Neel Shah, OB/GYN and Assistant Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School, spoke today at the American Association of Birth Centers Birth Institute today in Anchorage, Alaska. His presentation was “System Complexity and the Challenge of Too Much Medicine.” Neel gave a rather insightful perspective on birth centers from the lens of an obstetrician who practices in a hospital-based setting. He described his experience of visiting birth centers. He said that hospitals describe their setting as a “20-bed” or “10-bed” unit. As Neel sees it, the “bed” is something hospital patients are expected to occupy. He noted, “birth centers are set up with the expectation of women being up and moving around, rather than staying in bed.” As he said, hospitals are not set up for this, but birth centers are.
Midwives know that being able to move freely in labor, walking, and changing positions helps facilitate labor progress and reduce discomfort. Clients comment, “my midwives suggested moving and changing positions frequently. I don’t know how I could have done this (natural birth) in a bed.”
Birth centers are set up with the expectation that our clients will be moving around a lot. Walking, going up and down stairs, lunges, squatting, sitting on a birth stool or toilet, getting in and out of the birth tub or shower — these are all considered to be normal at a birth center. We’re set up for that kind of thing.
Midwives have equipment that’s portable, and we contort ourselves in all sorts of positions as we support our clients. We get down on the floor and help you there, if that’s where you’re most comfortable. We have a waterproof Doppler to listen to your baby’s heartbeat if you’re laboring in water. We use a rebozo (long scarf used by Mexican midwives) to help “sift” the baby into a better position, or to help you get leverage as you push. Our goal is to do everything we can to safely support your natural birth, and if that means we feel a little stiff and sore the next day from all of the physical things we did to help you, so be it. In fact, we expect it.
There’s nothing wrong with a hospital birth. The hospital offers many tools to help women give birth. But, if what you seek is support for a natural birth on your own terms, a birth center is set up to help you in a way that a hospital can’t. It’s “the right tool for the job” of natural birth.