Richard Jennings, CNM
Bellevue Hospital Center
New York, New York

Richard Jennings, a Certified Nurse Midwife for 29 years, has delivered more than 1,500 babies and has been director of midwifery practices whose midwives have attended more than 10,000 births.
More about Richard Jennings

How is a birth center different from a hospital?

A birth center cares for women with low-risk pregnancies who want to have their babies outside a typical hospital labor and delivery unit. Some birth centers are freestanding and independent of hospitals. Others, like the one where I work, are located within a hospital, but as a unit separate from labor and delivery. In any setting, birth centers offer a more relaxed environment and greater choices in comfort techniques and practices for labor and birth.

How they look

Hospital labor and delivery units look like most places in a hospital, with bright lights, neutral-colored decorations (often tan), beeping machines, and a sense of bustling and rushing.

Birth centers tend to look more like a home, with pleasing colors, softer lighting, and few hard edges. The atmosphere is calm and soothing. Options to help the birthing woman relax may include music of her choice and aromatherapy.

Position during labor and birth

In many hospitals, the laboring woman remains in bed at all times with an intravenous catheter (I.V.) line connected to a vein in her arm to provide fluid (because she is not allowed to eat or drink) or in case she needs medication. She is strapped throughout labor to a fetal heart rate monitor, which measures fetal heartbeats. Most women in hospitals receive powerful drugs to cope with the pain of labor and deliver while lying on their backs.

In birth centers, I.V. lines are rarely used because the woman in labor is encouraged to eat and drink. The fetal heartbeat is checked as often as necessary, but not constantly, with a small, hand-held device. For pain relief, she may move about as she pleases, relax in a tub or Jacuzzi, and push and give birth in any position that feels best.

Who’s company?

In most hospitals, the laboring woman is typically allowed to have one or two support people of her choice (besides the health care team) in the room.

In birth centers, the laboring woman may invite as many support people as she wants to attend her labor and birth.

Vaginal versus cesarean birth

Hospitals: Nearly one third (30%) of babies born in hospitals are delivered by cesarean birth, a form of major surgery. In many hospitals, the rate is higher.

Birth centers: Cesarean rates at birth centers in the United States range from about 4% (one in 100) to 10% (10 in 100).

Fathers and other partners

Many hospitals restrict visits by the mother’s partner after the day of the birth to regular maternity floor visiting hours.

At birth centers, the new family is never separated.

For more about birth centers:

United States:
American Association of Birth Centers
3123 Gottschall Road
Perkiomenville, PA 18074
215-234-8068; toll free: 1-866-54-BIRTH
www.birthcenters.org

United Kingdom:
BabyCentre
www.babycentre.co.uk/pregnancy/labourandbirth/planningyourbabysbirth/bir...

Please describe your outcomes at the Birth Center at Bellevue Hospital Center in New York City.

Our center is honored to serve women and their families who are mostly immigrant and Medicaid eligible.

In an unpublished study, we analyzed data from all births at our center from November 2001 through December 2007. Our intervention rates are dramatically lower than those in hospitals. For example, our cesarean rate for 2,715 consecutive admissions was 3.7%, compared to a national rate of more than 30%. In hospitals, a rate below 15% for normal women is considered excellent. Our rate of assisted birth with forceps and vacuum extraction was 2%.

Nearly all (94%) of the women gave birth using their own power. Only 8% required epidural anesthesia for pain relief. Four percent (4%) required narcotic analgesia; most (74%) of that small group remained in the Birth Center for delivery. The transfer rate to the labor and delivery unit was 20.4%.

Our Birth Center babies have been healthy without exception.