Sorry in advance - this is LONG . . .
DH and I really want a natural childbirth (barring any complications of course). We know that it's not easy or glamorous - and to try to prepare ourselves, we are taking Bradley classes.
The OB I'm currently with says she respects people's wishes for natural labor, but then in the very next breath says something like, "But just so you know, 90% of all my first time moms end up 'needing' an epidural." It's one of those things where she's saying she'll honor what I want - but I can tell that it's definitely not something she's going to "help" me with. (She also thinks doulas are a waste of money and that birth plans are well meaning, but silly.)
Based on the research I've done on both her and the hospital, I've learned that it is possible to have a natural birth, but it's difficult, and you really have to be willing to stand up for yourself.
I feel like it somewhat defeats the purpose of trying to have an intervention free birth, if DH and I have to worry about being defensive about our desires.
So it seems obvious I should switch to someone more supportive of a natural childbirth route, right?
Here's where it gets complicated. My OB is one of the best in the entire area. I've had some complications (non-pregnancy related) in the past, and I trust this woman more than anyone with my gynecological care. She's virtually impossible to get an appointment with if you aren't already with her practice, and I don't know that I'm willing to lose the long term ongoing relationship I have with her. DH also LOVES her - because of the way she's handled my previous gyn issues. The other thing we have to consider is that if something were to go wrong during birth, I would trust her completely - and the hospital has a NICU with private accommodations for parents to stay comfortably around the clock.
(And to prevent any confusion ahead of time - DH and I are both extremely open and understanding to the fact that not everything goes as planned, and that what we want may not end up being what we get - regardless of who our provider is. This isn't about he and I insisting on only one way for child birth. It's about wanting to make sure that our provider understands what we would want in a perfect world and helps us make the best choices for why and when we would need to deviate from those choices.)
So do I switch in order to find someone more supportive of a more personalized approach to childbirth? Or do I stay with her knowing that if we want something other than her "standard" delivery that we'll have to really struggle to get it?
Re: Natural childbirth moms - Would you switch? (long)
Could you hire a doula? This seems like the perfect situation for one. Your doctor can't force an epidural on you - actually most doctors will just show up the last minute anyway, and it's the nurses who will take a more active role in your labor. But a doula could help make sure you have the birth you want.
I have heard negative things about birth plans, even from midwives and doulas, just for the record... they are often seen as kind of over the top and at times even insulting, as though you are telling people how to do their jobs. It's better just to express your wishes verbally.
I would hire a doula if you can. This is the type of situation that could really benefit from one. (If you can't afford it, you may check to see if there are any doulas-in-training who will work with you for free. That's what we are doing).
I sympathize with your situation. My OB is great but she also has a very high c-section rate which makes me nervous. I read The Thinking Woman's Guide to Child Birth (can't think of the author) and it gives you examples of how to make sure you get what you want without being rude.
Good luck!
I am in the exact same boat as you!!! And we're shopping around, looking at some Cert. Nurse Midwifes that deliver out of local hospitals. I got a copy of my medical records from my OB by saying we might be going out of town and I wanted to have them just in case and they were totally fine with that. So this way I'm not breaking any ties to my OB unless I totally love one of the midwifes we meet. As a Bradley student many OBs don't like how informed and assertive we are about not wanting intervention. I would ask her how long she'll "let" you labor before insisting on pitocin, or breaking your water/stripping membranes. Many OBs will do one of all of those things without even asking you first just because you have been laboring for what they consider too long. My OB group is great except for one (I would throw her out if I got her, and go with the attending on staff), and one in particular did my surgery when I had an ectopic so I trust him 100%, but he's a surgeon as are all OB's so I don't think they really understand natural childbirth.
I am looking around and having consultations with midwifes, and I would highly recommend it. Just try to do it discreetly so as not to burn any bridges in case you don't find one you like.
A birth plan is a great reference for you and DH. When you're in hard labor if you think you'll have the mental capacity to verbally express your wishes you are dreaming. And pretty much all women have moments of self doubt where all a nurse has to do is suggest pain meds and BAM you have an epidural despite your actual wishes. That's why having a medical team who is on YOUR side not their own is in your best interest. Of course complications can arise and should be dealt with to the best medical ability there is, but if there isn't any at all and you just happen to have a long labor, most hospitals and staff want you out of the room, and could care less if you don't want to be rushed.
I say stick with the OB you have. Just because she mentioned having an epi doesn't necessarily mean they will pressure you to have one. She just may want to make sure you are comfortable knowing all of your options. If you don't want to have one, just stick to your guns and refuse if it is offered. Hospitals in general, just want to offer you certain things (procedures), doesn't mean you have to have them. Its not like you will be the first patient of hers to not have an epi.
When I had DS, I went quite awhile without getting one, it was offered once and I refused, but as labor continued, I was so tired the nurse offered again and I accepted. I was able to relax and get some sleep. It wasn't pushed on me and the first time I refused it was no big deal. I just think most doctors/nurses just want you to be aware their are options. Just remember--no one can force you into getting an epi if you don't want one.
I would stick with the doctor you currently have since she does seem to be knowledgeable. When we did our hospital tour they asked what our birth plan was and aligned nurses to assist in natural birth rather then one that would push drugs. Our nurse was awesome and I only met the doctor that was going to deliver when it came time to push.... and I didn't care what she was thinking at that point. I was going to a practice that didn't assign specific doctors. I have changed for this pg to my gen'l prac.
I also took Bradley classes and recommend them 110% but be aware (as I know you are) that birth doesn't always follow our best laid plans. Out of 6 couples in my class 2 ended up delivering naturally, 2 had epis, and 2 had c-sections. I was one that went naturally but an epi wasn't an option b/c of the meds I'm on.
First, it will probably be very hard for you to switch at this point. Unless you've moved, most doctors are skeptical of someone who changes OBst his late in the game.
Secondly, you're going to be working with the nurses more than the OB while you labor. The OB most likely won't even show up until right before you deliver. So, if you're comfortable with your OB, stick with her. Just make sure you have a strong advocate for you who knows exactly what you want and how far you are willing to go. We had one nurse who was great - she helped us with different positions and exercises to speed up labor. In contrast, our second nurse was horrendous. She yelled at us every time I adjusted. Her aide even apologized for how aggressive she was.
Also, I'd recommend against a written birth plan. I've heard from several sources, including nurses at our hospital and my sister who works L&D and post-partum that nurses and most doctors HATE birth plans. They normally set you up to fail. Just make sure you know what you want and how far you are willing to go and verbalize this to the nurses when you arrive.
I think that your doctor sounds like the one to stay with.
I just started taking my preparing for childbirth classes last night. They are tought by a doula. She is very experienced and has worked at the hospital (where the childbirth class is/and where almost all the moms in the class are having their babies) and with all the practices that deliver there. She said that the doctor isn't there for a lot of the time during the birthing process (since it can last quite a long time), so that might be a benefit for you. She is very into helping woman have a natural childbirth or pre-longing the epidural for as long as possible.....so not to slow down the process.
A great doula that can stick up for you and assist you through the process might be just the thing.
There is also a girl in my class that is very very set on natural childbirth. She is not telling the practice (she uses the same doc as me) that she is wanting natural until near the end....since she has heard the same story as you - high rate of epidurals!
wrong. they can't give you an epidural against your wishes. it's a very serious decision that women ARE capable of making in the moment. do you think women go into labor and just lose their minds? insulting. and getting an epi requires a discussion, signing paperwork and then verifying with the anesthesiologist that yes indeed you want it.
when i finally asked for one at 7cms the anesth came in and asked if i wanted it and i said "i think so. i don't know." he didn't move an inch until i was ready to say, absolutely yes 100% give me the epi....
Your situation sounds identical to ours - great OB, "top docs" etc...I always got the impression my Ob was telling me what I wanted to hear, so I did do some research and I found a midwifery practice that delivers either at a birthing center or a NICU hospital that I feel is 100% in line with my beliefs so I am switching at 24w. Until I started looking around, I didn't realize how out of line my OB was with what I was looking for. It doesn't mean she isn't one of the best, but she isn't for me at this point.
If you do decide to stay with her and you really want a natural birth, you need to hire a doula (as long as your OB and hospital will allow it) and write down a basic birth plan. Even my old OB suggested it - she said they keep it in the file and all the OBs review it and discuss it with you so there are no miscommunications and she also said it is super important for your nurse to have it.
As a pp mentioned, you also need to ask your OB some very direct questions and if there is no common ground, you probably need to switch.
is there a time limit on your labor once your water breaks? do they break your water or let your progress normally?
how often do you need to be monitored?
how much freedom of movement is allowed? walking? birthing ball? shower? etc...
is an iv required or just a heploc?
what are their csection and induction and episiotomy rates?
what is their philosophy on induction? do they use cervidil? cytotec (run far away if they do)? foley catheter? are you allowed to refuse induction drugs?
are you allowed to eat and drink during labor?
what classes do they recommend - bradley? hypnobirthing?
GOOD LUCK!
I switched OBs during my first pregnancy for this reason, but it was an easy decision for us; our OB, who we really liked, told us upfront that he was not familiar with natural births and would prefer we work with the midwives at the same practice. We switched to them and had a wonderful experience, then back to my OB for gyn care after the birth.
As a pp said, most OBs are not comfortable with natural births because that's not what they are trained to do. OBs are trained as surgeons and to treat medical problems during pregnancy. Many (not all, by any means) have a hard time allowing labor to progress without treating its symptoms medically (pain medication, pitocin to speed things up, etc.)
I don't know what I would do in your case. We used a doula the first time and will again this time, and that may be a good option for you (even though your OB doesn't like them.) If you do use a doula, talk with them about how they usually interact with the medical staff, and find one who will support you but not be too "in your face" to your OB. Some doulas can be very pushy and seem to have a "the world is out to get us" mentality. I think that's why a lot of doctors don't like them, honestly. If you find one who has worked at your hospital before and who is not overly aggressive, you'll have a better chance of it going well.
I think if it were me I would also ask your OB to describe a non-medicated birth that she (he?) has attended. Ask specific questions about what they normally would do and what they did differently for the unmedicated birth. This might give you a better idea of how willing your OB is to work with you on this.
Thank you all for some really good suggestions. As much as she really got defensive when I asked her about her opinion on doulas, I think if I stick with her, I may have to consider that route.
I have different story than you, but a similar outcome. Basically, my philosophy is more in line with a birth center approach. However, I'll probably end up continuing with the hospital birth. Here's my strategy, we'll see if it sticks....
I am resolute about having a natural birth. Our birth plan is for us only. I don't plan to share it with my doctor/nurses. When I get checked in, I'll explain that I want minimal intervention. The plan will just help to keep me focused when the "drug pushers" start. I also plan to labor at home for as long as possible, so I can control my environment.
If you like her, stay with her. Most hospitals ask you when you first arrive in labor if you want pain meds of any kind. When you tell them, "no" they will ask if it is okay to ask you at some point if you have changed your mind. What I told my nurses was that under no circumstance were they to offer me medication unless I asked for it. And I made it fine without anything!
Be up front with your OB. Tell her that this is what you want and you will stick by it.
One thing I agree with her: I'm not a fan of written birth plans. The best thing to do is know what you want, verbalize it, and trust that it will all work out. From what we were told by nurses in our birthing class, most hospital nurses won't even read it because they figure it never works out as planned...
Usually, by the time you're in hard labor, it is too late to receive an epi. If you are mentally prepared for labor and prepared to labor med-free, the pain is manageable. For me, the only time I started saying, "I can't do this. I need something!" was when I was at the pushing stage at which point the nurses said, "that means you are ready to do it and, no, you can't have anything because it's too late."
I was told by many people (not my doc) that the hospital will try to push an epidural on you, but that wasn't my experience at all. I DID have a doula who was totally great and if you can afford one, they would be a great asset since you want a med free birth. If you don't have a doula, tell the nurses when you are admitted that you are shooting for a med free delivery and all questions they have reguarding meds should be directed at DH first. That way, HE can ask you about it instead of you feeling pressured by the nurses if that's what you're worried about. Your OB probably won't be there until you start pushing anyway, so she won't really have anything to say about it.
I did end up with an epi, but because I decided on it, when I wasn't having a contraction....that's when you should decide IMO. That way you're not deciding when you're in a lot of pain.