Birth Justice: Where You Birth

Everybody deserves pregnancy care that centers them and makes them feel safe. Unfortunately, many families face barriers to accessing the care they deserve. As we know families of color, queer folks, those with disabilities and those with less economic power are all subject to disparities in the medical care they receive. While research has shown that, “obstetric racism is a threat to positive birth outcomes… birth workers including midwives and doulas, mediate obstetric racism and stratified reproductive outcomes" (https://doi.org/10.1080/01459740.2018.1549389). This means that midwives and doulas are doing something notably different than hospitals and research is showing higher rates of safety and satisfaction with these births. Because of obstetric racism and medical trauma a standard hospital birth may not feel like the safest space for all families to give birth. This article aims to share all of the places families in Santa Cruz can birth and how these spaces vary in the care they offer.

Typically folks choose to birth in one of three places, at home with a home birth midwife, in a hospital with obstetricians and nursing midwives, or in a stand alone birth center with midwives and other birth attendants. Here in Santa Cruz we have two hospitals available, Sutter Maternity and Surgery Center, and Dominican Hospital Birth Center. We are also lucky enough to have an independently owned birth center, Full Moon Birth and Family Wellness Center, run by Sunshine Tomlin LM (http://www.fullmoonbirthing.com).

The models of care are different between hospitals and midwifery care. In the medical model, the physician is of primary responsibility, meaning they guide and prescribe your care. At both Sutter and Dominican the care provider you see prenatally will be the same, however come time to birth midwives and OB’s work in rotation and you will receive the provider present at the time you arrive. You will receive standardized prenatal care. All clients receive the same number of visits and the same types of testing and monitoring. There are also online portals where you can ask your providers questions throughout your pregnancy (https://www.sutterhealth.org/smscsc).

The midwifery model, however, views the parent as the primary responsible party for their own well-being and the well-being of their fetus. If you choose a home birth or Full Moon, your attending midwife will offer more prenatal visits with personalized questions and more in depth care. This is meant to offer you childbirth education and better understand your goals for birth. Conveniently these visits are in your own home or the comfort of your providers office. To deepen support, midwives often offer 24//7 access to call or text them with questions related to yours or babies health.

When it comes time to labor at Sutter or Dominican you may be offered pain medications, an epidural, inductions and other medical interventions as your provider sees fit during birth. With birth at home or in a birth center many of these interventions are swapped out for natural modes of pain management. Some of these include doula support, massage, heat therapy, birth tubs, hypnobirthing, movement and position adjustments, as well as breath work to move through contractions. Many midwives will still offer IV’s and can perform sutures to repair perineal tissues if needed. However, if a client needs medications or other interventions to achieve birth they will be transferred to Sutter or Dominican to receive full spectrum medical care.

Each family deserves to know their options and choose the place that make them feel safest. Below is a chart so that you can visually compare the offerings of each birth place in Santa Cruz. Once you have chosen the place, you can begin choosing the ideal care provider serving that location. If you are curious about providers in the area, please reach out for referrals!

Locations:	Home Birth Midwives	Sutter	Dominican	Full Moon Birth Center
Who can birth here?	Low risk pregnancy, pregnant with one baby, delivering after 37 weeks and before 42 weeks	Low risk pregnancy, multiples, delivering after 37 weeks and before 42 weeks, multiples	High risk, delivering before 37 weeks, or having multiples, as well as low risk births NICU available	Low risk pregnancy, pregnant with one baby, delivering after 37 weeks and before 42 weeks
Care Team	Team of midwives, doulas, birth photographer etc. that YOU chose	Large team of nurses and staff to support, providers work in rotations	Large team of nurses and staff to support, providers work in rotations	Team of midwives, doulas, birth photographer etc. that YOU chose
Prenatal Care	More frequent prenatal care with your provider (up to 1x week after 30 weeks) *culturally competent, personalized & extended*	Prenatal care with your provider	Prenatal care with your provider	More frequent prenatal care with your provider (up to 1x week after 30 weeks) *culturally competent, personalized & extended*
Medication/Pain Management	IV offered if needed, movement, tub and doula support for pain management Induction and epidural NOT available	Medications for pain, epidural, IV, cesarean available	Medications for pain, epidural, IV, cesarean available	IV offered if needed, movement, tub and doula support for pain management Induction and epidural NOT available
Birth tub/Shower	Birth tub can be brought to your home	Birth tub available in your delivery room	Birth tub available in separate spa room (not always available)	Birth tub available in your delivery room
Food/ Eating	Kitchen always available for doulas and partners to cook for you throughout labor	Hospital meals available at times of service, restricted access to eating during labor	Hospital meals available at times of service, restricted access to eating during labor	Use of kitchen to prepare food throughout labor
Continuity of Care	Possibility of transfer to Sutter or Dominican if needed	All medical care can be attended to here	All medical care can be attended to here	Possibility of transfer to Sutter or Dominican if needed
Postpartum Care	Stay in your bed and receive immediate postpartum care from your midwives and doulas in the first day(s) postpartum	Stay in the same room you delivered in, immediate postpartum support from staff, extended stays available if needed	Moved from delivery to separate postpartum room, immediate postpartum support from staff, extended stays available if needed	Stay in the birth center until you feel ready to head home (2-24 hours generally) while receiving care from the midwives and doulas available