Need opinion on hospitals (Bethesda, DC)

[SweetLana]

We have moved to Bethesda recently, and I am trying to figure out what hospital to choose for delivery. It seems like not an easy thing to do! I've read reviews about many hospitals in this area(Bethesda/DC), and there seems to be NO hospital with positive reviews (at least as far as birth) in the area.:

I'll appreciate your opinion, and if you would like to share your experience - you are welcome!


P.S.My friend recently delivered at Sibley, and was very happy absolutely with everything, but I would like to hear more opinions.

[mysticmomma]

have you considered a home or birth center birth?

[SweetLana]

Home birth or birth center option is out of the question for me.
Hope to find decent hospital.

[mysticmomma]

That stinks. You have a great birth center near you. I'm not help on the hospitals though... hopefully barbara will come on and give some advice.

[KimPM]

Is a midwife at a hospital an option? I used Loudon Community Midwives at Loudon Hospital up near Leesburg (and I live in Gaithersburg). When I was there with the midwives it was a good experience. If you need an OB instead, then I don't know how it is. I really really did not want to go to Shady Grove.

[Contented73]

If you have to birth at a hospital, then go to Whitney Pinger at Washington Hospital Center. Most of the hospitals around here are pretty similar with regards to their policies and services. None are "great", especially with regards to unmedicated birth or avoiding other interventions. Most of them have outrageously high c/section rates. Your best bet is to find an excellent care provider and go to whatever hospital they work at. So, I'd definitely put Whitney Pinger in the excellent category. Maybe a few others but none that I can think of this moment.

[MeiTaiMamma]

The midwives at the DC Birth Center also deliver at the Washington Hospital Center. I really like them. I also think Whitney is a good bet for a natural and safe labor and delivery.

[SweetLana]

Thank you, guys for sharing such helpful information. I'll do my best!

I can't get one thing though - do you have to have OBGYN anyway if you choose a midwife (for hospital birth). If not, then how about all these tests and consultations during pregnancy? Does a midwife do it all instead of regular OBGYN?

[Contented73]

Does a midwife do it all instead of regular OBGYN?

In short, yes. Midwives are medical care providers and can provide all aspects of normal maternity care, including tests and prescribing medications as needed, etc. If you develop a high-risk complication during the pregnancy some midwives can still manage your care with the consultation of an OB or, depending on the situation, they might turn it over entirely to the OB. If you wind up needing surgery (either planned or unexpectedly) to deliver your baby, an OB would need to handle that of course, but your midwife might still be with you during the cesarean and would handle your follow up care as well. If you have more questions just ask. Good luck finding an awesome midwife!

[SweetLana]

Contented73, thanks so much for clearing it up! The first pregnancy is like a "bumpy road",so much to learn.:
I suspect, that no insurance will cover a midwife?:

[Contented73]

Of course insurance covers midwives! The DC Birth Center (mentioned above) takes almost every insurance out there. There are many many midwives in the area who take insurance. Where did you get the idea that they wouldn't? They are professional medical care providers who deliver babies in hospitals.

Quick midwife lesson:

CPM - Certified Professional Midwife. In this area, this type of midwife only does homebirths. You hire an independent midwife who comes to your house for prenatal care and for the birth. This is the most independent kind of midwife - she does not work at a hospital and she does not work under the supervision of an Obstetrician. If you wind up needing a hospital for your delivery, she transfers with you and becomes your "doula". Many CPM's can bill your insurance, and sometimes at least part of it will be covered. Sometimes not. Compared to other types of maternity care, CPM's are usually less expensive so many families just pay out of pocket.

CNM - Certified Nurse Midwife. These are midwives who were first nurses, and then got an advanced degree in midwifery. All the midwives who have been mentioned in this thread are CNM's. CNM's can work at home, in birth centers, and at hospitals. Most of them have some sort of official relationship with an OB who serves as their consultant (as needed). CNM's always take insurance. They are also more "medically minded" usually (not always). They can administer pitocin and other medicine during labor, and you can even still get an epidural if you want one (as long as you are in the hospital).

You should call the midwives mentioned here and interview them. Ask them if they take your insurance, too. I think you will be very surprised with the level of care they offer. Midwives typically offer BETTER care than an OB, because they actually take the time necessary to truly understand you and your physical needs. An appointment with a midwife usually lasts 30-45 minutes, and they answer every question you have.

[KimPM]

Originally Posted by SweetLana

Contented73, thanks so much for clearing it up! The first pregnancy is like a "bumpy road",so much to learn.:
I suspect, that no insurance will cover a midwife?:

BCBS did cover ours.

I'd like to gently suggest that you please read up a little on midwives, so you can feel confident in your choice. I know I was confindent in my choice and it was the best thing out there. Personally, every one I know who's chosen a midwife has been happy with that choice after the birth. I agree that my care was BETTER with the midwives than with any OB I have ever seen. And she spent the entire laboring time with me! Just try to find an OB that will do that! Midwives will also typically try everything they can during your whole labor to help you give birth vaginally, rather than just saying oh well, let's cut.

[InDaPhunk]

Originally Posted by SweetLana

Thank you, guys for sharing such helpful information. I'll do my best!

I can't get one thing though - do you have to have OBGYN anyway if you choose a midwife (for hospital birth). If not, then how about all these tests and consultations during pregnancy? Does a midwife do it all instead of regular OBGYN?

I used a CNM for my my DS's birth and I'll give you a rundown of how it worked in my case- I was clueless about midwifery, too, and when I was first pg and a friend of mine suggested using a midwife- her mom was one- I quickly discounted it bc I thought for sure that my insurance wouldn't cover it (military insurance Tricare), you know, because midwives aren't "real" medical professionsals. I've come a long way in 4 years (though most of my education happened while I was pg with DS, just not soon enough). Ah well, we're all evolving aren't we? I'll have a HB if I get pregnant again and all is going as expected.

My midwife was a CNM in a very mainstream OB practice. I went to the OB office for all the appointments with my midwife. She ran all the medical tests that the OB practice had access to (or didn't run them, depending on my wishes, I suggest you educate yourself on all tests available...utilizing both mainstream medical and midwifery texts). I met with each of the OBs in case for some crazy reason my midwife ended up not be able to be at my birth and one of them attended my labor (ugh!)- like in case her head had spontaneously combusted or something, bc that's about the only thing that would have kept her from being there. I used a doula that worked frequently with my widwife, so they both were on the same page regarding interventions, expectations of each other, etc etc. My doula had over 20 years experience as an OB nurse, had delivered 6 kids of her own, and was totally invaluable to me.

If I'd used an OB I can pretty much guarantee that I'd have ended up with a c section. I pushed for three hours, not making much progress for a lot of that time. My midwife never, ever rushed me, she acted like she could have stayed there all day- even though she'd been up for over 24 hours (well, ok she had a 2 hr nap from 2-4 am) and was assisting in other deliveries at the same time- though I think I took precedence because I was largely unmedicated (I did have a nubain nap for two hours, and while I wish I hadn't, it is what it is and if I hadn't I might not have been able to push for three hours because I'd been up for days and days, so I guess it all worked out. That's the thing with being a parent, you gotta roll with the punches).

Keep in mind that no matter the personal beliefs of a CMN, she is required to follow certain protocol set up by the mainstream medical establishment (aka the AMA etc), the hospital, and possibly the OB office she is associated with (if any). This can give you less freedom over your birth choices, so make sure you discuss with her each of your assumptions regarding what exactly will happen during labor, afterward, your expectations for both, her role as birth attendant, options, etc. HTH. GL!

[pssimon]

What about Shady Grove? They seem to be a whole lot better than they were a few years ago! Renovated rooms, and it seems a different philosophy (like rooming in for babies). Also, the midwives from old Maternity Center (http://www.midwiferycareassociates.com/) in Bethesda now deliver there. They work through a doctors office too, so it could be covered if you're interested in midwife services.

[Anne512]

pssimon, I just called Midwifery Care Associates to become a patient there on Monday. Do you have any personal experience with them? My dh is not thrilled about midwifery and it's becoming hard to convince him of the benefits. Or in general, has anyone used Midwifery Care Associates and what has been your experience? Is there another midwife practice in Montgomery County?

Anne

[Contented73]

Anne - there is not another midwifery practice in Mont. CO. Has your husband done any research at all regarding birth choices? Tell him that if he wants to make an informed opinion about midwives and other birth choices, he will need to do a little homework. For starters, he should accompany you to some appointments so he can ask his questions. He should also pick up a book or two - Ina May's Guide to Childbirth, The Birth Partner, or The Thinking Woman's Guide to Childbirth. You should also ask him "Why should I hire a surgeon to attend my natural childbirth?" and let him try to defend the choice of a hiring surgeon instead of someone who specializes in normal childbirth.

Oftentimes the husband has an idea of how pregnancy and birth should be handled, yet has no real information. I've heard about many dads who start the pregnancy "opposed" to midwives or birth centers, but as the pregnancy progresses and they become a little more educated, their opinion changes dramatically. Good luck and congrats to switching to MCA, you are lucky to have discovered them.

[pssimon]

Anne512, I used to go there for yearly checkups, but stopped because they closed their birth center. I'm going to Birthcare in alexandria right now, but they are my backup if insurance issues don't get settled with Birthcare..

Go to one of the Midwifery Care Associates orientation sessions, if possible - they were really thorough in the whole thing, and it may settle your husband a bit. My husband had no idea what I was getting us into at first, but is starting to see the light! The orientation session helped a lot - I learned more than at most of my appointments so far. That practice is nice, because it has both doctors and midwifes - if you need to switch, you can without going far!

Also, I recommend also getting the "Business of Being Born" DVD from the library if you can and having him watch it...

Really, Shady Grove seems pretty nice these days, and the best of both worlds! Doctors are always down the hall if you need them, so that's a definite plus if it makes your husband happy!

[Anne512]

I went to the Midwifery Care Associates orientation last night and Karen spoke. She was informative without being overwhelming to someone who never has been with a midwife. Most of my dh's questions were answered and he felt confortable with using them. Then I opened my big mouth about homebirth as another option and we went 'round and 'round with that =)

But otherwise, I was happy about their practice and they do seem to encourage natural birth and are all for making it your experience, which is what I needed to hear.

[pssimon]

Yeah, my husband at first thought homebirth would be great (no rushing to hospital / birth center!) but then got pretty freaked out! He'd love for me to be at a hospital, but sees why I don't want to be. Maybe if we have a second kid after this!

[womancaredoula]

re: hospital choices

Barbara here. Please email me over at ICANofBaltimore @ comcast.net if you'd like a copy of the Maryland hospital cesarean rates. I can also send you a copy of my "Spectrum of Caregiver Choices" that illustrates the range of choices available to birthing women and, in particular, how not all midwives are created equally.

If you go with a hospital birth and use an OB you will receive a different kind of care then if you move farther left on my spectrum and chose say a birthing center. Women who chose OB/hospital births simply need to understand this and become fully educated about birth choices and their rights to refuse unwanted medical intervention. The reviews you hear are because many hospital births are all the same - arrive labor, get put on a monitor, have them break your water and give you Pitocin to speed up contractions (for no other reason than to make more money on the turnover of your hospital bed), then, if you are lucky, the baby comes flying out. If there is any kind of challenge to the labor then its forceps or vacuum then cesarean.

Compare that to a birthing center birth where you arrive in early labor, they asses you and tell you to go back home until things are more well established. When you return they simply monitor you while you labor and encourage you to move, eat and drink -all essential to getting a baby out vaginally and avoiding pain medication. If labor stalls the midwives may suggest position changes, may offer herbal tinctures or homeopathy, or may try to rotate the baby's position through your dilated cervix if possible. You are given a wider window of "normal" to complete your labor and medical intervention (which would occur after a hospital transfer) is only suggested if the midwife detects a problem.

See the difference?

So if you are planning on a hospital birth with an OB you must know this, hire a kick butt doula who can help you advocate for yourself, have your husband/partner fully on board ready to speak up as well, and have a back up plan in case things don't go they way you like - for example if your OB insists on an induction simply because you reach 41 weeks gestation.

34% of women in our state are being sectioned. At least half of those are unnecessary and many involve surgical complications including death (three in 2007 alone). Sorry to raise such a scary fact but it is the unfortunate truth of the situation.

-Barbara Stratton
ICAN of Baltimore chapter leader
www.icanofbaltimore.org
www.ican-online.org