THE vast majority of American babies are born in hospitals. And there the options are expanding. ``There's a lot that's up for discussion today,'' says the director of the birthing unit at one large suburban hospital.
``Couples can decide whether they want to deliver with a midwife or a physician.
``And they can choose how they want to labor - whether they prefer natural childbirth, or whether they want medication and IVs and all that.
``Of course, things can change, and we sometimes have to rewrite the script at the last moment,'' Ruth Allen says.
``But generally, there's much more respect today for the couple as decisionmakers, as partners working with the obstetrician, and there's much less of the old `It's-for-her-own-good' paternalism.'''
Ms. Allen is nurse manager of the birthing unit at South Shore Hospital here in this large commuter town near Boston.
During the past 20 years, she has seen attitudes of attending physicians change, as women have become more outspoken about their own preferences.
``It's changing because of consumer pressure,'' she says of the hospital's approach to birthing. ``Older, better-educated women are coming in to have babies today - women who have read up on the subject and are able to articulate what they want.''
Ninety percent of the couples who have their babies delivered at South Shore Hospital attend childbirth classes for eight weeks.
Husbands are urged to take part in the birth process, and South Shore was one of the first hospitals in the country to allow them to be present in the delivery rooms for Caesarean births.
Couples may opt for the birthing rooms or the traditional labor and delivery rooms, which are equipped with fetal monitors and other technology to aid in deliveries and any obstetrical complications if they should occur.
But whatever the environment, the nursing staff is there to support them and help them feel comfortable.
``We want to give them as positive a birth experience as we can,'' says Allen, ``and sometimes that can happen in unexpected ways. For instance, we often find that the women who want a lot of medication surprise themselves by how well they do without it.''
Birthing centers generally accept only ``low risk'' women - those in good health and under 40 years of age, and hospitals tend to accept anyone who applies.
Allen feels that ideally, couples should have a range of settings available for a positive childbirth experience.
``I don't think there's one optimum place for everybody, but I do feel that everybody should be able to elect where they are most comfortable,'' she says.