Frequently Asked Questions
How is the Birth Center licensed and accredited?
Nativiti is licensed by the State of Texas Department of Health, the regulating body for birth centers. The Center is also nationally accredited through the Commission for the Accreditation of Birth Centers. A voluntary process, the Certificate of Accreditation symbolizes the excellence a center has achieved in providing quality care to childbearing families. Nativiti is among about 75 accredited birth centers in the United States and less than 10 accredited centers in Texas.
What does a birth in the Birth Center cost?
We will be happy to discuss our fees with you in detail, but generally, a birth in the Birth Center with a certified nurse-midwife costs approximately two-thirds the comparable cost of birth in the hospital with an obstetrician.
Who can use the Birth Center?
Generally, any healthy woman who expects a normal pregnancy and labor can use the Birth Center. Following evaluation, this group may even include the following:
Women with RH Negative blood
Women over 35 having their first baby
Women with a history of miscarriage
Women with mitral valve prolapse
Women with medical conditions which do not affect pregnancy
Women who have had controlled gestational diabetes in a previous pregnancy
Women who desire VBAC after one C-Section. (Special consideration with each case.)
What is a Certified Nurse-Midwife?
A certified nurse-midwife (CNM) is a registered nurse with advanced education and training in midwifery. Midwives are primary health care providers to women throughout their life. They perform physical exams, prescribe medications including contraceptives, order laboratory tests as needed, provide prenatal care, gynecological care, labor and birth care as well as health education and counseling to women of all ages. In short, women, children and families have better lives because of the work of nurse-midwives.The American Collect of Nurse-Midwives is the professional association that represents CNM's.
Should I consider a Nurse-Midwife instead of an obstetrician or gyn physician?
Midwives have a long tradition of caring for women. Indeed, midwife means "with woman". Today's Certified Nurse-Midwife carries on this proud tradition combining rigorous scientific, clinical and academic training with genuine sensitivity to clients and their care. Your nurse-midwife is qualified to provide primary well-woman gynecological care throughout the life cycle as well as OB care when you are pregnant. If at any point in your care it is deemed advisable, your nurse-midwife will consult with and/or refer you to an appropriate specialist. By choosing a nurse-midwife, you may truly receive the best of both worlds.
What if I need or want genetic testing or a sonogram?
The Birth Center staff can counsel, provide and/or arrange for all forms of genetic testing (CVS, amniocentesis, AFP) as well as sonograms.
How is the Birth Center different from a hospital?
The Birth Center is a homelike, private place where labor and birth are treated as normal life events. Laboring women are carefully and continually assessed by the nurse-midwife and an experienced midwife assistant to assure that mother and baby are doing well.
The Center is equipped with whirlpool baths and mothers are encouraged to walk, eat, drink and get into positions that are comfortable for them during labor and birth. At birth, the baby is immediately placed into the hands of the mother. Each mother receives careful guidance in the first few hours after birth so that when she is discharged a few hours later, she will feel confident in her ability to breastfeed and care for her baby. The nurse-midwife closely follows the family via phone as well as home and office visits for the first few weeks of the new baby's life.
What if there is a medical emergency?
Emergency medical equipment is maintained in the Center and the staff is trained in its use. In such an emergency, the woman/infant would be stabilized for transfer to the to the nearest Emergency Room. EMTs are just minutes away from the Center and on call 24 hours a day.
Who cannot use the Birth Center?
Various conditions can prevent a woman from being eligible for delivery in the Center. (You should inquire. Depending on condition, you may be able to get prenatal care at the center and deliver with a nurse midwife in the hospital.) These conditions include:
Women expecting twins
Women who are breech at term
Women with diabetes not controlled with diet
Women with chronic high blood pressure
Women who have had more than on Cesarean Section or have vertical uterine incision. (Must have available operative record from previous cesarean birth.)
What complications can be handled in the Birth Center?
Our CNMs and medical staff are prepared to manage complications of birth, including the following:
Postpartum hemorrhage – Excessive bleeding can be treated by the CNM with the same drugs that are used in the hospital. If necessary, an IV can also be started. When required, the nurse-midwife will transfer the stabilized mother via ambulance to the hospital. (See Statistics section.)
Infant resuscitation – If the baby is having difficulty breathing, the CNM and staff are trained to resuscitate, suction and intubate the baby to establish an airway. The Birth Center has the necessary medications and euqipment to stabilize the infant for transport to the hospital via ambulance.
Tears – CNMs are trained to repair tears and episiotomies with a local anestetic. Episiotomies are done only as needed.
What cannot be done in the Birth Center?
The following conditions require hospitalization:
Anesthesia – We do not use anesthesia or excessive pain medications in labor because they depress the baby. We lavishly use coaching and support for the mother-to-be and her family so that labor, while challenging, is a good experience for all. On the rare occasion when more extensive pain relief is needed, the CNM will transport the mother to the hospital where anesthesia can be administered safely. Xylocaine, a local anesthetic, is available, however, for the repair of a tear or episiotomy.
Forceps or C-Section delivery – These procedures are done by physicians in the hospital, if needed.
Pitocin induction or augmentation – Because this requires continuous electronic fetal monitoring and immediate access to surgical delivery, you must be delivered in the hospital.
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.