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Active Birth

The New Approach to Giving Birth Naturally

Part Two

By Janet Balaskas

it is as safe, if not safer, to have a baby at home as to have it in the hospital, and home usually provides the best conditions for a physiological birth. But different factors, such as your health, your insurance plan, your proximity to a hospital, and whether you have any problems in pregnancy, will help to determine the most appropriate place of birth. The most important thing is to discover all the possibilities, to consider what your priorities are, and then to make a choice that feels right for you. Your instinctive feelings are really important, and they will arise most strongly at the end of your pregnancy. Your choice of birth place may depend upon your choice of birth attendant, or vice versa. Most births in the United States are attended by obstetricians-surgeons who are trained to handle complications, and who are likely to resort to obstetrical interventions. You may instead choose a family practitioner, a physician who provides both obstetrical and newborn care and is trained to view birth as a normal process. Or you may choose one of the growing number of certified nurse-midwives (CNMs). Experts in the normal birth, CNMs may attend deliveries in hospitals, birthing centers, and homes. They sometimes work in group practice with physicians, and they refer women with complications to specialists. Finally, you may prefer a "direct-entry" midwife--a midwife who has entered the profession directly, usually through apprenticeship, rather than going to nursing school first. These midwives specialize in home birth. Their legal status varies from state to state, and your insurance company probably won't pay expenses for a birth attended by a midwife who is unlicensed. But sometimes, for a home birth, there is no alternative. A minority of CNMs and very few physicians attend births at home because of pressure from hospitals, colleagues and insurers, and sometimes because of legal restrictions.

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