Hospital conundrum - clicky!

papagena

So, in addition to there not being an OB on the floor at all times at the hospital I'm currently planning on, I just found out yesterday that the residents (that used to be 24/7 when DS was born) aren't there evenings and weekends....  ????  So basically the labor/delivery is staffed by nurses only during those times, unless an OB or other doctor is called in for a delivery or complication (I have yet to find out about anesthesiologists).

I have more thinking and a lot of discussion with my doctor about this, but as of right now I'm divided:

on one hand, it seems crazy not to have some sort of doctor there as a VBAC patient.

on the other hand, I'd love a midwife only birth center experience, so (while I'm well aware that nurses don't have the midwifery training) I don't know that it terrifies me that much not to have an OB ready to do the same thing my last did and call for a c/s at the first sign of malpositioning.   I'm still in the hospital, and will be monitored (most likely) pretty closely, for better or worse, with an experienced doula for support. 

The issue for switching hospitals for me is that this is the place I had DS - I'm pretty comfortable there, as (other than the actual c/s) I had a great experience with the nursing care and LC's that were there.  The other area hospital I've had some aih experiences with nurse attention (although, to be fair, not in the L&D wing) and some general stories of the same, so I'm already a bit leery.  I've recently heard some fabulous stories about their LC's, and one person say that they're losing some of that more negative perception.  They have a very slightly lower c/s rate, from what I've heard (although I haven't checked it myself, and even so, both are high).  My doctor will deliver at either.

 

[Poll]

iris427

Well I would definitely ask how they handle emergencies (not just VBAC but any labor emergency) if there is no OB or anesthesiologist on the floor. 

I mean if you were at a birth center, you'd be asking how they handle emergencies and what their transfer protocol is, so this is kind of the same thing.

Not having an OB there does not in itself make me say you should switch, but I'd want to know there is a plan in case things go wrong.

MAprincess

I thought it was mandatory for a doctor to be in house when a VBAC is laboring?  I changed hospitals with my second pregnancy. The first hospital was definitely safe, etc but NOT VBAC friendly.  The hospital I changed to was a smaller community hospital but was fully supportive of VBACs.

iris427

MAprincess:

I thought it was mandatory for a doctor to be in house when a VBAC is laboring?  I changed hospitals with my second pregnancy. The first hospital was definitely safe, etc but NOT VBAC friendly.  The hospital I changed to was a smaller community hospital but was fully supportive of VBACs.

It's not mandatory unless your state has passed a law making it so. There are laws in some states prohibiting midwives from attending out of hospital VBAC (i.e. birth centers or home birth), but as far as I know, there are no laws prohibiting a hospital from doing VBAC without a doctor on the floor.  If anyone knows of any laws like that, let us know!

papagena

iris427:

Well I would definitely ask how they handle emergencies (not just VBAC but any labor emergency) if there is no OB or anesthesiologist on the floor. 

I will be - hence the lots of talking to the doctor that I need to do. 

And as far as I know, there aren't any laws that prevent them from having a VBAC w/o a doctor on the floor.

JoelsGirl07

I'd want to be where I would get the most attention - by people and not by monitors. That's the beauty of MW (REAL MW, not medwife) care. They are there, watching you. They can catch things so much sooner than a monitor.

welshgirl

JoelsGirl07:

I'd want to be where I would get the most attention - by people and not by monitors. That's the beauty of MW (REAL MW, not medwife) care. They are there, watching you. They can catch things so much sooner than a monitor.

Yeah, this is me too. I'd ask how much experience/training the nurses have re: birth - I mean (in a totally positive way), are they the ones who normally deliver on evenings and weekends? Would you be bothered by never seeing a doc as long as you knew they were on site?

What happens if you need an 'emergency' cs and no docs arae there? Do they get called in?

ZacksBride

as an anesthesiologist i would never consider attempting a VBAC (1 prior low transverse c/s) in a hospital that did not have OB and anesthesia in house at all times.  when things go wrong, they go wrong FAST.  just last week we had a uterine rupture in a patient attempting VBAC - thankfully it was recognized quickly and within 5 minutes the patient was in the OR and baby was out within 2 minutes later and all parties were OK.  but, had we not been immediately available, the outcome would have been much different.  as it was, the mom still lost a good amount of blood, had to have an embolization procedure to close off arteries going to the uterus to help stop bleeding, needed blood transfusions, etc..  attempting VBAC is definitely not without risk.