The American Association of Birth Centers (AABC) defines a freestanding birth center as a “homelike facility, existing within a healthcare system with a program of care designed in the wellness model of pregnancy and birth. Birth centers are guided by principles of prevention, sensitivity, safety, appropriate medical intervention, and cost effectiveness. Birth centers provide family-centered care for healthy women before, during, and after normal pregnancy, labor, and birth” (AABC, 2016). Freestanding birth centers are not housed within a hospital facility; however, they are a part of the medical system with established relationships and protocols for consultation, collaboration, and transfer of care when necessary. Birth centers provide the ideal setting for midwives to practice and promote the midwifery model of care. Additional information about birth centers can be found at www.birthcenter.org.
What is the Midwifery Model of Care?
The midwifery model of care is based on a belief that puberty, pregnancy and birth, and menopause are normal physiological processes for women. Although these transitions are not a state of ill health or disease, they are often treated this way by the conventional medical model.
Midwifery care is designed to address more than the physical needs of a person. Birth especially affects all aspects of a person’s life including relationships, finances, employment, etc and all of these in turn influence health outcomes.
In addition to caring for pregnant persons, midwives also provide care from puberty through the lifespan. Nurse-midwives' scope of practice includes well person care, gynecological exams, family planning, and basic primary care services. The midwifery approach is holistic, wellness-based, and patient-and-family-centered, and interventions are used only when necessary. Midwifery care also includes extensive education and continuous, supportive care; for these reasons, midwifery care is generally more time-intensive than typical conventional medical care.
Am I a candidate to give birth at Heart of Houston?
Giving birth with us is an option for most healthy persons experiencing an uncomplicated pregnancy.
Some medical conditions which would make you ineligible for birth center birth include:
Hypertension and cardiovascular disease
Bleeding and blood disorder disorders
History of seizures
Previous preterm birth (less than 36 week gestation) and/or certain previous pregnancy complications.
Occasionally conditions arise over the course of a pregnancy that make the hospital a safer location for birth. Some of these circumstances include:
Gestational hypertension and/or pre-eclampsia
Gestational diabetes not controlled with diet alone
Baby in a breech or transverse presentation at the time of labor
Placenta previa, accreta, and other certain placental anomalies
Fetal anomalies or poor fetal growth
I am considered high risk, could I still benefit from midwifery care?
Women with preexisting risk factors or who develop complications during their pregnancy can still benefit from midwifery care through consultation or collaborative management. Midwives are the experts in normal pregnancy. Inside every high risk pregnancy still lies the normal, although it is often left unaddressed in conventional medical care. Our Midwives are available to provide supportive care that compliments your other clinical care. This collaboration frees up physicians to manage medical conditions and complications while midwives address the normal pregnancy changes including emotional, spiritual, and psychosocial needs.
Our Whole Heart Collective offers the opportunity to receive midwifery support that compliments the medical care you are receiving from your doctor or other care provider.
Are birth centers safe?
Yes, birth centers are considered a safe option for low risk pregnancies. Women accessing birth centers and midwifery care have fewer prenatal ultrasounds, epidurals during labor, and are less likely to have their labor induced or augmented to speed it up. Cesarean section rates for birth centers average 6% as compared with the national average of 32%. Despite decreased use of medical interventions, women who give birth at birth centers also experience fewer preterm births, low birth weight babies, infant emergency room visits, and infant hospitalization following birth.
At each of your prenatal visits the midwives will screen and assess your and your baby for any developing complications. Most potential birth complications can be detected prior to the onset of labor, allowing you and your midwifery team to make appropriate consultations and modifications to your care.
Occasionally complications occur during or immediately following birth that require transfer to the hospital for additional services. The vast majority of hospital transfers are not urgent or emergent, in fact, only 1% of hospital transfers are considered emergencies. Should you or you baby require a hospital transfer you will be accompanied by one of our midwives.
In most cases, our nurse-midwives are able to continue to care for you at the hospital should a transfer of care be necessary before, during, or after your birth. Our midwives have privileges at Texas Children's Hospital's Pavilion for Women. We are the only midwifery practice in Houston with the ability to attend birth both in and out of a hospital setting.
Can I have an epidural at a birth center?
No, but our midwives and staff are experts at minimizing and helping you cope with the discomforts of birth. Laboring and giving birth in water has been shown to greatly improve a mother’s discomfort and ability to cope. Other techniques your midwife and birth team may use to support you during your labor include: movement and positioning, massage, sterile water papules, birth slings, and rebozo sifting. In addition to these natural techniques, nitrous oxide and pharmacological therapies may also be options for your birth.
Why don’t you take insurance?
That is a long and complicated answer - but the long and short of it is that insurance reimbursements don’t adequately cover the costs for the care we want to provide. We like to compare our care to the Slow Food Movement. We nourish the mind, body, and soul - not only for our clients, but all of our staff, and the community at large. Each client receives care that is uniquely tailored to their needs. There is nothing rushed, or cookie cutter about it.
Have you ever wondered why traditional medical appointments are 5-10 minutes long and frequently preceded by an hour long wait? Or why you might not see your OB at all during labor until just before the baby is born? It isn't because doctors don't care, or are lazing about, it is because reimbursements for professional maternity fees are too low. In order to cover the cost of their practice they have to have a huge panel of patients. This usually means cramming as many appointments into a day as possible and scheduling surgeries early in the morning and late at night. It is exhausting for providers, increases burnout, jeopardizes outcomes, and frankly is unsustainable.
A 2019 study found that on average, the out of pocket cost to have a baby, for people with traditional employer health plans was $4500! And this doesn’t include monthly premiums, childbirth education, newborn care, breastfeeding services, or any community support. We price our services thoughtfully to not only include the value of care provided to our clients, but also to consider the quality of life it could offer our staff. We can't take care of you, if we also can't take care of ourselves.
What is group care and why is it awesome?
Group health care brings people out of the exam rooms and into a comfortable group setting. You get up to 10x more time with your provider and have the opportunity to learn and share with your peers. Group prenatal care has shown to improve maternal and newborn outcomes as well as decrease racial disparities.
A typical group prenatal session lasts 90 minutes to 2 hours, however, it is all productive time; there is no time wasted waiting in the lobby or clinic room. When you arrive at the center you go directly to the group meeting room. You will be assisted in taking and recording your own vital signs and health information with private time with the midwife for personal exams and belly checks. After health assessments are complete the group will come together to answer questions and facilitate discussions and in-depth learning. For example, instead of getting a 30 second “soundbite” about breastfeeding you have a whole hour with the midwife, lactation consultant, and a room filled with experience and questions.
The real power of group care is the group. Bringing people facing similar circumstances together creates a broad base of knowledge and support. It builds friendships that go beyond the center’s doors and last years. In Houston this is especially important. We are a city where the majority of its residents are from somewhere else. Most new families don’t have the luxury of a network of family and friends close by to offer support. Group care helps you build your village so you don’t merely survive, but you thrive.