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The Out-of-Hospital Birth Center: Candy's story
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We stand on the shoulders of hundreds and hundreds of years of midwives, being with women, helping women have our babies, and that's part of our tradition - that nurturing, that sitting, that holding the hand, that witnessing what a woman was going through and encouraging her and giving her support. We bring all of that tradition and then we bring the best of modern medical obstetrical knowledge.
-Jennifer Dohrn,
certified nurse-midwife
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Story summary:
Candy is a 20-year-old woman having her first child. Surrounded by family and friends, she labors at the Childbearing Center of Morris Heights (CBCMH) until the midwives discover that her amniotic fluid contains meconium, which might represent a risk to her baby. At that point Candy is transferred to the hospital, where she gives birth to a healthy baby boy several hours later.
Obstetrical Viewpoint:
In a study published in the New England Journal of Medicine in 1989, birth centers were found to provide equally safe care with fewer interventions and at lower cost than hospitals. Many obstetricians still express concern that nonhospital-based birth centers may not have the rigorous protocols that hospitals do, thus exposing mothers to unnecessary risk. Candy's transfer might demonstrate the danger of out-of-hospital births from this point of view, since midwives are not equipped to handle all emergencies.
Even when individual obstetricians are supportive of out-of-hospital births, liability issues may make it impossible for them to provide medical back-up or formal consultation to midwives practicing out of the hospital. Limitations imposed by malpractice insurance providers can restrict physician/midwife collaboration.
Midwifery Viewpoint:
To the midwives and the medical director at the CBCMH, Candy's story epitomizes an appropriate collaboration between midwives and doctors. Candy's prenatal chart was reviewed by a physician, and her labor was attended by midwives until risk factors became evident. When a potential risk arose, Candy was transferred to the hospital in a timely manner, and her birth proceeded without complication. Like most birth center transfers, Candy's case was not an emergency but rather an example of midwives demonstrating appropriate case management. In the event of an in-house emergency, birth center midwives would use anti-bleeding medications and are trained in infant resuscitation.
While midwives must deal with liability issues, they base their care on an informed consent model, emphasizing client education and mutual responsibility. It is common for women in midwifery care to chart their own urine test and weight gain before each prenatal appointment and to take primary responsibility for decision making throughout their care.
Despite the fact that African American women have significantly higher rates of infant and maternal morbidity (illness) and mortality than Caucasian women, the CBCMH has demonstrated excellent results with low income African American and Latina women.
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