Birthing Choices in Portland

Portland is great, for a number of reasons, right?  It is a great place to bike, be close to nature, shop at farmer’s markets, go paddling, take the bus, run into your friends at the grocery store, AND give birth!  We have a lot of different options in the Portland area, which means all families get to chose what works best for them.

Portland is home to numerous hospitals, a couple free standing birth centers, and many midwives.  So, what is the difference between all these options and what does each options look like for your birth?

Hospital

Well, the first option is the standard one that most Americans still go to for giving birth, and the majority of Portlanders do too- the hospital.  We have some great hospitals and each one has its own flair.  You could go down the standard American route and see an OB doctor for all your prenatal appointments.  This is a good option for someone who has some high risk factors, like diabetes needing insulin treatment, among other risk factors.  Often the doctor works in a group practice and takes turns being on-call fonewborn in hospital r deliveries.  Some doctors have multiple hospitals they deliver at while other doctors only work at specific hospitals.  Make sure to get to know the doctors in your group practice as well as taking a tour at the hospital that they deliver at.

Another option in the hospital is to work with Certified Nurse-Midwives (CNMs).   Like an OB practice, CNMs work in a group and you get to see different CNMs in that practice during your pregnancy.  Whoever is on-call during your delivery is the one you’ll get!  CNMs practicing in the hospital setting work under different protocols than homebirth midwives, as they are under the direct supervision of the hospital OBs and their protocols.  Hospital based CNMs are perfect for low risk clients who are most comfortable delivering in a hospital but want a natural birth and/or trying for a lower intervention birth.  The Portland hospitals currently that have CNMs on staff are Providence Portland, OHSU and Legacy Emanuel.  Some of the hospitals allow for laboring in the birthing tubs with the midwives and provide telemetry units that allow movement while still being monitored.  Providence Portland also has a doula program that works with the families that are under the CNM care.

Birth Center

For families that are unsure where they want to give birth, but leaning towards out of hospital, a free standing birth center could be an option.  In Portland there are now 4 birth centers that are not in the hospitals and are staffed by a combination of midwives.   Most of the birth centers are staffed by midwives on rotation, like the hospital CNMs, so you don’t have continuity of care (like with home birth midwives), but many practice differently than the stricter protocols from the hospital.  There are CPMs/LDMs, CNMS, and ND midwives at the area birth centers.  The birth centers are made to resemble more of a home like setting than a sterile hospital environment.  All of them have birthing tubs that you can labor in and at least two of the centers you can stay and birth in them.  This middle ground is great for families that want a natural birth (no epidurals here!) but aren’t ready to commit to a home birth.

Homebirth

And then there are homebirths!  We, of course, love homebirths but completely acknowledge that it’s not the place for all families.  And that is OK!  It’s important to give birth where you are comfortable and where is the safest for your pregnancy, birth, baby, and set of risks.  Homebirths are not for women who are high risk.  But, if a woman is low risk and wanting a natural birth with her loved ones, pets, candles, pillows,  and kids around her then this is her best option!  A home birth is nice because you don’t have to leave your house in labor or get in the car with a tiny, new human being.  You have all your own things and can eat out of your own refrigerator (yes, we want you to eat in labor!).  There aren’t strangers coming into your room while you are in labor.  It also provides the best option for homebirth baby continuity of care and individualized care with midwives.  We bring all the emergency equipment to homebirths along with a whole bag of other supplies.  You also have the option to have an inflatable birthing tub which some women use just for laboring in and others give birth in it.  You have more options in your movement and birthing positions if you are at home.  We also come back to you three times in the first week postpartum, another great reason for a homebirth!  There are a lot of homebirth midwives in Portland so go ahead and interview a couple to find the right fit for you and your family if this is the option that best suits you.

It is important to know there are multiple birthing options and find the best match for you.  Just because your best friend had a homebirth doesn’t mean that’s right for you if you are worried to be out of the hospital.  Or just because your mother in law thinks all babies are born in the hospital doesn’t mean you shouldn’t look into a birth center or homebirth like you’ve been wanting to.  Go ahead, do some research, visit a couple places and talk to a couple providers and the right choice will present itself.

Happy birthing!

 

Homebirth Transports

pregnant womanWhen you come into our care your hopes for a natural birth at home are on the forefront of your mind.  Maybe it’s something you’ve wanted since before you were even pregnant or maybe you didn’t even know about home births until you were into your second trimester.  At Portland Natural Birth, we work really hard to provide you and your baby the best, comprehensive but holistic care possible.  We spend an hour at each prenatal appointment going over your physical and emotional health, all while making sure you continue to be low risk and safe for a homebirth.

At interviews, transport questions are always asked by either the birthing person or their partner.  Rarely, I’m the one to bring up the “what ifs”.  But, we always talk about what we do in an emergency, what kind of equipment and training we have, what it would be like to transport to the hospital, what we as the midwives do during the transport, and what clients can do to best prepare themselves for any possibility.  Then, as your pregnancy progresses, we bring up the transport discussion again.  At the 36 week home visit we fill out a hospital transport plan which includes what hospital clients prefer to go to and which one is the closest in an emergency.  We also talk about any fears the family may have surrounding emergencies or hospitals or just about the birth itself.  And we are always open to having some or all of this discussion before and after this 36 week visit.  Some clients need to talk about it more than others to process the “what ifs” while others feel ok with just the planned discussion.  Either way is entirely ok and that’s why we provide individualized care- every person needs something a little different to feel comfortable!

So, what does a transport from a homebirth look like?  Well, it depends on the reason for transport.  Most hospital transports from home are for non-emergent reasons.  The most likely scenario is when a laboring mom asks for additional tools that we don’t have at home.  She may have been in labor for multiple days, exhausted and possibly dehydrated and desires and epidural or maybe needs a little pitocin to meet her baby.  While no one goes into a homebirth with this desire, sometimes families get there… and that’s ok!  We have a lot of resources, tools and tricks as experienced midwives to encourage babies to be born at home but sometimes they have different plans.

If we transport for maternal request in this non-emergency then we go by our own cars.  I always call the preferred hospital and A) make sure they have room and will accept our transport and B) give them all the pertinent information so they can best help us.  Then, after a bag is packed and mom is ready we caravan over to the hospital.  At least one of the midwives always stays with our clients in the hospital.  Especially if we have been there for a long time, we may rotate through the birth team so we can also get little sleep so we can come back and provide the best support… but always one midwife is with the mom!  We become ah-mazing doulas in the hospital!  We are no longer your medical care provider but help you navigate through the new surroundings and requests of the hospital.  Also, we know most of the Portland area hospital providers so we seamlessly work with them to continue providing our clients great care that they can still feel like they made their own decisions, even though the place of birth was different.  We stay with you until baby is born and help with the initial breastfeeding session.  And of course, we continue all of our normal postpartum care visits- we’ll come to you 3 times in the first week, wherever you are!

Very rarely but it does happen, a transport is for an emergency.  And then we go by ambulance.  I still call ahead to the closest hospital to let them know we are coming and we continue all our supportive care like we do in a non-emergency situation.  It can be scary when we move fast but we always communicate to our clients as to what is going on and what we think needs to happen.

Sometimes, I get the question/comment: but if we transport to the hospital then we are stuck with both midwifery bill and the hospital bill and don’t get our homebirth.  Yes, unfortunately birth costs do go up if we end up at the hospital from a homebirth.  But, the care we continue to provide is unmatched and our clients feel that.  Providing midwifery care through pregnancy is a different experience to begin with- one that you are met with caring providers who take the time to listen to you and help problem solve as any issues come up.  Midwives provide a safe and nurturing environment that empowers our families into taking the next step to becoming first time parents or seasoned parents.  We are able to walk beside you and gently guide you through harder decisions if a homebirth transport becomes desired or necessary.  To still be able to make your own decisions and come out feeling empowered from a birth that didn’t go exactly how you thought is pretty remarkable and worth every penny!

We want to help all our clients have beautiful homebirths but sometimes that’s not in the cards and that’s ok. That’s why we continue putting all our energy into our clients’ care, regardless of where they end up giving birth and how they give birth.  Though it can be a hard transition and hard to acknowledge that birth doesn’t always go according to plan, we do work with clients so they feel supported and empowered through their pregnancy, birth, and postpartum and I think we do a pretty darn good job at that!