What do you do when hospital birth is your only option?

[mamaley]

I have 2 children, both born vaginally. One was in a hospital with an epidural in a smaller town. The second was in a freestanding birthing center with a midwife in a city (we moved since the birth of the first child).

Well, we moved back to the smaller town. There are no midwives here, and no female obgyns here. The birthing facilities at the hospital are great, but c-section rates are high, and I think it's safe to assume that the majority of births are medicated, from what I've heard.

I asked one D.O what he thought of natural birth (he delivers babys) when I went in for an unrelated illness. He said "all births are pretty natural" and I went along and said "true, I mean unmedicated" and he said that he believes it should be the woman's choice, but there is going to be monitoring and IVs, and if that's not ok, a woman should birth at home.

But how? There are no midwives here. He said the closes is 1.5 hours away.

We're considering ttc a third child. It's a decision we're taking a lot of time on, and this is one factor. Part of me figures that my labor with my second went so fast, that I'll be lucky if I didn't deliver in the car on the way to the hospital with my third. But the thought of possible interventions, and of not being able to birth in a position that is comfortable with me scares me.

I'd like to get some advice, and some stories from people who have btdt. Especially from women who have delivered in hospitals naturally, and from anyone really! Thanks for listening.

[dogmom327]

Unless you have really fast labors, 1.5 hours away for a midwife may work okay. It's obviously not ideal, but then again it sounds like your local hospital isn't either.

Any chance you could UC? Personally that's what I'd do if faced with no HB MW and a hospital.

[Raene]

I plan on UC even though there are midwives. I'd never have a hospital birth and wouldn't blame you for not wanting to. There are so many fabulous UC books and resources out there...maybe you could check out Laura Shanley's site and read her book and some others?

[JamieCatheryn]

Well, you have a few options, some would be way out of your way and some would be less than ideal but you can consider everything.

You can hire an OB, anybody who's willing to listen to your wishes and recognize you have choices, even if it's a guy and he prefers medical birth and prenatal care. Then you can labor at home until transition and you and DH can be firm about your wishes in the hospital.

You can leave town for your due range and go birth with a midwife somewhere else, just be in touch ahead of time and find someone who will work with you. This might be hard to arrange.

You can birth at home alone and just have the hospital for emergency backup. This can be realistic and safe, and is 100% legal.

I had a decent female OB and birthed naturally in the hospital. I had a long hard labor, most of it at home, the last several hours in the hospital. The staff was unfamiliar with normal birth. I did have intermittent Doppler monitoring after the 20 minutes on the belt (this was unfamiliar to them but my OB approved it), and a heplock, annoying tests and interruptions, and a horrible 1 day stay after with no sleep. It was ok, but sooo not ideal.

[meganmarie]

You can hire an OB, anybody who's willing to listen to your wishes and recognize you have choices, even if it's a guy and he prefers medical birth and prenatal care. Then you can labor at home until transition and you and DH can be firm about your wishes in the hospital.

The above is what I did. We do have access to homebirth midwives but DH could not get comfortable with a birth outside hospital, and I value his partnership stake in our offspring so agreed to accept and accommodate his fears.

If you decide the midwife distance is okay, then great. If not (which I can understand - its not just a question of how long to get to your birth but how much travel for every prenatal etc.) then you just have to figure out a way to make the most of hospital birth. Lots of posters on here have managed it even in less-than-mother-friendly hospitals. It just means more work for you.

Get a doula. Find an OB willing to at least acknowlege some flexibility, as JaimeCatheryn suggests. Offer compromise alternatives that work for you and your OB (could be - heplock not IV, intermittent not CFM, pushing on side instead of back). Write a short simple birth plan focused on your big deal-breakers. Get your OB to sign it and put it in your chart so its there for the RNs in L&D to see when you arrive. Arrive as late as possible - when cx are 2-3 minutes apart. Labor in the parking lot if you have to. Make sure your DH and doula know what you want, and that they know to help remind you of it when you are in laborland.

Both my hospital births were 100% intervention free and here in Northern NJ that's basically a miracle. Both times, the attending RNs had ever seen anything like them.

[MegBoz]

Originally Posted by JamieCatheryn

I did have intermittent Doppler monitoring after the 20 minutes on the belt (this was unfamiliar to them but my OB approved it)

After lots of reading, I was terrified at birthing in a hospital! Even though I switched from Johns Hopkins to a practice of CNMs who are VERY natural birth friendly- I still had anxiety.

I posted on a local yahoo group about it & one of the best responses was a lady who said she'd arranged all the above type things with her OB in advance. When the nurses were like, "Huh? You're not changing into a gown, not going on EFM, getting into the tub with ruptured membranes, eating, etc.???" She would explain her OB had already approved it. The nurses would go call the OB, he'd explain & then everythign was fine.
(Of course, all those details should be on an OB-approved Birth Plan as well, but the nurses just wanted to check on the phone.)

This lady also said she thought of her LDPP room as her room and when people walked in, she was entertaining them & greeted them with, "Can I help you?" As opposed to thinking she was in their territory. I LOVED this viewpoint. Just shifting my perception of laboring in the hospital this way helped relieve some of my anxiety.

I also read a great tip, I think in the book "Pushed" that you can have your OB literally write out a prescription for normal birth on a prescription with all the above type details.

Another tip I heard was Don't ask, just do. One of my fav MWs said this about eating! Official hospital policy was that we could have clear fluids, but not food. I pretended not to know this & asked her. She paused, & said, "Well... I would say... just go ahead & eat, don't ask." She didn't say, "Official hospital policy is..." Cool chick!

Same goes with walking, removing EFM after initial 20 min, removing BP cuff, showering, etc.

In any case, if you go with the hospital, I'd get a doula & I'd make sure she was one tough chick who would be a strong advocate for me & my baby. I'd also get the doula if you UC so she'd be there for you if you end up transferring - since you'd then need an advocate for you AND the baby (to avoid stupid baby interventions too.)

Good Luck!

[Rylins mama]

Ohh I understand totally. My first birth was eh okay. I had no epidural but due to waiting on the dr. and me trying not to push they gave me fetynal in my iv without my permission. Then they went on to give me an episiotomy after 10 minutes of pushing without asking first!!! It was no big deal at the time but after realizing what they had done to me I was SOO upset. Im pregnant again and due in 8 days... I really thought about going with a hospital birth. It was my plan until a few months ago. We live on an island with NO midwives or anything. Well I found a very experienced midwife who is a 2 hour plane ride away. She is flying out here on the 24th just 3 days before my due date and will stay with us until baby is born. I am VERY nervous about going into labor before then because unfortunatly there is no way she would make it but Im trying to stay positive that I can make it 5 more days. I would go with the midwife and hope for the best!

[solinox]

I would UC before going to a hospital...but I would try the midwife 1.5 hours away first. I've had too many bad experiences with hospitals to want to go there without a real good reason.

[Girlprof]

I had two very positive hospital births, but both with care providers that I felt really good about. In your situation, I would interview all available care providers and see if there's anyone who is a better fit with what you're looking for. Even if the majority of births in the hospital are medicated, that doesn't mean there isn't a natural birth friendly doc hiding in there somewhere. Worth asking.

[paintedbison]

I could have written almost your exact post. I had my first in a very medical hospital here. I avoided an epidural, but it was a huge fight to not be induced at 38 weeks like the doctor did to everyone else. We moved to Houston and I had a waterbirth at a birth center that was perfect. Now we are back to the smaller town with the same hospital I had my first at as the only option insurance covers.

The closest midwives are 2 hours away and expensive. I've found a supposedly natural birth friendly family physician here and have my first appointment with her next week. I'm waiting to see how she responds to some of my questions about wanting to do things different from the norm. If I don't feel comfortable with her... I'm not sure where I'm left. Probably with trying to come up with money for the mw...

It's a bad predicament to be in. I'm very jealous of those with close options that insurance will pay for. Or the money to pay out of pocket. I hate walking into a birthing situation that I know is not ideal. But, I just don't see many other options right now. I feel your pain...

[Juniperberry]

I had to have a hospital birth with my second even tho I had wanted a HB. I was told no getting out of monitoring or IV etc... I did all my laboring at home and turned up to the hospital ready to push...so no time for any meds or IV at all :

[cappuccinosmom]

I make myself a nuisance and make it clear that I am going to be non-compliant when I think something is unnecessary. It helps that both my parents are MD's with experience in obstetrics, and dh is a nurse, and they support me, so they can't claim I'm a crazy ignorant nutcase.

All three of my births have been in the hospital. To be honest, the actual births in the hospital weren't dreadful, though the first one wasn't that nice. Not the ideal "birth experience" but that's not my priority anyway. It was the emotional manipulation and threatening that I endured prior to the birth that were the hardest--if you don't let us induce your baby will die--be brain dead--rip you from front to back...you know the lines they throw out. : I said "NO" to induction over and over again, because induction was not medically indicated and my babies remained healthy and thriving in my womb. And then I stayed away from the hospital until I was absolutely sure labor was well established and going strong. I've never arrived in a hospital any less than 7 cm and feeling pushy.

[sparkysgirl]

there is always the option of a traveling midwife...

[kltroy]

You can have a great natural (unmedicated) hospital birth if you find someone who will work with you. Try a family practice doctor who also does obstetrics - he/she is not a surgeon and is much more likely to manage your medical care like a midwife, versus an OB/GYN. Write a good birth plan - short and to the point - and discuss with doc a few weeks beforehand. Make sure the notes about the plan are in your chart. Have a doula. Go into the hospital late - do most of your labor at home. Have someone - your husband/partner - remind the nursing staff of key elements of your birth plan as they become relevant. If you have no other risk factors, there's no reason you need continuous monitoring - occasional should be fine. Also no reason for an IV unless you're severely dehydrated - a hep-lock will keep them happy. I was able to have a fabulous natural VBAC at a hospital 5 months ago with the family practice doctors, and felt very empowered to make my own decisions about my and my baby's care.

[Mama Poot]

Go unassisted. We planned for a UC with Henri until we finally found a midwife at 34 weeks. And even if the nearest mw is 2 hours away, many will travel-I know mine does.

[2sweetboysmom]

For various reasons all of my births to date have necessarily been at a hospital. Each time I have gone over my birth plan in detail with the OB and had them sign it. I still had a problem with the nurses "just doing" their normal procedure/ Dr's normal procedure and not reading the birth plan, or if the first shift nurse read the plan then the next shift did not.
For my third birth I made a list with bullet points of the main/most important things. I created it to all fit on a 8 1/2 X11 sheet of paper in a fairly large size font. I taped it up in several highly visible places with in my room, on the outside of my door, and on the top of the isolette. I also asked the first shift nurse to place a copy on the top of my chart. This worked really well. They all saw and knew my wishes. It also gave me the opportunity to educate some of the staff about "WHY" I was chosing those things, and more natural means of birth.

[bobandjess99]

there are ALWAYS options. you never have ONLY one option. now, you might not choose any of the other options, you may not feel they are realistic choices, but there are ALWAYS options/choices. .
for example, in your situation...
you could go to a mdwife an hour and a half away.
you could UC.
You could have a hospital birth in any number of ways, with doula, without, with birth plan, without, etc.
You could move.
you could fly in a travelling midwife.
Sicne you aren't pg yet, you could just not ttc.


you have many, MANY choices. You might decide you are not comfortable with uc..you might decide you don't like the 1.5 hr away midwife, or maybe you will decide you can't afford her, you can decide moving just to be in a better birthing climate is not the best choice for you family right now. You might decide paying for a travelling midwife isn't the best use of your family's income, etc, etc, etc, etc...but know that by choosing not to pursue another option, you ARE CHOOSING to birth in a hospital. It isn't something that "happens" to you, or something you are "forced" into....or somethign you "have" to do...you CHOOSE it. Now..you may not like it..you may, as almost all of us do, find yourself choosing between 2 less than ideal scenarios (such as hospital birth or UC) but reagrdless...it is still a CHOICE on your part.

And I'm not even knocking hospital birth - I think you can have a good hospital birth experience, absolutely.
i'm just trying to make sure you stand up and own your choices, right fom the start. Because everything is a choice. that is the best way to become empowered and go down that path of an empowered birth, regardless of where it might end up occurring......if you start saying things like "I have to..." or "i have no choice but to.." can you see how that is such a different mental place? Good luck in making the best choices you can for yourself and your family.

[cristeen]

First of all, I wouldn't take his word for it that there aren't any MW around. He may be right, he may not. Call around. Call doulas, CBEs, etc., and ask if they know one in the area.

You could also always look into The Farm. I don't know how far that is for you, but it is always an option.

[kerikadi]

Originally Posted by solinox

I would UC before going to a hospital...but I would try the midwife 1.5 hours away first. I've had too many bad experiences with hospitals to want to go there without a real good reason.

This.

But if I HAD to birth in a hospital I would show up crowning and check out ASAP.

[MsBlack]

These womyn have all given very good advice on various options. I only want to emphasize what one pp said--there very well may be other mws in your area, but your D.O just doesn't know about them. He doesn't sound like the sort who actually makes it his business to know such things, eh?

You've got time--look around and see if there may be other mws around. Consider all the things contained in these posts, in case you/dh just really feel that the local hosp is the best thing for you. I bet you'll come up with just the plan and helpers that best suit your family.