Is it safe to labor without a fetal monitor?
Repeated studies have shown the answer to this question to be "Yes" – if you have had a normal, healthy pregnancy. The CNM and assistant will intermittently listen to the baby's heart with a hand-held doppler. If any abnormalities are heard, they will listen continuously and transfer if they think there is any danger to the baby. Studies have shown that in a normal population, this routine is as safe as a fetal monitor. Clinical trials have also failed to show that continuous electronic fetal monitoring results in healthier babies, except when limited to women and fetuses known to be at high risk. It is clear, however, that continuous electronic fetal monitoring does result in a higher cesarean section rate.
Are there statistics regarding care with Certified Nurse-Midwives and Birthing Centers?
The following information is from a study of 17,856 women, the results of which were published in the December 1989 issue of the "New England Journal of Medicine". Low risk women were divided into two groups: those receiving care from nurse-midwives and expecting a birth center delivery, and those receiving physician care and expecting a hospital delivery. Of the birth center group, 11.9% of those admitted into the center in labor were ultimately transferred to the hospital —primarily for delayed progress in labor. Less than 1% of mothers and 2% of infants were transferred postpartum. Overall cesarean section rate was 4.4% (hospital group: 8.4%). There was no maternal mortality. The intrapartum and neonatal mortality rate was 1.27 per 1,000 births (hospital group: 2.1 to 2.6 per thousand). Our own statistics closely parallel this data. Upon request, we will be happy to discuss our statistics with you in detail.
We believe that the study referenced in the "New England Journal of Medicine" article, as well as our own data, demonstrate the safety of birth in the Birth Center. There are, however, certain risks associated with childbirth, whether in a hospital, the Birth Center or at home. We feel that in order to make a reasonable decision, you must be well-informed. We would like you to consider the risks/benefits of birth in the Birth Center vs. the customary hospital delivery with an obstetrician. In the end, you should deliver where your needs and concerns are best met and you are the most at ease.
