Hi Di,
Have to hoe in on this one. I have been very concerned about the "definition" of a Birth Centre for some time. In the UK, where I do tend to get about a bit each year, many hospitals are suddenly sporting "Birth Centres". For example, I have a glossy brochure from the Birth Centre at Chelsea and Westminster Hospital in London (very up market, famous and fashionable) where they proudly state that at their Birth Centre you can "have everything except and epidural". In practice this means you could be induced, have pethidine, certainly Entonox (nitrous oxide) and even electronic monitoring in their birth centre. There are water births there of course, and it claims to be midwifery led care, but it makes you wonder.
At Guys and St Thomas' Hospital (the home of Florence Nightingale) in London, the "Birth Centre' sign outside the main lift actually leads to the regular labour ward and it is the "Home from Home Unit" that tries to approximate the homelike atmosphere usually associated with birth centres (as long as you like wall to wall bright blue paint). Kings College Hospital in London has done the same thing - a real con for women who think they are going to a "birth centre" and then find they are having all the usual obstetric care found in big city teaching establishments. In the UK all the birth centres I have heard of offer drugs in labour and other invasive management techniques such as mandatory 15 minutely checks of the fetal heartrate during first stage and after every contraction in 2nd stage (although a NICE guideline, there is no evidence that supports this doctrine).
To my mind, a "birth centre" is run by a select team of midwives (not midwives who are allocated on a needs basis from the regular labour ward) and the aim is to promote midwifery and natural birth. That means no drugs, monitors, drips or interventions. If a problem develops, the woman is transferred to labour ward where she can get the necessary and appropriate help. Water and other non pharmacological comfort aids are encouraged and a family atmosphere prevails, with the woman free to bring whomever she likes to the centre with her. Siblings as well, if desired.
This was how the original birth centres operated when they opened in the early 80s. The concept seems to have become diluted over the years, which I think is a shame, for the women and for the midwives. A birth centre offers a midwife the chance to gain confidence in natural labour and birth, which will give her skills she may then decide to use in home settings.
These days, midwives are under such pressure from management (euphemistically called "risk management") that they feel obliged to carry out unnecessary observations and apply rigid criteria over every aspect of the admission to the program and the following care that they can hardly operate as autonomous practitioners. I remember well that the first birth centre at Crown Street was established as a means of stamping out home births, the thinking being that women would come to a nice cosy birth centre in a hospital if it was pretty enough and not "risk" a home birth. They were wrong of course!
There is the argument that hospitals should be seen as "birth centres" because that is where babies are born and I can accept that as a valid argument. However, the birth reform movement created this term "birth centre" (an American idea) as a means of delineating midwifery care and natural birth from the standard hospital approach. I fear we are losing sight of these original goals.....
Sorry about the rave. I have written about this before, especially in Diary entries, but it keeps cropping up. I will be interested to see what others feed back to the discussion.
Andrea
At 12:05 AM 15/01/2005, you wrote:
Ok, ive outed myself now,
I have been lurking on this list, drawing upon the wisdom of all you beautiful, passionate women, for some time now and I finally have a question.
What is the accepted Australian definition of a "Birth Centre"? Is there one?
Our midwifery led, low risk unit offers team midwifery and hopefully soon, caseload care. Our brand new unit is linked closely to the maternity ward where we have only postnatal care.
We have obstetricians available on call, and they have the ability to perform an emergency c/s if needed.
We would love to call our new unit, with it's big baths in all three birthing rooms, a birth centre as this would help to demedicalise the concept and help us bring our midwifery services to the local women and the community.
Any thoughts?
Di.
----- Andrea Robertson Birth International * ACE Graphics * Associates in Childbirth Education
e-mail: [EMAIL PROTECTED] web: www.birthinternational.com
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