When deciding where to give birth services women should be aware that hospitals vary significantly in their ability to help them achieve the type of delivery they want. Some are better at supporting vaginal birth after cesarean (VBAC) and some have more experience with low-risk C-sections. Other important differences include whether a hospital or birth center is accredited or certified, which can affect a woman’s likelihood of having a VBAC and the chance of having a medically necessary Cesarean section.
Most of the women who give birth in the United States are cared for by obstetricians, doctors who specialize in gynecology and maternal/fetal health. OB/GYNs have four or more years of medical school training and can handle complicated pregnancies, do C-sections and perform other surgical procedures. They may work in a variety of settings, including freestanding birth centers, homes and hospitals.
Many women who choose home or birth center deliveries also have a midwife or other qualified nurse-midwife for prenatal care and labor support. These providers typically work with a group of OB/GYN consultants who assist them in the delivery. They may have a limited number of patients who have healthy and low-risk pregnancies and will work with those clients until they reach 37 weeks’ gestation or until they are considered high risk.
At home, a woman’s attendants may be family members or friends. Attendants may stay with the mother for the duration of the labor and afterward, depending on the setting. If the birth is in a hospital, the number of attendants will be more limited. During a vaginal birth, only three people — or sometimes less—are usually allowed to attend.
Birth centers are health care facilities that focus on providing a safe and respectful environment for women who are experiencing low-risk pregnancies. Most birth centers have a doctor on staff and offer noninvasive monitoring during pregnancy, labor and delivery. They also provide nitrous oxide and other pain control options for the mother and her partner. Several hospitals have separate units within their labor and delivery departments that resemble freestanding birth centers.
Hospital maternity care units are staffed by nurses, obstetricians and a wide range of specialists. They may have a specialized unit for obstetric surgery and a perinatal care program, which is designed to ensure the best outcomes for newborns and mothers. They may also have a maternal-fetal medicine specialist and neonatologists, who can assist in cases of complications.
According to a national analysis of payments on behalf of women who had a full episode of care from pregnancy through postpartum and newborn care, about 4 in 5 dollars paid on their behalf went for intrapartum care (excluding the cost of anesthesia). These costs varied by mode of birth, with private insurers spending more on vaginal than cesarean births and Medicaid payers spending more on cesarean births. (Truven Health Analytics, 2013). The data were obtained from the Giving Voice to Mothers US (GVtM) survey. GVtM is a nationally representative cross-sectional survey of women who gave birth in 2010 at home or at a freestanding birth center.
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