Kitsap Birth Options – Birth Center

In the previous blog post, Kitsap Birth Options – Hospitals, we explored the local options for families who plan to give birth in the hospital.

In this post, we will explore the option of a freestanding birth center birth experience. There are several birth centers serving Kitsap County families, but only one that resides within our community. You may choose from the Salmonberry Birth Center, located in Poulsbo and just a few minutes away from Harrison Memorial Hospital, or in Tacoma, The Birthing Inn, just blocks away from St. Joseph Medical Center. For this post, we’ll talk about our homegrown birth center, Salmonberry.

Birth Center Options

Both of these beautiful birth centers offer large tubs in which you can find pain relief during your labors, and go on to have waterbirths, should you chose to do so. Birth centers do not offer medical pain relief (narcotics, epidural, etc.) but there is soon to be nitrous oxide (laughing gas) offered at Salmonberry, which has shown a lot of success, safety and the preference of many mothers, in other communities where this is offered. Salmonberry will be the first venue in Kitsap county offering this service, starting December 1!

General Birth Experience

During your labor and birth at a birth center, your midwife will strategize with you on when to arrive at the center. Unlike hospitals which generally encourage you to arrive somewhat early so that you can be assessed, and then sent home if needed, your midwives will stay in close contact with you during early labor, so that you will arrive in active labor. You’re encouraged to spend early labor at home where you are more comfortable and can eat, sleep, toilet, have visitors, and pass the time that can often be quite lengthy, and then come to the birth center when things are more serious.

You are encouraged to move throughout your labor, or rest in the large bed in your private room. There is a large jacuzzi tub that may accommodate both you and your partner, and you may bring food and eat freely throughout your labor to keep your stamina up. The midwives will monitor your well-being by checking your vitals, tracking your labor progress, and listening to your baby’s heart rate frequently through the use of dopplers. You can push your baby out in the position you prefer, whether on the bed, or in the tub.

You will stay after the birth for up to six hours or so, and then will be released home with your baby.  The midwives will follow up with you when your baby is 24 hours old, and four days old, at your home. Your baby will be discharged to the pediatrician you’ve chosen at that time, and then will see your midwives for the last visits at 3 and 6 weeks, at which time your care with their team will be closed out. Salmonberry midwives will perform the metabolic screening, hearing tests and other newborn screens during your care with them.

At Salmonberry, your birth will be attended by one of the 3 midwives in the practice, a birth assistant, a student, and whomever you bring for your support team. While this might seem like a lot of people, the midwives are sensitive to give you, your partner, doula, and anyone else with you, space to create the birth environment you desire, to move freely, and be supported by the people closest to you, whilst watching over the progress of labor and safety of you and your baby. In an emergency, all hands are needed in order to manage a complication or work with providers at the hospital for transfer of care.

Should you transfer to the hospital, your midwife and student midwife will accompany you along with your birth team, if they are available, and you desire it. Depending on the circumstances, they may continue the postpartum care format outlined above after you are discharged from the hospital and depending on your care needs at that time.

While transfers are uncommon, most often, clients transfer from the birth center to the hospital for pain relief and for stalled labor. In other words, in need of support that the birth center can not provide, but not necessarily for emergencies. In emergencies, the midwives are very skilled at stabilizing both mother and baby until they can be transported to the hospital for more advanced care.

Choosing a midwife for your birth center birth

The state of Washington licenses midwives as clinical providers who can care for you throughout the course of your pregnancy, birth and postpartum period. Midwives bring life-saving drugs and tools to every birth they attend, whether at home or in the birth center. They can manage postpartum bleeding, resuscitate a newborn who is having trouble breathing, and more, keeping mother and baby stable until a transfer is made to the hospital for more advanced care. It’s a great system that works well for families who experience an unexpected complication, to ensure safety.

Birth centers are operated generally, by midwives. Washington state has either certified-nurse midwives, or licensed midwives. The pathways to licensure for each of these are different, and as a result, there are some differences in the ways each kind of midwife can practice in our state, but both types of midwives have demonstrated their skills and abilities to ensure the safety of both mother and baby through the pregnancy, birth and postpartum.

Salmonberry birth center has their own midwifery team, so you will work with possibly, all of the midwives in the in-house practice, and the midwife on call when you go into labor will attend your birth. Washington law prohibits birth centers from accepting patients who have had previous uterine surgery, so for clients exploring their VBAC options, unfortunately, a birth center would not be an option for you.

If you desire an unmedicated birth, consider exploring the option to birth in a freestanding birth center or at home. Both are safe options for low-risk pregnant people, and the birth centers that serve local families are beautiful venues in which to have a baby. We recommend that even if you aren’t considering birthing outside the hospital for this birth, make an “informed no” by getting your questions answered, and then deciding with knowledge.

Next we’ll be exploring the option of homebirth in Kitsap County. Stay tuned!

Kitsap Birth Options – Hospitals

Here in Kitsap County we enjoy many options for low-risk, healthy clients who are looking into venues where they might like to give birth. This post is applicable to clients with every health situation; hospital birth is where most people will give birth and it’s the safest place for high risk clients. I hope you find this information helpful!

When we work with clients who are trying to figure out their options, our first question is, “Beyond safety,  what are your birth goals?

Knowing the ultimate destination in which you are headed helps us to ascertain what options might be most helpful to you. Do you want to have an epidural at a certain point of labor? A hospital is the place for you. Would you like to have more control over your experience but don’t want to deal with having people in your home? The birth center would be a great option for you. Feel most safe and comfortable birthing at home? Midwifery led homebirth might be the option for you!

Let’s break down what those options look like here in Kitsap County.

Hospital Options

We have two hospitals serving Kitsap County, Harrison Memorial Hospital for civilians and Naval Hospital Bremerton (NHB) for military families.

Clients birthing at Harrison will choose from The Doctor’s Clinic, Women & Children,  right inside the hospital, or Kitsap OB/GYN just a few blocks away. As a patient in one of these practices you will choose the provider you wish to work with and they will attend most, if not all of your prenatal visits. The physician that is on-call during the time you deliver will be the one to attend your birth. Some of the providers will make an effort to come to your birth even if they are not on call, but you aren’t guaranteed to have your provider at your birth. Harrison does not (yet!) support midwifery care but we are crossing our fingers that this will change!

Clients birthing at NHB will choose a provider and generally, work with that provider and their team throughout their pregnancy. When the time comes to deliver, your provider will make an effort to attend your birth, or the provider who is on call. This could be a certified nurse midwife, a family practice physician, or an OB/GYN, depending on what your care requires and who is available during the time you deliver.

General Birth Experience

During your labor, your nurses will attend your care and support you and your team, answer questions you have about your medical care and help you strategize, and liaise between you and your provider. Your doctor will visit once or twice during the day, and generally stays connected through updates by the nurses to what is happening during your labor. When you are pushing and the baby is crowning, the provider will come to catch your baby, take care of any bleeding or repairs, and then once again, you’ll largely be cared for by the nurses.

Each hospital has routine procedures they require of all patients birthing in their facilities. Some of these might include:

  • IV access via a saline-lock upon admission
  • Routine cervical exams at certain time intervals, and/or marked changes in your labor
  • Use of Pitocin routinely after the delivery to help prevent postpartum hemorrhage

During your stay, the staff does not remain in the room with you during your labor, they are oftentimes busy working with other patients as well. The nursing staff changes shift every 12 hours, so you will have a fresh face in the morning and late evening, every day.

Different hospitals have different amenities, from having midwives on staff or not, to things like labor tubs, peanut/yoga balls, telemetry units for mobile monitoring of your baby, even down to microwaves and refrigerators in your room, or in a common area, space for your support people to rest, etc. Both hospitals offer the gamut of pain medication options, have anesthesiologists/anesthetists on staff to serve your needs, and have operating room in case a cesarean is needed, as well as lactation staff for after the birth. Both facilities also offer childbirth classes, and may have other types of classes as well.

You will remain in the hospital for 24 hours after your uncomplicated vaginal birth, and 48 hours after your uncomplicated cesarean, and then will be discharged to go home with your baby. You may stay longer if you or the baby has a health issue. If your newborn is required to stay longer, you’ll be allowed to stay at the hospital as a “boarder”, which means you will have a room, and a stipend for one meal a day, but will not receive interaction from nursing staff as you will technically be discharged.

Neither hospital has advanced special care for your newborn; if there is an emergency that goes beyond their ability to care for your baby, they will be transferred to Mary Bridge Children’s Hospital in Tacoma, or Seattle Children’s Hospital, or Madigan Army Medical Center, respectively.

Choosing a provider for your hospital birth

All obstetricians are surgeons, and some OBs are more comfortable with unmedicated, active birth, than others. Some OB’s are more comfortable doing cesareans as an earlier intervention, than others might be. Some providers are very comfortable offering Vaginal Birth After Cesarean (VBAC) in low risk patients, or, as it’s known in the hospital, Trial of Labor After Cesarean (TOLAC), and some are less so.

If you and the provider you are working with are not a match, you have the right to change providers at any time in your pregnancy. The further along you are, the more challenging this might be as calendars fill up for due dates, so if you are feeling a disconnect or a lack of alignment in goals, don’t wait to interview other providers.

All of the providers serving families in Kitsap County, in the hospital and outside it, offer safe, licensed medical care for you and your baby. When you imagine your birth, beyond safety, what do you want that experience to feel like? How do you want to remember it? Use those questions to help guide you in your research on which provider, and which venue, is right for you.

Frequently Asked Questions

What does a doula do, exactly?

A birth doula provides information, encouragement, mentorship, and support to you and your family during the birth of your baby. If you think about learning a new skill, there will be a time of preparation, and a time to execute what you’ve learned.

What does doula care look like?

Prenatally, you have as many visits as you need to connect with your doulas and to help plan for your birth. When you go into labor, your doula will join you when you feel the time is right for more support, and will remain with you through the duration of the birth. For very long births, we might call in a back up doula so that we can rest and refresh. During the course of your birth, we might be sitting quietly near you, not speaking or touching you if that’s what works for you, or we could be playing music and dancing with you to get your baby out. Mostly, it’s a lot of well-timed and context-based information to help you make informed decisions, knowledgeably physical support that is relative to the stage of labor you are in, and emotional support for you and your partner along the way.

My partner will be at the birth, won’t a doula be in the way?

We know your partner is the expert on you! It’s our job to support your partner in supporting you, just the way you both envision. That varies from family to family, and we help fill the gaps between where your vision ends, and your partner’s vision begins.

Whether it’s providing information, demonstrating pain coping techniques, keeping watch while he rests, or working through unexpected changes, we are there to help you, help yourselves have the best birth possible. Your partner is the number one support person for your experience, and we are there to help, not get in the way or take over.

How do I choose a rate in the sliding scale?

Choose the rate that works for your family. That’s it! We give a sliding scale guideline of $800-$1300 within which you can choose, and the number is entirely up to you. Whether you decide to hire Laura or Kristina, you choose your rate, let her know what it is, and then send 50% with your contract to begin services. No haggling!

How many visits can I have with my doula before and after the birth?

Again, this is completely up to you; you are in charge. Support should feel supportive- we don’t want our clients worrying that they will ‘use up’ a visit if they need a little more attention. We will work together to decide whether your needs can be addressed by phone or email, or if a visit would benefit you more.

What is an independent childbirth class vs. a hospital class?

Hospital based classes, while free or low cost, are often-times more a primer of what to expect when you arrive at the hospital to give birth. Independent childbirth classes are aimed at informing you of all of your options without attachment to the outcome you choose (natural vs. medicated, induction, cesarean, etc.).

Independent classes not only help to inform you of the process, but also expose you to options you might not have considered. They are also many times, influenced by the needs of the parents present, rather than what can be a rigid curriculum aimed at suiting a broader audience.

There are merits to both approaches! If you’re interested to find out more about Taproot classes, click here.