Birth, Baby!

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Hula Share is a free event happening in the Austin area on Saturday, October 21st from 1130 to 230 at the Pflugerville Public Library.

Come out and meet local doulas, check out their booths, and learn more about a variety of topics surrounding pregnancy.

The first 50 people through the door will get a free swag bag.

Be sure to register at the link in the show notes so we know you're coming.

Welcome, this is Birth, Baby.

Your hosts are Ciarra Morgan and Samantha Kelly.

Ciarra is a Birth Dula, Hypnobirthing Educator, and Pediatric Sleep Consultant.

Samantha is a Birth Dula, Childbirth Educator, and Lactation Counselor.

Join us as we guide you through your options for your pregnancy, birth, and postpartum journey.

One of the first decisions we tend to help clients navigate is where the heck to have their baby.

Sometimes this takes many long conversations with a ton of explanation, and getting both the birthing person and their partner feeling really informed so they feel safe about their choices.

So our hope is that this episode will help guide you on what questions to ask yourself to figure out where you feel safest giving birth.

So first, Samantha and I are going to talk to you about what even are the options of where to give birth.

Some people don't even know all of the options.

So Samantha, do you want to go over a couple of those for us?

Yeah, definitely.

So different kind of options that are typically available, and a lot of this is going to vary based on where you live and yeah, just kind of where you're at in the country.

But typically, what's going to be available are hospitals.

There are hospital-based birth centers, free-standing birth centers, and of course home births.

And all of those options are going to vary based on where you are.

I know there are some areas in the country where you can't find a home birth midwife who can deliver.

Or there's not free-standing birth centers.

Maybe you have to travel two hours into another town to find a free-standing birth center.

So definitely knowing what's around you.

And again, I think we say this all the time, but connecting with the local birth workers around you is going to be really helpful here too because the doulas and different people like that who are in that scene are going to have a really good idea of what's available and what's not available and how viable those options are for you.

So having those discussions with people in the know is always helpful.

Yeah, you better narrow it down before you get your heart set on one or the other.

Yeah, unless you're willing to travel, which is okay.

That's really okay.

We've had clients, we've talked to people who have wanted to travel the two hours somewhere so that they can feel comfortable where they're giving birth.

And you don't have a precipitous labor.

Yeah, exactly.

There's always that risk, which that's just something you have to plan for.

You gotta read that chapter of the Birth Partner Book, Dad, and be ready to catch if you have to.

So when we're talking about all of these things, there's gonna be different provider options within those places, right?

And we're gonna talk more about all of those options in a different episode, but we're talking about either midwifery-led care or obstetrician-led care.

So obviously if you're delivering at a hospital, that's where you're gonna find obstetrician-led care, and OBs are not gonna be delivering at home or in birth centers.

In most cases, I think there is the odd OB who will do a home birth here and there.

I've heard of a couple.

Yeah, when I used to listen to the Birth Queens when they had their podcast, and shout out to Birth Queens, you were the reason I wanted to do a podcast.

And they were talking about at one point, there was a doctor in California that an OB, and he would actually attend births for like a little bit higher risk or for multiples or something.

And I think in California, if it's multiples, you do have to have an OB present.

And so he would basically sit in the corner and only do something if he had to.

So if that's really cool, I wish we had that here in Austin.

I think Dr.

Stu does that too.

I think that-

I think that's who, yeah.

I think that's who it was.

Yeah, it's kind of interesting.

So anyways, typically in most places, definitely here in Austin, if you wanna know who you're gonna be delivering in the hospital.

There are midwives who deliver in hospitals, and of course midwives who are going to be running birth centers and home births and all of that as well.

So again, we're gonna talk more about all those, what the differences are between all of those options in another episode, but those are kind of what you're looking at.

So when we're talking about, let's kind of get into it with all these different options.

So when we're talking about a hospital birth, what does that look like, Ciarra?

So if you're planning a hospital birth, the first thing you should figure out is what the policies are for that location, because some doctors have even more strict of rules than the hospital does.

So for example, there are some hospitals that are okay with intermittent monitoring of 20 minutes on, 40 minutes off.

And there are some providers at those hospitals that no matter what, no matter how low risk you are, they're not okay with them.

So that's something that's important to not only find out the policy of the hospital, but find out what your doctor is okay with.

Unfortunately, I've also had a situation that was opposite where the doctor was like, oh yeah, that's totally fine.

That's totally fine about certain things.

And then the person goes into labor and they're at the hospital and the hospital's like, no, that's against our policy.

And the doctor's like, yeah, sorry, it's against our policy, which feels like a bit of a bait and switch.

Totally is, it totally is.

I had a birth recently where the mom had done all of her education.

This was her second baby.

And she decided that she wanted intermittent monitoring, which means that when they're checking the baby's heart rate and the contractions and all of that, they have the monitor on for, normally it's like 20 minutes on, and then you get to be off of it for 40 minutes.

The policies differ at different hospitals as we've come across recently too.

We've seen some places that are like, oh, we just have to get a contraction every 45 minutes.

That's pretty cool too.

But anyways, so she had decided that she wanted intermittent monitoring, and her OB, the first OB that was on call, said, yeah, that's totally great.

Everything was looking really awesome.

Baby was doing great.

There were no medications being used.

So she was okay with that.

And then the providers switched out during the day, and the new provider that came on said, oh, I'm not comfortable with intermittent monitoring, so you're gonna have to go on the monitor.

And she kind of said it like that.

And my client was like, well, I don't want to go on the monitor.

I don't really wanna do that.

And she was like, well, the doctor really thinks, this was a nurse that was telling me, the doctor really thinks that you need to do that.

It's just her policy.

And she was like, well, I'm refusing that.

I don't wanna do that.

And the nurse came back a little bit later and was like, well, the doctor is refusing your refusal.

And y'all, when I say my jaw hit the ground, I think that all three of us, the dad and the mom and I, were like, excuse me?

And thankfully, this was a second time mom, and something about second time moms, they just kind of have a little bit more confidence a lot of the time.

And she said, oh, is that legal for her to refuse my refusal?

And she's like, oh, well, I guess not.

I guess we can just chart that you're refusing it.

And she was like, yeah.

So sometimes something like that happens.

It was insane.

Yeah, I've flabbergasted.

I've been talking about that just forever now, because it was just the craziest thing, but that happens.

That sort of stuff happens all the time.

And if we were in a situation where our nurse wasn't as willing to work with us on that, or if the doctor had come in and started arguing with her about it, or if my client hadn't been so firm and felt confident about why she was saying no to continuous monitoring, we would have ended up on continuous monitoring, which would have restricted her movement.

And she had a baby two hours after that, less than, I think, she had a baby very quickly after that.

And so she would have been tied to a monitor for the full hour leading up to her birth.

And the problem here is that that puts you into a fight or flight situation.

So if you're sitting there having to argue with your provider or even the nurse through, you know, through the nurse with the provider, that puts your body into fight or flight and actually makes you more likely to need the interventions that are being proposed by the place that you're giving birth.

So another thing you have to think about here is when you choose a provider, you're not hiring a provider, you're hiring a whole practice.

So if you're hiring the practice, that means that your doctor may have said, and this has happened, your doctor may have said, yeah, I totally am down with that for labor.

And again, this has been with intermittent monitoring.

It's also been with prophylactic pitocin.

I've had this happen where the doctor that you see throughout your pregnancy says yes, and then you go into labor and they are on a long-call schedule.

So that's something else to think about with a hospital birth is that oftentimes these providers are on an on-call schedule, usually with doctors within their practice.

But here in Austin, we do have one hospital where it seems that all of the practices are floating between all of them backing each other up.

And so that really opens you up to a heck of a lot of different options for who is okay with what.

So they said yes, that person was in labor, got to the hospital.

It was not their doctor that was on call.

And the other doctor was like, no, no, we're not doing it.

We're monitoring.

And yeah, it's still your choice.

You could still refuse, but again, puts you into fight or flight, really skews the hormones of labor, gets you out of that labor zone and into the, I've got to argue for what I want zone.

That's not to say that it's not worth arguing it though, because we can calm down those fight or flight receptors.

And if you have a good doula with you, if you have your partner with you and you have those tools available to you, we can calm down that fight or flight and get back into the flow of it, but it does.

It throws you through a loop and you have to recover from that.

And that sucks when you're having a baby, you have other things to worry about rather than worrying about calming your body back down again.

And I would say that's more doable, like getting you back into that space is more doable when it's an unplanned, like, oh shoot, I didn't know this doctor was gonna say no to this.

However, I think that if you have a provider that you've had through your pregnancy who is saying no to things and you're saying, well, I'm just gonna refute, is it in labor?

You're going into labor knowing that you're going to have to fight.

And I do feel like that's harder to get past because it's like you're living in this kind of negative flow zone of preparing yourself for battle beforehand.

And I do think that that's more detrimental.

100%, 100%.

So why would we want to deliver in a hospital?

Here we are just kind of crap talking about hospital births, but there are reasons that you would want to deliver in a hospital.

And I think the first and maybe the most important reason is how safe you feel where you're delivering.

And all of this talk about monitoring and all these different things goes into that.

But if delivering out of the hospital is going to make you feel unsafe, then that's not the right place for you this time.

And sometimes that's just how it is.

We talk to first time moms all the time who are like, well, I kind of want an out of hospital birth, but I'm really nervous about it.

And after we talk to them for a while, we just kind of see like, yeah, I think this is going to be a sticking point.

I think this is going to cause more anxiety for them than it would be just to deliver in the hospital.

So for those people, absolutely.

Delivering in a hospital is a great option for them.

I absolutely agree.

And so I'm going to, I just think I was maybe going to go into this later, but I'm going to go into it now.

If you are someone who feels safer giving birth in the hospital, that's absolutely where you should be, because you're going to be too afraid out of hospital to have all of your hormones and everything kick into gear, right?

So there's two different schools of thought here.

Most, a lot, not most, take that word back.

A lot of people that are going to give birth out of hospital think it's very low risk.

There is, and I am a low risk person, I'm not having any complications from my pregnancy.

There's no indication that anything's going to go wrong in labor.

So why would I be in a hospital setting if I'm probably not going to need it?

And there's other things that may restrict me that I don't want to do.

And that's completely fine.

There are other people who think, I know that it's, they still know the possibility of them needing emergency services in a hospital are really low.

The likelihood is really low, but that little, even if it was a 1% chance to them feels too big to risk it.

And they feel safer in the hospital setting.

And I just want to say that that is completely fine either way.

Same thing with intermittent monitoring.

Some people don't want 20 minutes on, 40 minutes off.

They want continual fetal monitoring.

They know that the evidence says, because they took a birth class, that it increases your risk of cesarean by 20%.

But they know that if they don't get an update all the time, like have somebody watching all the time to make sure the baby is OK, that they're going to sit there and worry, is my baby OK?

And some of that has to do with the psychological portion of how it was for them to get pregnant.

Have they had lots of losses?

Do they have a close friend that something bad happened with them?

So that's OK.

And we don't think that everyone should have an out-of-hospital birth.

People are sometimes surprised to hear that.

I don't think that everyone should.

If you are high risk and there are some different things that make you high risk, then it is going to possibly be required that you birth in hospital because you won't be able to find a provider that will do out-of-hospital birth.

And if that's the case, but you still wanted kind of a low-intervention birth, you can find a middle ground option there, and your provider is going to be really important, and the provider group is going to be really important to make sure that everyone's on the same page.

So do you want to go into, there's kind of a middle ground here of a hospital-based birth center, and then there are of course freestanding birth centers.

So do you want to talk a little bit about that, Sam?

Yeah, yeah, definitely.

So like I said, there's kind of two different types of birth centers.

There are freestanding birth centers, and then there's hospital-based birth centers.

So there's benefits to both of them, absolutely.

Freestanding has just a lot more flexibility on their regulations since they're not under the kind of hospital umbrella of rules.

And if you listen to our episode with Moon Tower and Midwifery recently, you heard them kind of talk about some of those different things like water birth, for example.

A lot of hospitals just don't allow, it's against their policy for people to give birth in the tub, but you can labor in the tub.

So you kind of have that benefit of being in a hospital, you can labor in a tub with the birth center there.

You also, you don't have to, if you're in a hospital birth center, you have the ability to kind of move to where you need to be if something happens.

I think that's a huge benefit.

If we know that we're not super low risk, but we're not really high risk, like you're not high risk enough to be in a hospital under the care of an obstetrician, but you don't feel quite comfortable maybe delivering at home or in a birth center.

If you are delivering in one of these hospital-based birth centers, you are kind of already where you need to be if something does happen, which is really great.

If you need an epidural that happens later, or if you need more medication, or if something is going on, you're kind of right there, which is, I mean, honestly, it's just fantastic, both just for your peace of mind, but also for the financial piece, which is really, we understand that side of it.

And I think that's another huge benefit to hospital-based birth centers, is that they work the same way as hospitals do, where most of them, they take all of the insurances, they're able to kind of work with everybody.

And a lot of birth centers and midwives just don't have that ability because it's a lot more expensive to take insurance or to take Medicaid, and it requires a lot more work than what they have the ability to do because they're focusing on their clients.

So in these hospital-based practices, they're able to take insurances, which means that you could have your birth fully covered under the same care that you would if you were delivering with an OB or something.

And that's, I mean, I can't understate how huge that is.

I wish that that had been an option when I was looking at where I wanted to deliver with my babies.

Yeah.

I think also it's important to, and I'm kind of playing opposite side, the devil's advocate.

I think you're a good cop, I'm bad cop today.

Yes, it's great that it's in a hospital setting, but if you are somebody who seriously does not want pain relief medication, if you're someone who is like, I do not want an epidural, like it would have to be like an emergency situation for me to accept an epidural.

And some people that's just like grit for them, and other people it's because of religious or whatever beliefs and that's fine.

If that's the case, being in a hospital based birth center does make it a lot easier to change your mind and get an epidural.

So I think that that's a little bit of a downside for those people.

However, we just did an interview with Moon Tower Midwifery, who has a hospital based midwife practice, midwifery practice.

And they were saying that that is part of the design reason for the birth center being on a different floor of the hospital is because they don't want it to be as easy.

I mean, I know it's still only a floor away, but it is a floor away.

And so you do have to change rooms, you do have to go upstairs, and that kind of makes the difference in some people's brains.

It's also kind of a downside of being in a hospital based birth center is you do usually have to go check in in the same area as everyone else is checking in for the hospital setting.

And then they make sure that you are in active labor.

And then when they admit you, then you go over to the birth center area and not all of them, but that's how ours is here.

And that little piece of your brain, of being in that area with everyone else who's going into the hospital setting can sometimes be a little bit mentally jarring.

And it just messes with the psyche a little bit.

It's that the mind is so powerful.

So you feel like you're in a hospital for a second, and they do that 20 minute NST or non-stress test before getting entered into the birth center as well.

Whereas at a freestanding birth center, they kind of just do a quick little Doppler, make sure everything is good, take your blood pressure.

It's much less, I don't know, intervention is the word that's coming to mind, but it's a lot less medical than going to a hospital and checking in for a hospital-based birth center and then getting put into the birth center.

Right, yeah, I mean, that's definitely a huge piece.

We talk all the time in birth classes about how you can kind of walk into the hospital and you have these bright fluorescent lights and a million people are asking you questions and you're out of your safe space.

And because you're going into a triage room, you can't really set up your stuff and make it feel really great because it's just kind of something you have to get through and you're still gonna have to get through that thing if you are delivering in a hospital-based practice.

So it's definitely a huge, huge piece to consider.

And I think a lot of it really comes down to your goals and like I said before, how safe you feel.

So in an out-of-hospital birth center, yeah, a freestanding birth center is what they're referred to as.

So typically, they're gonna have a little bit stricter rules about when they can kind of keep you, when they're gonna check you in.

In a hospital, they have more rooms available, they have more staff available.

So if you get there and you're three centimeters and things kind of slow down for a little bit, they might be able to keep you for a while and see if things do pick up.

Whereas in a birth center, they don't have as many rooms.

Most birth centers are gonna have, I don't know, two to six rooms, maybe if you're at a bigger one.

And so they-

And I'm gonna interrupt you real quick because Moontower did say that in their birth center rooms too it is gonna be a little bit harder to get admitted in the low intervention rooms is what they're calling them.

So you're talking about the difference between a hospital versus a freestanding birth center.

Well, really any birth center.

It's gonna be a little bit harder to get admitted.

Yeah, yeah, definitely.

Yeah, I mean, so that's definitely something to consider as well is that you might have to go home.

I had this happen the other day too.

We've had a lot of babies lately, but I had this happen the other day too where a mom who was delivering in a birth center went to the birth center and she wasn't where she needed to be.

And so she had to drive back home and labor for a while longer there and then drive back again when it was time.

And that was, it was stressful for them.

And I do think it probably slowed things down a bit.

I mean, we saw her contractions really slowing down in the car, which is nice because then she doesn't have to have too many contractions in the car, but not nice because then we labored for a lot longer.

So that's definitely something to consider when we're talking about those things.

And then, like with the home birth, you have one provider who's coming to you.

So she's gonna come to you, gonna see where you're at, and if you're not ready for her to stay yet, then she can go do something else for a while, or she can go take a nap on the couch.

We've had midwives do that too.

They're like, you're not quite there, but you might be soon.

So I'm just gonna go work in the other room or take a nap on the couch for a while until it is time.

And that's so cool.

That's so cool.

Yeah, and with the freestanding birth center as well, there's positive and negatives.

It's a little bit harder to be admitted as or taken on as somebody who can give birth there because they can't take as high risk people.

So a hospital-based birth center can't take super high risk people either, but they could be a little bit more flexible than an out of hospital birth center, freestanding birth center because they do have access to a little bit more.

So they can do some more continual fetal monitoring and they know that they're right there if they need to transfer over to one of the regular hospital rooms, whereas the freestanding birth center is not.

They can't do that.

It's a little bit more strict as to who can give birth there, but they have less rules about all the things, pretty much.

So you can give birth wherever you want.

You could be standing on a, well, you can do this in the freestanding birth center too, but you could literally be on the, I'm sorry, the hospital base.

You could literally be on the toilet pushing if you wanted to.

In a hospital room, you're not going to be allowed to do that.

As well as in some of the hospital based birth center rooms, you can labor in the tub, but not deliver in the tub.

And at birth centers that are freestanding, you can generally labor and deliver in the tub.

So things like that, or, you know, gosh, what else I'm trying to think?

Is there anything else that like big differences between hospital based and freestanding birth centers?

One thing that it sounds kind of silly, but honestly, I've seen it be a huge benefit, is you can go outside.

I have had people go outside and take a walk for a while, or just go sit in the sun for a little bit.

I have this really clear memory of this one mom who wanted to go outside as the sun was coming up.

We've been laboring all night long, and we went outside on this beautiful early June morning and watched the sunrise as she was laboring on a yoga mat in the grass.

And it was just the most beautiful moment.

And that's kind of huge, and you really can't do that at a hospital.

I don't think they even really like you to leave the unit at a hospital.

So you're kind of, you're where you are.

It's a little more homey.

I always say it kind of feels like you're showing up to like a cottage or something, you know, or like an Airbnb.

Sometimes I say it's like pottery barn threw up in there, you know, it's just a little bit nicer.

It's a little bit more unique.

So hospital-based birth center rooms or low intervention rooms tend to be a little bit sterile.

It still has a regular bed and things like that, but they're, you know, it probably all matches.

Each room is probably very similar.

Whereas at a birth center, sometimes a lot of different, or a freestanding birth center, they'll sometimes have different themed rooms and the tubs look different and the tiles different in different rooms and just kind of some uniqueness there, which for everyone doesn't matter, but aesthetics are big for some people.

And, you know, certain devices that you can use or whatever, like, you're gonna have to ask the differences between the little nuances of the different places.

And I think that that's gonna be important when making your decision as to what you are comfortable with.

And I think it's really important for you all to listen to the Out of Hospital Birth episode that we did with Home Birth Honey's Leonora, because she does talk about kind of the risks of it, and it's really not dangerous.

If you're a low risk person, it is not more dangerous to have a hospital out of, or I'm sorry, a birth out of hospital, hospital out of birth, I almost said.

Because that's actually the safest place for you to be, and your body is able to do what it needs to do more smoothly, and you actually end up needing less intervention because you're not in a more medicalized place.

So sometimes just the rules that they have make it restrictive enough to end up kind of having this cascade of interventions.

And it comes down a lot to confidence too.

I mean, when you're at a hospital, it tells your brain that you're at a hospital, you're sick.

You know, you have to put on a hospital gown, which you don't have to, but you have a hospital gown, you have a hospital bed, you have all these different things that are kind of happening.

And those are communicating to your brain, whether you are feeling it or not, it's telling your brain that you're sick.

And so you're more likely to kind of lean on other people for what you need to do to have your baby.

Whereas in a out of hospital, freestanding birth center or at home, the focus is on you connecting with yourself and doing what you need to do to bring your baby into the world.

Moving the way that you need to move, laboring where and how and when you want, eating and drinking as much as you want and how you want.

The subconscious is so strong.

It's really the subconscious is huge at play here.

Another thing that I just thought of that could be potentially a difference, and I don't know the rules where you guys live on, you know, the hospital-based birth centers or freestanding, but a lot of the freestanding ones will allow things like burning the umbilical cord if you want to, like ceremony type things and incense and things like that.

Whereas a hospital-based birth center may not.

So ask those questions, especially if you have some sort of ritual that's really important to you.

And we haven't talked yet about home birth, but it's pretty much like, there's like not a whole lot of rules.

Home birth, you pretty much get to do what you want.

And anything you could do at a birth center, you could do at home and more.

And the only difference would be sometimes there are more restrictions on just how low risk you have to be to have an out-of-hospital birth.

So things like a VBAC, some home birth midwives are okay with VBACs, some are not.

Some freestanding birth centers are okay with VBACs, some are not.

So that's an important question to ask.

Same with gestational diabetes, whether or not you are monitoring it yourself and being able to take care of yourself with food and just your diet, or are you having to take some sort of insulin or medication to help with it?

Same with, gosh, what else?

Group B strep isn't going to risk you out of anywhere, really, because you can have antibiotics at home or birth centers or whatever.

What else am I missing?

Like blood pressure issues, those are going to pretty much put you in the hospital right away.

For sure.

Anything kind of sneaky going on with your placenta, we're probably looking at at a hospital.

Birth placentas are tricky.

Sneaky placentas.

Sneaky placentas, that's right.

So anything going on there, that's probably going to risk you out.

I mean, there are 100% reasons that you need to be delivering in a hospital.

There are medical reasons that you need, that you would be considered high risk, and hospitals are for high risk people.

Out of hospitals are for low risk people.

And I would argue that most low risk people should be considering at the very least an out of hospital birth.

I was just gonna say, I'm gonna be bold, y'all.

And I'm gonna say, I truly believe that if you are low risk and if you are truly low risk, you really shouldn't be in a hospital setting.

I just really truly believe that.

It's like, I mean, unless your anxiety, yeah, unless your anxiety is gonna be debilitating and like you've got to, you know, and that's okay.

But if you're not super afraid and you're taking classes and preparing your body and doing all the things, there's no reason that you shouldn't be able to give Birth out of hospital.

So let's talk about what the heck is the right choice for you.

Let's say there are no risks, like we're a low risk person, you are eligible for out of hospital Birth.

What, you know, how do you choose?

What do you choose where you wanna give Birth, Samantha?

What questions should you ask yourself?

Well, I think one kind of obvious question is, what are your goals for comfort measures during labor?

If you want an epidural or you want pain medication, you should be in a hospital.

You should, and you can still prepare yourself to have a low intervention medicated hospital Birth and hire a doula and do all these different things.

Yeah, absolutely.

Hey you guys, that's totally fair.

If you just want an epidural, there is zero judgment.

Go, be at that hospital.

Do it, do it, absolutely.

Yeah, epidural, we have nothing against a good epidural.

And sometimes we even feel really strongly that somebody should have an epidural.

We have had multiple clients, many, many, many clients, I would say, over the years that we have felt like, that's a good person to get an epidural, or you need an epidural while you're in labor, different things like that.

So that's probably the number one thing.

If you are a low risk person and you want pain relief, go to the hospital.

However, if you are a low risk person and you are thinking that you would like to labor unmedicated, then that's really where I think we need to start looking at some of those out of hospital options.

So I think some really important things to consider is, one, how far are you, how far is your home from where you're thinking about delivering?

If you live four hours away from any hospital and there's, you know, I would say, honestly, I would say two hours or I don't know.

I don't know.

What do you think?

What do you think would be a comfortable?

How far away would be for what?

Having a home birth or?

For a home birth.

I think that really depends on the person because personally, if I were having a home birth, I don't think I'd be more comfortable being more than 30 minutes away from a hospital.

Personally, I really think it's a personal choice because for me, it's for bleeding and for baby.

And that's probably because I did hemorrhage in my birth with my son.

And I was glad to be across the street just in case, and I didn't have to go, but it did give me a sense of comfort that we could literally just put me in a wheelchair and roll me over there if we had to.

So I think that that's an important piece.

And I do think that the biggest catch in making the decision on whether a birth center or a home birth, a freestanding birth center or a home birth is safer is which one is closer to a hospital in case of emergency.

Because we had somebody who lived downtown and she could walk to Seton, and I don't, sorry, I'm gonna say it, I don't love that hospital, but she could walk there if there was an emergency.

And the birth center was like 15 minutes from the closest hospital.

And I was like, it's actually safer for you to give birth at your house, you know?

Yeah, absolutely.

Yeah, so I think that's a big piece.

I think most midwives that I know, at least in our area, are looking at about a 45-minute home to hospital transfer time.

So if you are more than 45 minutes away, they're gonna really have to think about if that's a good option for you or not.

So in those, you know, if you live far from a hospital, then you might wanna start looking at a freestanding birth center instead or exploring some other options that would be available to you.

One thing that we talk about all the time is who is at your house?

Do you have, you know, five kids at your house and they're annoying and loud and they're gonna be all over you when you're in labor?

My kids are annoying and loud.

I've thought about that.

Like if I ever had another baby, I don't know if I'd want my kids there because they're like all up in my grill.

I don't know if that'd be the vibe for me.

So maybe that's you.

We have a sweet mama.

We have a sweet mama right now that was wanting a home birth and this was her seventh baby.

And she's totally down for having a home birth and having all six of her kiddos around, which that's great for her.

It kind of depends on your personality.

Same with, but I also tell people, if you really want to be in your own home, but you actually don't want your kids there, then maybe have somebody take them for the weekend or whenever you go into labor.

If you have the support to have someone around you to come take your kids so that you can be in your own home, I think that that's great.

And same with, you have to think about who do you want at your birth and will they be allowed where you're going to give birth?

So if you were considering planning a hospital birth, but you really want your seven-year-old to be allowed to be there when you're crowning, pushing, all of that, they're not going to allow your seven-year-old to be there.

So that would be an important piece of, maybe you wanna have a birth center birth that would allow them to be there, or maybe you wanna have a home birth now because you want your seven-year-old to be able to be there.

My daughter was seven and a half when my son was born, and it was very important for me that she was in there and she wanted to be in there.

She heard her brother's first cry.

She was right there.

So it depends on the kid.

It depends on who you're wanting there, how many people you want there, how comfortable you feel with those people.

Another thing I have people talk about is I've had second, third, fourth time moms want an out of hospital birth, but not wanna have to go right home because they don't wanna have to go home and take care of their toddler.

And so they're like, well, I really wanted a birth center birth, but I don't wanna go home six to eight hours after I have a baby.

So maybe I'm actually gonna have a hospital birth, which is also another benefit.

Yeah, that's another cool benefit though to the hospital-based birth center, because at least the one here in Austin, if you don't wanna leave after that six to eight hours, you actually can have a traditional hospital postpartum stay and still have the low-intervention room that you're in to give birth.

So it's one of the best of both worlds.

Yeah, it's pretty nice.

So yeah, I mean, I would say those are kind of the biggest things that I'm thinking about.

I'm trying to think of what other differences I can think of between home and birth center and hospital.

I guess at birth centers, a lot of them have nitrous oxide available for pain relief, and at home, I don't think anybody really is carrying around nitrous.

So that is something, again, going back to those pain relief techniques.

I think there's one in Austin that you can rent it from, she can bring it, but also, what if she's had another birth in the middle and a backup midwife has to come?

That's just a little bit.

That's another thing to think about.

Who are the possibilities of who you could give birth with?

So no matter where you're giving birth, think about who are the alternates of that provider?

Is it another provider in the practice of an OB?

Is it another midwife that's in the same practice at the freestanding birth center?

Or who is the backup to your home birth midwife?

Sometimes I really love the home birth midwife, and then I find out who their backup home birth midwife is, and I'm like, oh, okay.

And I have to talk to the client about, okay, well, the one you chose is really great, but who you're saying that they have, I'm gonna just tell you about kind of the situations that I've seen, and it's up to you, but you may want to ask to interview that other potential midwife so that you can find out if you guys are in alignment and how the personality goes.

Sometimes it's simply personality.

I'm like, oh my gosh, it's just a completely different personality than the one that you chose.

So let's make sure that you're also okay with that personality.

So those are considerations.

Also, where are your appointments?

How far is your appointment gonna be?

You know, at first, there's not very many of them.

It's kind of spread out, but eventually you're gonna be having every two weeks and then every one week appointments.

And so how far is it from home?

How far is it from work?

Some home birth midwives will come to your home for all of the appointments, which is really cool.

It's not as common.

So, I mean, don't get too disappointed if they don't, but that's a super awesome option if it is.

And your birth centers are usually gonna have the appointment right there.

I think our hospital-based birth center or hospital-based low-intervention rooms, I guess they're calling them, is they have a office that's not gonna be right there.

I think it's gonna be like across the street or something, but it's close by to where that is.

Yeah.

If you're having a home birth and the home birth midwives office is like an hour from your house, that's possible.

Because maybe their house is 30 minutes from you, so they're willing to do it.

But maybe their office is really far, so you gotta look at that as well.

Yeah, yeah, definitely.

Yeah, knowing who the players are, where you're going and how you feel, I think that's kind of the formula for choosing which one is right for you.

I think, I mean, there's definitely some more nuance to it.

And I will advocate for hiring a doula and talking to doulas every day, taking good childbirth education is huge, is really, really huge.

And choosing your providers wisely is important.

So I think all of that is probably what I would say is kind of the formula for choosing which is right.

What do you think?

Yeah, and I wanna also just put out there again that the reason that we tell people that we think that they should take a class with a live instructor, whether it's over Zoom or in person, a live instructor that's in their area, that knows the birth culture in your area, because we kept saying, but in your area, it might be different.

And so that is why it's so important to be connected in your community and not take just like a pre-recorded online class from somebody in Timbuktu, because they are not going to know what the little nuances are of the places in your area.

Yeah, definitely.

That's it.

I think we did it.

We did it.

Can't wait to talk to y'all about providers and the differences between those, because I know there's a lot of confusion around that too.

Yeah, definitely.

I think that's going to be a really interesting, interesting conversation.

We'll see y'all next week.

Thank you.

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