Expectant parents face some daunting choices — and conflicting information — before the baby even appears. Here’s what you need to know about your options in Minnesota
Home births
What are the benefits?
Giving birth at home allows women and their families more control and comfort throughout their birthing experience, with few to none of the medical interventions often routine in a hospital birth. Women may also invite friends and relatives to a home birth. “A mom is much more comfortable and relaxed if she has people around that she’s asked to be at the birth,” says Jeanne Bazille, a certified professional midwife practicing in the Twin Cities area.
What are the risks?
If complications arise, a home won’t have the facilities and staff of a hospital. But, one of the first things a mother and her midwife will discuss is the back-up plan to transfer a mother to the hospital should it be necessary. Not all insurance covers the cost of a midwife, which is usually less than a hospital birth.
Who might choose a home birth?
Healthy mothers having a normal pregnancy with no medical or obstetrical risks are the best candidates for a home birth.
Who shouldn’t choose a home birth?
Mothers with high blood pressure or diabetes or who have had a cesarean section or other uterine surgery are more likely to experience complications during labor and should not give birth at home. Women expecting a multiple birth or with complications such as premature labor, preeclampsia, or a breech baby are also advised not to have home births.
What does Minnesota law say?
There is nothing in our state’s laws to deter women from having a home birth.
How common is home birth?
As in the rest of the country, less than 1 percent of births in Minnesota are at home. In the Netherlands, for comparison, about one-third of births are at home.
Midwives
What are the types of midwives?
Certified nurse midwives (CNMs) have nursing degrees and may have a master’s or PhD. They have completed midwifery training and passed state and national exams to be certified in every state. CNMs mostly work in hospitals and may work alongside doctors.
Direct-entry or traditional midwives (DEM or TM) do not necessarily have a degree, certification, or training but have learned their skills hands-on. They typically practice in home settings or freestanding birth centers. In Minnesota, licensure is voluntary. Traditional midwives who choose to be licensed become certified professional midwives (CPMs) through the North American Registry of Midwives. They typically practice in homes and birth centers.
What does Minnesota law say?
Along with the licensing laws, Minnesota statute says midwives should provide initial and ongoing screening of the woman’s pregnancy, have a back-up plan to transfer the mother to the hospital, provide prenatal education, assist in the labor and the birth, and provide postpartum care for the mother and child. Licensed midwives, for the most part, may not perform surgical procedures, use surgical instruments, or prescribe or administer prescription medications.
What are the benefits?
“Women know that their midwives are available at any time and will answer your phone call,” says Bazille. Appointments with midwives are discussions that usually last an hour. Midwives also typically attend the whole labor, while ob-gyns come in just for the birth.
What does it cost?
$1,500–$3,000.
Birth Centers
What are they?
Birth centers are more relaxed, comfortable settings to give birth than hospitals but have more technology and professional staff readily available than a home birth. They can be either freestanding facilities or housed within hospitals, and are typically staffed by certified nurse midwives, direct-entry midwives, nurses, and an on-call doctor. Birth centers perform few medical interventions, such as induction, fetal monitoring, drugs, episiotomies, and C-sections.
What are the benefits?
Women are allowed to move around, eat, and drink during labor, to invite friends, family, and their children, and are encouraged to have a drug-free labor. At the same time, IV lines, oxygen, infant resuscitators, and local anesthesia are on hand. Birth centers are often cheaper because there are fewer medical interventions and shorter stays.
What are the risks?
If major complications occur, birth centers do not have the same life-saving equipment as hospitals.
Who might choose a birth center?
Women at low risk for complications who want a more natural setting, more control, and fewer medical interventions.
Where are birth centers in Minnesota?
There are no freestanding birth centers in Minnesota, but there are several housed within hospitals.
What does it cost?
$3,500–$5,000
Standard Hospital Births
What are the benefits?
Hospitals are equipped with the resources and staff to save the life of both mother and child if complications occur and use medical interventions, such as pain medication for women who wish to have it. Some hospitals will try to accommodate a mother’s birth plan, including using fewer medical interventions.
What are the risks?
Many hospitals may not have enough staff to give mothers the physical and emotional care they would like. Nurses and doctors may focus on standardized care, using routine medical interventions, rather than individualized care. Mothers are generally not allowed to eat or drink during labor and typically must be lying down during delivery.
Who are the care providers in hospitals?
An ob-gyn specializes in pregnancy, labor, and birth and is trained to detect complications. A family practitioner is trained in more general medicine including obstetrics and pediatrics and can be a good choice for mothers with low-risk pregnancies. A certified nurse midwife is also a good choice for women with low-risk pregnancies.
What does it cost?
$6,000–$11,000
Cesarean Sections
Who might have a planned C-section?
Some nonurgent medical reasons include a previous C-section or uterine surgery, a multiple birth greater than twins, a larger baby or a baby in breech or transverse position, and placenta previa (when the placenta covers the cervix).
Who might have an unplanned C-section?
Some urgent medical conditions that might make it unsafe to continue with a vaginal birth, include changes in the baby’s heart rate, a danger to the baby’s oxygen supply, heavy bleeding from the mother, prolonged labor, or labor that has stopped progressing. According to the national organization Childbirth Connection, some of these are not urgent medical reasons to have a C-section but can be reasons for a woman’s doctor to give her the option of having a C-section.
What are the risks?
Risks include infections, excessive bleeding and blood clots, a longer recovery time, more postpartum pain, and emotional difficulties. In some situations, mothers may have less contact with their babies early on and could have difficulty breastfeeding. C-section babies can have trouble breathing right after birth and could have breathing difficulties, such as asthma, later in life. Women who have C-sections are also at a greater risk for complications with future pregnancies, such as ectopic pregnancies, lower fertility rates, problems with the placenta, or a ruptured scar.
Where does Minnesota rank?
Nearly 25 percent of births in Minnesota in 2004 were C-sections, up from 18 percent in 1990. In the United States, 30 percent of births in 2005 were C-sections, up from 23 percent in 1990.
What does it cost?
$10,000–$15,000
Doulas
What is a doula?
A doula provides physical and emotional support throughout labor, helping with breathing exercises, movement, and positioning. Doulas can attend births at home or in a birth center or hospital and may help with breastfeeding and infant care after the birth. Anyone can call herself a doula, but most receive training through Doulas of North America, the Association of Labor and Childbirth Educators, or the International Childbirth Education Association.
What are the benefits?
Women who are supported by doulas may produce lower levels of stress hormones, have shorter labors, and be less likely to need medical interventions. Doula-assisted mothers may also experience less postpartum depression and anxiety and are more likely to breastfeed.
Who might hire a doula?
Some women may want to give birth in a hospital but worry that the hospital staff will be unable to give them the attention they desire. A doula fills in that gap.
What does the law say?
Doula practice is not regulated by the state or federal governments.
What does it cost?
$350–$800
Dorothy Wickens is an intern at Minnesota Parent.
