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Natural Birth
ESUJessey
member
Hospital (for safety/calm fears) or Birth Center (for more respect of my choices/natural birth)?
ESUJessey
member
My husband and I are on the fence about if we want to stay with a hospital setting with our obgyn or try a free standing birth center with midwives instead. Obviously I think the birth center would be more inline with what we want and would be better about promoting natural childbirth. My husband is really wanting to switch, but a part of me is still unsure simply out of fear something bad would happen and we would not be near a hospital. People keep telling me things like "you could hemorrhage and not get to the hospital in time" and scary stuff like that. Thus far I am low risk (though I am taking metformin and also just found out I have an anterior placenta). Just hoping for some insight, maybe some advice. We are going to take a tour at least to see what we think. Are my fears about needing to stay with a hospital at all valid? Thanks!
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Re: Hospital (for safety/calm fears) or Birth Center (for more respect of my choices/natural birth)?
I personally don't feel like a hospital is necessarily safer. You are more likely to have unnecessary interventions that can be harmful to you and baby.
It is very rare that you have a complication that needs to be handled in the next 15 minutes in a manner the midwives can't. When I interviewed my midwife I asked about the most serious complications (placental abruption and cord prolapse) and I felt comfortable with her answers.
Ultimately though YOU need to feel comfortable with your place of birth.
You should go where you feel safe. I would definitely at least interview the MWs at the BC and share all of your concerns and ask your questions. They may very well be able to calm your fears.
FWIW, I switched to a BC at 28 weeks. I was low risk until I went into labor. DD was not handling contractions well and they did a transfer. It was not an emergency, but it was where we were safest. I do not regret at least trying for the BC. I really trusted my MWs and their judgement and it has helped me deal with all of the interventions I ended up having even the c/s.
One thing I do regret is not doing my due diligence on the hospital i'd be transferred to. They were not baby friendly and I am very sad about the hours I missed with DD while I was stuck in recovery, having to fight to room in, etc. So, whatever you decide, make sure you have yourself covered for all circumstances so you can feel safe and comfortable with your decision.
Because I've had a homebirth I've had a lot of people make comments about "what if" or my baby had a low heart rate, etc. To be honest, I would say over half (if not 75%- again, I say it, its not a stat I found or anything) of the "what ifs" were caused by medical intervention or even laboring on your back can cause a low heart rate. Also, we interviewed many midwifes and went with our midwife because we were very comfortable with her and confident by her education and experience that she would know if an issue is arising (hemorrhaging, etc.). She's a CNM and well respected with hospitals and I know if I did have to transfer (which is 25 min away) she would be on the phone with the hospital giving them info, etc. and coming with us to the hospital to assist. The way I look at it is I'd rather be monitored nonstop by a midwife at home then have a doctor stop by once or twice to check on me. With my 2nd child I actually had a 80% placenta abruption at 37 weeks (not in labor). We rushed to the ER and it was a very scary situation and we are both lucky to have survived it. However, I'm still choosing to have a homebirth this time around (which surprises a lot of people) but that would have happened regardless of where I gave birth at especially since I wasn't even in labor at the time. The hospital staff was very nice to us and I have no bad things to say about them (in fact they were very accomdating to us and never gave us the side eye to our requests: no bath, no hearing test, no eye ointment, vit k shot, etc), I just prefer the benefits of a homebirth.
HOWEVER, I will say if you have ANY type of fear with a birth center you shouldn't convince yourself to go there vs. a hospital. You need to surrender yourself and be comfortable in labor and if in the back of your mind you're even a bit scared you could have a longer labor, more difficult labor, etc.
I'm with everyone who mentions that hospital interventions may cause more "emergencies" than nature. Keep in mind as well that most transfers are not emergencies--there's plenty of time and no one is at risk from the time it takes to hop across the street or whatever (most BCs are near and affiliated with/have transfer agreements with a hospital--is yours?). And finally--many of the true emergencies that end up with women needing hospital intervention don't occur during labor--they're pre-term labor situations or issues like placental abruption that happen when you're not even headed to the hospital yet.
And as pps said--learning more about the hospital might sway your decision. If they're very pro-natural-birth, you might have a similar experience to a birth center (though my opinion is that even a pro-natural-birth hospital is still, well, a hospital) and many midwives deliver at hospitals if you prefer a midwife.
You need to be where you're comfortable--but make sure it's good assessment of the risks and your comfort that's driving you, not fear. Fear makes us go with poor decisions.
I think the pp's have valid points, but I also want to point out that you will need to make sure that you insurance covers the birth center. If they don't, it might not be the end of the world, but you would have to fight for it!
Best of luck!
As a side note, I think I got the best of both worlds: a birth center located INSIDE a hospital...completely separate from the regular L&D.
I think it depends both on the hospital/your OB and on the birth center. I'd tour both and ask lots of questions and see which one feels more comfortable.
I chose a hospital birth with my OB. She is very NB friendly and I am comfortable with her. The hospital is not a baby factory type place - they always have enough rooms and are never pushing people to have babies faster. The nurses are trained in how to help women labor without pain meds. They encourage use of the shower, birthing ball, walking, changing positions. Intermittent monitoring and hep lock (no IV) is standard policy. They have LCs on staff and encourage breastfeeding and rooming in. I didn't have to fight any battles with my doc or nurses - they asked what my "pain management" plan was when I came in, I told them I wanted to try going natural, and that was the last I heard about it. I had a wonderful experience.
If the hospital had been different, I would have considered a birth center. But I was uncomfortable with the "what-if"s and I did not like that if transferred, I'd be sent to the baby factory hospital that I was really uncomfortable with.
Also, I think it's good to remember it doesn't have to be all or nothing. There are natural birth friendly care providers that deliver in hospitals. My practice follows the traditional midwifery model of care, but deliver in the hospital. I think homebirths are wonderful, but based on my labor/delivery experience last time I'm not personally comfortable with it for this birth and we don't have any birthing centers in the area so the hospital with a midwife is the best choice for us.
I think you should explore your options. Check out the birthing center, talk to the care providers there. Discuss extensively what you want your labor/delivery experience to be with your current OB/GYN and really listen to what their opinion is to see if they're a good fit. If they're not, and you still want to deliver in a hospital, explore your options for a more NB-friendly provider.
As far as your fears, you're the one who has to be comfortable. I think you should research things and come to your own conclusions rather than listen to people trying to use scare tactics. I think a lot of times people discount the risks associated with hospital births like higher rates of intervention, poor maternal/fetal outcomes, higher risk of infection, etc. and immediately assume the hospital is the safest place in the unlikely event that an emergency happens. A lot of people don't understand the midwives are fully capable and prepared to handle a lot of common emergencies that arise and can often successfully handle the situation long enough to get you transferred if something arises that you would need surgery or additional care, KWIM? They're not just a baby catcher, they're trained medical professionals.
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I think it's common to have some of these fears as a first-time-mom and as early in your pregnancy as you are. I think a tour and meeting the birth center midwives is a great idea and can help you make up your mind. As a 3rd-time mom who has had a natural hospital birth with my first, a healthy, surprise breech baby in a free-standing birth center with my second, and just switched from a hospital midwife birth to a home birth at 32 weeks this time (no birth centers in my new town), I understand some of your concerns.
Since I did end up with a unconventional birth in a free standing birth center and did have to transfer to the hospital after for a 4th-degree episiotomy/tear repair, I'll let you know that it was really no big deal and that everyone was very cautious and careful about the transfer. The birth went very professionally with the midwives (and way more relaxed than at the hospital - I walked in pretty much ready to push and surprise...the baby had flipped, but luckily the midwife on call had been trained by one of the foremost OB breech docs in the area) and the transfer of care was wonderful - the midwives accompanied me to the hospital and the hospital was welcoming and non-judgemental and also very professional. Plus since I didn't give birth at the actual hospital and the baby wasn't/didn't need to be admitted, I was home that same day snuggling my new baby in my own bed, which was worth it's weight in gold to me.
Hope that helps relieve some fears about unexpected issues and transferring and that it usually happens at a time when things are relaxed and there is still some time to make decisions, the midwives at free standing birth centers are very preemptive.
...baby #3 is here...
Fear is what keeps us alive. Your fears are valid because there are risks that come with birth. Fortunately they are measured in 1 out of a 1000's and 1 out of a 100,000s in most cases.
I am having a home birth (if all is well of course). That being said, my midwifery practice has a higher than normal transfer rate because she is a registered nurse with hospital privleges. If something looks to be going wrong, and there are a lot of signs to indicate most things early on, she doesn't hesitate to transfer. Because she has HPs she still has a 5% c-section rate for all patients. You may just need an epi to get some rest while your body continues to work. Or the baby may be showing signs of distress that are mild but still warrant being in a hospital, just in case it increases rapidly. If the midwives at your birth center have HPs have a good standing relationship with certain OBs or hospitals, your risks of death, etc. are a lot lower still.
Just know that most things that are life threatening at home or in a birth center, are just as life threatening at a hospital. The risk of a pulmunary embolism are equal no matter where you are.
Though in this case, a person can pay for MW care out-of-pocket (but still be covered for the hospital portion if a transfer has to happen). It may seem like this could go without saying, but with my first PG I got too hung up on what insurance would or wouldn't cover. I really discounted the value of paying OOP (which in some cases may not be that much more).
More Green For Less Green
I had to be in a hospital because I had a medically necessary induction... that said, I was quite glad I was already there when after I had been pushing 3-4 hours with a big baby head stuck against my pubic bone that I had the option of getting some vaccuum assistance. I can't imagine being transferred at that point, and I was beyond exhausted and there was no way I was getting that posterior baby out all on my own.
I still had a "natural birth" in so far as I took no pain meds and did not have an epidural. I had almost every intervention in the book. Cytotec, Pitocin, IV, continuous fetal monitoring (telemetry), and vacuum delivery-- so hospital was the way it had to be for me. I still labored/pushed how I wanted, including spending most of my time in a tub, and used my hypnobirthing to get through it all.
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I've done both, and vastly preferred the birth center. The atmosphere in the hospital (even though everything was normal) was very much one of "something could go wrong at any minute", and there was a sense of fear through it all, even though they had quick access to all the tools if something did.
My son was born in a birth center, and his shoulders got stuck on the way out (just a little) but the way everything was handled and the way I was cared for was SO much nicer.
Just my experience, of course, but it was profound enough to me that I wanted to chime in
Just want to say, hospitals are for sick people. They are full of disease, infection and contagion.
Pregnancy and birth are not a disease. Why put yourself and your baby at unnecessary risk of infection? I vote for BC. I wish I had that option!