Mother and new babyThe Puget Sound region is a special place; glorious vistas, old-growth forests, majestic mountains and sparkling lakes surround us. But did you know this area also boasts some of the best childbirth options in the country?

“We moved to Washington when I was pregnant because I didn’t like the options in Minnesota,” says Ballard mom Jennifer Enich. What’s so great about Washington? The variety of birthing options it offers: hospital births with highly skilled physicians and midwives, as well as births under the care of midwives at freestanding birth centers or at home. Western Washington is crawling with doulas and childbirth educators; in fact, experts say women in our area have more opportunity for vaginal births after cesarean (VBAC) and water births than in most places in our country. With so many options for childbirth, how do you choose?

First and foremost, consider your health and risk factors. Identify them with the help of your prenatal care provider, then discuss the possibilities. Here’s a look at some of your options.

Hospital birth
Most Washington babies — about 98 percent — are born in hospitals, and while aesthetics may seem important during a hospital tour, most women don’t notice the wallpaper while in labor. When choosing a hospital, try instead to focus on hospital policies, cesarean section rates and quality of nursing staff.

In a hospital, the nursing staff will be with you for most of your labor. A physician will arrive to “catch” the baby, and perform surgery or provide emergency care, if needed. Your doctor may check in to observe progress and give care instructions, but the person holding your hand and attending to your comfort is most likely going to be a nurse.

You may also want to consider whether the hospital has adopted the Baby-Friendly Hospital Initiative (BFHI), a global program sponsored by the World Health Organization and UNICEF to encourage and recognize hospitals that offer an optimal level of breastfeeding support.

Hospital policies and programs vary. For instance, St. Joseph Medical Center in Tacoma has spa suites, and women can choose to have a water birth (not available at all hospitals). When touring a hospital, don’t hesitate to quiz hospital staff on policies. Think about the birthing experience that you want — then find out if that hospital can make it possible.

While most assume that only obstetricians attend hospital births, women can also choose to work with family physicians and midwives in hospital settings. Because different types of maternity care providers offer different styles of care, it’s worth exploring all of the options available in a hospital setting before making your choice.

Women in our state have a uniquely rich slate of options in midwifery care: certified nurse-midwives, licensed midwives, naturopathic physician licensed midwives and certified professional midwives are all available here. Midwives attend births in hospitals, in birth centers and at home, and provide complete maternity care for low-risk women. While midwives come from a variety of educational backgrounds and will all have their own personalities, values systems and philosophies, they all are trained in the Midwives Model of Care, which is based on the concept that pregnancy and birth are normal life processes.

According to the Parent Trust for Washington Children, a statewide nonprofit, women who use a midwife experience far fewer interventions, such as augmentation of labor, pain medication, surgical birth, episiotomy and vacuum or forceps delivery. This may be in part because midwives generally attend women for the entirety of active labor. “Midwifery practice views mothers and babies as an essential unit,” says Seattle midwife Suzy Myers, C.P.M., and cofounder of the oldest direct-entry midwifery training program in the United States.

Usually, an expectant mother will work with several midwives in a practice, so that one is always available when she is ready to give birth.

“I loved appointments with my midwives,” says Seattle mom Leah Eister-Hargrave, whose midwives offered hour-long appointments to discuss all of her concerns. “I always felt like my questions were answered and taken seriously. I felt like they really cared about me and my family.” Eister-Hargrave’s midwives also visited her home two days after she gave birth, then again at one, three and six weeks postpartum. The standard for most care providers requires only one postpartum visit for mothers, at six weeks postpartum.

Choosing a midwife doesn’t have to be an all-or-nothing decision; many midwives will collaborate with obstetricians when a woman needs additional medical support, say, in the case of multiple births. Audrey Levine, L.M., C.P.M., a midwife from Arcadia Home Midwifery Care in Olympia, says she has cared for women pregnant with twins or with other complications that kept them from choosing an out-of-hospital birth by providing most of the prenatal care and attending the birth as a doula, with an obstetrician leading the birth team.

Freestanding birth centers
While birth centers provide birth suites, tubs and supplies associated with birth, they don’t actually offer any technological differences from a home birth. Birth centers do not offer women access to epidurals or other pain medication during labor, and there is no doctor on staff to provide emergency surgical intervention or special newborn care.

Birth centers do offer a safe, comfortable setting for low-risk women to labor under the care of a professional midwife. The cost of a birth center is thousands of dollars less than the cost of hospital admission for birth services. In addition, most birth centers are close to large hospitals to provide easy access should it become necessary to transfer care to a hospital for pharmaceutical pain relief or other medical intervention.

Birth centers provide a great option for women who seek a home-like setting and can’t make it work in their own homes for some reason.

Carmel Drage chose a birth center for her daughter’s birth because she wanted a “natural childbirth” and liked the center’s flexible policies. After a long and arduous labor, her midwife suggested she crawl up and down the stairs in the lobby of the birth center. “I could hardly believe that she was suggesting this!” says Drage, but it worked. “My daughter finally emerged into my husband’s eager arms. She was literally born on the stairs in the lobby in the middle of the night,” says Drage.

Home birth
While the American College of Obstetricians and Gynecologists strongly opposes out-of-hospital births, a 2005 study published in the British Medical Journal found home birth to be as safe as hospital births in low-risk pregnancies. Three other studies published in 2009, one Dutch and two Canadian, confirmed those results. These studies also found that home birth involved far fewer interventions, such as medical augmentation of labor, episiotomy, or cesarean section, than did hospital births for the same category of low-risk women.

The first place your mind might go when you think about home birth is to the messy parts — what will it do to the carpet? In reality, the mess is easy enough to contain and clean. Of her home birth, Enich recalls, “I was in bed with a beautiful baby, all messes gone before the midwives even left the house.”

One of the perks of a home birth is the fact that you don’t have to go anywhere during what most consider an extremely private and uncomfortable time. “Staying in the comfort of my own home, never having to get in a car while in labor, and cozying up in my very own bed with my newborn was the way to go,” says Eister-Hargrave of her home birth.

While birthing out of a hospital means no access to pain medications, many women will attest to the fact that a labor tub provides significant pain relief, and women who give birth at home can rent that valuable tool. Labor Tubs Northwest will even come to your house when your labor begins and set up a labor tub any time — day or night.

Reaching back to historic wisdom when a pregnant woman’s friends and family members would attend her labor and lend support, women can now hire a labor support doula, who provides continuous physical, emotional and informational support to the mother before, during and just after birth.

Even with a rock-solid partner or best friend at your side during labor, you can benefit from a doula’s presence. Numerous clinical studies have shown that the presence of a doula tends to result in shorter labors with fewer complications and reduces the need for medical interventions. A doula is essentially a birth coach; she is not licensed to deliver your baby, as a midwife may be.

Women who have the benefit of doulas when giving birth report more positive feelings about their birth experience. It’s hard to argue with such strong positive results!

A birth plan
Whichever birth option you choose, you will want a birth plan — a written list of your priorities and wishes for your birth experience. “Most of the time, a woman’s birth plan is respected in the Puget Sound,” says Penny Simkin, a local childbirth educator and doula. “This is not necessarily the case in other parts of the country. I have even had a nurse ask me for my client’s birth plan was when she didn’t have one.” Having a written birth plan makes it more likely that nurses will consider — and follow! — your wishes.

Phoebe Ho, M.D., a Tacoma OB/GYN, encourages her clients to make birth plans as a reality check. “It’s helpful for the patient to prepare, so they know what they want and what an ideal experience may be for them,” she says. “When they have that, I can go over the plan and also tell them what I typically see and what my perspective is.”

And having that birth plan can help you stay in control of your birth experience — something that matters to many women. Simkin performed a long-term study on women’s feelings about their birth experiences. “I found that the woman’s perception of the quality of care provided to her was very important,” she says. The women who reported the highest satisfaction with their birth experience said they felt in control. The women who were dissatisfied reported feeling discounted and disrespected. This research suggests that choosing a health care provider is perhaps the most important choice you will make about giving birth.

Whatever your hopes or concerns are about childbirth, you can find a childbirth education class to help prepare you for the inevitable. Getting this education, asking questions and interviewing health care providers will all help you choose a path that best meets your priorities and matches your values. “Listen to your instincts about your care provider,” encourages Enich. After all, you will never forget your childbirth experience.

Tera Schreiber served the birth community as executive director of Great Starts Birth & Family Education, and is proud of the Puget Sound area’s history of women taking charge of their birth experiences.


Do your research: The Coalition for Improving Maternity Services (CIMS) publishes a list of 10 questions that women can ask when considering birth services. Visit Mother Friendly; click on “free documents and downloads.”

Pacific Association of Labor Support 

Doula Match

Midwives Association of Washington State

Midwives of Washington 

American College of Obstetricians and Gynecologists 

Washington State Medical Association 

More about midwives here and also here.



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