FTM; 36wk+4 and considering OB change

H&H2014

Hi all,

For my entire pregnancy i've been planning a med-free birth. It wasn't until recently however, that I realized how generally unsupportive the hospital environment is of this approach. I'm not sure why I didn't get it until now - but now my eyes are wide open.  Although I'm at a progressive hospital that doesn't do episiotomies or vacuum, they of course have the standard protocols of pushing the pit if they don't think things are progressing, etc. 

I'd much rather deliver in a birth center but I'm on the Peninsula in San Francisco Bay area and would have to cross a bridge to get to either (one is 1.5 hrs away, the other 45 min on a good day not at rush hour).  If I really pushed it my DH would support, but he's standing pretty firm he thinks it is too far to go.

My OB is in a practice, so basically you can get anyone when it comes time to deliver. I saw an OB from there last wk that I absolutely hated. When I asked what support they give for alternatives to pain meds she answered with "Well, there is no magic potion. Hot shower or him (points at DH rubbing your back)".  I've been searching for another OB that is more "dedicated" and would make every attempt to attend the birth but I haven't found that (do OBs not do that anymore??). 

I've armed myself and my partner by being as knowledgeable as possible. We are also hiring a birth doula (after my original OB said "you don't need one, our nurses are really good").  It was a  late decision so it's hard finding someone with availability has been a challenge. We are going with some junior doulas which to be is better than no doula at all. 

Anyway, I'm trying to decide if I should change OBs or consider the far-away birth centers.  Am I going overboard? DH feels the education & doula are enough. I feel like this is the most important thing I've ever gone through or will potentially ever do and I don't want it to be in an environment that half-heartedly supports what I want or is going to be negative or argumentative. 

Any thoughts or advice or shared experiences are greatly appreciated.

Thanks in advance!

sschwege

I think you should trust your intuition above all else.  Nothing you have posted seems like a huge read flag to me, but I wasn't there I didn't hear the tone of the conversation.  

Do you know their c-section and epi rate?

What kind of monitoring do they support?

When do they recommend induction if your EDD comes and goes?

Has your doula said anything about this hospital or doctors?

Will your doula come to your house and encourage you to labor at home?  That to me would be key at any hospital birth.

I really don't know what to tell you, if that voice is telling you that something is off, listen to it.  I would at least be asking more questions.  To answer your question a BC that was 45 + min a way doesn't sound too, too, bad.  Particularly since laboring at home wouldn't be as important, since you know you would be in a supportive environment.  But I'm not going to lie, laboring in the car is pretty miserable, and I was only in the car 15 or so minutes, but then again I was 6cm the first time and fully dialted the second, I'm sure that had something to do with it.

aylafsu88

IMO what the OB said is pretty reasonable. There is no magic potion to deal with pain and everyone has their own way of coping. She gave you two really good options that a lot of women find helpful. I stayed in the tub for most of my labor. I found hands and knees there to be the best way to cope with contractions.
Few OBs deliver all of their patients now and many are in practices. It is hard to have a life and be an OB so going into a practice really helps them with that balance. In my area many OBs and MW have gone into practice together. You can see a MW and they do all of the labor stuff unless something comes up. Then the OB can step in a do a C/S etc. It seems to give many patients a good balance of having an expert (OB) if a C/S is needed but the low interventions of the MW for routine L&D. Is there an option like this in your area where OB and MW practice together? 
IMO a 45 minute car ride would be to long. I had a high rupture and my contractions started right away at 10 mins apart. It was hell dealing with the 10-15 min car ride I had to get to the hospital. However, since you are going to a BC you could always go right away and not wait around at home like I did.

I just wanted to say that there are natural birth friendly nurses out there. I had one for my L&D. She was amazing and did not even push the Heplock on me. My doula worked at the hospital and had me request that particular nurse since she had worked with her before. So it is possible that you could have a supportive nurse.

Overall, I think you should go with your gut. If you are not comfortable with the practice then change, it is your L&D and you need to be comfortable with your provider. GL!

stephl3055

The nurses really play more of a part in your birth than the OB, I think.  I had 2 nurses during my labor and both had read my birth plan and were so excited I was trying to go natural.  They were really great.  I had to be induced (GD), so I did have some interventions I would've otherwise not wanted.  The nurse that was with me the longest had me try all these different positions and (privately) gave me her opinion when my OB tried to push things on me she thought were unnecessary.

But yeah, my OB was another story.  I gave him my birth plan, which he said he would read (doubt he did) and include in my file that went to the hospital (he did this).  Every time he checked on me he wanted to do something to speed things up.  He wanted to break my water.  I said no and it broke on it's own a few hours later.  I wasn't progressing, so he wanted to try an enema (nurse said that was really outdated and not necessary).  I said no and the nurse helped me with some positions.  In general he sucked and I wish I would've had a different OB.  But, he was easy to deal with and say no to.  I'm not sure how it would've been if the nurses were as pushy or had the same opinions.  

Aurora_Borealis

Most OBs, especially in large metro areas, work in a practice arrangement so you will be hard-pressed to find an OB who will be guaranteed to be at your birth. It would be difficult for a doctor with a busy practice to do this successfully.

That said, have you considered St Lukes in the SF Mission District? If you're on the Peninsula you wouldn't need to cross a bridge and it's easily accessible from both 101 and 280. They have a fantastic midwife/OB practice and are affiliated with CPMC and actively encourage natural birth.

runrinserepeat

Just my two cents, but I really didn't care at all that my OB wasn't there. The OB resident checked me twice, so I saw him for maybe 5 minutes total, and then the actual doctor came in to check me a final time and oversee pushing for about 40 minutes. That was it, they didn't really play a role in my experience (except that the OB resident told me I was complete before I was, but that's a whole 'nother story, and something I don't think I would have avoided had my OB actually been there that night).

As far as the drive, 45 minutes in the car sounds like the last thing I'd want, but it's really up to you and what you'll be most comfortable with. Most of the time, women who want a natural birth try to labor at home as long as possible before going in. I didn't leave until my water broke and my contractions were right on top of one another, and the 10 minutes car ride was almost unbearable.

H&H2014

Thanks ladies. I've since hired a great birth doula team and feel much more confident. They were all very reassuring that the hospital experience isn't as bad as it's made out to be.  I'm feeling much better - I just need to relax.

sschwege

H&H2014 said:

Thanks ladies. I've since hired a great birth doula team and feel much more confident. They were all very reassuring that the hospital experience isn't as bad as it's made out to be.  I'm feeling much better - I just need to relax.

That sounds like the perfect solution!  Thanks for the update!