How far is too far to drive during labor?

jennypolkadots

We are trying to hammer down our birth plan and I am having a hard time deciding what I want to do. This is our first baby and, unfortunately, we live in Alabama where midwives are practically non existent. I am trying really hard to decide what is best to do. I feel confident about my decision for a natural birth and have been doing everything possible to make this a healthy pregnancy, but am a bit uneasy about the idea of being far from a good hospital just in case something happens to LO since this is my first rodeo. Healthy baby is our #1 priority.

Today we are going to check out a birth center in Chattanooga, TN. It would be about a 2 hour drive from home, more or less depending on traffic. We have some closer options, but I love the pictures I have seen of this home and that it is only 5 minutes from a great hospital with NICU, while our other closer options are 20 minutes from smaller hospitals. I would not be driving myself, my husband would be with me for all appointments and delivery. I am just worried how far is too far to drive during labor. Or what it would be like to make a 2 hour drive as one of our first memories with a newborn. On the positive side, it would be 2 hours closer for my family in Atlanta and keep family from home from planning to come wait on me to deliver.

Another factor is I have a family history of short labors. My mom had her first in 4 hours and me in 45 minutes. She and I have the same build and similar pregnancy so far. Other women on both sides have had babies pretty quick too. I know this doesn't mean that I will, but I don't want to be naive about the possibility. 

Opinions? Advice? Thanks!

mandi195

Every doctor is different. My OB does not want me any more than an hour from the hospital I will be delivering at during the last month. I'd talk to your midwife. 

Aurora_Borealis

Two hours is too far, IMO. Especially since 2 hours can turn into 2+ very quickly depending on weather, traffic, time of day and a whole bunch of other stuff out of your control.

Also, while all labors are different, I had a short labor and only the first 2.5 hours of it were 'early' labor. After that came 3.5-4 hours of major contractions. Then transition hit. Hard. The thought of having to be in a car for 2+ hours for any of that is, um, unappealing.

Another thing to consider is that shorter labors generally have fewer interventions simply because there isn't time. If you show up to the hospital fully dilated and pushing, no one is going to ask if you want an epidural. And other stuff isn't going to be such a big deal because you know you're so close to delivering. Like I actually wanted an IV for fluids because I was so dehydrated and the thought of drinking anything made me want to barf.

lovesazzie

I think that's too far. I have a family history of fast labors and arrived pushing or near pushing with both births to a birth center that is about 30 minutes from my house. I will be having #3 at a hospital closer to home because of it!

iris427

I can't think of anything worse than 2 hours in the car during active labor. I also wouldn't be comfortable having an OOH birth 20 minutes from the nearest hospital. That is a long time in an emergency. And you said they are smaller hospitals--how equipped would they be to handle an emergency cesarean if you needed one?

catsinawindow

2 hours would be too far for me.  Before my DD, I would have been willing to drive around an hour to get to a preferable birth location.  However, after experiencing a 15 minute car ride during labor and delivering my DD 30 minutes after arriving at the birth center, I don't even know if I would be willing to drive an hour at this point.  My labor with DD got intense fast and the car ride during labor was MISERABLE.

jennypolkadots

Thanks everyone! So the consensus across the board is 2 hours is too far This is how we feel, too but I wanted to keep our options open.

We met with the midwife at that birth center yesterday. She was great and the center is beautiful. It would be perfect if it were closer to home. She didn't seem concerned about the drive for us because she encourages mothers to come in early labor. She has several birthing bedrooms and is patient with delivery... Still, I totally hate the idea of making a 2 hour drive in labor, or for appointments, or with a newborn shortly after birth. And it is the most expensive options at about $5000 once we add in all the travel expenses.

So here are our other options:

Try my chances at a local hospital. I will have an iv inserted and constant fetal monitoring, it is policy everywhere here. It will be a real fight to get delayed cord clamping. The hospital is brand new and very nice, just about 10 minutes from home. All doctors who deliver there are in big practices on rotation (6-8 doctors) so you never know who you will get unless you choose induction. I would have a doula and labor at home as long as possible. Cost would be about $1500 including doula.

Go to a private hospital 20 minutes away and deliver with the only natural birth friendly doctor in my area. He is not so much a supporter, as just more "we can do whatever you want" about it. I would have a doula and labor at home as long as possible. Cost would be about $1500 including doula.

Use a local midwife practice and deliver in a birth house just past the state line in TN. The birth house is 20 minutes from a hospital, but the midwives have a great track record and very low transfer rates. Cost would be about $3500.

Drive 45 minutes to use a CNM in south Tennessee and deliver in her birth center. I have not been here yet. It is about 15 minutes from a hospital if needed. Not sure on the cost, but I may be able to file insurance with this center. Probably around $3500 also.

What would you choose? I just want to figure this out asap so I can start really planning for our birth. 

iris427

I'd pick one of the hospitals. Do you know if they would let you do a heplock, or if they have telemetry monitors?

Keep in mind that if the birth center is 15-20 minutes from a hospital, that does not mean you can have an emergency cesarean if needed in 15-20 minutes. If a serious sudden emergency happens, you may have a pretty significant delay in getting care.

jennypolkadots

iris427 thanks! It is a hard decision because I want every good chance at having this baby naturally and without being hooked up to all sorts of medical devices during the process. What I would prefer would be a midwife delivery in hospital but the only one in our area just retired (go figure). I also worry that the hospital environment will stall my labor or just make me feel less secure. No hospitals in our area offer water birth as an option and it will be like pulling teeth to get some of the most important parts of my birth plan followed, like delayed cord clamping.

The hospital does heplocks and has a wireless monitor. So I wouldn't be bed ridden, but I would have more medical gear hooked up to me constantly than I am comfortable with. 

The midwives we are considering all carry emergency medicine for things like hemorrhage and are trained in neonatal resuscitation. I also love that they have such an invested interest in keeping me low risk and provide more personalized care. They all have working relationships with local doctors in case I need to transfer or become high risk. They do birth classes, read my food journal, and I can call or come by anytime. My prenatal midwife appointments are an hour long and my husband is included in the discussion, with my OB I would wait an hour to be seen and then talk to her for 10 minutes while she practically ignored my husband. I have another midwife prenatal today and am going to share my concerns with them and see what they say.

Still planning to interview another doula, visit the birth center in south TN, and visit another hospital in my area... I'm so glad we got the ball rolling on this very early. I had toured two hospitals by 6 weeks lol 

jennypolkadots

@jennish11 - thanks! I am more comfortable with the midwives, but as a FTM it is easy to have self doubt about the unknowns of labor and home birth. Oh gosh do I wish our midwives just has local hospital privileges, that would make this so easy!! I hate Alabama's stance on midwives and birth.

You are right, I am just going to talk honestly at my midwife appt about how I am feeling and go from there. I'm sure the widwives have heard these concerns from pretty much every mother. 

MsMacual

I'm hearing a lot of hesitation in how you are describing the hospitals- yes closer, but it sounds like you aren't really on board with some of the what ifs that they could present.

I'd go with one of the midwife options (probably the one just over the state line in TN)- even if it requires a slightly longer drive.  I happen to live in a big metro area so I have every option under the sun available, but they also can be up to an hour or more away without traffic so being 20 min from a hospital isn't unusual, if that makes sense.  The closest free standing birth center is 20 min from my house with no traffic and probably 40-50 min if there is traffic. 

Also, is it possible for you to find a midwife to do a home birth?  She would come to you and then you wouldn't need to worry about traveling, etc.  Just a thought.

Finally- would the Farm be an option for you?  From what I've read, you could potentially go to the Farm a few days before your due date and stay until you have the baby.  I'm not exactly sure where it is in TN so it might be on the opposite side of the state.  How crazy cool would it be to give birth with Ina May Gaskin!

jennypolkadots

@MsMacual - Thanks! I am really leaning towards the midwives. I recognize the risks that can happen - like needing and emergency c section or potential issues with the baby. I am very low risk from what I've been told. I am 24, healthy weight, all lab work has been perfect. I eat really well and have exercised the whole time. I know awful things can happen to anyone, but my personal risk is pretty small as long as the pregnancy stays healthy. I try to remind myself of that and not make a decision based solely in fear!

Alabama has crazy laws. Home births are technically legal for moms, but it is illegal for a midwife to attend one. So mothers give birth unassisted down here, or midwives do it under the radar and if you need to transfer they can't go with you because they risk prosecution. So just all around not an option at all for us, although I would love to give birth at my home 10 minutes from a hospital if needed.

The farm is not an option we are considering even though I love Ina May's books and philosophy. We are counting the Chattanooga center out because of distance, and the farm is 10 minutes further than that and much further from a good hospital than the Chatt. center. So basically, it's out. 

iris427

jennypolkadots said:

iris427 thanks! It is a hard decision because I want every good chance at having this baby naturally and without being hooked up to all sorts of medical devices during the process. What I would prefer would be a midwife delivery in hospital but the only one in our area just retired (go figure). I also worry that the hospital environment will stall my labor or just make me feel less secure. No hospitals in our area offer water birth as an option and it will be like pulling teeth to get some of the most important parts of my birth plan followed, like delayed cord clamping.

The hospital does heplocks and has a wireless monitor. So I wouldn't be bed ridden, but I would have more medical gear hooked up to me constantly than I am comfortable with. 

The midwives we are considering all carry emergency medicine for things like hemorrhage and are trained in neonatal resuscitation. I also love that they have such an invested interest in keeping me low risk and provide more personalized care. They all have working relationships with local doctors in case I need to transfer or become high risk. They do birth classes, read my food journal, and I can call or come by anytime. My prenatal midwife appointments are an hour long and my husband is included in the discussion, with my OB I would wait an hour to be seen and then talk to her for 10 minutes while she practically ignored my husband. I have another midwife prenatal today and am going to share my concerns with them and see what they say.

Still planning to interview another doula, visit the birth center in south TN, and visit another hospital in my area... I'm so glad we got the ball rolling on this very early. I had toured two hospitals by 6 weeks lol 

I had a heplock with baby #3 and telemetry monitors with babies #1 and #3 and I honestly don't remember noticing either during labor (aside from the initial insertion of the heplock, which was annoying but not a deal breaker--it only lasted a minute).  I was completely focused on contractions, not what was around me.  With a heplock and telemetry units, you aren't really "hooked up" to anything, that's the whole point of those two things.

Delayed cord clamping is nice, but personally it wouldn't be a deal breaker for me either.  The benefits for term infants are small.  Anecdata, but neither of my hospital birth babies were able to have delayed cord clamping because of circumstances at delivery, and there was no difference between them and my home birth baby who did have delayed cord clamping.  

Will the hospital let you labor in the tub or shower if you get out to deliver?

It's great that your midwives have some emergency medicines on hand and can do some aspects of NNR.  But they can't do everything for hemorrhage or NNR that can be done in a hospital.  For example, part of the NNR protocol involves endotracheal intubation, which OOH midwives cannot do.  A severe hemorrhage may also require things that can't be done OOH.  Those scenarios are unlikely to happen to you, but I do think it's important to recognize the limitations of OOH birth.  The absolute risk of delivering OOH is low, but it is possible to have a sudden, unanticipated emergency arise that can't be handled there and you need to consider what that would mean and what would be involved in transferring under those circumstances, since you said that safety is your top priority.  I'm not trying to tell you where to deliver, just to make an informed choice regardless of where you end up delivering. 

 

jennypolkadots

iris427 - you make a lot of good points and I really appreciate your input. I wish we could meet for coffee lol

You're right about the limitations of OOH intervention in the case of something going wrong. It is a risk, especially with my first birth, and I haven't sorted out all my feelings on it yet. I am glad to know you weren't bothered much by the medical gear being on you during labor. It's hard to know what it would be like for me since I have never gone through this before, or even been hospitalized or had a surgery at any point in my life. So it is the "big unknown" for me. I'm not scared of hospitals and would even be fine with a cesarian if my baby were at risk. I think hospitals are great for those who need them, but feel that I should explore more options if I have a low risk pregnancy. The hospitals allow you to labor in the stand up shower, but I don't feel like that is the same level of comfort as a tub provides.

The delayed cord clamping isn't a complete deal breaker, but it is something my husband and I both really want for our baby. A higher concern is that an ob is going to start tugging on my placenta trying to deliver it asap instead of allowing me to try birthing it on my own. I guess it doesn't bother some people, but it is not something I am comfortable with. So much to consider! Wish me luck at my appointment in an hour, I'm hoping to get some questions answered!

iris427

Yeah, it's hard to know what you will like, even if you aren't a FTM--you just never know until you're in the moment. There is so much conflicting info out there too. Definitely talk about your concerns about cord traction, clamping, etc., with the midwife or doctor. I think being respectful and honest with people is a good strategy--for example I wanted to keep cervical checks to a minimum with my most recent birth so I explained to my doctors why it was important to me and then asked them what they thought. They were very understanding and even made a note in my chart about it. GL!

conradraging

Having a doula is a big help if you should choose the hospital. However, I'd choose the private one thats 10 minutes further in order to have the natural-friendly OB. It sounds like you're leaning toward the midwives, but if you do decide that you're worried about not being close enough to a hospital, at least with hospital #2, you have a provider who is on board with a med-free birth, as well as your doula to be an extra advocate.

usernewname

2 hours is too far. 15 minutes was more than enough for me and I had a relatively quick labour.

Birthing centre's are beautiful but like ppsaid maybe a doula would be worth checking out.

jennypolkadots

Thanks everyone! My prenatal yesterday went awesome. At just under 14 weeks the heartbeat was clear as a drum on the doppler and found it right away. My heart melted! I feel so relaxed with the group of midwives (2 midwives, 2 midwife assistants) and so does my husband. I feel like my gut is saying they are the right option for our birth. We have visited other midwives, doulas, and doctors and I haven't felt trust with any of them. I spoke very frankly with the head midwife (practicing for 30+ years) about hospital transfer and her answer was that it is very rare for someone as low risk as me to need transfer, but they always transfer early rather than wait for something to really go wrong. She also will monitor the baby and keep me in whatever position the baby seems to be doing the best during transfer. I just get so many good vibes from these ladies and usually have a hard time connecting with strangers, but it feels so right. If I go overdue or have any risk factors, she works openly with a midwife turned OB that is just an hour from us, and also has a doctor who takes her transfers at our local hospital for a real emergency like preterm labor.

They can deliver anywhere in TN, they just have access to a birth house about 40 minutes from my house. I double checked and it is actually 15 minutes from a hospital. I have a close friend who lives 45 minutes from my house and only 5 minutes (2 miles) from a hospital, so I am going to subtly ask if she may be open to me birthing in her home. If not, my grandmother is also in TN close to a hospital. Or we could rent a place. Or the birth house is still an option as well. We have time to hammer out the details but I feel like we are on the right track!

Thanks everyone for the opinions, I really appreciate it! Making these decisions is very difficult when the options seem limitless. 

rae_dylanzmom

I'm in a sort-of similar situation with the rural-ness and accessibility of care. For me, I'm just looking for an option that enables me to have a VTOL if the opportunity presents itself. and here's what I've decided (I'm almost 37 weeks, never got my siggie to work)...

Starting next week, I am transferring care from the small, non-VBAC hospital/practice that is 1 hour away (closest option) to a VBAC-friendly hospital/doc that is 2 hours away (already consulted with him, so now it's just paperwork).

So, the local hospital OBs have all met me, I know the hospital, and I'd be comfortable going there. (It's where my DS was born after my home-birth transfer.)  If things happen too quickly to get to the hospital farther away, that is my plan.... but that guarantees me a RCS.

We are planning to spend more time closer to the VBAC-friendly hospital during my 38-39th week... camping, hotels.... and we have my MIL coming to stay with DS starting at 39 weeks, so that it doesn't throw the whole family out of whack to be farther away.

My new doc said he wasn't concerned about the drive being too long (because he expects I will have a long-ish labor), but brought up that the whole 'when to go to the hospital' decision gets a little tougher to make with the longer drive.

I know the consensus here was that 2 hours was too far to drive in active labor... just putting it out there that you could look to craft a flexible plan so that you have options and backup plans since it's tough to anticipate what you'll need when the time comes.

Sounds like you're finding some other options that feel good for you.... so that's great.

jennypolkadots

@rae_dylanzmom I'm glad it is working out for you. Update me after your birth, I will be thinking of you!

I feel like 2 hour drive in labor is doable if we didn't have better options. But when we add in the travel expenses, the driving to the next 13 prenatal visits, and then driving home with a newborn... it just feels really inconvenient when we have local options. I would TOTALLY drive 2 hours for VBAC. It would be pretty complicated for us to arrange to stay up there around the due date because we have no clue when that would be as a first time mom, we are trying to keep all our PTO for after the birth so DH can stay home at least 3+ weeks with me,  and we have three pets at home that we hate leaving. It costs us about $60/day for the pet sitter and we don't have much family help. Oh yeah, and we are due in February so camping is not really an option, and ice or snow is possible during that 2 hour drive.  

One thing we really liked is that at our 37 week visit we will work with the midwife to write out a transfer plan. Hospital preferences, what reasons we would want a transfer, etc. so that it is all clear and she can call for help or get prepared for transfer quickly if the time came. I like that there is a lot of backup planning going on so it is not just left up to chance. 

GL with your birth plan, I think you are amazing for seeking out a more supportive doctor and traveling to have the birth you want. 

:x

rae_dylanzmom

You are lucky to have closer options. Most of us here in this area have to travel the 2-3 hours for a VBAC or NICU. Sorry to jump in on your post.... I was late to the party, but it really resonated with me.

Working out the hospital transfer scenario is a great thing to tackle ahead of time. Would have probably helped us out if we'd done a better job with that. It's hard to think about backup plans when you are really trying to focus on the positives. (Our midwife basically sat with us in admitting and then wasn't around at all after that. We paid her in full for the home birth, so I felt a little ripped off that she didn't stick around to at least support me/us. I think it's likely she wasn't welcomed there by the staff, who were jerks to me for the first 12 hours.)

And good on you for trying to save PTO.... due to my unproductive early labor and my husband's work situation, he blew through 5 weeks of paternity leave BEFORE DS was born and had to go back to work (in another city!) a week after he was born. He is really looking forward to being around this time.

Will give you an update in a month!!! I'm hoping all you other posters are wrong about the 2-hour drive.

jennypolkadots

@rae_dylanzmom - it sounds like an awesome option for you. We live in a pretty large city, but Alabama is just not natural birth/home birth friendly which is the cause of my conundrum. I've read other places of many moms having no choice but to travel 2+ hours, or use several lines of public transit during labor, and it's just a non issue because they don't have other options. I wasn't really concerned with the drive during labor and was surprised by all the responses against it, but I mostly hated the idea of every prenatal appointment being a 5+ hour ordeal with travel plus appointment time. Since you are later in pregnancy this is not such a concern. Like I said, if there were no good close options and I was attempting a VBAC, I would have no qualms with driving 2 hours. I would probably leave in very early labor and then just get a hotel room if I was going to be delivering in the hospital. A doula would be a great idea, too, if you don't already have one.

JCWhitey

I actually find it funny that people are saying two hours is too many.  For some people that's the only option they have!  With my son the closest hospital was an hour away and the one we ended up choosing was an hour and a half.  We chose that one because it was newer, nicer, and the doctors were very NB friendly.  As luck would have it, we were at the cabin when I went into labor and only half an hour away, but it was still cutting it close because I had a quick labor.  

But that being said, my husband brought up moving to a town 60 miles north of where we were living when my son was born, which would put us two hours away from the nearest hospital and 2.5 hours from my hospital.  My initial thought was "ugh, I don't want to do that", but if I have to I will.  It's literally the only option because Canada won't let you go up there.

So, it's doable but not ideal.  With my fast labor last time we'd probably call an ambulance to transport when the time came, or if I thought I was in labor leave and either go to my parents house (the town 60 miles away), the cabin (30 miles away), or just get a hotel until it was for sure and hospital time.

For you, though, I'd take a look at the smaller hospitals.  Smaller doesn't mean not better.  In fact the smaller hospital in my area is AMAZING!  I was just chatting with a mom the other day about her two experiences- one at the large hospital in the bigger city and one at the small hospital where I had my son.  She agreed hands down that the hospital and doctors were amazing and the two experiences don't even compare.  Her daughter's birth was horrible and her son's birth a fantastic experience.  So don't rule out small! 

jennypolkadots

@JCWhitey - I think most people just feel that 2 hours is a long drive if you have a lot of closer options like I do. I am 10 minutes from a good hospital, 20 minutes from a relatively NB-friendly hospital (keyword:relatively lol), or can deliver with midwives just 30 minutes from home. I know what you mean though. There are plenty of rural places that a 2 hour drive is the best option, or in a large city where it could take several hours on different lines of transport to get to where you need to be. It's funny how relative these things are! 

If I wanted to deliver in a hospital setting, we would definitely be open to a smaller hospital. But we don't want to deliver in the hospital for a lot of reasons. The one 10 minutes from home is very small (3 L&D rooms) but brand new and so nice. It is also owned and staffed by the larger hospital in our area and has highly trained staff. For an emergency illness, that would be where I would go without hesitation. For birth, they are not known to be very NB-friendly and there are many policies I am just not comfortable with. 

Since we are currently planning an out of hospital birth, I like to know how far it would take to get to a large hospital with an advanced care NICU and all the pediatric support staff we could need in a real emergency. If we were at our local hospital and our baby needed specialized NICU care.. the baby would have to be transported 20 minutes by ambulance to the closest large hospital with a level 3+ NICU. The mother can not join the baby until she is discharged, which is usually 24 hours. If you are looking at a small hospital, it is still something to consider what would happen if the baby needed to be transferred. If I went into labor early or we had any complications, I would only consider birthing at a larger hospital where I know I could stay with my baby no matter what. But ultimately we all make the best decisions given our individual circumstances and I agree that a lot of smaller hospitals offer more personalized care in an uncomplicated delivery scenario. 

memo9

We drove an hour for our birth center.  Totally worth it!

Mnerani

Though I would hate to labor 2 hours in the car (the trip to the hospital was definitely the worst part of my labor with LO#1), I think giving birth at a friend's house would be even worse. I can't imagine doing that at a friend's house- unless she was like a sister or something.

jennypolkadots

@mnerani - I get what you are saying. I think right now after learning more about the early transfer policy of the midwives and the home birth center they birth at, that is where we want to be. Mostly because they have a wonderful jetted birthing tub and the midwives are very comfortable there.

The friend is more like a sister than my sister is lol I have known her since 7th grade and she just had her first baby too. She is also super supportive of natural birth and not weirded out by these things. She was the first person we told I was pregnant, like 6 weeks before we told anyone else... so we are very close! I wouldn't birth at some acquaintances house. That would be super weird!

jennypolkadots

Oh, and we will be birthing a 30 minute drive from home. And can go as early as we want to get settled because it is not a hospital. We just call the midwives when we are ready for them to come. We quickly ruled out the 2 hour drive option since we have a lot of closer options available!