Looking for thoughts and advice(very long, sorry)

PeacePath · August 2013

Hi everyone,

I've never posted here before so I hope this is ok. I'm going through a bit of panic right now as I get closer and closer to my due date. I'm 27 weeks pregnant and against years of imagining a totally different birth, I'm signed up to deliver at a local hospital with an OB practice. I trained and even practiced for a bit as a doula and am 100% in love with the midwifery model of care and keeping birth as natural and intervention free as possible. But man, after having a loss and now trying to make the best choice for myself and my new baby it feels a lot easier said than done! I never fully put myself in another mom's shoes until now, unfortunately. I'm feeling like I want to make a change, but scared I'll make the wrong choice.

I really don't have a major issue with my ob practice and the 5 women I see there are nice enough. Every time I go, I'm weighed, they take my bp, check my urine, check the baby's heartbeat, and rush me out. I've tried a few times to bring up questions about the delivery/talk about my feelings or wishes and it gets dismissed every time. They'll say something like "well we'll work with you when the time comes." or "We can go over your birth plan towards the end of your pregnancy" which bothers me. I'm extremely low risk so far and couldn't have asked for a less complicated pregnancy, but I do feel like they keep looking for me to "mess up" somewhere along the way. I am a bit overweight, but have gained next to no weight so far, have great bp, no protein in my urine, baby's heart is great and he consistently measures 5 days ahead, placenta is perfect, cervix is perfect...so I thought we're doing fine, but one of the doctors had me take a 1 hour glucose test at 22 weeks which I failed and take a 3 hour test at 24 weeks which I passed perfectly. Now they're telling me that they basically ordered the test so early because I'm overweight and I'll have to take it again, even though I passed, at 28 weeks because I could still develop GD. Well that felt very underhanded to me because I trusted that they would order it at an appropriate time, not early because I'm fat and then disregard the results either way. I'll still take it again just to be sure I haven't developed GD, but it feels very disrespectful. So far all I can get out of them about the delivery is that I can labor in water, but absolutely NOT give birth in water(which is my dream), I'll have to have an IV which I don't want, and my husband is absolutely forbidden to even help catch the baby because of liability even though we both really wanted one of us to be the first hands to touch our baby. My point is that I'm bothered that no one will budge even a little and that I'm being treated like I'm about to break when I couldn't be much more low risk.

I won't consider another OB practice because this is the only all-female one at all in my area and delivering with a female OB or midwife is extremely high on my list. I found a birth center and have no idea if they would even take me at this point, or if it would be a good fit, but from everything I'm seeing it looks absolutely amazing. It's a group of women who are all CNMs and have admitting privileges to a hospital about 25 minutes away from the center. They have amazing birth suites with jacuzzi tubs for labor AND delivery and they really seem to be open to allowing a birth plan like the one I have. I have no problem delivering with a midwife, but I'm so terrified that if something goes wrong we'll be too far from a hospital to save the baby in time. This is something that really scares my husband. If I need to be transferred, the hospital just feels SO far away. Is this normal for a birth center like this to be so removed from a hospital? I think this is really my main concern and of course the midwives will say "we've never had a problem getting there in time" but there's a first time for everything, right? Am I being overly concerned or would this be out of your comfort zone?

I'm also scared of becoming high risk towards the end of the pregnancy and having to go crawling back to my OB saying "I'm sorry, I made a mistake, will you still help me?" What happens when you become too high risk for a birth center birth near the end? Do you end up just showing up at the hospital and saying "someone help me"? I know you can't always predict it, but I really don't want the stress of switching so late in the game, just to have to go back to the doctors who will probably hold a grudge against me for leaving. Plus they may not take me back anyway right? I'm just not sure how that all works.

Ugh, so sorry for crashing this board with my concerns and rambling. I'm just wondering if anyone else has ever dealt with these fears and if anyone has any good insight. I don't want fear of a medical birth to push me into a birth that's wrong for me, but I don't want fear of something going wrong to push me into a place where things going wrong is "normal". Thanks in advance if you read through this and have any opinions you want to share

spicysurro · August 2013

I understand your concerns, but I feel like you would be in amazing hands with Certified Nurse Midwives. They are nurses essentially so I feel like they would be able to handle any kind of emergency and help with transfer if ever needed. I think your best plan right now would be to just go and get a consultation with the nurse midwives group. They can talk about all your (completely normal) fears and explain to you how everything will work. Just remember Midwives come to all homes completely equipped with medical equipment and will be able to help. I think you should go and visit them and chat and then see how you feel afterwards. You shouldnt have to give up your dream birth!

hamiltks10 · August 2013

I agree with the pp...it doesn't hurt to go in and talk with the midwives at the birth center. I think all of your fears are completely normal. They can talk to you about your options and help you decide what is best for you.

I had a difficult time deciding between a birth center and a hospital birth. I decided on the hospital birth mainly because they were the closest to my home and my OB/Midwife group delivered there. But, I hired a doula and spent the long majority of my labor at home where I wasn't stuck in a bed with an IV in my arm. We timed it just about perfectly to where I got to the hospital at 10cm and DS was born in less than 30 minutes after arriving. I was perfectly happy with my birth experience, because for most of it I was relaxed in my own home.

So...that is something to think about. Labor at home for as long as possible and you will avoid many of the routine procedures and interventions. Remember, your OB's will "tell" you what they want you to do. One for example is to leave for the hospital right when your water breaks. But you don't necessarily have to do what they say. Understand the pros and cons, the risks and rewards, and make the right decision for you. It is possible to have positive birth experience in the hospital.

Arielle27 · August 2013

First of all, it is so normal to start getting nervous about all the what ifs at this point in your pregnancy. But I think you should really try to have an open mind and be ready to somewhat go with the flow, as the unexpected is bound to happen... But also remember that no matter what, it is your body and you DO have a say in what is happening to you, wherever you are and whatever is happening!

It can be disheartening how little attention they seem to pay throughout your pregnancy until the end if you have a very normal, healthy pregnancy... I recall feeling that way with my first. But it actually is good news - there is just nothing they need to do because everything is going so well! I wouldn't let that deter you from continuing with the MW route.

In terms of the birth center, I think it is pretty standard to be that far from a hospital, and for many women it isn't a problem at all. Personally, I wouldn't feel comfortable with it. However, I have only had hospital births because I feel more comfortable being at a hospital in case anything goes wrong, and because I am terrified of being stuck in traffic midway through transition or well into active labor!!

Good luck in whatever you decide! I hope the rest of the pregnancy continues to go well!

AmyRI · August 2013

I would take your DH and go on a tour of the birth center.
There are very few complications that would cause trouble in under half an hour, but I understand your hesitation in being so far from the hospital. Talking with the midwives should help you.

Also ask the MWs about who you would be transferred to if complications arise. They could be affiliated with a specific doc or practice, or it could be whoever the hospital's on-call OB is that day if it's an "in labor" kind of thing. If complications arise, or induction is necessary, it's entirely possible that one of the CNMs will still be your care provider, but you will deliver at the hospital instead unless you need a c-section.

With the glucose tolerance test, it isn't inappropriate to do the test twice. You're at a higher risk for GD, so they wanted to test early. Testing early doesn't rule out developing it later, so it's justified to test again at the "normal" time. They are taking a very cautious approach (one that my OBs and MWs never thought was necessary despite me being overweight) but it isn't really wrong, and I would encourage you to take the test again next week. GD should not be left untreated.

I delivered DS with an OB. OB's practice sucked when I was pg with DD, switched to a MW practice. Borderline high blood pressure, but it never developed into PIH or Pre-E, so nothing ever came of it. Went into labor at 40w6d. Nurse misses DD's positioning, when I hit 7cm MW checks me and, uh oh, she feels a butt, not a head. I was transferred to the hospital's on-call OB at that point, which could have been my former OB. (thankfully) it was not - but it was a male OB. I didn't want a male OB at any point prior to that moment, but it turns out he is one of 2 providers that's trained in breech births. He let me deliver her vaginally. If I had stayed with my old OB, or gotten a different one, I would have been wheeled into the OR for a c/s immediately.

Now my MWs changed hospitals and I'm about to transfer all care to that male OB, and while it feels a little wrong to me, I know that medically it is the right choice. I really encourage you to choose a provider based on their skills, success rates, and supportiveness of natural birthing and not stay with the status quo just because it's what is familiar.

nodito · August 2013

It sounds like you feel disrespected at your current OB practice. I don't think the ordering two glucose tests is underhanded, but that you feel rushed and disregarded would be a red flag for me. Tour the birth center, meet the midwives, see what safeguards they have in place to help in case of emergency. Our birth center accepts new patients until 33 weeks, though of course it's desirable to switch before then if you can.

Another option to consider, if you live close to a hospital, is to plan a home delivery. It is very safe for low-risk mothers. You would find an experienced midwife who could take over prenatal care, labor at home, deliver in a birthing tub or have DH catch the baby, and be closer than 25 minutes to a hospital in case of emergency. Midwives usually work with backups and are adept at referring patients well before crisis point if they feel mother would benefit.

About having to return to your OB: If you see 5 different OBs on a rotating basis, it won't strike the individual doctors as odd that they haven't seen you in a couple of months. They'll notice that they don't have measurements and stuff for several weeks but you could always just be honest (and offer a little flattery): You were exploring the possibility of delivering at a birth center (where these OBs presumably don't work) but were told that it wasn't safe for you and you came back because you want the best care possible and of course, that would be the OB you're seeing at that visit.

There's a lot to think about. Your body was made to do this and childbirth is not a disease, so if you want to plan for a natural delivery, you should feel free to do so in whatever way feels most comfortable.

sschwege · August 2013

First of all always remember that you have the final say. Provided that you are of sound mind you must give consent to all medical procedures.

As for the GD test, I have heard of doctors doing this and it's not necessarily a bad call. I have a friend who was tested early because she was at risk for developing it, failed the 1 hour passed the 3 hr. Same pregnancy, the second time around she failed both. So it can develop at any time, better to catch it earlier than later. I'm sure the way your OB is looking at it, is this is a test with basically no risk, but the information it provides can be very important. As for your husband catching a baby in a hospital setting, I think this would probably be a common response to your request. OBs live in fear of being sued and letting dad help is probably a chance most doctor are not willing to take. If my hospital had wanted me to have some sort of open line, I would have insisted on a Hep-lock and declined any kind of IV fluids unless I needed them. Maybe that would be a good compromise? If you really don't want anything just decline it when you get to the hospital. I wanted a water birth too, but just like you my hospital only allows you to labor in the tub. With my first I had to get out to push, I thought it would be miserable, but it wasn't that bad. Still think a water birth would be awesome, but it wasn't a deal breaker for me.

What's concerning to me is that you feel so rushed through your appointments. You should feel listened to and have your questions answered. What if at the next appointment you say that you are feeling rushed and could they schedule you for an extra long appointment next time to have your questions answered? In the mean time I would go and visit the birth center it sounds wonderful! Doesn't hurt to talk to them right? If you end up staying with this practice definitely labor at home as long as possible. You avoid having to deal with most of the red tape if you arrive late in the game, plus you will be much more comfortable at home.

Good luck, it's not an easy decision but you are smart to be thinking about it now.

tokenhoser · August 2013

You sound like you'd be much happier at the birth centre. You know you can't have the birth you want where you are. You may or may not get EVERYTHING you want at the birth centre, but at least it's possible. What you don't get, you'll know it's because you and your baby needed something else. It won't be about policy, liability, and doctor convenience.

Go for what you really want. Don't sell your birth short to play it safe. (And honestly... I don't think the "safe" route is really safer here.)

huntjul · August 2013

Definitely go to the birth center and at least get a tour and have an appointment/consult with the CNMs. It will probably put your mind at ease and help you make the decision easier. Personally, I'm switching from OB care to a CNM here very shortly and am counting down the days because I now the midwifery model of care fits my desires better. And that's with a low-intervention OB too.

Foutzie44 · September 2013

I agree with at least going for a consultation! I just changed from an ob practice to a midwife practice at 30wks.... It was hard to leave that comfort zone of what I knew with my ob group, they delivered DS.....but they were not being very supportive of me wanting a vbac..

When I went for my consultation, I was worried I would leave conflicted...but when I left there I knew 100% what I wanted to do...the midwife group was so supportive and on board with what I wanted for my birth...it was the best thing I could of done and I feel like the last 2wks of my pregnancy have been the most stress free!!

nosoup4u · September 2013

Talk to the MW like everyone else said. If you end up leaving your current practice, just let them know it's you, not them. Practices won't refuse to let you come back if you need high-risk care or anything, they understand it's a business relationship at a certain level. Luck is on your side if you've had a low risk pregnancy so far, anyway.

hth and good luck!

MamaWombat · September 2013

As pp say, it won't hurt to visit the birth center for more details and see if you and YH think you can feel comfortable there. If you do have to make a transfer back to the OB, I'm sure that the OBs are professional enough not to take it personally - after all, right now you're low-risk and a good birth center candidate; if something changes and you're not, then it makes sense to return to OBs who know you at least a little.

My insurance won't cover birth centers, so the point is moot, but I'd otherwise be in favor, while DH is very much on the side of being near the highest tech equipment/staff possible. Hopefully, though, the birth center staff can ease his fears.

I plan to labor at home as long as I can, and I'm also hiring a doula, which as someone above said, might be good compromise options if you do stay with the OB practice. A doula will be able to offer the support for going drug-free that it doesn't sound like you'll get from the OBs, and she can help you and YH remember to ask questions about interventions that will help you feel in control and comfortable with your decisions about them.

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