TF: Could you say some more about alternative birth renters?

MW: Sure. They're a good example of hospitals being responsive to people who want more control over their own birthing experience. The alternative birth centers are often scheduled months in advance.

The labor and birth usually take place in a room down the hall from the delivery room. The family has a good deal of control over this room—they can decorate it as they like, play their favorite music, and have their kids and friends and family members present. So on the one hand, there are many of the benefits of a home delivery.

On the other hand, if any complications develop—if the baby starts to come out feet first, or if the mother or the baby are having any difficulty at all—the parents and the doctor or midwife have the option of zipping down to the delivery room in a few seconds.

TF: An obstetrician friend said that he advises prospective mothers to pick the hospital first, then pick the doctor.

MW: If you're planning a hospital birth, that's not a bad idea. Most hospitals have regular tours of the labor and delivery facilities for prospective parents. If you pick a doctor first, you're limited to the hospitals where he or she practices.

TF: You were saying that the changes in obstetrical practice here in Marin County over the last five years may foreshadow the kinds of changes we can expect in the country as a whole. How have things changed here?

MW: Five years ago the doctors here took a very interventionist, technical view of birthing. Deliveries were done in the hospital delivery room, period. Now we've become very family oriented. There's much more concern for the quality of the birth experience. A significant percentage of babies born in Marin last year were born at home. This certainly reflects a change in consciousness among health workers and potential parents alike. It also indicates the power consumer demand can really have.

Probably the most important reason for this change is that the families have put on economic pressure. They've said, "If you don't provide what we want, we'll go elsewhere. We'll do it at home, or in another hospital, or in another city." We've had people from all over the state coming here to deliver because they couldn't get what they wanted in their home town.

And what's happened is that the health workers and the hospitals have responded to the economic pressure. Obstetrical units are usually real money-makers for a hospital, but not unless they're active. When a few hospitals offered alternative birthing services, the staff at the ones that didn't ended up sitting around twiddling their thumbs. They were forced to offer those services. Now you walk in the door of any obstetrical unit, and you'll see this sign, "Family Birthing Experience."

HB: Yes, they talk about it all the time, about losing patients to other hospitals.

CB: How should a family go about choosing between a home birth and a birth in an alternative birthing center in a hospital?

HB: It really depends on the family—especially the mother. Very few alternative birthing centers offer an atmosphere as supportive as being at home. If they went to the hospital, they might feel too out of their culture to really relax and have the quality of experience they want.

MW: Some women have a terrifying image of the hospital, or see it as a place very foreign and scary. Heidi and I have seen that lots of times—where a woman who's in labor at the hospital has trouble because she can't relax. On the other hand, there are plenty of women who wouldn't be able to relax anywhere but in a hospital.