Why does the birth center have a cesarean rate of 2.7% while the hospital has a cesarean rate of 38%? Is it gross malpractice? Fear? Unnecessary interventions? After spending the last month working with hospital midwives and obstetricians, here are my conclusions:

1. Most importantly lack of education through the prenatal period. Women come in to the hospital in labor, and don’t know anything about labor. They want to be admitted at 2cm, want an epidural by 3cm, and have been failed by their providers for not helping them prepare for labor

Compared to birth center prenatal care, that delves deep into preparing for birth physically, emotionally, and spiritually, through hour long appointments and helping women gain understanding of the process and the power and mystery of childbirth.

3. Ignoring holistic health counseling, BMI > 30, severe nutritional deficiencies and lifestyles that predispose women to preeclampsia, diabetes, inadequate protein intake causing difficult cervical dilation, poor uterine stamina, ineffective pushing, tearing, and hemorrhage.

Versus birth center care that spends a lot of time counseling on prenatal nutrition for mom and baby far beyond the OTC prenatal vitamin garbage, identifying nutrition deficiencies, counseling on ancestral diet and encouraging exercise, chiropractic care, + functional medicine.

3. Long labors. Causes include offering elective inductions anytime after 39 weeks and mandatory inductions at 41 weeks, admission < 6cm, immobility caused by epidurals, heart monitors, IVs, and laboring in bed, shift change every 12h with no trust and rapport with your care team

and an overstimulating and stressful environment, with beeping machines, frequent interruptions, bright lights, cervical checks, pressures for intervention, annoyed staff, lab draws, requirements for dilation progress, and restricted food intake.

Versus birth center birth, where we encourage the body to go into labor naturally through 42 weeks, admission > 6cm, full mobility, undisturbed labor and privacy, continuous support with a single midwife and assist who you know and trust, and a calm, quiet, dark environment.

to bear down which can cause drops in baby’s heart rate, common to push as a first time mom for 3-4 hours, increased risk of vacuum assisted delivery, risk of 3rd-4th degree tears, hemorrhage, or cesarean for arrested descent of the second stage or fetal intolerance of pushing

Versus birth center birth, where we help you cope with non pharmacologic pain management like hydrotherapy, massage, meditation, and breath work, so your body can begin to push instinctively when ready and much more effectively in birth positions that allow full pelvic mobility.

I see most first time moms push for about an hour, maybe 2 if baby’s position is unfavorable. I have never seen an unmedicated mom push for 4 hours or be diagnosed with arrested descent, I never need to tell a mom how and when to push, and I pretty much never hear decels.

5. Hospitals are icky places with lots of infections. The chorioamnionitis rate at our hospital is usually around 10%, and IV antibiotics are tossed around like candy. Longer admissions, more checks, and more invasive procedures all contribute, and cause dysfunctional labors.

I’ve never seen or heard of a single case of chorioamnionitis at an out of hospital birth, and I’ve been involved in over 100. If your water breaks at home, you have a higher risk of infection if you go into the hospital than if you wait at home for labor to start on its own.

Conclusion of the story: It’s not direct medical malpractice cutting a bunch of unnecessary cesareans. Most cesareans, by the time they occur, are necessary interventions. The root causes are system level issues that trace back to the first prenatal appointment

and fail mothers who desire a safe and low intervention vaginal birth. Yes, by the time a mom has preeclampsia, a failed induction, chorioamnionitis, arrested labor, and fetal decels, she needs a cesarean. Could a better model of care led to a different outcome? I think so.

@huckleberrypnw I'm curious about this holding breath instruction. Isn't that only when pushing or do they instruct holding your breath at other times?

@LfPorsche During pushing. It’s effective to help moms with epidurals push, but without an epidural, the body basically pushes for you and you don’t have to be instructed to hold your breath. They have you hold for 10 seconds, bear down, and repeat x3 per contraction, it can cause decels