Opinion on Hospital Midwife — The Bump
Natural Birth

Opinion on Hospital Midwife

We are going to start interviewing midwives and one of our options is to see a local midwife and during labor we go to the hospital and the midwife delivers the baby there.  This is my husband's choice as he is very scared that something might happen (okay me too) but he respects my desire to have a natural birth.  Being in the hospital should something occur allows us direct access to emergency care since we are 45 minutes away from the closest hospital.  What are your opinions on this?  Will I still get the type of birth I desire this way (if everything goes smoothly with labor)?  TIA

Re: Opinion on Hospital Midwife

  • It can be done.  I did it.  Totally agree with PP's suggestions.  Would also add - try not to get to the hospital too early.  You want your labor to be good and active when you arrive.  Even if you are with a midwife, once you are in the hospital you are "on the clock."
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  • I'm going the same route - the midwives have a separate area in the hospital and it's equipped with pools, balls...etc. and, god forbid, an emergency were to happen we would just have to go to another side of the hospital. I don't think I would be able to do a home birth for my 1st one - I'm too nervous! - but I might consider it for my 2nd
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  • iris427iris427
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    You can have a great, natural birth in a hospital but you may have to work harder.  Most hospitals have Cover Your Ass policies designed to protect them that can come into direct conflict with natural chilbirth.  Your midwife is subject to the policies and decisions of those higher on the food chain, some of whom are beaurocrats who haven't cared for an actual patient in years.  She may have to put her job security ahead of your needs and wishes.  If you want a natural birth in a hospital, you really need to be prepared to fight for yourself and say "no"--possibly over and over again.

    It's also harder to have a natural birth in a hospital because all the technology and drugs are so readily available.  When you're at home or a birth center and labor is painful, you know that you have no choice but to keep going.  In a hospital, you know that all you have to do is press that call button and get an epidural.  When you're in pain, that can be really tempting and it makes it harder to stay committed to natural birth.  I also think that because the OR is just down the hall and the vacuum, monitors, etc. are right there on the floor, the medical staff is more likely to use them when they are not needed.  Outside of the hospital, a MW is more likely to try natural methods first because those are the options most at her disposal.

    Obviously it varies by hospital and you really can't know until you're in the door.  Some hospitals are more natural birth friendly than others.  If you go to The Unnecessarean and look up your state, you may be able to find your hospital's cesarean rate and compare it with other area hospitals and that might be a helpful clue.  GL!

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  • Maybe I'm lucky, but I can't see any reason why you can't go med free in a hospital.   Our hospital encourages med-free and has an excellent L&D nursing staff that works very closely with women in labour in order to help ease discomfort using a variety of techniques and guidance.  

    Talk to the hospital staff (or liason) about what their policies are and what they encourage.

  • I've heard nothing but good from the ladies I know who went the route.
  • I'm doing a midwives group that works in a local hospital, and I do think that it will be possible to go med free and intervention free. We did learn that, like PPs have said, they are subject to hospital regulations, which could get in our way if I wind up with breech presentation, uncontrolled high blood pressure, placenta previa, or diabetes that can't be controlled by insulin.

    That said, I asked a LOT of questions before making my decision. Lots and lots and lots of questions. I wanted to be sure that the things that were important to me would be not only allowed, but respected and encouraged. I asked point blank about being on a labor clock when I entered because it was a hospital, and they assured me that they did not use one, and that pitocin was an absolute last resort (and then explained why it was, and what they did instead). When I asked about their c-section rate (7%) and they gave me not only that number, but also their VBAC rates (85%), episiotomy rates (1 in 500), information on how they deal with Group B Strep, and what essential oils they use as a routine part of labor as part of the answer to that one question, I felt really good. And then I asked more questions anyway.

    It was important to me that the nurses also be on board, and that I only be offered any sort of pain meds once, and both those concerns were addressed and put to rest quickly.

    So asking 1,000,001 questions without apologizing for them, and trusting my gut, was really important to me, and wound up being how we made our decision. PM me if you'd like to see the questions we used to determine how well a practice would line up with our desires!

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  • I agree w PP. For me this is really important too - and MW's relationship w the docs & staff there is important but I found out the hard way that hospital policies matter more than your MW's orientation once you get there. 

    I recommend that you find out in advance what the L&D standard procedures are for the hospital so you can prepare appropriately & research what you are comfortable refusing. What non-medical comfort measures are available ? Can you wear your own clothes? Do they allow students or residents on rounds? Do they require a saline/heplock/IV? Will you be allowed to drink or eat or move around? What are the circumstances for continuous fetal monitoring? What about induction/ augmentation? How long will they let you labor before they think interventions are in order? What are their rates for CS/ for failure to progress? Will your MW be allowed to continue to manage your birth if complications arise? You can call L&D and ask to speak to the Nurse Manager for the unit to ask these questions, although I'm sure you will want to get your MW's impressions as well.

    I also highly recommend considering a doula for many reasons but especially because you are far from the hospital. Natural birth can go on for quite awhile but hospitals expect you to give birth w/i a 12 hr timeframe. A doula can keep you comfortable at home so you dilate enough before heading to the hospital, and then she will help you advocate for you at the hospital and actually stay in the room with you the whole time, unlike your MW or the staff. Out here they run 500-1000 out of pocket but I hear in CA they can run double that. Your birth expereince is such a pivotal thing that can affect you & your LO for the rest of your life so we consider the $ well spent.  Good luck!

  • I think that's the safest way to go. 
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  • iris427iris427
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    image monkeyqueen:

    Maybe I'm lucky, but I can't see any reason why you can't go med free in a hospital.   Our hospital encourages med-free and has an excellent L&D nursing staff that works very closely with women in labour in order to help ease discomfort using a variety of techniques and guidance.  

    Talk to the hospital staff (or liason) about what their policies are and what they encourage.

    Yep, you are lucky.  The typical American obstetrics ward is nothing like that. 

    I found out the hard way (and have the cesarean scar to prove it) how much seemingly innocuous hospital policies and the attitudes of the staff can interfere with your ability to listen to your body and let your labor progress naturally.  I'm not trying to scare anyone, just trying to be realistic.  Hospitals have much higher cesarean rates, even among low-risk women, than home birth or birth centers and they do not have lower mortality or morbidity rates.  So while it's certainly possible to have a natural birth in a hospital, you are lowering your odds just by being there.

    And this is even true for "natural birth friendly" hospitals with midwives, birthing tubs, etc.  Our local hospital is supposed to be really good for natural birth, has a Baby-Friendly certification, and still has a cesarean rate over 37%--higher than the national average.

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  • I delivered DD in a birthing center in the hospital. My OB has 2 female Dr.s ans 2 MW's. The Mw's do all deliveries unless there is a emergency c or dr on call.

    You want to labor at home as long as possible. When I got to hospital I was 6 cm already...Just ask her questions and ask how that day would work?

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  • Gosh I love you ladies, I am learning so much!  As for the doula there are 2 options for me, one is to sign up with someone who also teaches the Bradley course I plan to take anyway, and the other is to see if my friend who is a previous L&D nurse would have any interest in becoming my doula.

    I really want a home birth but I'm just a bit scared because both my brother and I were delivered cesarean, he is older and was breech, with me it was optional but then it turned out that I had pnemonia at birth and had to be in the NICU for a while.  The possibility of complications frighten me.  My mom's house (the house I grew up in) is only about 10 minutes or so in regular traffic from the hospital so I think I'll ask her if she'd care if I had the baby at her house.  She may freak and say no but at least I'll ask, I feel very comfortable there.  As a back up if she says no I'll start looking at the website you mentioned Unneccesarean and see what the hospital's records are.  Thank you so much!

  • image Carabiner252:
    I say it CAN work if your midwife has a good relationship with the L&D nurses and is explicit in supporting your desires to go natural. She should write directly in your chart what she means by natural birth, such as Intermittent Monitoring (vs. Continuous Monitoring), pt is allowed to sit in the shower/tub, pt is allowed to have no IV, or only a hep' lock, etc. I would also recommend either reading or taking classes on natural birth to help allay your fears, because I think that fear makes everything worse, especially pain - I have been reading HypnoBirthing and this is a big tenet in the book. The reason I mention this is that it will be so much more tempting to get an epidural if the anesthetist is sitting right outside your door - so you will have to be especially vigilant if you want to avoid his/her services. Good luck! I have seen many women go natural in a hospital setting, especially if they are prepared.

    This. She made some very good points. A lot of women go into the hospital intending to have a natural birth and it doesn't happen because there is something like peer pressure there, as well as the convenience of having medications available to you. Make sure you've thoroughly detailed with your midwife what you do and do not want and make sure that it is also clear with the hospital staff. All in all, no hospital birth, natural or not, is going to be like a home birth, but if you'll be more comfortable there, you can make your wishes known and I'm sure you'll be happy with the decision in the end. 

  • image iris427:

    I found out the hard way (and have the cesarean scar to prove it) how much seemingly innocuous hospital policies and the attitudes of the staff can interfere with your ability to listen to your body and let your labor progress naturally.  I'm not trying to scare anyone, just trying to be realistic.  Hospitals have much higher cesarean rates, even among low-risk women, than home birth or birth centers and they do not have lower mortality or morbidity rates.  So while it's certainly possible to have a natural birth in a hospital, you are lowering your odds just by being there.

    This. This link has good questions to sak (more directed towards OBs, but still a good place to start). http://www.themidwifenextdoor.com/?p=769

    And ask about the hospital - will you be required to have continuous monitering, an IV, things like that? It's no impossible, just harder.

    Try not to worry about the "what-ifs" (or try to work through them before you go into labor) - the chances of something happening to the baby or you are really, really low. And worrying seriously messes up the laboring mojo - hth.

    DS1 - Feb 2008

    DS2 - Oct 2010 (my VBAC baby!)

  • I think it depends a lot on the midwife and the hospital.

    We chose our midwife very much on purpose.  Her "backup" OB is her husband.  The hospital is SUPER natural friendly (they do waterbirths at the hospital, don't make you get an IV, and the maternity wing has a kitchen for families and looks like a house, not a hospital). 

    I'm glad we made the choice we did.  After the birth, my placenta got stuck and I started to hemmorhage.  The OB was able to remove it manually, but I did need a blood transfusion.  It's a rare complication, but if I'd been at home it would have been very difficult to deal with and I really could have died.  I lost SO much blood so fast....it was scary.    Not saying the same thing would happen to you - but it is real and does happen.

    The hospital is a "baby friendly' hospital - I have found that these hospitals tend to be very good about natural birth.  Is there one near you?

    http://www.babyfriendlyusa.org/

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  • I think you can - I did.  Granted, it was a very natural birth-friendly hospital.  Brand new birthing center separate from the hospital.  Jacuzzis in every room.  I was there for nearly 24 hours - from early labor on (couldn't labor at home b/c we had no power or heat after an ice storm), and there was not ONE mention of drugs.  I refused the hep lock when admitted.  Worked with no fewer than 6 nurses over the course of the day (and, of course my MW, and her student).  All of them we incredibly encouraging and helpful.  Everyone knew what I was shooting for and no one questioned it.  So, while I can see why being in a hospital setting might be a detterent to natural labor, if you have the right folks in your camp, and have your mind set, you can do it!
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  • That is exactly what we are doing, and for the same reasons. It's my first baby and I just feel more comfortable being in the hospital in case I want/need anything medical. But I know I'm not likely to get the birth I want with an OB, so a hospital midwife with an OB backup was the perfect solution. I think it's the best of both.

    Unlike an OB, the midwife will be at the hospital laboring with me throughout - she won't leave that to L&D nurses and just show up right before I push. I even have her personal cell number to call when i go into labor. She isn't a part of a practice where I'm not likely to get her when i go into labor either. It's just her, and she'll be there unless there is a true emergency that prevents her from coming.

    I hired a doula first and this is what she recommended for me based on the hundreds of births she has attended, and I totally trust her judgment since she's seen it all!

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