Where to give birth in NH

Where you give birth, and with whom, is an important decision

By Andi Diehn

We're all familiar with this stereotypical scenario: the glowing pregnant women packs her bag two weeks before her due date, waits until the pains are three minutes apart, has her worried husband drive her to the hospital where he sits in the waiting room with other fathers-to-be, while she lays prone in the delivery room with a rubber mask over her mouth and nose. Baby is born, baby is brought to nursery, baby is viewed by parents only during certain times of the day.

That may have been a likely scenario back in the 1950s, but times they have changed. Now expecting parents – why yes, dads expect their babies just as much as moms these days – have the option of a midwife-assisted birth in a hospital, birthing center or even at home. They might have a doula on hand. Obstetricians are still a popular way to go. Natural birth, water birth, drugs that take the edge off – there are many, many options. So many that sometimes the choices can be overwhelming, even before you start picking out nursery themes.

Doctors and hospitals

Sterile white hallways, kind nurses in sensible shoes and doctors with stethoscopes are still the image many of us have when we think of giving birth, and there's a good reason for that. A hospital is a great place to be in an emergency. If anything goes wrong with the birth, or if the baby needs immediate treatment, you'll be relieved when your doctor has all the tools at hand he needs to address the issues.

Hospitals are where the vast majority of births take place. Not only are emergency services just a hallway away, but that's where you can find pain management. You may have heard the rumor that having babies hurts. Many women prefer knowing they can request that pain to be lessened or even taken completely away. Whether you choose to feel no pain or all the pain, a hospital can help you.

Midwives

Midwives have been around even longer than obstetricians. These days we're lucky to have both options. Most midwives practice in hospitals alongside their doctor counterparts; by choosing a midwife you get the best of both worlds – the time and compassion a midwife has to offer and the safety net of a surgical arena.

A Certified Nurse Midwife (CNM) has gone through extensive schooling and certification and will have birthing rights in hospitals and birthing centers; some of them may attend home births as well. There is also the choice of a New Hampshire Certified Midwife (NHCM) who may not be a certified nurse, but has been certified through the New Hampshire Midwifery Council.

“Physicians do a great job,” said Rebecca Keller, CNM, APRN at St. Joseph Hospital in Nashua. “We work closely with physicians, but they tend to focus more on the abnormal pregnancies – high risk, multiples, that sort of thing. We midwives are very focused on normal pregnancies. We tend to have longer prenatal appointments and we have the time to answer questions. We consider a big part of our job is to educate women so that when they go into labor they know they are safe, that they can trust us and feel comfortable. That usually leads to shorter, easier labors.”

There's a common misconception that by using a midwife women are automatically choosing no pain medication, no interventions, no prenatal testing; just all natural, all the time. But that's not the case.

“We make sure our clients are educated about any testing we do – you make the choice,” Keller said. Have no fear – pain management is part of their service as well.

While high-risk situations like multiples are generally handled by obstetricians, or sometimes by an OB and midwife working in tandem, midwives generally take on patients for whom pregnancy is an uncomplicated part of life.

“We are experts in normal,” Keller said, laughing.

Home births

“A home birth is not a good idea for everyone,” said Sara Johnson, Lebanon mom of two. “It's not for anyone with any kind of risk like twins or breech position.”

Johnson should know. Not only did she have a home birth with her second child, but she's also a nurse on the birthing pavilion at the Dartmouth-Hitchcock Medical Center.

“With my first baby I labored beautifully at home and then transferred to the hospital, which was also my workplace,” Johnson said. “It was like going into a very stressful environment and I ended up having a lot of interventions I hadn't wanted to have.”

Home births are the minority; many people find the idea of giving birth at home frightening, but for some people it's the best way to stay calm and relaxed during the birth. By laboring in a familiar, comfortable setting they can avoid much of the stress a hospital setting might induce and cut back on the chances of interventions.

“I'd definitely do it again,” Johnson said. “With the same mindset that if it looked like it wasn't going to be a good idea, we'd go right back to the hospital.”

Birthing centers

If a home birth sounds attractive, but you're not quite ready to set up a birthing tub in your living room, you might consider an in-between option: a free standing birthing center, like Coastal Family Birth Retreat in Stratham.

“We consider birth to be a life event and we strive to treat the experience with honor and respect without sacrificing safety,” Valerie Jacques, CPM, NHCM, said.

Birthing centers offer a serene atmosphere for the birth, plus extensive prenatal care, diagnostic testing, postpartum care, breastfeeding support and parenting classes. These centers aren't for everyone, however.

“We attend low-risk, healthy moms with uncomplicated pregnancies,” Jacques said. Again, hospitals are better equipped to handle high-risk pregnancies.

Doulas

Women sometimes remark on the number of people watching them give birth – doctors, midwives, nurses, family members, medical students – the number can feel excessive. But there's another person you may want to consider adding to that list: a doula.

“A doula is a calming, consistent and positive presence for a woman giving birth – whether it's their first time or their fifth time,” said Leah Wolcott, a doula working toward certification in Lebanon. “There can be a lot of interruptions in a hospital environment, lots of staff changes over the course of a woman's labor. A doula is there the entire time from the onset of labor through the delivery and can even assist with breastfeeding.”

Certainly spouses and partners can provide calm support, but the experience may be new or intimidating for them, too. A doula can be a steadying force for both partners.

Water births

Wolcott can also speak to the magic of a water birth. “Water has always been relaxing for me,” she says. “In labor it is so important to stay relaxed.”

Laboring in water has long been part of the birthing process in many hospitals and birthing centers across the country, but the last few years have seen a surge of women interested in actually giving birth in the water. With midwives, doctors and nurses in attendance, there is no danger of the baby drowning since generally the first breath doesn't occur until after the baby has been lifted out of the water.

Wolcott gave birth to her second child in the birthing tub at Alice Peck Day Memorial Hospital. “I was actually swimming in the pool,” she said. “It was small, but I could do it!” When asked if she'd deliver in the birthing tub again if she got the chance, she answered emphatically, “Oh my gosh, yes!”

Andi Diehn lives in Enfield with her husband and three sons. She writes during naptimes.

Resources:

To find a doula: www.dona.org

For more information on New Hampshire birthing centers: www.newmothersresourceguide.com/

More information on birthing at home: www.nhmidwives.org

Further information on midwives: www.mynhmidwife.com