My head is so conflicted (long vent)...

babyike · June 2012

Sorry for being an AW about all of this...

Okay, so my last couple of posts have been regarding having this next VBAC in either a birth center or with a supportive hospital OB practice. Since I've not had a birth with either location previously, I keep going back and forth with what I want to do this time. I realize that even having the choice is a huge blessing, so please forgive my "whining". But I just cannot choose at this point. If those who are reading this don't mind, I'm going to list the pros/cons for each place so I can try and make sense of it all. Please feel free to reply, skim through, or even leave the post if it gets annoying LOL. TIA!

Birth Center
~pros -- waterbirth, VBAC supportive, family/mom/baby-centered, experienced midwives, low transfer rate, obviously natural-birth minded, will let me go to 42 weeks, only 10 minutes from our home, shorter post-partum stay
~cons -- transfer time is on average 17-20 mins (though hospital is only 2 miles away), no labor augmentation meds if they are needed (transfer at that point), our current pedi has had issues arise with newborn patients born there (just found this out yesterday)

Hospital

~pros -- VBAC supportive practice (all 10 OBs are pro-VBAC), claims mom/baby-friendly policies (L&D area just opened this year, so that's TBD but so far all feedback I've heard is positive), will let me go to 42 weeks (will induce at that point), emergency care is readily available 24/7 (no need for a transfer)
~cons -- no waterbirth, more likely to be "on the clock" once admitted, possibility for more interventions, about 40 minutes away with no traffic, longer post-partum stay

I've talked with my DH and our doula a few times about the choices, and both have encouraged me to choose the place that I am most comfortable and feel the safest with... But for some reason, I just keep bouncing back and forth. My head is telling me to go with the safest option that has the potential for the overall best outcome (hospital). And then my heart chimes in to go with the option that has the potential for the best birth experience (birth center).

DH made a statement to me tonight. "To me, it seems like the birth center will not be average in terms of outcome. It will either go really well, or it could go really badly. The hospital on the other hand, could go well, or it could not meet your expectations (meaning either successful VBAC or RCS). But it seems like the outcome is more likely to be positive regardless (in terms of safety for both baby and me).

Thanks for reading if you made it this far. I think at this point I'm starting to lean towards staying with the hospital practice... mostly because of what my DH said. If I needed augmentation, meds, or god-forbid an emergency arose then at least I'd already be where assistance could be provided. Just getting my thoughts out of my head and into this post is helping!

Pad7 · June 2012

It is a lot to think about, alot to process thru...but I agree with your H's thoughts on outcome. And as much as you decide because you are pregnant, he is also your partner and baby's parent. Value his opinion.

babyike · June 2012

Pad7:
It is a lot to think about, alot to process thru...but I agree with your H's thoughts on outcome. And as much as you decide because you are pregnant, he is also your partner and baby's parent. Value his opinion.

Thank you for your reply Smile

Valuing his opinions/thoughts has been a priority of mine as well, so thank you for reminding me of that! It is definitely a lot to process, so it would be easy for me to overlook how my partner is viewing the situation at times. And his feedback is absolutely important in helping me to choose our birthing location!

emaddock · June 2012

i debated the same thing with this baby and decided to go with the hospital, which i am not advocating for just giving you why i made that decision for me. with the midwife center that i was going to go to i worried that i would have to be transferred to have a c-section and how awful that would make me feel physically and mentally. i also was worried that i wouldn't be able to tolerate the med-free birth. i know i could but that was starting to scare me. and i need to feel in control of this birth.

my OB is VBAC friendly, although i think my hospital is a little quick to section. i live in DC land of lawyers and i think they are so panicked about being sued that they don't think straight. that being said i know my doctor will support me and will tell me if we are at the point where a c-section is a necessity. i have built a trust with her.

i think the VBAC birth, in my humble opinion, is all about having control. and so i guess i would vote for which ever situation you would feel the most in control. and having my DH's support is super important. he was wavering on the VBAC before but now is supportive. and he likes our hospital and our OB so that made things a little easier on that end too.

good luck with your choice! have you already had a successful VBAC? if so, i am envious! i am so afraid of the unknown right now.

babyike · June 2012

emaddock:
i debated the same thing with this baby and decided to go with the hospital, which i am not advocating for just giving you why i made that decision for me. with the midwife center that i was going to go to i worried that i would have to be transferred to have a c-section and how awful that would make me feel physically and mentally. i also was worried that i wouldn't be able to tolerate the med-free birth. i know i could but that was starting to scare me. and i need to feel in control of this birth.
my OB is VBAC friendly, although i think my hospital is a little quick to section. i live in DC land of lawyers and i think they are so panicked about being sued that they don't think straight. that being said i know my doctor will support me and will tell me if we are at the point where a c-section is a necessity. i have built a trust with her.
i think the VBAC birth, in my humble opinion, is all about having control. and so i guess i would vote for which ever situation you would feel the most in control. and having my DH's support is super important. he was wavering on the VBAC before but now is supportive. and he likes our hospital and our OB so that made things a little easier on that end too.
good luck with your choice! have you already had a successful VBAC? if so, i am envious! i am so afraid of the unknown right now.

Thank you for your input!! I too am worried about having to transfer (both for augmentation or God forbid an emergency). I feel like I would just prefer to start labor where I will be certain to finsh, KWIM? As for control, I feel more "comfortable" at the hospital in case things become out of my control (hope that make sense). DH was so bothered by my experience and c/s with DD, so he has thankfully been on-board with VBAC from the beginning! His vote is for the hospital at this point, but he's also said he's 100% okay with whatever location I'm comfortable with.

And yes, I was blessed beyond belief with a hospital waterbirth VBAC with DS. We had moved up to Denver for DH's job for several months, and I found an incredible hospital midwife group and very pro-VBAC hospital!!

You can do this VBAC! Make that your "mantra" during labor. It is normal to be afraid before/during labor, so having support (your DH, doula, nurses, provider) is very helpful in getting you through the hardest parts of labor for sure Yes Med free labor was the hardest physical work I've ever done, but I'm honestly looking forward to doing it all over again for this baby (not the discomfort, but the outcome). And there are plenty of successful VBACs with meds as well, so do what is best for you. GL to you!

MAprincess · June 2012

FOR ME, I chose a hospital VBAC simply because I was comforted by the fact that my midwife assured me they could have the baby out in 8 minutes if an emergency arose. While the odds of an emergency are very, very slim- I just couldn't be calm about the idea of being so far from a hospital if something happened.

That said, I was able to deliver with a VERY VBAC friendly midwife who was extremely supportive of my choice. The hospital only allowed me to go to 41 weeks but did induce at that point. If you have a hospital with a 42 week deadline and an induction option before c/s, I'd go for it if you really believe your providers are on your side. VBAC supportive providers won't section you without a medical reason.

Again, this is a personal decision of yours. What I wrote above is what I would do personally in that situation.

babyike · June 2012

MAprincess:
FOR ME, I chose a hospital VBAC simply because I was comforted by the fact that my midwife assured me they could have the baby out in 8 minutes if an emergency arose. While the odds of an emergency are very, very slim- I just couldn't be calm about the idea of being so far from a hospital if something happened.

That said, I was able to deliver with a VERY VBAC friendly midwife who was extremely supportive of my choice. The hospital only allowed me to go to 41 weeks but did induce at that point. If you have a hospital with a 42 week deadline and an induction option before c/s, I'd go for it if you really believe your providers are on your side. VBAC supportive providers won't section you without a medical reason.

Again, this is a personal decision of yours. What I wrote above is what I would do personally in that situation.

I also have similar fears/worries about transferring in the rare event of an emergency. I honestly cannot even get past the idea of not getting to the hospital "in time"... Scares me to no end.

I do believe I have a very pro-VBAC OB group, and the fact that all 10 in the practice are as supportive as the OB I mainly see helps me feel good about getting one of them as the on-call OB if my preference is not there.

Thank you MA for your thoughts! I am truly appreciative of feedback Smile

Cooper81 · June 2012

Could you attempt a VBAC at the hospital, but with a MW (maybe I'm reading your situation wrong, but it seems like it is OB at the hospital or MW at the birthing center)? The two MW practices I looked into in my area that do VBAC's require VBAC's to deliver at the hospital, but they have privledges at the same hospital I had my DS. So while I don't have a choice since I'm going with the MW, it does make me feel better that I will be in the hospital, but under the care of a MW.

babyike · June 2012

Cooper81:
Could you attempt a VBAC at the hospital, but with a MW (maybe I'm reading your situation wrong, but it seems like it is OB at the hospital or MW at the birthing center)? The two MW practices I looked into in my area that do VBAC's require VBAC's to deliver at the hospital, but they have privledges at the same hospital I had my DS. So while I don't have a choice since I'm going with the MW, it does make me feel better that I will be in the hospital, but under the care of a MW.

I wish this was an option here, but it is not. I used a hospital midwife practice with my first VBAC, but that was in Denver. That was the best of both worlds, especially since I was allowed and encouraged to have a waterbirth VBAC in the hospital!!! I'd actually considered flying back up there if things hadn't worked out in finding a provider/location down here LOL.

In Houston, I could possibly switch to the county hospital and see a midwife, but there's still no guarantee she'll be on-call when I go into labor (midwives are on a rotation with the OBs there). At the hospital I'm currently at, there are midwives but they do not do VBACs. Only the OB practices do VBACs.

Twizzle · June 2012

I totally agree with what your H said, it was very insightful. If I were in your shoes, I would stick with the hospital because no matter what happens you'll be in a place you are comfortable with. I planned to give birth the first time at a birth center, and I think that it would have been wonderful if I had been able to birth there, but I had to transfer, and there were so many unknowns at the hospital and it was not a good experience at all. I also think that the birth center was very quick, maybe too quick, to transfer moms at the very slightest hint of an issue (confirmed by talking with other moms who transferred) because they want to protect themselves. After I was transferred and the midwife's shift ended, they kind of left me high and dry and I had trusted them so much. I really felt let down.

Obviously this doesn't mean that all birth centers are the same, but I do think that if you go with the birth center and have to transfer, your experience would not be as positive as it would if you just went with the hospital of your choice.

babyike · June 2012

Twizzle:
I totally agree with what your H said, it was very insightful. If I were in your shoes, I would stick with the hospital because no matter what happens you'll be in a place you are comfortable with. I planned to give birth the first time at a birth center, and I think that it would have been wonderful if I had been able to birth there, but I had to transfer, and there were so many unknowns at the hospital and it was not a good experience at all. I also think that the birth center was very quick, maybe too quick, to transfer moms at the very slightest hint of an issue (confirmed by talking with other moms who transferred) because they want to protect themselves. After I was transferred and the midwife's shift ended, they kind of left me high and dry and I had trusted them so much. I really felt let down.
Obviously this doesn't mean that all birth centers are the same, but I do think that if you go with the birth center and have to transfer, your experience would not be as positive as it would if you just went with the hospital of your choice.

Thank you so much for sharing your experience! I've heard similar things about the birth center here regarding being quick to transfer VBACs, but that honestly reassures me rather than bothers me... Mostly because I'd rather be transferred too soon than too late, but that's just me, KWIM? I do completely agree with you though that being transferred at all would have a negative impact on my birth experience for sure!

It does sound though that you were not treated appropriately in your prevoius birth situation I think you'll have a much better outcome with your next birth!

I did have a long talk with my doula today about my back and forth, and she helped me talk through my fears for this birth. I cannot stress how helpful that was, tears and all! It feels good to get the fear out in the open and out of my way so I can make a decision about my birth location. Just another reason why doulas can be such incredible support for those planning VBACs!

Thank you ladies again for all of your replies and advice

iris427 · June 2012

I don't agree with your husband. Most of the time, transfers from birth centers and home births are not emergent and most still result in a vaginal delivery. There is a perception, even among people than plan OOH deliveries, that either you have a great OOH birth, or you transfer because you need an emergency c/s, but if you have a responsible midwife that should not be the case. Most transfers end up with ordinary, run of the mill hospital deliveries, which is how it should be. If your only options are things going great or things going really badly, then that midwife should not be catching babies because it suggests she doesn't know how to evaluate and address minor complications and prevent major ones.

That said, if you can't get around the fear of not being in a hospital, the BC may not be the right place for you. I worried my whole second pregnancy about whether delivering at home was right though, so what do I know?

babyike · June 2012

iris427:
I don't agree with your husband. Most of the time, transfers from birth centers and home births are not emergent and most still result in a vaginal delivery. There is a perception, even among people than plan OOH deliveries, that either you have a great OOH birth, or you transfer because you need an emergency c/s, but if you have a responsible midwife that should not be the case. Most transfers end up with ordinary, run of the mill hospital deliveries, which is how it should be. If your only options are things going great or things going really badly, then that midwife should not be catching babies because it suggests she doesn't know how to evaluate and address minor complications and prevent major ones.
That said, if you can't get around the fear of not being in a hospital, the BC may not be the right place for you. I worried my whole second pregnancy about whether delivering at home was right though, so what do I know?

Thanks iris! The midwife at this birth center is extremely experienced and comes very highly recommended, so you're right that an emergency transfer is not likely. For me though, I guess even the idea of needing to transfer (non-emergency) makes me uncomfortable. I'm worried I'll feel defeated and that will not be helpful once at the hospital... or if I'm preoccupied with the fear of needing to transfer during labor, that would not be conducive for labor progress while at the birth center. That's the fear I've been trying to work through with my doula the past few days.

I'm doing the hospital tour on Saturday, and I have another consult with the birth center this Wednesday. I'm hopeful that I'll have my decision made after those two appointments...

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