Women give birth in hospital
Birthing Centers and Hospital Maternity Services (for Parents)
You'll make plenty of decisions during pregnancy, and choosing whether to give birth in a hospital or a birth center is an important one.
Giving Birth at a Hospital
Traditional hospital births are still the most common option. This means the mother-to-be moves from a labor room to a delivery room and then, after the birth, to a semiprivate room.
In a hospital birth:
- Pain medicines are available during labor and delivery, if a woman wants them.
- Labor can be induced, if necessary.
- The baby is usually electronically monitored throughout the labor.
Doctors "manage" the delivery with their patients. A birth plan can help a woman communicate her preferences, and her doctor will abide by these as much possible.
Many hospitals now offer more options for low-risk births, often known as family-centered care. These may include private rooms with baths (called birthing suites) where women can labor, deliver, and recover in one place without having to be moved.
A doctor and medical staff are still on hand. But the rooms create a nurturing environment, with warm, soothing colors and features that try to simulate a home-like atmosphere that can be very comforting for new moms. Rooming in — when the baby stays with the mother most of the time instead of in the infant nursery — also is more common.
Many hospitals offer childbirth and prenatal education classes to prepare parents for childbirth and parenting classes for after the birth.
How many people may attend the birth varies from hospital to hospital. In more traditional settings, the limit might be three support people during a vaginal birth. In a family-centered setting, more family members, friends, and sometimes even kids might be allowed. During a routine or nonemergency C-section, usually just one support person is allowed.
A variety of health professionals oversee hospital births:
Obstetrician/gynecologists (OB/GYNs) are doctors with at least 4 more years of training after medical school in women's health and reproduction, including both surgical and medical care.
They can handle complicated pregnancies and also do C-sections.
Look for obstetricians who are board-certified, meaning they have passed an examination by the American Board of Obstetrics and Gynecology (ACOG). Board-certified obstetricians who go on to receive further training in high-risk pregnancies are called maternal-fetal specialists or perinatologists.
If you deliver in a hospital, you also might be able to use a certified nurse-midwife (CNM). CNMs are registered nurses who have a graduate degree in midwifery, meaning they're trained to handle low-risk pregnancies and deliveries. Most CNMs deliver babies in hospitals or birth centers, although some do home births.
Registered nurses (RNs) attend births to take care of the mother and baby. If you give birth in a teaching hospital, medical students or residents might attend the birth. Some family doctors also offer prenatal care and deliver babies.
Anesthesia, if needed, will be administered by an anesthesiologist. A variety of pain-control measures — including pain medicine and local, epidural, and general anesthesia — are available in the hospital setting.
Giving Birth at a Birth Center
Women who deliver in a birth center usually have already given birth without any problems or have a low-risk pregnancy (meaning they are in good health and are not likely to develop complications).
Women are carefully screened early in pregnancy and given prenatal care at the birth center to monitor their health throughout their pregnancy.
Epidural anesthesia usually isn't offered at birth centers. So women are free to move around in labor, get in the positions most comfortable to them, spend time in the jacuzzi, etc. Comfort measures (such as hydrotherapy, massage, warm and cold compresses, and visualization and relaxation techniques) are often used.
A variety of health care professionals work at birth centers, such as registered nurses, CNMs, and doulas (professionally trained providers of labor support and/or postpartum care).
A doctor usually isn't on-site and medical interventions are rare. But most birth centers work with obstetric and pediatric consultants as a team. Nurse-midwives provide care during a woman's pregnancy, labor, and delivery. The OB/GYN consultants are available if she develops complications that put her into a higher risk category.
The baby's heart rate is monitored often during labor, typically with a handheld Doppler device. Birth centers do have medical equipment available, such as IV lines and fluids, oxygen for the mother and the infant, and other equipment necessary to treat sick babies and moms.
A birth center can provide natural pain control and pain control with mild narcotic medicines. But if a woman decides she wants an epidural, or develops complications, she must be taken to a hospital.
Birth centers provide a homey birth setting for the mother, baby, and extended family. In most cases, they're freestanding buildings, though some are attached to a hospital.
They often include amenities such as private rooms with soft lighting, showers, whirlpool tubs, and a kitchen for the family to use.
Look for a birth center that is accredited by the Commission for the Accreditation of Birth Centers (CABC). Some states regulate birth centers, so make sure the birth center you choose has all the proper credentials.
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Which One Is Right for Me?
How do you decide whether a hospital or a birth center is the right choice for you?
Some things to consider:
- If you've chosen a health care provider, find out if he or she can only practice at a particular hospital or birth center.
- Check with your health insurance carrier to see which options are covered. Often, major insurance companies cover accredited birth centers as well as hospitals.
Some risk factors might mean that you're not eligible to deliver in a birth center, such as:
- being older than 35
- carrying multiples
- having gestational diabetes or high blood pressure
- having a breech-positioned baby
And if you want interventions such as an epidural or continuous fetal monitoring, a hospital is probably the better choice for you.
A birth center can be an option for women who:
- don't have significant problems in their medical history
- have a low-risk pregnancy
- want a natural birth with minimal medical intervention or pain control
- want friends or family members there for the birth
To help with your choice, arrange a tour of the hospital or birth center. This lets you make sure that the staff is friendly and the atmosphere is one in which you'll feel relaxed.
With hospitals full of COVID-19 patients, she gave birth at home
When 33-year-old Kimberly Bonsignore learned in late March that her family members would not be able to join her at NYU Hospital during her labor and delivery, she began making plans for a home birth. Pregnant with her second child, she didn’t want to leave her husband, Al, and two-year-old daughter, Sativa, out of the experience.
“I wanted my daughter to be there, too, because I want her to really experience it,” says Bonsignore.
“I didn’t want to come home and say, ‘here’s your sister,’ like she’s a puppy or something.”
After the New York-Presbyterian and Mt. Sinai Hospital networks banned all visitors from labor and delivery rooms in an effort to prevent the spread of COVID-19, midwives across the city received a surge of phone calls. Not wanting to give birth alone, many women searched for an alternative.
3:35 p.m.
Bonsignore endures an intense contraction with the support of her doula, Angelique Clarke. Her two-year-old daughter, Sativa, ran to her dad, Al, and grandma, Louise, when her mom cried out in pain.
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New York Governor Andrew Cuomo has since issued an executive order allowing one support person to be present in the delivery room as long as they are screened for COVID-19. However, the prospect of giving birth in hospitals filled with coronavirus patients has driven up the demand for home births—a practice that is relatively uncommon in the United States, but has been steadily rising in popularity in the last 16 years.
According to the National Center of Biotechnology Information, a unit of the National Institutes of Health (NIH), home births accounted for more than 62,000 births, 1.61 percent of total in the U.S. in 2017. Certified nurse midwives attend about 10 percent of all births in the U.S., in the hospital or at home, though their role in patient care varies from state to state.
Women seek home births with a licensed provider—which can include a midwife or doula—for a variety of reasons: They want less medical intervention, such as pain medication and labor induction; they want the freedom to control their birthing environment; they feel a midwife would be more respectful of their religious values; or they feel dissatisfied with the hospital system. (Here's why giving birth in U.S. is surprisingly deadly—especially for black mothers.)
3:56 p.m.
Doula Angelique Clarke pours boiling water into the birth pool. She had initially used a hose connected to the sink, but the Bonsignores’ hot water ran out, so she heated water in pots.
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Preparing for birth
At 37 weeks pregnant, Bonsignore reached out to Angelique Clarke, her doula from her first pregnancy. Unlike midwives, doulas often do not have formal medical training but offer physical, mental, and emotional support for the mother. Clarke connected her with Cara Muhlhahn, a New York City-based Certified Nurse Midwife (CNM). Under different circumstances, Muhlhahn and Bonsignore would have had at least 10 prenatal visits from the beginning of the pregnancy to discuss potential complications.
Over two virtual consultations and a home visit they began to make the preparations needed for a home birth, filling out medical forms and ordering a birth kit. Staging for a home birth requires, among other things, a birthing pool that would be set up in the Bonsignores’ living room.
5:58 p.m.
Bonsignore climbs into the birthing pool with the help of Clarke, her doula, and midwife Cara Muhlhahn, right.
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Midwives generally take a different approach to hospitals. Instead of taking the lead and telling a woman when to push like a doctor might, they believe in letting a woman take the initiative herself.
“When we do birth at home we like to support something that’s called ‘physiologic birth,’” says Muhlhahn. “We tend to believe that in almost all cases births can proceed on their own if we support the woman, encourage her, do the best we can to provide pain relief, let her know that we are by her side, and [occasionally] give her guidance.”
Around noon on April 29, Clarke texted Muhlhahn, informing her that Bonsignore’s contractions had begun. Muhlhahn gathered her equipment and drove to Bonsignore’s block to stand by until the contractions intensified.
6:12 p.m.
Al Bonsignore records a video of his wife, Kim, midwife Cara Muhlhahn, and doula Angelique Clarke (not pictured), while his daughter, Sativa, plays in the water with her toys.
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Left: 6:20 p.m.
Bonsignore experiences a painful contraction. She was originally scheduled to deliver in a hospital, but changed her mind with the outbreak of the coronavirus.
Right: 6:44 p.m.
Sativa Bonsignore covers her ears while her mom pushes during labor. Kim’s screams upset the two-year-old, but Muhlhahn told her, “Mommy screams because it hurts, but nothing is wrong. That’s how it is when you have a baby.”
I didn’t want to come home and say, ‘here’s your sister,’ like she’s a puppy or something.
ByAl Bonsignore
“I do that because I live under the fear of someone calling me too late when things advance really quickly,” she says. “Angi was communicating with me the whole time I was in the car across the street.
She was telling me how far apart the contractions were and she took the lead in terms of knowing when to bring me in, which is often a role that doulas can play.”
Because she was at home, Bonsignore was able to move around freely. She took a shower while Clarke started filled the birthing pool using a hose connected to the sink. But after Bonsignore’s shower, they ran out of hot water and Clarke had to finish by heating water on the stove.
“I was able to do what I wanted,” Bonsignore remembers. “I got in the shower and the heat felt so good. And then when I got out I was able to walk around when I wanted, sit down if I wanted to. Stretch a little bit. When I got tired I was like, ‘I wanna lay down.’ When I laid down, Angi was massaging me. She was hitting the pressure points… Ten minutes after I laid down my water broke.”
A few minutes after Bonsignore’s water broke, at 5:27 p.m., Muhlhahn arrived at the front door, with her bags in tow and wearing a face mask.
6:18 p.
m.
Clarke and Muhlhahn check Bonsignore’s progress during labor while two-year-old Sativa continues to enjoy having a pool in her living room.
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“The first thing I do when I go in to a woman in labor is sit by her, greet [her] in the way that is appropriate, make her feel comfortable. I wait until the contraction is over and tell her I’m here. The first task is [to] listen to the baby’s heartbeat,” says Muhlhahn. “We listen right after the water breaks, and we like to know the color of the water breaking. Angi said it was clear, which is a sign that the baby is in [good] condition.”
For the next hour, contractions came and went. Bonsignore eventually climbed into the pool of warm water to help ease the pain. When she was too uncomfortable to lay on her back, she turned around to lean over the side of the pool. Muhlhahn checked the baby’s heartbeat every 30 minutes. At 6:32 p.m., Muhlhahn determined that Kimberly was fully dilated and could begin pushing.
I didn’t think it was that serious. When we spoke of it after, I cried and got really emotional. It's more traumatic now than in the moment.
ByKim Bonsignore
A moment of uncertainty
“She said, ‘Just listen to your body. Whatever you feel, just do it,’” Bonsignore recalls. “Cara kept telling me, ‘You’re made for this. You can do this.’ I didn’t think I was gonna make it. It was so painful. It was the worst pain I’ve ever experienced in my life. But it was pretty fast and I didn’t have to deal with it for so long. And her encouragement helped me. Her guiding me and telling me, ‘She’s almost there. She’s right here. You can’t give up. She’s right here.’”
When Muhlhahn saw the baby’s head crowning, she used her finger to check if the umbilical cord had draped around the neck—a common occurrence that does not harm the baby while inside the uterus.
“When there is a cord around the neck, which happens approximately 40 percent of the time, we don’t consider it a high-risk situation but we do try a few maneuvers to make sure that this doesn’t hold back the birth of the rest of the body,” says Muhlhahn.
Managing the cord is a crucial task. “Once you cut the cord, you’ve cut off another lifeline that the baby has. It protects the baby’s brain from a lack of oxygen,” Muhlhahn explains. She considered three options: lift the cord from the baby’s shoulders and over the head; cut and clamp the cord in utero; or unwrap the cord simultaneously as the baby is delivered. Because the cord wasn’t loose enough to lift over the baby’s head, Muhlhahn decided on the last option.
At 6:46 p.m., surrounded by family in her living room, Bonsignore gave one final push. But there was no crying. The baby was limp and unresponsive. Removing her face mask, Muhlhahn immediately began CPR and started chest compressions with her thumbs. The room was silent aside from her measured breaths and the Grateful Dead’s “I Need a Miracle” quietly playing in the background.
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Left: 6:46 p.m.
Midwife Cara Muhlhahn reaches for a bulb syringe to help clear the newborn’s airway. The baby was limp and unresponsive on delivery. “When I saw the cord and the color of that baby, I knew there was going to be a problem,” she says. Muhlhahn, who has been practicing as a midwife since 1991 and for the past 23 years doing at-home midwifery, rarely has had to resuscitate a newborn, but is ready when it's needed.
Right: 6:46 p.m.
Muhlhahn gives newborn Suzette mouth-to-mouth resuscitation to expand her lungs. Once the baby spit up mucus, Muhlhahn knew she would be okay. “I remember not wanting to give a sign of hope until I knew it was going to be hopeful,” she says.
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Left: 6:48 p.m.
Muhlhahn does chest compressions on Suzette after giving her mouth-to-mouth while her parents urge their newborn on.
“Come on, baby. Come on, Suzette,” Al Bonsignore said. “Please, come on, you’re there.”
Right: 6:48 p.m.
Baby Suzette cries out after being resuscitated. Kim Bonsignore says she didn’t realize at the time how serious the situation was. “Every day we talk about it, we look at her and she’s such a beautiful healthy girl,” she says. “It’s so crazy it could have went either way.”
6:48 p.m.
Muhlhahn hands newborn Suzette to her parents after resuscitating her. “That cry, that big cry, it was the most beautiful sound after all that,” Muhlhahn says.
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7:21 p.m.
Newborn Suzette Bonsignore looks up at her father, Al. “It’s daddy,” he told her. “You’re so perfect, baby.”
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Moments later, Suzette Indica Bonsignore took her first breath and let out a cry. “Talk to her,” Muhlhahn told the parents, passing the baby to Al.
“Mom and Dad are here. We need you with us. You [have a] sister you gotta meet,” Bonsignore’s husband recalls saying.
At 7 p.m., minutes after the baby was born, the sound of New Yorkers clapping for first responders drifted through the window—as if the city were welcoming baby Suzette into the world, says Bonsignore. “The timing was impeccable, it couldn’t have been better!”
Despite the scare, Bonsignore’s husband found the birth experience “exhilarating.” “It’s so much more organic than when you’re in a hospital,” he says.
7:33 p.m.
Muhlhahn weighs newborn Suzette in her sling scale as her mom, grandparents, and doula look on. Suzette weighed in at 8 pounds, 6 ounces, and was 20.25 inches long.
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After the birth, Muhlhahn listened to the baby’s heart and lungs, gave her vitamin K shots, and weighed her in a sling scale as her mom and grandparents looked on. Suzette weighed in at 8 pounds, 6 ounces, and was 20.
25 inches long. With the hard work done, Muhlhahn scheduled follow-up meetings with Bonsignore to check in on mom and baby.
Kimberly Bonsignore said that she didn’t realize how serious the moment of uncertainty had been. Or how crucial experienced providers are in an emergency situation. “When we spoke of it later, I cried and got really emotional. It’s more traumatic now than in the moment,” she remembers. “Every day we talk about it. We look at her and she’s such a beautiful, healthy girl. It’s so crazy it could have went either way.”
WHO: Women in labor and doctors increasingly opt for caesarean section |
According to the World Health Organization, modern surgical approaches, effective painkillers and antibiotics make it possible to perform surgery with minimal risk to mother and child. A new WHO study in this area has shown that in countries where at least 10% of women undergo this operation, maternal and child mortality is reduced. However, caesarean section certainly has its downsides.
“My doctor almost immediately recommended a caesarean section. He explained it by my age. Although this was the second birth for me, but I was already 44 years old. And when I came to the hospital at the appointed time, they said: why, actually, a caesarean? according to what evidence? But my doctor insisted, he didn't want to risk anything. And then, after the birth, he told me that the child had an entanglement of the umbilical cord, and during childbirth this loop could tighten around the child’s neck.
More and more women choose caesarean section as the most painless, quick and safe way to give birth. Caesarean section is especially popular in developed and developing countries. The numbers are impressive. For example, in Brazil, 45% of women choose a caesarean section. In European countries, this figure has increased from 15% to 22% over the past 20 years. WHO spokeswoman Dr. Marlene Temmerman says:
In Brazil, 45% of women opt for a caesarean section.
In European countries, this figure has grown from 15% to 22% over the past 20 years
“In many developing and developed countries, there is a real epidemic of caesarean sections. A cesarean is done even when there is no medical need for it. You may be wondering: so what? If women choose caesarean section and it is safe, why not? Yes, in modern conditions it is really safe. But do not forget that this is still an operation, a surgical intervention.
A caesarean section can cause serious complications for both the baby and the mother. Marlene Temmerman explains:
“Women who have a cesarean are at a higher risk of bleeding. Also, do not forget about the scars that remain from previous births that have passed with the help of surgical intervention. Serious complications may arise. And even in some developed countries, where caesareans are often performed, a higher level of maternal mortality has been reported compared to other developed countries.
Of course, this operation is not the main cause of death among women in childbirth, but the connection certainly exists.
However, the preference for caesarean is made, of course, not only by women, but also by doctors. And they are partly understandable. It is better to perform a scheduled operation at a prearranged time than to receive a call from a patient in the middle of the night and then have to deal with this or that unforeseen situation during childbirth:
adjust your schedule. The doctor sees patients at a certain time. He can do two surgeries a day. No unexpected calls, no late night work, no emergencies, no added stress. The quality of life of doctors thanks to caesarean section is significantly improved.”
At the same time, experts emphasize that in many cases, caesarean section really saves lives. According to WHO, in countries where the number of women who have undergone surgery reaches at least 10% of women, maternal and child mortality is sharply reduced.
But, unfortunately, in many regions, women still have no alternative to natural childbirth. Marlin Temmerman speaking:
In a number of countries, women still do not have access to procedures that can ensure safe childbirth. They also cannot opt for a caesarean section as it is not practiced. Women in these countries die during childbirth
“In a number of countries, women still do not have access to procedures that can ensure safe childbirth. They also cannot opt for a caesarean section as it is not practiced. In these countries, women die during childbirth.”
The conclusion reached by the WHO specialists is simple. Doctors should honestly tell expectant mothers about all the pros and cons of a caesarean section, not resort to it too often and only do it when necessary.
A woman in a coma gave birth in the USA for ten years. The father of the child is being sought among the hospital staff
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A patient who has been in a vegetative state for over 10 years has given birth at an Arizona State hospital. The police have launched an investigation into the rape and find out who could have made the woman pregnant by collecting DNA samples from the clinic staff.
The incident took place at the Hacienda clinic near Phoenix, the capital of Arizona. There, a woman who has been in a coma for about ten years after an accident gave birth to a boy on December 29. The child, whom the patient gave birth to, did not breathe at first, however, it is now reported that he is alive and is under the supervision of doctors.
Hacienda Clinic, according to its website, provides palliative care, a specialized service for terminally ill infants, children, teens, and young adults in Arizona.
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CBS TV, citing sources, reported that the hospital staff did not know about the patient's pregnancy.
The clinic said it was "deeply concerned about what happened." The interlocutor of the channel noted that the woman needed constant care and many employees had access to her room.
Attorney John Michaels, representing the patient's family, said that relatives said she was in a "highly vulnerable position". "Obviously the family is outraged, traumatized and shocked that their daughter was abused and not given enough attention at Hacienda," he told NBC.
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Image caption,Hacienda did not know the patient was pregnant until she went into labor
Relatives, he says, are not prepared to make public statements themselves. The lawyer conveyed from their words that the born child will have "a loving family in which they will take care of him."
Details of the injured patient, including her name, have not been released. What is known is that she was chained to a life support machine after she drowned.
The patient is also said to be a Native American Apache Indian from San Carlos.
"I am deeply shocked and horrified at the way one of our members was treated," said Tribal Leader Terry Rambler. "When your loved one is receiving palliative care when they are at their most vulnerable and dependent on others, you trust their caregivers. Unfortunately, one of her guardians could not be trusted and took advantage of her."
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The police have launched an investigation into the incident and are collecting DNA evidence from the men who work at the clinic.
At a press conference on Wednesday, a state police spokesman said he was not aware of cases of biomaterial refusals.
The clinic said they would do everything to ensure that the police investigation brought results as soon as possible. "We will continue to work with the Phoenix Police and other investigators to get to the bottom of this unprecedented story that has deeply shocked us," the hospital said.
The Arizona Department of Health said they have reviewed the conditions of the hospital and have implemented enhanced security measures. In particular, according to the Phoenix police, now male employees enter the wards of patients only when accompanied by women.
Bill Timmons, the CEO of the corporation in charge of the Hacienda Clinic in Arizona, resigned shortly after the incident became known.
The same company's executive vice president, Gary Orman, said he would get a full report on the incident. "We will do everything in our power to ensure the safety of each of our patients and our staff," he promised.
