? for those with out of hospital births...

babyike · June 2012

I am mostly a lurker on this board (I mostly post on my BMB and VBAC), though I have left a reply here and there and posted when I was pregnant with my DS (he was a hospital waterbirth VBAC in a different state, so going back to that location is not really an option unfortunately).

I'm having a dilemma in choosing a birthing location for this baby, and I'm down to the wire now at 33 weeks. I need to make a decision (for time reasons and for my own sanity). My choice is between a great OB and supportive hospital OR a great birth center with wonderful midwives, both providers are supportive of me having another VBAC and going natural.

Q: Why were you comfortable/not comfortable birthing out of the hospital?

TIA ladies!

iris427 · June 2012

I was comfortable with my home birth because I had a legal, qualified provider and lived very close to a good hospital. I had looked at a lot of studies on home birth and was satisfied with the safety statistics. I did have some moments of thinking "what if something goes wrong?" but I think that I would have those worries no matter where I delivered. I did have to ask myself, if something goes seriously wrong, will I blame myself for choosing a home birth? And that is a tough question.

The way I see it, the majority of low-risk pregnancies are better off OOH where maternal outcomes are better due to less interventions. But there is a certain percentage where something will go wrong and they are better off in a hospital. The problem is we don't know ahead if time which births will be which. So we have to decide which risks we feel better about taking.

stahlop · June 2012

lissydee:
I went out of hospital because working on a L&D unit, I see how we RNs and providers (OBs and midwives) react to the smallest nuance or deviation to the so called accepted "norm." That being in the hospital bed increases the chance of interventions taking place. That going in wanting to "try" to go natural or "planning on going natural" can change knowing that pain relief is just an arms lenght away so to speak. So for me, I knew that in order to be successful with my goal of a natural birth, and provided I had a low risk and otherwise boring pregnancy, I had to remove myself from that situation.
I also wanted a water birth and the options for such in the hospitals in my area are greatly limited. It wasn't with my midwives at their birth center.

I love when medical professionals do OOH births.

I did an OOH birth because I wanted to be comfortable with where I was birthing, and a sterile hospital environment confined to a bed did not sound comfortable. Plus, my OB practice couldn't guarantee which doctor would be there and I wanted to know the person helping me deliver. I also didn't want any meds and I thought I might be tempted if in the hospital. You have to go where you'll be the most comfortable. My MW said that the few non-emergency hospital transfer's that she had were women who weren't completely sold on an OOH birth in the first place so they had trouble relaxing until they were in the hospital.

Jcrab · June 2012

lissydee:
I went out of hospital because working on a L&D unit, I see how we RNs and providers (OBs and midwives) react to the smallest nuance or deviation to the so called accepted "norm." That being in the hospital bed increases the chance of interventions taking place. That going in wanting to "try" to go natural or "planning on going natural" can change knowing that pain relief is just an arms lenght away so to speak. So for me, I knew that in order to be successful with my goal of a natural birth, and provided I had a low risk and otherwise boring pregnancy, I had to remove myself from that situation.
I also wanted a water birth and the options for such in the hospitals in my area are greatly limited. It wasn't with my midwives at their birth center.

Almost exactly this! I work in the NICU though. I learned through experience with issues that occurred with my first pregnancy and complications my DS had that I can trust my body and mind I know when something is not right. I had a guy feeling we would be safer at home than in the hospital and even though my delivery did have some complications a few minutes before DD was born we were both better off being at home. I felt so much more comfortable and safer laboring at home that I can say my labor really wasn't painful, just work. In fact the MW only made it 30 minutes before baby was born because I was coping so well. GL with your decision!

julyjennifer · June 2012

I felt comfortable with a planned homebirth, and preferred that to the hospital this time around for several reasons:

-better continuity of care in that I was much more likely to have the same midwife at the birth who I'd had all my prenatals with.

-more extensive post-partum care (home visits post-birth at 24 hours, 3 days, 1 week, then visits at MW's office at 2 weeks, 6 weeks).

-post-birth protocols more aligned with my wishes - less likelihood of premature cord cutting or baby being taken away from me to be looked over or worked on, exams would be done with baby on or near me.

-I was more comfortable with how certain complications would be handled by my HB MW than with some luck of the draw on-call hospital care provider (e.g., if we had a shoulder dystocia--I trusted that no one would be panicking and yanking the baby when birthing at home with my chosen midwife)

goldene · June 2012

I have a slightly interesting (maybe) take on this because, with my first pregnancy, I planned a waterbirth with the midwives at the facility you had your first VBAC. Unfortunately, when I came in to the hospital at 38.5 weeks (water broken, dilated to 7 cm in two hours at home), the midwife on call discovered our baby was breech. Also unfortunately, it seems that the midwives had probably misdiagnosed her as head-down at previous appointments because after the birth it was apparent (from her legs and from a slight hip displaysia that is now resolved) that she had been breech for a long time. After a LOT of freaking out by care providers around me, I ended up with a cesarean. I don't say this mostly irrelevant backstory to tarnish your wonderful experience with them in any way, it's just funny that I ended up having such a different experience than you there. It totally depends on the specific birth.

This pregnancy, although I liked a lot of aspects about the other group, I switched to the midwives at another hospital with a slightly higher VBAC rate (85% of 150 women vs. 80% of 40 or so women). However, after 10 or so weeks with them, I realized that something was off. Although I didn't doubt the care I was receiving, it didn't feel as expansive, holistic, and personal as it could be. I think that's just the nature of the beast at facilities a lot of times.

I have chosen to go for a certified professional midwife and birth at home. We are less than 10 minutes from a good hospital (not great for natural birth, but good for emergencies) and 25 minutes from another hospital that actually wants homebirth transfers to come there. I feel confident that the personalized, 100% attentive, two-on-one care (two midwives come to every birth, plus my doula) will help me be safer than I would be in a hospital for almost every circumstance.

I agree with PP who said that neither choice is risk free. I also agree that I don't think you get over the "what if" - there are "what ifs" in any case, though, so you have to go with your gut.

The thing about the gut that I would say is, make sure that the gut that's responding isn't fear-based gut, you know? I don't think we make the best decisions out of fear. Fear can empower us to calmly make evidence and research-based good decisions, but acting out of fear alone leads to more cramped decision-making. I think you're doing just what you should do by exploring this question and seeking input from others and your own heart.

I am working on getting over what "people" would say and do what is best for our family. "People" are mostly very, very misinformed about birth. "People" think ALL birth interventions are necessary and that hospitals save them (the "I would have died if" stories). If something happens where it would have been better to be inside of a hospital at that specific moment (very, very unlikely), it will be horrible but I will know that I thought as carefully about this big decision as possible and made the best choices I could. This, of course, is something everyone should feel towards the huge decision of where to birth but 99% of people do not because they assume what everyone else is doing is the right thing. That's why I won't let "people" into this decision.

Longest post ever! Sorry!

vintagejjane · June 2012

I chose a home birth for a lot of different reasons. The rate of Csections in my area is pretty high at the local hospital. I wanted a water birth and wanted to deliver in the water. I also wanted to be able to move around freely during labor and not be confined to a bed. Walking during labor helped so much. I also loved the level of care I was given by my midwife. My appointments were an hour and sometimes went over because we would chit chat. I was so comfortable with her like I would be with a close friend.

CTri17 · June 2012

Everything Iris said.

And I have really bad white coat syndrome so I knew being in the hospital would be a scary time for me and would likely lead to more interventions.

I had another friend who also had homebirths so I had her experiences to see as well.

babyike · June 2012

Wow, ladies your input is greatly appreciated! Thank you all so much for sharing your comments with me! I'll respond to each of you in one post...

~ iris, you hit the nail on the head with this statement. "I did have to ask myself, if something goes seriously wrong, will I blame myself for choosing a home birth? And that is a tough question" This is the one question that I struggle with when thinking about the birth center. Knowing myself, the answer to this question would absolutely haunt me with guilt if something went terribly wrong. That's just me...

~ lissydee, you've just described the hospital environment that our DD was born in via c/s. That same hospital would also be the main transfer option from the birth center if a transfer was needed. Which obviously concerns me... The other hospital where I'm currently at is a complete 180 in terms of L&D care. Being both mom- and baby-friendly, the L&D nurses and providers are supportive of VBACs, natural birth/unmedicated labor techniques, mom-chosen birthing positions, etc.

~ stahlop, "You have to go where you'll be the most comfortable. My MW said that the few non-emergency hospital transfer's that she had were women who weren't completely sold on an OOH birth in the first place so they had trouble relaxing until they were in the hospital." I feel like I would be one of those women, and DH has said that is his worry for me at the birth center.

~ Jcrab, I know what you mean by learning that you can trust your body and know when something is not right! When I was in labor with DS, I just had this overwhelming feeling that it was time to get to the birth center at the hospital. Though I might have arrived a couple of hours too early, things turned out beautifully with the waterbirth. Thank you for sharing!

~ BreanneL24, I cannot tell you how many times I wondered how things might have turned out differently had I gone to a birth center with midwives for DD's labor and birth... I've moved on since having my VBAC with DS thankfully, but you make an excellent point about being with a provider that you trust! That absolutely makes all the difference Yes

~ julyjennifer, your first three points were all on my "pros list" for the midwives at the birth center. But I feel like I haven't really connected too much with the midwives since I've only had 2 appts and an u/s with them. Since I started prenatal care with the OB group, I've gotten to know and connect with several of the providers over the past 7 months.

~ goldene, I seriously you for your long reply! If I tried to c&p each point I agreed with, I would likely just be quoting your entire post Yes I will say that you are definitely right that every birth is different, regardless of location. And in regards to "fear vs gut", this is what I have been working through the past few weeks with my doula. We finally got through my fear last week, so I'm now able to look at both locations with a mostly clear head! Again, your reply's length and detail is so very much appreciated. And GL with your upcoming HBAC!!

~ vintagejjane, my waterbirth with DS was incredible to say the least! I would be lying if I said that wasn't the main part of my focus with using the birth center. Though the hospital does support mobility and water tubs during labor, they do not yet have approval for waterbirths at this time (they just opened at the end of March and have applied for several accreditations/certifications regarding mom/baby friendly status, so those are their main focuses right now). However, my OB practice has said that waterbirth is on their list of future goals!

~CTri17, I had pretty intense white coat fear after my labor with DD. It was horribly mismanaged by the on-call OB, whom no one even had met before because it was his first call shift at my previous hospital. By the time my OB got there the next morning, she was pissed and appalled when she saw my chart... I was hesitant about being in the hospital with DS for my VBAC, but I was with supportive and qualified midwives. I freaked out a tad before I agreed to low-dose pitocin, but everything went as well as it could have and I ended up with the birth I wanted!

Thank you thank you thank you ladies again for your wonderfully helpful comments!

goldene · June 2012

I have been reading these posts of yours with interest because I am still grappling a little with the hospital vs. homebirth idea for myself (I NEVER imagined homebirth until I was, um, 25 weeks in this pregnancy and I'm adjusting to the idea now at 32 weeks). I will say that based on what you've posted, I think I know what you should do! I will also say that if you do choose the hospital and are in the tub pushing, they can't force you out...

babyike · June 2012

goldene:
I have been reading these posts of yours with interest because I am still grappling a little with the hospital vs. homebirth idea for myself (I NEVER imagined homebirth until I was, um, 25 weeks in this pregnancy and I'm adjusting to the idea now at 32 weeks). I will say that based on what you've posted, I think I know what you should do! I will also say that if you do choose the hospital and are in the tub pushing, they can't force you out...

We have a lot in common, as I didn't even know the birth center was an option until about 26ish weeks. I have been in contact with my doula, and she really wants me to feel settled so I can enjoy the final weeks of this pregnancy without the stress of all of this. I am fairly sure of my decision at this point, I just needed to hear why others were comfortable and compare their responses with how I really felt. If only the birth center could be inside the hospital... Smile You're right about the pushing in the tub, and that's definitely crossed my mind!

And I'm happy that my posts meant something to you too!

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