What to expect from a typical Northwest birthplace

This information is summarized from the 2004 Survey of Birth Practices by Great Starts, which sent surveys to all local birthplaces. Completed surveys were returned by 13 hospitals, three hospital-based midwifery practices, and 10 midwifery practices serving birth centers and home birth clients. For specific policies for your planned birthplace, it’s best to attend a tour and ask questions.

Support in labor. All hospitals offer 1:1 nursing care during active labor. If the primary caregiver is a physician, she is likely to be in attendance only during the pushing stage, or in case of complications. If the primary caregiver is a midwife, she may be there for a larger portion of the labor process. Several local hospitals have midwives on staff, or extend privileges to midwives. However, they are not allowed at some hospitals.

For out-of-hospital birth, typically a midwife and a midwife’s assistant attend throughout active labor and delivery.

Typically, all birthplaces allow any family members, visitors, and support people the mother chooses. However, they reserve the right to ask visitors to leave if necessary in order to provide quality, safe care to the mother. All birthplaces allow siblings to attend the birth; it is recommended that there be an adult who is solely responsible for meeting the needs of the child. During a cesarean birth, typically limited to one support person (occasionally two). All birthplaces allow doulas.

Rooms. In all Seattle hospitals, women labor, birth their babies, and recover in the same room, without needing to go elsewhere (except in case of cesarean). In the majority of hospitals, mom also stays in this room for her postpartum stay, until returning home. Some of the larger hospitals move mom to a postpartum room about two to three hours after the birth. All rooms are private rooms, where partner and support people can stay with moms.

Comfort measures. All hospitals offer birth balls, squat bars, ice packs, warm packs, CD or tape player, rocking chair. In a home birth, a mother can use any of her typical comfort tools. All birthplaces allow walking/mobility in labor, assuming there are no medical contraindications. Typically, nurses and midwives suggest comfort measures, breathing techniques, and positions. However, we recommend that expectant parents enroll in childbirth preparation classes during late pregnancy so that they also are familiar with several comfort measures, and know which measures work well for them.

Baths and showers. Most Seattle area hospitals have tubs or Jacuzzis moms can use for comfort in labor. Typically, hospital patients are not allowed to birth in the tub. Birth centers all have tubs. For home birth, if you don’t have a large tub, you can rent one for the birth. Many home birth midwives allow water births.

Food in labor. Over half of hospitals say they allow moms to eat in labor, though often only with your doctor’s written order. Typically, if a mom receives epidural anesthesia, she will be allowed only ice chips after that. Birth centers and home births allow moms to eat according to their own wishes.

IV (Intravenous fluids). Two hospitals use these with 60-75 percent of their patients. All other hospitals report 80-100 percent. Out-of-hospital birth services may use IVs. Rates are typically low.

Labor induction/augmentation. Hospitals: Rate of medical induction ranges from 10–70 percent. For out-of-hospital births: May occasionally recommend methods such as acupressure, orgasm, nipple stimulation, or castor oil.

Fetal monitoring. Most hospitals use electronic fetal monitoring as their primary method for monitoring baby. Doppler ultrasound is used for out-of-hospital birth (this is the device used to listen to baby’s heart rate at prenatal appointments with your caregiver).

Episiotomy. There has been a huge reduction in recent years! Most hospitals aren’t tracking. Hospitals and midwives say “not a standard procedure,” rare/less than 10 percent, though exact rate depends on caregiver.

Epidural pain medication. Hospitals: epidural rates range from 40–90 percent. Out-of-hospital: epidurals are not available, so rate is 0 percent for those who birth at home or birth center. The survey did not ask if any clients chose to transfer to a hospital for pain medication.

Cesarean birth. Hospital: Total cesarean rates at local hospitals range from: 16.5–34 percent. Primary rates (for women who have not had a prior cesarean): 12–21 percent. Out-of-hospital: If a client requires a cesarean, she is transferred to a hospital. A recent study (Johnson, 2005) indicates that of women planning home birth, 3.7 percent ended with a cesarean.

Vaginal birth after cesarean. Currently, the large hospitals in the region all allow VBAC. Some of the smaller, more rural hospitals are no longer allowing VBAC births. Birth centers do not allow VBACs. Home VBACs are legally allowed, but rare, due to insurance issues.

Postpartum stay. Hospitals: 18–48 hours after a vaginal birth. Two to three days after cesarean. Typical patient: nurse ratio is 3:1 or 4:1 after the birth. Birth Centers: average stay after the birth is four hours. Typically, the midwife does a home visit within the next 24-48 hours to follow up on mom and baby. Home births: Midwife and assistant typically remain for two to six hours after the birth. Midwife returns for a home visit within 24-48 hours.

Nursery care vs. rooming-in. Hospitals. All hospitals practice rooming in, meaning the baby remains in the room with the parents. Several no longer even have a nursery for normal healthy newborns. Most hospitals in Seattle have either a level II or level III special care nursery. Out-of-hospital: Babies stay with parents. If there is a need for special care, baby is transferred to a hospital, and parents go with the baby.

Breastfeeding support. In hospital: Most nurses are trained in helping moms begin to breastfeed. Many hospitals have lactation consultants available, but they may have limited hours. Hospital follow-up: Some hospitals offer telephone hotlines for breastfeeding questions. Many hospitals offer lactation clinics. Out-of-hospital: All midwives are trained in breastfeeding support, and are available for phone support after the birth. Great Starts offers a free breastfeeding information line for all moms, regardless of where they birthed: 206-615-8078.

Pacifiers, formula, and glucose water. Only given to baby with parental consent.

Postpartum follow-up. Hospital. Only one hospital does a routine home visit by a nurse. For three hospitals, the parents return to a clinic for a routine follow-up. Most hospitals offer a follow-up phone call after the birth. Out-of-hospital: Home visits in the early days are the norm.

Cost. Hospitals: Hospital costs would typically be over $6000 for a normal birth, though the information was not requested in the survey. Midwifery services for home birth: $2500–2800, includes prenatal care, birth, normal newborn care, and postpartum follow-up. All accept medical insurance. All accept DSHS coupons. Birth center fee: adds approximately $1500 to the midwifery fee.

Copies of the detailed survey report are available from Great Starts. Great Starts Birth & Family Education is a community-based, non-profit organization dedicated to educating and supporting new and expectant parents by showing them their options and empowering them to make informed choices in pregnancy, childbirth, and early parenting.