If you're considering a birth center, you won't need to find a doctor or a midwife, as the person and the place are a package. Read over the questions for hospitals, too, as some will apply to these centers as well. Most questions do not, though, because birth centers typically have low intervention rates and little opportunity or interest in separating you from your baby, partner, or friends.
getting ready for birth
1. Is your birth center accredited by the commission for the Accreditation of Freestanding Birth Centers? (Contact the National Association of Childbearing Centers in Your List of Helpers at the back of the book for more information.)
2. Are you staffed by certified nurse-midwives and nurse practitioners or physicians? Most birth centers have CNM's on the staff even if there are doctors as well. If you're considering a center that doesn't have any CNM's, be sure and ask about their hospital-transfer rate and use of drugs. (See Chapter 3 of A Good Birth, A Safe Birth to find out how this birth center compares with others on all the issues in this list of questions.)
3. How many of your clients transfer to the hospital? Transfer rates vary among birth centers, and if your birth center has a higher rate than average, ask why.
4. Are childbirth education classes, as well as prenatal, childbirth, and postpartum care included in your fee? They usually are, and the overall cost generally is far cheaper than hospital rates.
5. How long are prenatal visits? Midwives often spend up to an hour with you during each monthly visit.
6. Who will be with me during labor and birth? If there are several CNM's, will more than one be with me? What chance is there that a midwife or doctor that I don't know will be there during labor?
7. How long is a typical postpartum stay a the birth center, and is a home visit part of my postpartum care?
8. If my baby needs the care of a pediatrician at birth, how is that handled?
9. What's your cesarean rate? Cesareans, of course, are not performed at birth centers, but women who need them are transferred to a hospital. At the same time you're asking this question, ask what are the reasons for the cesareans.
10. What is your opinion of prenatal testing, and in particular, the use of ultrasound? Do you use a Doptone, an ultrasonic device, or do you use a fetoscope for prenatal visits and labor? In 1989, ACOG said that fetoscopes are as good as electronic fetal monitors (EFMs) for monitoring normal births. However, many doctors and nurses are unfamiliar with their use, while midwives are quite comfortable using them.