Parents of the 14,000 babies born each year in New Hampshire have many choices about how and where their babies will enter the world, and who will attend the birth.

These decisions affect the whole family. The birth attendant and setting can make all the difference in a birth experience that is satisfying to mom, dad, siblings, and the family’s newest member. The goal is to find the combination of birth method, birth setting and attendant that help laboring mothers and their partners feel most comfortable.

Who will attend your birth?

New Hampshire families have several options:

• A medical doctor—either a family doctor or obstetrician Obstetricians (OBs) are trained to handle high-risk pregnancies, and can perform surgery and other high-tech interventions when necessary. A few obstetricians perform elective, or on-demand caesareans for women who choose to have a surgical delivery for reasons other than medical necessity. Elective cesarean is a controversial choice and is something that parents should research carefully before making a decision.

• A Certified Nurse Midwife (CNM) A special category of Advanced Registered Nurse Practitioners, CNMs have taken advanced training in childbirth. Certified through the N.H. State Board of Nursing, CNMs usually work in group practices with obstetricians and attend births that take place in hospitals. CNMs support natural childbirth and tend to spend more time with women in labor than doctors do.

• A New Hampshire Certified Midwife (NHCM) An NHCM has specialized training in low-risk pregnancies, childbirth, and lactation and newborn care. NHCMs are certified by the state, and their training requirements and scope of practice are regulated by state statute. NHCMs accept only women with low-risk pregnancies. The same NHCM you see for prenatal care typically also attends your labor and birth.

• Unassisted childbirth Some women choose to give birth without a trained attendant, although they may ask close friends and family to help them during labor and delivery. Although pregnancy and childbirth are natural processes that rarely become medical conditions, those who choose to give birth without professional help take on a great responsibility. Like elective cesarean, unassisted birth is a controversial choice you should research carefully before making a decision.

Your choice of birth attendant will affect where you have your baby .

Family doctors, OBs, and CNMs work almost exclusively in hospitals, whereas NHCMs attend births in homes and free-standing birth centers licensed by the state but not affiliated with a hospital.

Research has shown that all settings can be equally safe, provided mothers have received adequate prenatal care, parents are well prepared, and birth attendants are well trained.

• You might choose a hospital if you are among the small number of women with a high-risk pregnancy, if you feel more comfortable knowing that emergency interventions are available on site, or if you know think you may want pain medication during labor.

• Homebirth is an option for women who feel more comfortable at home, knowing they won’t have to interrupt labor to drive to another place, follow a hospital’s routine, or interrupt their bonding with their newborn by leaving to go home. Homebirth works best when mothers feel confident in their ability and safe in their surroundings. Homebirth also requires different preparation from hospital birth.

• Birth centers are an option for only a few New Hampshire families, as two centers have closed recently. If you aren’t likely to need the high-tech interventions offered in hospitals, you might still prefer the security that comes from knowing the center is completely set up for birth and any emergencies that might arise. If you can afford a birth center birth, and you live within an hour of one, this could be an option for you.

How can you decide?

Talk to other families, especially those who share your values. Talk to families who have had their babies in hospitals, birth centers, and homes, with different types of attendants. Ask midwives for references if you don’t already know women who have given birth outside of a hospital. Ask what preparation each family made for the birth and what they wish they’d known ahead of time. You are looking for a good fit for you and your family.

Tour the hospital or free-standing birth center. Ask a lot of questions. You are looking both for good answers and a good attitude about parents who are involved in their own birth experience. In a hospital, the maternity nurses—not your OB or CNM—may provide most of your care.

Consider finances. Most insurance carriers cover hospital births attended by medical doctors or CNMs, though you should check your terms of coverage before you become pregnant. Although N.H. Medicaid and some smaller carriers cover births attended by NHCMs at home or in a birth center, the major health insurance carriers in New Hampshire don’t.

A bill (SB 175) introduced during this legislative session would have required all insurance companies to cover midwife-attended out-of-hospital births, a service N.H. Medicaid and some smaller insurance companies already cover.

Although the bill passed the full Senate, and the House Commerce Committee voted 14-7 to recommend passage, the House sent it back to committee for further study and revision. Supporters expect to reintroduce a revised version of the bill in January, 2006.

Homebirths cost around $2000, birth-center births a little more. Hospital births may cost four or five times as much, but if you are not on Medicaid or covered by one of the small health insurance companies offering out-of-hospital coverage, you probably will have to pay for an out-of-hospital birth out of pocket.

You can change your mind. Birth attendants need enough time to assess your well-being and preparation for birth before your baby is due. You’ll want to have your birth attendant and setting arranged by early in your third trimester if possible. But you need time to assess your own decisions about where to have your baby and who will attend your birth.

Keep learning and talking to other parents and birth providers. You may you may discover available alternatives you didn’t know about, and change your mind about how and where you want to have your baby, and who will attend the birth.

Links:

• MaternityWise
• Listening to Mothers Report
• New Hampshire Midwives Association
• Baby-friendly Hospitals Initiative
• Baby-friendly Hospitals in New Hampshire:
  • Alice Peck Day Memorial Hospital, Lebanon
  • St. Joseph ’s Hospital, Nashua

by Kathy Becker Blease, former UNH Cooperative Extension Family Education and Policy Specialist, and Peg Boyles, Extension writer/editor