDRs and sometimes not at all in LDRPs. Assistance is available in case of a complication.

Alternative Birth Centers may be physically separate from the hospital obstetrics unit or in close proximity to it. Delivery and operating rooms and NICU (neonatal intensive care unit) are often accessible if necessary.

Freestanding Birth Centers offer families an alternative to home birth providing a compromise between hospital and home. Admission and at-risk criteria may include: usually low-risk women are seen. Ambulance service and emergency procedures must be readily available, physicians should have privileges at local hospital(s), and quick transfer should be possible as a low risk pregnancy could develop into a high risk birth.

Homebirth represents only 1% of the births in United States but a larger portion of the births in countries such as Sweden and Norway. Here the family is in control of the experience in a more physically and psychologically natural environment. It is important that the care provider (midwife, physician) obtain backup emergency care in a hospital should things not go as planned. If an emergency delivery is necessary, no effective way to do this rapidly exists in a home setting.

Often designed for quality control and cost effectiveness, LDRs, LDRPs and ABCs may be a primary marketing tool for the facility's obstetrical unit and although they "walk the walk", they may not "talk the talk". When choosing a birthing facility, be aware of pretty spaces and lousy attitudes. By this, the hospital provides these home-like environments, lots of homey furniture and little extras. However, the attitudes of the staff are not consistent with the homey environment. "Lousy attitudes" can include resistance to change or new concepts, lack of information on new data, reliance on technology rather than one-on-one nursing care, limited knowledge of non-pharmacological (anything but drugs) pain relief techniques such as relaxation or breathing, reluctance in allowing family any control over the birth experience. To avoid having to cope with lousy attitudes, word of mouth referrals and personal touring (and asking questions) are your best bets in choosing a birth facility.

References:

1. Lothian, J. The Official Lamaze Guide. (2010)
2. Nichols, F., Humenick, S. Childbirth Education: Practice, Research & Theory (2000) Saunders & Co.
3. Simkin, P.  et al. Pregnancy Childbirth & The Newborn: The Complete Guide. (2010) 
4. Reeder, S., Martin, L., and Koniak-Griffin, D. Maternity Nursing: Family, Newborn, and Women's Health Care. (1997) Philadelphia: J.B. Lippincott Company.