Active Birth

You will probably be asked to choose the place of birth right at the beginning of your pregnancy, and you may be expected to stay committed to your original choice. But it is not always easy to decide at this time, as you may not know very much about the whole subject, or the options available. Certainly you will not yet know how the pregnancy is to progress, which must influence your final choice. Women, like other mammals, have a powerful "nesting instinct," which usually arises towards the end of the pregnancy. Just as a cat chooses her corner of the house before the kittens are due to arrive, you too may not know where you wish to give birth until closer to the end, though you may have some idea of the kind of setting you would prefer.

When you begin your prenatal care with your doctor, midwife or clinic, keep open all your options for the birth. In the meantime, explore the possibilities. You may wish to change your doctor for the remainder of your pregnancy, or to choose a hospital that may not be your nearest because you like its approach. It is advisable to pay a visit to any hospital you are considering before committing yourself, to find out about the general approach in the labor ward and whether the staff encourages activity during labor and upright positions for birth. Also find out what happens after the birth, and how long you will be expected to stay before you can go home with your baby. You might prefer to explore the other options available. Remember: You are always entitled to change your mind.

There is no way of removing every risk in childbirth. Although the vast majority of babies are born safely, the final outcome of any birth is always uncertain. Unexpected complications can arise, machines can break down; anyone can make a mistake. There is now plenty of evidence that in general it is as safe, if not safer, to have a baby at home as to have it in the hospital, and home usually provides the best conditions for a physiological birth. But different factors, such as your health, your insurance plan, your proximity to a hospital, and whether you have any problems in pregnancy, will help to determine the most appropriate place of birth. The most important thing is to discover all the possibilities, to consider what your priorities are, and then to make a choice that feels right for you. Your instinctive feelings are really important, and they will arise most strongly at the end of your pregnancy. Your choice of birth place may depend upon your choice of birth attendant, or vice versa. Most births in the United States are attended by obstetricians-surgeons who are trained to handle complications, and who are likely to resort to obstetrical interventions. You may instead choose a family practitioner, a physician who provides both obstetrical and newborn care and is trained to view birth as a normal process. Or you may choose one of the growing number of certified nurse-midwives (CNMs). Experts in the normal birth, CNMs may attend deliveries in hospitals, birthing centers, and homes. They sometimes work in group practice with physicians, and they refer women with complications to specialists. Finally, you may prefer a "direct-entry" midwife--a midwife who has entered the profession directly, usually through apprenticeship, rather than going to nursing school first. These midwives specialize in home birth. Their legal status varies from state to state, and your insurance company probably won't pay expenses for a birth attended by a midwife who is unlicensed. But sometimes, for a home birth, there is no alternative. A minority of CNMs and very few physicians attend births at home because of pressure from hospitals, colleagues and insurers, and sometimes because of legal restrictions.

If you, like most American women, choose to have your baby in a hospital with an obstetrician, you can still have something like the constant nurturing a midwife provides. You can have an experienced friend or relative, a trained labor support provider, a lay midwife, or a childbirth educator accompany you to the hospital to provide support throughout your labor.

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