From the moment Hannah Milot found out she was expecting her first child, she knew that giving birth in the traditional way was not something she wanted.

“I have heard from friends about their experiences at hospitals, and knew I wanted something else,” Milot said over email.

Milot decided to use a birth center to help her facilitate a more natural and holistic approach to pregnancy and labor. She did have to make a trip to the hospital to check on the baby when her due date came and went, but that visit only reinforced her desire to give birth in a natural setting.

“The hospital was a very stressful experience,” Milot said. “At first, they wouldn’t let my husband in the room and then they tried to pressure us into inducing for no reason. Both my baby and I were perfectly healthy.”

Milot went into labor naturally soon after the visit and was brought into the birth center. She was allowed to deliver the baby mostly on her own while her midwife—a professional specifically trained and certified to guide and monitor a natural birthing process—checked on the heart rate of the baby periodically.

“The lights were off and they had candles lit,” Milot said. “It was a beautiful experience.”

Most people in the United States only consider giving birth at a hospital, but some expectant parents like Milot are looking for a different way to bring their children into the world.

Traditional hospital births are undoubtedly still the most popular, with about 98% of births in the country conducted at a hospital, according to recent data from the California Department of Public Health.

Births through more natural methods, however, have been gaining popularity in recent years. Department of Public Health data shows the percentage of births happening outside of hospitals has doubled since 2007.

The main advantage of hospital birth is safety—having a plethora of resources within close reach to minimize the consequences of any of the potentially serious complications that can arise during labor. Medications can be used to help speed up a birth and mitigate intense pain, and most women opt for this safety net.

But there are some who want to avoid giving birth at a hospital for a number of reasons, including past experiences with hospital births, a disconnect with doctors as a whole or simply because they want to welcome their child into the world in a calmer environment. In Long Beach, expecting mothers have several options to experience a more natural birthing process.

The safest option for giving birth outside of a hospital, according to experts, is a freestanding birth center, a facility equipped with beds and other tools. There were just under 400 accredited birth centers that are not directly attached to the hospital as of 2020, where mothers can experience a more holistic birthing journey.

Long Beach Birth Center, where Milot gave birth, is one such facility, located 1224 E. Wardlow Road near Signal Hill. Owner Meredith Bowling decided to open a birth center after having her own difficult experience at a hospital.

“Coming away from that, I realized why we need another place for women to give birth, especially if their pregnancy is low-risk, and there’s nothing wrong with them,” Bowling said.

Birth centers limit their use of medication in favor of a more natural process, Bowling said, and replace nurses with midwives, who are trained to oversee the natural birthing process and handle many of the common complications one sees, including a neonatal resuscitation training program done every two years. Midwives are accredited by the American Midwifery Certification Board.

Long Beach Birth Center has four midwives and five “birth assistants,” also known as doulas.

The facilities themselves are heavily monitored and accredited by the Commission for the Accreditation of Birth Centers to maximize patient safety.

The midwifery model of care is centered around the idea that labor is a natural human process that shouldn’t require significant intervention from medicine. Specific knowledge and procedures are laid out to ensure the birth is carried out as safely as possible, but facilities like Long Beach Birth Center have medication on standby for emergencies.

During labor, induction and medication are replaced by more natural solutions like position changes and the use of methods like acupressure to relieve pain. Midwives are extensively trained to respond to common complications but may transfer a patient to a hospital should they need additional resources and specialized care.

Patients are examined regularly during prenatal appointments over the course of the pregnancy, similar to traditional hospital visits. Midwives are trained to look for any number of potential risk factors that may cause complications during a natural birth.

Bowling said complications are rare because of the intense evaluation required to be cleared for a natural birth outside a hospital setting. These appointments are far more personalized and detailed than one might experience at a hospital.

Risk factors that could complicate a birth center experience range from the patient’s medical history—like if they’ve had a cesarean section or given birth prematurely in the past—to issues related to their current health such as having diabetes or high blood pressure. Certain circumstances related to the fetus, including position or the number of fetuses, are also signs hospital birth is needed.

But for healthy patients like Milot, giving birth at a center can be a much more peaceful and welcoming experience than the fluorescent lights and loud machinery at a hospital.

“A hospital is cold and bright and loud, with lots of people running around,” Milot said. “At the birthing center, you have the whole place to yourself—just you and your birth team.”

Milot explained the welcoming feeling was a key part of her experience with the birth center, recalling small details like the comfortable couches she waited on for her prenatal appointments.

For an even more intimate experience, midwife services can be enlisted at a patient’s own home. Popularity of home birthing saw a noticeable bump amid the COVID-19 pandemic, according to the California Department of Public health.

Midwives are able to build a deeply personal connection with their patients, allowing them to be more in tune with the health and experience of the individual. Jessie Rockwell, owner and sole midwife of Long Beach-based home birth service Gold Soul Midwifery, explained that this allows midwives to provide broader support.

“In the standard obstetrical model of care, they are usually just looking at the physical part of pregnancy … but so much more needs to be evaluated,” Rockwell said. “We are talking about truly the most intimate moments of someone’s life, so we need to make sure emotionally and mentally they’re in a good place, because those things matter just as much as the physical stuff.”

Intensive screening to ensure that a patient is a suitable candidate for home birth is vital, Rockwell said, as the options for emergency intervention are even further limited than at birth centers.

“A lot of people, especially those that have had previous hospital-based care, are always very shocked about how detailed the appointment is,” Rockwell said of her meetings with patients.

The American College of Obstetricians and Gynecologists states that while home births are a viable option, it does not believe they meet the same standards of safety that other birth settings offer.

Some studies have found that, while home births correlate to fewer interventions during labor, they are also associated with an increased risk for serious complications, including the onset of seizures and other neurological dysfunction in the baby during the first four weeks of life.

Despite its opinion, the college has acknowledged that patients have the right to make medically informed decisions about where and how they give birth. The topic, however, is still debated by experts as, according to ACOG, there has yet to be “adequate randomized clinical trials of planned home birth.”

These factors make a hospital trip in response to complications more likely than in a birth center, but home birth providers like Rockwell ensure that patients know the risks involved.

“There are a plethora of potential complications, even with a low-risk pregnancy,” she said. “I don’t promise a home birth, I am promising to keep everyone safe.”

After safety, comfort is one of the most important aspects of birthing naturally. Water birth is a natural method offered at Long Beach Birth Center as well as by various home birth services in the city. As the name suggests, patients sit in warm water during the birthing process.

Jhoanna Galvez, who runs Malaya Midwifery out of Long Beach, said having both options—water and bed—readily available is important because many patients in labor decide where they would prefer to give birth in the heat of the moment.

Currently, no studies have shown a direct benefit for water birth, but natural birth providers claim that many of their patients attest that the method is good for pain relief and relaxation.

“Water is a relaxing place,” Galvez said. “When you get into a warm bath or water, you’re able to relax, and that’s a huge part of being able to give birth.”

Postpartum care is another important step in the process for both birth centers and home birth providers. Long Beach Birth Center, Malaya Midwifery, and Gold Soul Midwifery each provide six weeks of support after birth for both the baby and parent to ensure they remain healthy.

The extra work these providers put in reflect the overall message of the midwifery model of care: being supportive and building a personal connection with patients to provide a natural and intimate experience.

“I really think that when you craft that relationship,” Rockwell said, “it makes such a difference in the birth.”

Christian May-Suzuki is a reporter at the Long Beach Business Journal.