Monday, February 4, 2013

Welcome to the Olive Garden...

In case you missed it, the American Association of Birth Centers released The National Birth Study II this week.  You can read the article here.  The findings are HUGE!  I want to give you the condensed highlights and then we'll chat....

The study included 15,574 women at 79 birth centers across the U.S. between the years of 2007 and 2010.  This is a respectable sized study.  About 80% of the women were married and about 3/4 of them had at least some college education.  Half of them were having their first baby, while the other 50% had given birth previously.

Here's the awesome part of the study - 94% of the women planning a birth center birth had a vaginal birth!  This means that only 6% of these women had a cesarean section.  It's true, they were all low-risk.  But in the hospital, the rate of cesarean section for low-risk women is 27%!  Read this paragraph again.  I'll give you a minute...

There were no maternal deaths ("I would have died if I would have had my baby out of a hospital!") and the stillborn/newborn death rate was very consistent with other birth places.  In other words, these babies likely would have died regardless of where they were born.

Interestingly, the rate of cesarean birth in the hospitals has dramatically increased over the decades, while it has remained stable - and low - in the birth centers between 4.4%-6%.  The women in this study saved more than $30 million simply by birthing in a birth center instead of a hospital.

According to Rebecca Dekker, "The National Birth Center Study II shows that when women receive midwifery-led care in birth centers, preventable C-sections are prevented...  Legislation is needed to align payment methods and regulations so that we can better promote the proliferation of birth centers."  In other words, if you are low-risk, hire a midwife, birth out of hospital, and demand that insurance cover midwifery care at a birth center!

For years I have said that birthing in the hospital is like eating at the Olive Garden.  Before I go any further, let me just say that I worked for Darden Restaurants at the Olive Garden for nearly 4 years.  They are a fabulous company to work for.  Seriously.  I got vacation, insurance, incentives.  Sometimes I still miss it.  It's also still one of my favorite places to eat.  With that being said....

When you walk in, you are welcomed by the hostess.  Hopefully you don't have to wait too long for a table.  You have a lovely meal, but if you camp out, your server starts getting nervous.  Because of all the refillable items, the server's section only consists of 3 tables in order to give great service.  If he/she is going to make any money, they've got to turn those tables.  When one table hangs out, it hurts the profits of both the server and the restaurant, and the lobby starts filling and backing up, especially if several tables are "camping out."

When you are birthing at the hospital, you simply cannot labor in a room for hours upon hours, or sometimes days.  The lobby (triage) is filling up and your table (room) is needed.  Even the best care providers working in the hospital will tell you to "come in pushing" because they know that women are much more likely to have things done to them to speed things along once they are in the hospital - things that interfere with and interrupt the natural process.

One of the most significant points worth repeating from the study is that low-risk women have a 6% c-section rate at a birth center, but in the hospital, they are more than 4 times as likely to have a c-section, at 27%!  Some of the reasons for higher c-section rates when mom plans a hospital birth include:

* We need your table - i.e. Failure to Progress - Mom has "failed" to progress within her time limit imposed by the hospital.

High rate of induction and not allowing labor to start on its own - A first-time mom is twice as likely to have a c-section when her labor is induced.

*  The use of epidurals and IV drugs do affect the course of a woman's labor.  These are not options in a birth center.

*  Baby is more likely to have heart decelerations with pitocin and other drugs in mom's system, causing care providers to worry more - not just about the baby but also about lawsuits.  The what-if factor is huge and a lot of cesareans are performed as a direct result.

*  We cannot ignore the money factor.  C-sections make more money.

*  We cannot ignore the time factor.  The more time the OB is in the hospital, often, his lobby is full over at his office.  Ever wonder why you wait for 3 hours at your OB appointment?  He/she is aware they are getting further behind the longer you are taking to have your baby.  They don't have time to wait around.  (I actually get this one.  I am super selfish with my time.  I can't stand to wait - on anything - and know I'm getting behind with other things.  I would make a terrible midwife for this reason.)

Personally, I believe at the root of choosing hospital birth is the desire for an epidural.  I believe that if women (and men) weren't so afraid, they wouldn't ignore this evidence about the safety of out-of-hospital birth.  Education takes the fear away.

 "You CAN have an amazing birth!"  -  Birth Boot Camp

Now, go enjoy a delicious meal at the Olive Garden and tell them Banned From Baby Showers sent you!


Melissa Shamburger said...

What a great analogy! And great research stats for birth centers! Thank you for sharing. I am due for my VBAC in May, and taking Birth Boot Camp classes with my husband at Harris Fort Worth. Education IS invaluable. My first delivery was text-book for all of the things mentioned here, despite my wishes for an epidural "only if necessary". Hospitals are not bad places, but mothers need to be aware of all the interventions that will be offered/suggested/proposed and the risks/benefits they carry. Birth Boot Camp has helped us to make a decision about these things BEFORE I am in the throws of labor and my emotional brain takes over!

AtYourCervix said...

you hit it right on the head -- it's about turnover in the L&D unit. The faster we can turn them over, the more rooms we have available for the next 3 on their way in.

Refrigerator Memories said...

I seriously love you (in a non-weird sort of way)! I just wish you were closer so my town could benefit from your teachings. So for now I just share your info and hope others read and educate themselves. Our local hospital has almost a 50% c-section rate and the next nearest hospital choice is an hour and a half away. Lucky for me, I have a midwife and will be birthing at home.

Kayla Coons said...

I just found this article through Pregnant Chicken & I have already shared it on my Facebook.

Long before I became pregnant (I'm 9 weeks right now) my husband and I knew that we would be doing a home water birth with a midwife who has been in the business for 40+ years (she even delivered my youngest sister, almost 18 years ago).

It is refreshing to find informed advocates against hospital L&D.

Thank you for your article!

Lapiz de la Guerra said...

This is great; I almost have half a mind to send the data to my insurance company. I birthed my first babe naturally in a hospital. Long story short, I was given some cockamamie story by my OB that my being RH negative wouldn't allow me to have a home birth and ended up delivering in a hospital (and to make matters worse, it wasn't even the hospital I wanted since she moved two months before I gave birth and wouldn't let me transfer to another OB!). For this pregnancy, I really wanted to deliver in a birthing center, but my insurance company won't cover it at all and our finances are stretched too thin to afford it on our own. It still blows my mind that the insurance company would rather shell out tens of thousands of dollars for medical care instead of a fraction for that for a different methodology. Thank you for promoting education and awareness, and sharing the facts as they become available. Hopefully as this info becomes more available, insurance companies will change their minds and their policies!

The Future Mrs Drawz said...

"Ever wonder why you wait for 3 hours at your OB appointment?"

Err... no? Yikes, I would throw a fit if I had to wait that long. I've never waited longer than 10 minutes.

Anyway, thanks for the interesting and informative post. I do have to question comparing infant (and maternal) death rates between facilities that already segregate based on risk- for that reason alone, I would expect birth centers to have lower rates for both- but overall, they sound like a reasonably safe alternative for low-risk deliveries. As for me, I'm far too much of a hypochondriac to give birth anywhere but a hospital, haha.

Megan O. said...

I am all for natural child birth but I would like to point out that there will, of course, be less c-sections done at a birthing center because someone who knows they are having any risk with pregnancy would already be going to a hospital. Is the statistic of 27% of c-sections done in hospitals just low-risk or is that all deliveries? I feel like most women know what is best for their bodies and for their babies and that might mean delivering at a hospital. I appreciate this information as too many people are uneducated but I also desire each person to know what is the best option in their situation.

Miranda said...

Interesting blog post. While there isn't a birth center available anywhere near me, I was able to lessen some of the risk factors by carefully choosing an amazing, patient midwife to deliver both my babies. We talked extensively ahead of time about what I wanted, and she was fully supportive, worked carefully with me during my labors. I did the first half of my first pregnancy with a doctor who never kept me waiting for more than a few minutes, but never made me feel comfortable to talk to her, did my appointments with her hand on the knob of the exam room door. I switched midway through to my midwife, and it was the best decision. Although I sometimes waited longer for my appointments, I also got so much more out of them, and I knew that the reason they got canceled sometimes is that she did her own deliveries instead of handing off to the doctor slated for deliveries that day, like my first doctor usually did.

I had two amazing vaginal births, one fully natural and one with an epidural after 40 hours of contractions (to allow me to sleep enough to have the strength to progress and get ready to push). I think a doctor would have pushed for pitocin, since I was still only 4 cm dilated after 40 hours, but she thought I just needed rest. Two hours of sleep allowed me to wake up 10 cm and ready to push. I am fairly sure that I would have ended up with pitocin at minimum if I hadn't switched providers, and maybe a c-section.

While both were hospital births, I think we achieved as much of the birth center experience as we could, with both births 100% covered by my excellent health insurance. So people shouldn't despair if a birthing center isn't an option, either because of proximity or finances, but should instead do some research about the local options and look for the next best thing.