Natural Birth

doula vs birth center

My last post (about whether or not a doula is worth it) got me thinking. 

Which would you choose:

A) Laboring at home with a doula who then accompanies you to the closest hospital (10 minutes away) where the nurses are uncomfortable with natural births and the OBs are used to delivering women on the bed.  You expect resistance from the staff about laboring positions, your ability to do it without pain meds, etc.

 B) Delivering at a well-regarded birth center 45 - 60 minutes away where the midwives are comfortable with natural birth even though there is a high (almost 30%) transfer rate to the hospital across the street.  No doula. 

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Re: doula vs birth center

  • ooh, good question.

    That birth center transfer rate is interestingly high - usually they are below 5%.  I would go Option A (but maybe I'm biased since I'm pushing for a natural delivery in a hospital).  If you have your doula with you, she will really be an advocate for you.  She will help keep the hospital staff away when they don't need to be there, and ensure you get the care you want.  I think if you are really confident in your doula, she will stand up for you in that hospital setting and make sure you have the birth you want.

    Having said that, I think you have two great options and will be well taken care of in both of these settings... you can't really go wrong here.

  • A couple of questions:

    1. Are you SURE that the hospital staff is 'uncomfortable' with natural birth?

    2. Is the cost an issue?

    3. Which hospital would you be transfered to in the second scenario? (i.,e., how far would it be from the birthing center and what would the position of the staff be there on other decisions you might later have to make regarding medical interventions?)

    I have had two unmedicated, natural births at two different hospitals. Neither are regarded as super-friendly towards natural birthing, but I had NO resistance from staff members in regards to my wishes.

    With the first birth, I had a doula, but didn't 'need' her to defend my wishes or anything. With the second, it was just me and my husband, and everything was totally fine.

    With my first birth, the hospital was five minutes away. With my second, it was 40 minutes away (would have been more if there had been traffic). I was SO nervous about being so far away from the hospital the second time that I got there much earlier than I would have wanted and didn't really have the 'relaxed experience' that I had had with my frist birth and wanted to have again (i,e., I didn't have time to labor at home because I rushed to the hospital as soon as my water broke, even before contractions started).

    As you can see, I'd probably be more in favor of the first scenario, based on my experiences... but that is just my opinion.

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  • noditonodito
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    image Arielle27:

    A couple of questions:

    1. Are you SURE that the hospital staff is 'uncomfortable' with natural birth?

    2. Is the cost an issue?

    3. Which hospital would you be transfered to in the second scenario? (i.,e., how far would it be from the birthing center and what would the position of the staff be there on other decisions you might later have to make regarding medical interventions?)

    At the close hospital tour this week, I noticed the rooms were pretty small and when I asked whether women were allowed to deliver in a position other than reclining the nurse kind of looked at me blankly and said, "I think we have a squatting bar around here somewhere.  I'm not sure whether it is.  No one uses it.  Everyone gets an epidural."  I just didn't get the lip service to "we'll do natural if you want" I was expecting.

    Cost is definitely an issue.  Doulas around here cost about $1000.  Experienced ones even more so.  Students are less.  I think my husband could be convinced to bring me to a birth center, but I would have to really try to persuade him about the doula.  Fact is, I might be looking at labor at home with no doula and birth at close hospital vs birth an hour away at birth center.  The hospital close to the birth center is right across the street and I know very little about it except that it is well-regarded.

    I'm mostly still trying to work all this out in my head.  I wanted a natural birth with my first but was induced and scared and requested an epi.  We're in a new location now and I'm already in my third trimester so I would have to switch providers to deliver at the birth center.  And while I want to go natural, I'm not sure I trust myself enough to refuse meds if I'm in a lot of pain in a place where they are routinely given.  At my last delivery it felt like I whispered "epidural" and a second later the anesthesiologist was by the bed.  I thought it might be helpful and encouraging to be with providers who were saying stuff like, "You can do this, you're doing great." as usual course, but I also hate the idea of laboring in some place other than home and the long drive scares me.  My husband works near there, so he would need to drive home to pick me up and bring me back down town.  We'd also need to figure out what to do with our toddler.

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  • Why is there transfer rate 30? I'd be more inclined to chose the birth center but the high transfer rate is interesting.
  • Our plan is to stay at home with doula as long as possible and then drive to hospital about 15 minutes away. So, I'm biased.  

    Might there be a modified option 1 for you? For example, working with a mw or NB-friendly OB who will honor your wishes with a hospital birth? For example, our hospital requires that one be "on the bed" to deliver -- but they provide squat bar upon request and actual position is up between mom and OB. 

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  • That seems like a high transfer rate. Probably A. I think more and more hospitals are open to women's desires to birth naturally nowadays. I'm going to a hospital with a somewhat high csection rate but am seeing midwives. I planned on a birth center birth last time but I had a transfer to the same hospital I'm using this time and thought my experience was much better than I had anticipated. During my time at the birth center my doula was with me the entire time. The midwife came and went, due to another woman in labor as well so it wasn't a guarantee the midwife was with me constantly. My doula was much more helpful than the midwife in my opinion.
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  • I would have to choose option A by default because I had a pretty fast first labor and expect my next may be even faster. A 60 minute drive is outside of my comfort zone. If that wasn't a factor I would choose a birth center 100x over a doula, especially if the hospital is as you describe.
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  • I would say option A.  How do you know the nurses and staff are against natural birth?  Hospitals seem to get a bad wrap for being intervention pushy.  However, many are trying to change and become more accommodating to natural birth.  I delivered in a hospital with an OB.  My nurse was amazing, knew my doula, and very supportive of natural birth.  My OB was also very supportive but I choose the practice because they are very pro natural birth.  The transfer rate at the birth center seems very high. For me it is way to high and I would not be comfortable with it. 

    ETA: The nurse on the tour was probably not informed or educated on natural birth.  My Bradley instructor recommended  asking for a natural birth friendly nurse when checking into the hospital.  We did that as the doula we used knew a few nurses at the hospital who were pro natural birth.  We ended up with a great nurse because of that.

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  • Can you ask why the transfer rate is so high? Is that first time moms or overall? How many of those are emergencies, how many are mom's choice? How many end in cesarean or induction?

    As for the first choice, can you afford a more experienced doula with experience and success at that particular hospital? 

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  • I would be choosing B, but understanding that the high transfer rate is likely because women in long labours are so close they can taste the drugs and easy pain free labours, so if I was in active labor I would have a hard time not hauling ash across the street for an epi with no regard to my birth plan lol I would have a doula for sure, they can cheer you on, remind you why you want no interventions etc.
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  • image nodito:
    image Arielle27:

    A couple of questions:

    1. Are you SURE that the hospital staff is 'uncomfortable' with natural birth?

    2. Is the cost an issue?

    3. Which hospital would you be transfered to in the second scenario? (i.,e., how far would it be from the birthing center and what would the position of the staff be there on other decisions you might later have to make regarding medical interventions?)

    At the close hospital tour this week, I noticed the rooms were pretty small and when I asked whether women were allowed to deliver in a position other than reclining the nurse kind of looked at me blankly and said, "I think we have a squatting bar around here somewhere.  I'm not sure whether it is.  No one uses it.  Everyone gets an epidural."  I just didn't get the lip service to "we'll do natural if you want" I was expecting.

    Cost is definitely an issue.  Doulas around here cost about $1000.  Experienced ones even more so.  Students are less.  I think my husband could be convinced to bring me to a birth center, but I would have to really try to persuade him about the doula.  Fact is, I might be looking at labor at home with no doula and birth at close hospital vs birth an hour away at birth center.  The hospital close to the birth center is right across the street and I know very little about it except that it is well-regarded.

    I'm mostly still trying to work all this out in my head.  I wanted a natural birth with my first but was induced and scared and requested an epi.  We're in a new location now and I'm already in my third trimester so I would have to switch providers to deliver at the birth center.  And while I want to go natural, I'm not sure I trust myself enough to refuse meds if I'm in a lot of pain in a place where they are routinely given.  At my last delivery it felt like I whispered "epidural" and a second later the anesthesiologist was by the bed.  I thought it might be helpful and encouraging to be with providers who were saying stuff like, "You can do this, you're doing great." as usual course, but I also hate the idea of laboring in some place other than home and the long drive scares me.  My husband works near there, so he would need to drive home to pick me up and bring me back down town.  We'd also need to figure out what to do with our toddler.

    The answers given at the hospital sound disappointing, but it could just be the person you spoke to. Can you call to speak to someone else in the ward?

     As for the cost, isn't a birthing center even more expensive than a doula? It is in my area (Los Angeles).

    It kind of sounds like the first option you have might be better for you (I.e., the doula), considering all of the factors...

    In any case, good luck! I hope your experience is what you are hoping for in either case, and of course the most important thing, that everyone is healthy!!

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  • I say option A because of being closer, having and keeping your doula with you and already being at the hospital. Birth center would be nice, but I wouldn't want to be that far away and go without a doula. Just be firm and very assertive at the hospital.
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  • Lurker jumping in here but I'm also in Boston, so I'm 99% sure I know which birth center you're talking about (CBC?).

     I will be delivering there in a few weeks and I absolutely feel comfortable with that even though the transfer rate is high. They are very strict with their guidelines (for legal/insurance reasons, from what the midwives told me) and will send you over to the hospital if your blood pressure gets too high, for instance - in most cases it is not an emergency transfer and you can either walk yourself over or they wheel you over in a wheelchair. 

     I've been seeing a midwife at this birth center since the beginning and I can't say enough good things about them - I can't even imagine having this baby anywhere else. We did end up hiring a doula but even if we didn't have her, I would still go to the birth center, no question. 

    A friend of mine was at the birth center and got transferred to the hospital and she still had a wonderful, natural birth experience - from what I've heard the hospital that the birth center is affiliated with is much, much more natural birth friendly than any other hospital in the Boston area.  

    Whatever you decide, good luck! And feel free to PM me if you have specific questions about the birth center! 

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  • I have a question. Do the midwives at the birth center have attending privileges at the hospital across the street? If yes, then I think that would be a big factor in choosing the birth center, at least for me. They may transfer at a higher rate because they're being extra cautious or because some moms know they can get an epidural so close. You should ask them. But if you get to have your baby with a practitioner who is experienced with and supports your desire for a natural labor AND is there the whole time - wether you're in the birth center or the hospital, that seems like a big plus. 
  • We are doing a hospital birth with a doula (hopefully- we just decided this and are on the search now). Yes, they're expensive but as you said, you can get students for less. Generally, all the student doulas have completed their training but they just need to finish certification (which, if you look up what's needed on DONA, is relatively extensive actually). The person who taught our childbirth class is a very experienced doula (300+ births) and she said that honestly, it's personality and compatibility that are more important than the number of births attended. So, we decided to look into the lower tier doulas to see what we can find! Honestly, if I had known this I think I would have skipped the expesive childbirth class and just hired a doula instead. Oh well, the more you know!

    I had a friend who gave birth at a birth center and she didn't regret not having a doula because the staff there were so supportive. I've had another couple tell me they really wish they had a doula for their hospital birth. It's really up to you and your comfort level.
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  • For me, definitely the first option.

    I've had two unmedicated births in two different hospitals, both of which supposedly have a high c-section rate and neither of which are necessarily pro-natural birth.

    I had NO problem with any staff member regarding my choices (to get into the shower, intermittent monitoring, no drugs offered to me, etc), and actually felt very supported in both situations.

    In the first birth I had a doula, I did not in the second.

    Personally, I felt very comfortable in the hospital setting because I didn't want to worry about the what if scenarios and I was open to interventions and medications if I felt I couldn't handle something or if something was medically necessary. But that is just me.

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