birth center vs. hospital vs. home birth?

jessicaleighupchurch · June 2014

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jessicaleighupchurch · June 2014

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jessicaleighupchurch · June 2014

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AllieAlba · June 2014

I'm in the UK, so obviously my situation is vastly different, especially since everything is free, but, I can say that over here, no matter how low or high risk your pregnancy is, you are not allowed to have a home birth or give birth at a midwife led birthing centre if it is your first child, because you are more likely to have things go wrong. If it is not your first, and you are not high risk or pregnant with multiples, they prefer you to use a midwife led birthing centre or a home birth.

jessicaleighupchurch · June 2014

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Megs528812 · June 2014

My only advice is that I have two friends, just in the past year, that had emergency situations while delivering. If either of them weren't in the hospital to get the immediate attention they needed they both would have died. No way they could have made it to the hospital in time.

Eta: I understand the other birth wishes, but I've never heard of someone not being ok with an IV Why?

jessicaleighupchurch · June 2014

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MNgirl326 · June 2014

Why do they require an IV? that makes no sense. If you are a healthy, low risk patient, whose labor is progressing fine, then you shouldn't need an iv.

I guess if it were me, I would figure out the insurance part first. Figure out where you are living and then go from there. After that, once you have the insurance part figured out, then figure out where to have the baby. I find it really hard to believe they won't let you go natural. Something doesn't seem right with that. I would be asking for more info.

jessicaleighupchurch · June 2014

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MNgirl326 · June 2014

Also what hospital doesn't accept your insurance? what insurance do you have? I have never heard of a hospital not accepting a certain insurance at all. I have heard of them being out of network providers so it costs more then in network, but I have never heard of it not being accepted at all.

jessicaleighupchurch · June 2014

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jessicaleighupchurch · June 2014

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MNgirl326 · June 2014

jessicaleighupchurch said:

Has something to do with my blood pressure dropping precipitously from the needle triggering an overactive vagal response. Happens every time without fail.

I would think that if there is a medical reason/ history for not wanting it, they would be more accommodating.

Also have you talked to your OB about this? I would think that they have a lot more say about what happens to you then a worker at a hospital who doesn't know your history and your concerns.

I guess when looking at your history I would be concerned about a home birth - you just never know what could trigger something and cuase some problems. I don't think you would be considered low risk enough for a home birth. But I don't really know. I think this is something you really need to be talking to medical personal and asking their advice, once they have looked at your history.

Good luck to you, I hope you are able to get it all worked out.

jessicaleighupchurch · June 2014

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MaPetiteFamille · June 2014

I think they like to have a hep locked IV (unattached catheter) because if your BP were to drop (due to bleeding, syncope, whatever), it'd be harder to place an IV. Still, I can't imagine any hospital refusing to care for you because you refused an IV. When I was a hospital RN, people refused them all the time. Our job was just to make them aware of the risks of not having one.

I had a totally unmedicated childbirth at a hospital with a CNM. Staff were not phased at all and were totally supportive (though of course that varies from one hospital to the next).

Edit: My iPhone is forever correcting "unmedicated" to "unmediated."

nursemarie925 · June 2014

Vasovagal reactions are pretty common. When someone has a history of them, we have them lay flat before starting an IV. With your history of having them, as well as seizing, I'd be more concerned about any other potential complications and would be less willing to deliver somewhere that wasn't equipped to properly handle medical emergencies

Someone mentioned being hep-locked which is what most facilities will offer to alleviate being "tied" to machines or IV poles in this case. (Not saying that's your concern). IMO this is the safest way to ensure immediate access if needed. IVs don't take long to place, but that's in an ideal situation. In emergencies, they may not be able to get venous access as fast which would delay a possible life saving intervention

All that being said. I'm not anti birth centers or home births. I feel like do whatever makes you happy. Just be fully aware of the risks and make the best decision for YOUR health and the health of your baby.

jessicaleighupchurch · June 2014

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Stargirlb · June 2014

Homebirth!! If you are considering homebirth, I recommend watching all the homebirth videos on youtube. They are very affirming. I love homebirth birth stories. I've probably watched/read hundreds.

my first two babies were home births, and this one will be too

jessicaleighupchurch · June 2014

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hamlett17 · June 2014

@jessicaleighupchurch‌ I had a completely natural hospital birth with ds. I hired a doula who helped me advocate for myself. I did a hep-block but was not hooked up to IV fluids. It was only in case there was an emergency. For me insurance coverage made my choice. We were also closer to the hospital than the birth center. You can have the birth you want in any setting assuming no complications (true) come up. Look into the bradley method & Ina May.

mellie86041 · June 2014

jessicaleighupchurch said:
For the life of me I can't figure out why they require an IV for low-risk, uncomplicated deliveries. It's their hospital policy, probably has something to do with liability in the case of emergencies. But as a healthcare provider myself, I can tell you that in an emergency it only takes 10-15 seconds to put in an IV.

The IV is normally given to keep you hydrated. Once you're admitted for L&D you're usually not allowed to eat or drink anything, just in case you need to go in for a c-section.

And on that note, please keep in mind that while having a birth plan going into L&D is all well and good, sometimes things happen that are beyond your control.

polevaultRN · June 2014

Seriously, just get the IV...for your sake and baby's! I work labor and delivery and we require patients have AT LEAST a heplock in place, just in case of emergency. I understand not wanting to be connected to IV lines and such, but just opt for the heplock. You will regret it if something happens during your labor that could have been corrected by bolusing IV fluids and so forth. Not a risk I would take. As far as hospital, home births, and birth centers, I chose to have DS at a hospital and will do the same with this baby. I was able to have a med-free birth with minimal interventions. I've seen many low-risk, healthy pregnancies result in baby needing some assistance and I'd rather have a NICU readily available then have to wait a few minutes or longer to have my baby transferred. Not trying to worry you, just keepin it real.

Stargirlb · June 2014

polevaultRN said:

Seriously, just get the IV...for your sake and baby's! I work labor and delivery and we require patients have AT LEAST a heplock in place, just in case of emergency. I understand not wanting to be connected to IV lines and such, but just opt for the heplock. You will regret it if something happens during your labor that could have been corrected by bolusing IV fluids and so forth. Not a risk I would take. As far as hospital, home births, and birth centers, I chose to have DS at a hospital and will do the same with this baby. I was able to have a med-free birth with minimal interventions. I've seen many low-risk, healthy pregnancies result in baby needing some assistance and I'd rather have a NICU readily available then have to wait a few minutes or longer to have my baby transferred. Not trying to worry you, just keepin it real.

It's not a risk.

https://evidencebasedbirth.com/are-iv-fluids-necessary-during-labor/

If a woman has normal access to fluids during her delivery there is no benefit.

Pips09 · June 2014

Well, first I think you need to decide where you are going to live. That's a pretty major decision and should be the most important. I've never heard of providers not accepting transfer patients. Is that just the practices you are looking at? I'm actually switching providers at the beginning of second tri. No one questioned it.

I think you are going to get a lot of personal feelings about this decision based on everyone's experiences. I think a home birth is a terrible idea, but I am sure that is colored by own experience with an emergency during birth that required an emergency c-section. (As in, likely both my baby and I wouldn't have lived if I hadn't had it). So it seems like taking a completely unnecessary and serious risk, especially if you are a FTM and have no idea how your body will respond to labor. If I were you, I'd consider the hospital or the birthing center. Good luck in your decision.

polevaultRN · June 2014

Stargirlb said:

polevaultRN said:

Seriously, just get the IV...for your sake and baby's! I work labor and delivery and we require patients have AT LEAST a heplock in place, just in case of emergency. I understand not wanting to be connected to IV lines and such, but just opt for the heplock. You will regret it if something happens during your labor that could have been corrected by bolusing IV fluids and so forth. Not a risk I would take. As far as hospital, home births, and birth centers, I chose to have DS at a hospital and will do the same with this baby. I was able to have a med-free birth with minimal interventions. I've seen many low-risk, healthy pregnancies result in baby needing some assistance and I'd rather have a NICU readily available then have to wait a few minutes or longer to have my baby transferred. Not trying to worry you, just keepin it real.

It's not a risk.

https://evidencebasedbirth.com/are-iv-fluids-necessary-during-labor/

If a woman has normal access to fluids during her delivery there is no benefit.

What do you mean "normal access to fluids?" Like if there are extra bags of lactated ringers or normal saline hanging around then there's no benefit to a heplock?! Makes no sense. Even if the mom doesn't need IV fluids during labor, she should have a heplock...what if she were to hemorrhage afterwards and needed bolusing right away or if something were to go wrong during the labor and you're rushing back to the OR for an emergency c-section? A heplock isn't a bad idea.

jessicaleighupchurch · June 2014

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jessicaleighupchurch · June 2014

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Beauxbaton · June 2014

I think like a pp said, pick where you want to live first. Then pick a provider. And honestly, if you aren't low risk enough for a birthing center then I wouldnt even consider a home birth. FWIW I've know people who have had good and bad experiences at all three venues. If you decide to go with a hospital then just be ready to stand up for what you want, but also yo be realistic about it. And discuss what happens if you need to get to a hospital asap for any reason.

jessicaleighupchurch · June 2014

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mellie86041 · June 2014

jessicaleighupchurch said:

I am fully aware of the risks of not having an IV (I'm a Pediatrics resident) and I still don't want one. Plus I want to be able to eat and drink while in labor because the whole process expends thousands of calories and I will want nutrition during the 5+ hours of labor.

And what happens if you require an emergency c-section? Elect to have one without anesthesia?

Kelliann98 · June 2014

I'm curious as to why you are pursuing a career in the medical field when you don't trust the hospital to respect your wishes for a least restrictive birthing process.. Unless I've got it all wrong. I really have no preference in where other people deliver, but I was sure happy to be in the hands of my drs and nurses at the hospital during my DDs birth.

Maebb · June 2014

jessicaleighupchurch said:
I am fully aware of the risks of not having an IV (I'm a Pediatrics resident) and I still don't want one. Plus I want to be able to eat and drink while in labor because the whole process expends thousands of calories and I will want nutrition during the 5+ hours of labor.

My labor with DS did not last that long, and only 15 minutes of pushing, so I probably did not burn thousands of calories.

There are a lot of unknowns in labor. If you have a very specific idea of the kind of labor you want, you should try to think of every possible scenario (of which there are probably hundreds) and decide what you would do and have it in writing. You've probably already thought of that, but just a recommendation.

For example, my DS had meconium, so they had to pump a bag of saline trans-vaginally to flush it out so that he wouldn't breathe in his own poop and get sick. Because of that, I couldn't get up and walk around during labor, and I was fine with that. I am grateful for a labor experience that allowed him to be born healthy.

MaPetiteFamille · June 2014

I think a bigger concern than whether or not to get IV fluids is your history of vasovagal syncope. Pain, stress, straining-- each of these can trigger a vasovagal reaction. While I've never worked in OB, I had plenty of patients pass out on the toilet when I worked in telemetry. If you were seizing, ideally you would have IV access rather than getting some sort of IM benzodiazepine.

ETA: And IV or not...I would not be comfortable anywhere other than a hospital if I had a similar history.

Lanatir · June 2014

jessicaleighupchurch said:

Also of note is that the birth center is not near the hospitals that are in-network with my insurance

Ugh. That's a PITA. The hospital I delivered DD with between month 6 and 8 of my pregnancy stopped taking a BCBS plan that was the plan supplied by the main employer in the area. Something about a billing dispute? Idk. Anyway, if you had their insurance, you wouldn't be refused treatment, but you would be covering everything out of pocket or you had to go 20 or 30 minutes up or down the road to the next place. It was really dumb and worrisome as a FTM because it would have turned a 45 minute drive to the hospital to somewhere between 60 and 90 minutes...

Definitely decide where to live first and then worry about where to give birth and finding an OB or midwife. You don't want to pick one in Omaha and end up living in Council Bluffs. The bridge traffic can be ridiculous.

nursemarie925 · June 2014

Kelliann98 said:
I'm curious as to why you are pursuing a career in the medical field when you don't trust the hospital to respect your wishes for a least restrictive birthing process.. Unless I've got it all wrong. I really have no preference in where other people deliver, but I was sure happy to be in the hands of my drs and nurses at the hospital during my DDs birth.

This. I Cldnt think of a way to word it without sounding snarky. Lol

NatureLovers · June 2014

jessicaleighupchurch said:
Thought of that. I've been on tons of antibiotics over the years (chronic tonsillitis for 3.5 years) so I seriously doubt I have GBS. But I will have myself tested early, so in case if it is positive I will request to be treated with oral antibiotics to avoid an IV during labor.

I have tried to stay out of this since my opinion on homebirth has already been stated, but this? This is bat shit, and if you are a Peds resident, you should know better. You can be GBS+ and negative multiple times throughout your pregnancy, which is why you should be tested towards the end. And if you're positive, will you refuse abx like you're refusing a heplock? You are being militant about natural childbirth to the point of extreme recklessness. How are you going to feel if you see your baby in the NICU, severely ill or dying because of your birth choices? Will it still be worth it? Why are your needs the only ones being considered?

I can't even with this craziness. This is how women and babies die or suffer permanent injury. It's tragic.

Stargirlb · June 2014

I was GBS+ both pregnancies and It's perfectly fine in canada to refuse ABX, you just have to sign a waiver that you are aware of the risks. They also monitored the baby after. My son got RSV at two weeks old which could have been related but the doctor said that he has seen lots of babies get that no matter how they are born so there is no way to know for sure. I will still refuse again this time if I am positive. The midwives said I could try the whole garlic-in-vagina thing if I wanted. Fun. haha.

I don't take antibiotics lightly, due to all the emerging research on how they irreparably change your gut flora, etc, and am extremely hesitant to use them in preventative ways. The last time I took them was for a kidney infection two years ago (and then two years before that for another kidney infection,) and suffered absolutely horrible candida overgrowth issues after that still linger.

Stargirlb · June 2014

NatureLovers said:

Thought of that. I've been on tons of antibiotics over the years (chronic tonsillitis for 3.5 years) so I seriously doubt I have GBS. But I will have myself tested early, so in case if it is positive I will request to be treated with oral antibiotics to avoid an IV during labor.
I have tried to stay out of this since my opinion on homebirth has already been stated, but this? This is bat shit, and if you are a Peds resident, you should know better. You can be GBS+ and negative multiple times throughout your pregnancy, which is why you should be tested towards the end. And if you're positive, will you refuse abx like you're refusing a heplock? You are being militant about natural childbirth to the point of extreme recklessness. How are you going to feel if you see your baby in the NICU, severely ill or dying because of your birth choices? Will it still be worth it? Why are your needs the only ones being considered? I can't even with this craziness. This is how women and babies die or suffer permanent injury. It's tragic.

Dude, stop using the whole BABY DEATH thing to shame women on their birth choices. We know the risks, and can do whatever the f we want.

Bigboneded · June 2014

Wow, you are a doctor? You dont know you can refuse any treatment? You dont know a hospital can not kick you out for not wanting an iv? Doesnt speak much for UNMC, if you went to school in NE I will certainly look at those graduates differently. Go home, do your own dang research. You are a special snowflake with an MD after her name.... physician, heal thyself. Just wow. I cant believe you even started this thread.
ETA: removed some cranky meanness.

NatureLovers · June 2014

Stargirlb said:

NatureLovers said:

jessicaleighupchurch said:
Thought of that. I've been on tons of antibiotics over the years (chronic tonsillitis for 3.5 years) so I seriously doubt I have GBS. But I will have myself tested early, so in case if it is positive I will request to be treated with oral antibiotics to avoid an IV during labor.
I have tried to stay out of this since my opinion on homebirth has already been stated, but this? This is bat shit, and if you are a Peds resident, you should know better. You can be GBS+ and negative multiple times throughout your pregnancy, which is why you should be tested towards the end. And if you're positive, will you refuse abx like you're refusing a heplock? You are being militant about natural childbirth to the point of extreme recklessness. How are you going to feel if you see your baby in the NICU, severely ill or dying because of your birth choices? Will it still be worth it? Why are your needs the only ones being considered?

I can't even with this craziness. This is how women and babies die or suffer permanent injury. It's tragic.

Dude, stop using the whole BABY DEATH thing to shame women on their birth choices. We know the risks, and can do whatever the f we want.

...........END QUOTE

What you really mean is, stop pointing out how these decisions can cost the life and health of the baby you are supposed to love and protect above all else. You're right, you obviously know that your child can die or be injured due to your choices, and you just as obviously don't care, since this is about you. If you're expecting a high five, it's not going to happen. I'm sure there are forums out there that are just chock full of the woo, who will support your choices. Perhaps you should seek them out if you're looking for validation.

NatureLovers · June 2014

Also, I simply couldn't believe that the OP is actually a Peds resident due to her glaring ignorance of, well, everything. Then I googled her (not very smart to have your entire name in your profile) and it looks like she is in fact a student of medicine. That is just terrifying.

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