PHILOSOPHY OF CARE

Hospital-based midwives tend to view low-risk birth as a natural, healthy life event that can also benefit from having technology immediately available. They keep routine interventions to a minimum while following hospital policy. They expect you to be a partner in your own care. If this philosophy resonates with you, a midwife-attended hospital birth could be a good fit.

If you are low-risk birth as a natural, healthy life event that is safest and most satisfying without routine interventions, you might consider birthing at home or in a midwife-led birth center.

SURROUNDINGS

Some hospitals have home-like family birthing suites that are as comfortable and pleasant as midwife-led birth centers. Hospitals have the technology and expertise to care for you if you develop medical complications, including operating rooms for C-sections. Most also have neonatal intensive care units (NICUs) to care for sick babies.

Your hospital room may have monitors and other equipment that give it a clinical, impersonal feel. There is less privacy in hospitals than in other birth settings. Nurses, residents, anesthesiologists and medical students whom you've never met may come into your room, which can feel disruptive and intrusive. You may feel less in control of your physical surroundings than at a birth center or at home. Your family and visitors may not have comfortable, pleasant spaces to hang out. They will be sharing public spaces with other families.

FEELINGS

You may feel safer and more relaxed in the hospital, knowing that hospital technology is there if you need it and a C-section is available just down the hall. Feeling relaxed and safe can make birth easier, faster, and less painful.

The hospital setting may make you feel stressed, anxious, or unsafe. These feelings can make birth harder, slower and more painful.

MANAGING PAIN

Hospitals where midwives practice sometimes provide birthing bars, rocking chairs, birth balls, or other equipment that can help you manage your pain without medication. A few offer labor tubs; laboring in water can be an effective way to manage pain. Showers are usually available. Pain medication is available, including epidural anesthesia.

In most hospitals, you will have less freedom to move, eat and drink, take a shower, or change position than you would at home or in a birth center. This can make your pain harder to manage. Few hospitals offer labor tubs.

WHO TAKES CARE OF YOU

Your birth in the hospital will be attended by a certified nurse midwife (CNM). CNMs have extensive training in their field and are experts in normal birth. They are trained in the midwifery model of care, which is personalized, holistic, and family-centered. They treat low-risk birth as a natural, healthy process that is safest and most satisfying without routine interventions. CNMs are expert at helping you labor effectively and manage pain without medications. Hospital-based CNMs may be able to care for you even if you have risk factors that rule out birth at home or in a midwife-led birth center.

Hospital-based midwives practice under the oversight of doctors. They follow hospital policies and may be influenced by hospital culture. They may not have full autonomy to practice the midwifery model of care. If you are high-risk, you may not be eligible for midwifery care.

SUPPORT IN LABOR

Hospital midwives typically spend more time with you in labor than a doctor can. You will also be supported by the labor & delivery nurses. Some hospitals have liberal policies about who can be with you during your labor and delivery—for instance, family, friends, a doula, etc.

Hospital midwives often have to divide their attention among several patients at at time. Many women are surprised when they are left to labor on their own for periods of time in the hospital, with their labor & delivery nurse as their primary support. Labor & delivery nurses in the hospital vary widely in their philosophy of birth. Some are very skilled at supporting natural childbirth, some are not. Most hospitals limit the number of people who can be with you during your labor and delivery—for instance, family, friends, a doula, etc.

POLICIES & ROUTINES

Hospital midwives may be able to offer alternatives to hospital routines that you wish to avoid.

You will be subject to hospital rules and requirements. There may be rules about whether you can eat or drink. You will probably have an IV. There are likely to be time limits on your labor. Continuous fetal monitoring may limit your ability to move or change position.

INTERVENTION RATES

For low-risk women, intervention rates —including C-section, episiotomy, and pain medication—are higher for doctors than for hospital-based midwives.

When you choose a hospital-based midwife, you are more likely to have interventions than women who choose a birth center and or home birth. C-section rates for low-risk women who choose a hospital-based midwife are higher than for women who choose a birth center or home birth.

SAFETY

If you are low-risk, planning a birth with a midwife in the hospital is at least as safe as planning a birth with a doctor. If you have certain risk factors, hospital care with a midwife in collaboration with a doctor can be safe as well. (See "The Research Says" below.)

Certain medical conditions require care by an OB or maternal fetal medicine specialist.

CONTINUITY OF CARE

If you decide you want pain medication or if your labor becomes complicated, your midwife may continue to care for you in collaboration with hospital doctors.

If your labor is very long, the shift may change and a new midwife may take over your care. You will not meet your labor & delivery nurse until you arrive at the hospital.

GETTING THERE & TRANSFER

You will not have to transfer to a different setting if you decide you want an epidural or if you develop complications during labor

You will need to drive to the hospital once your labor starts.

PRENATAL CARE

Midwives generally spend longer with you at your prenatal visits than doctors can.

Depending on the size of the practice you may see a different midwife at each appointment.

AFTER DELIVERY

Many hospitals have updated their policies to keep mothers and babies together after birth in order to support bonding and breastfeeding. Nurses and (sometimes) lactation consultants will help with breastfeeding and baby care. If you want or need to have time away from your baby to rest and recover, hospital staff will care for your baby in the nursery.

You may be separated from your baby for the new baby check up. In some hospitals, babies are routinely taken to the baby nursery. Your sleep will be interrupted by frequent check ups. Many hospitals do not allow fathers or birth partners to stay overnight. Sibling visiting hours are restricted. You will need to make plans for your absence. You will usually be able to see friends and family only during set visiting hours.

COST

Hospital birth—whether with a midwife or doctor— is generally covered by health insurance.

Birth in the hospital is generally more expensive than birth at home or in a birth center.