Compromising the birth experience

[holz]

I've been doing a little bit of research on midwives and birthing centers in my area, and it seems like there aren't a whole lot of options. It looks like I'll be able to find a midwife, but deliver in a more mainstream hospital setting...

Ideally, I'd love to homebirth, but my husband isn't 100% comfortable with the idea for our first birthing experience, and our current home doesn't have a lot of space, and is pretty isolated. I was fine with the idea of a small birthing center, but it looks like that isn't going to be an option.

I'm going to try to tour hospitals in the next few weeks, and I've seen one that does look nice and has CNMs on staff, but I'm just concerned that I'm going to be giving up the control I want...

One issue that may seem silly is that I want to be able to spend our first days as a family of 3 in our own home. I don't want to have to stay any longer than is absolutely necessary in the hospital/center. Has anybody had any experience with this?

Thanks for any and all input. It's early in the game, but I'm new to this area and want a head start on researching my options!

[kltroy]

Leaving early from the hospital, if everyone is healthy, is really not a problem at all. With my second birth (first was a c-section, so that was a different story) I had my daughter at 3:26 AM on Sat morning. I stayed in the hosp. by choice on Saturday (b/c I needed to sleep, having pulled an all-nighter) and left on Sunday, about 36 hours after the birth. I certainly could have left earlier, but wanted a little time to enjoy just my baby before heading home to a 2-year old. I know many moms who left between 6-12 hours after the birth, depending on how they were feeling. One thing to keep in mind is that you may lose some blood during the delivery, and may not really feel too excited about going home for at least a few hours until you've taken a shower (and can stand long enough to shower without passing out!) etc.

The only reason that 2 days is typical for a hospital stay is b/c mothers actually asked for it and insurance companies got afraid that if a doctor discharged a mom after 1 day (because that was what was covered by insurance) and then something happened to the mom, that would be bad. So now all insurance just standard covers a 2-day stay even though the outcomes aren't any different if you leave after 1 or 2 days.

The only 2 issues assoc. w/ leaving early (assuming everyone is healthy) are:
1. PKU and genetic screening tests. Usually done 24 hours after birth. You'll need to clear this w/ your ped first b/c it's state law that all babies get screened. So you'll have to convince them that you will follow up for this. It is really important to get these done.
2. Weight check around 2 days of age - they want to make sure baby isn't losing weight too fast and make sure breastfeeding is going ok. We just took a quick walk up to our clinic the day after bringing our girl home to check how things were going. You could probably arrange to do the PKU etc, at the same time.

Best of luck with your birth!

[*MamaJen*]

Good luck with whatever you choose, and it's great that you're starting your research early.
If you've already decided that you want a low-intervention birth, then you just have to decide between hospital, free-standing birthing center and home -- and it sounds like the birthing center isn't a possibility for you?
A lot of partners start out uncomfortable with the idea of homebirths, but as they research, they often become big homebirthing advocates. Here's one really well-done article on that: http://www.mothering.com/pregnancy-b...ve-birth-where.
A hospital-based midwifery practice can be a great choice -- but -- and here's the but -- it really depends on the practice. Some are terrific and really support a mother in her desire for a natural and empowering birth. They might have birth tubs to labor in, they might have progressive policies on welcoming doulas, birthing in various positions, that sort of thing. But some are terrible. And it's very hard to tell from just the hospital tour. Of course they're trying to sell themselves and they show you the pretty parts -- you see the nicely appointed labor room and think it would be a great place to have your baby. But that hospital might still have a 40 percent c-section rate, and bad policies to go with it. New Jersey, if I'm not mistaken, is pretty high up on the c-section ranking. It takes a ton of research to be able to sort the bad practices from the good. And of course, there are good, bad and mediocre midwives.
I couldn't tell from your post, are you already pregnant or getting ready to conceive? I'm not sure how much research you've already done, but there are some great resources out there. This website is a good place to start. Also, the documentary "The Business of Being Born" is a great introduction to the topic. I really like the book "Pushed" by Jennifer Block -- it's a journalistic look at birth politics. And then books like "Gentle Birth Choices" and books by Ina May Gaskin are good for learning about the actual process of birth.
As far as the safety of homebirths, the study that you see most frequently referenced is Outcomes of planned home births with certified professional midwives. That's from 2005 -- it looked at virtually every homebirth attended by a certified professional midwife in America over the course of a year and found that for planned homebirths attended by a CPM, outcomes were as good or better as hospital births. Basically, mortality was very similar but homebirths had far lower rates of harmful interventions. A Canadian Medical Association study that came out just a month or so ago also showed very good safety rates for planned homebirths.
Good luck!
One other thought -- you might try positing in the New Jersey forum under "Tribal Areas" and ask for recommendations or reports on specific hospitals/midwives.

[Turquesa]

I can't tell from your post if your mind is made up about the hospital or if there's still a slight chance of an alternative.

If it's the latter.....Is your DH open enough to at least go to an interview with a birthing center or homebirth midwife? A lot of us here can vouch for how effective that is at putting the guys at ease. It gives them an opportunity to ask all of the sticky what-if questions and feel a little more secure with the idea.

The reason I'm asking is because first-time mothers typically take longer to deliver their babies, and if anybody--your physician, the on-call physician, or other hospital staff--gets impatient, they will insist on Pitocin to induce or augment your labor. I have read that artificial induction in first-time mothers can increase the likelihood of cesarean twofold or threefold. And the damage from a cesarean can be irreparable; IF down the road you have another baby, you're either stuck with a repeat cesarean or scrambling to find a VBAC provider who doesn't look for excuses to refuse that VBAC.

My point is that if your DH wants you to be safe on your first birth, barring any factors that would make you high-risk, getting out of the hospital is most likely the safer route to take!

If I'm wasting my keystrokes on this topic and you've already made your decision, I apologize. At a minimum, I would suggest getting a doula to minimize costly and unnecessary interventions AND make sure that your wishes, such as leaving the hospital early, are honored.

[nikirj]

Birth centers typically contain exactly the same level of equipment/gear that your midwife would bring to your home (it's a lot of gear!). The only possible benefit is how close you are to the hospital; but rip-roaring emergency transports are really rare compared to "drat, we should really go to the hospital for this (thick meconium, superlong labor, 96 hours of ROM, etc) just in case, let's pack some bags and take our cars" transports. I don't have numbers for you on that. But I do know that the CPM2000 study (the one others have referenced here) includes all the births attended by MWs, even those that take place 2hr from qualified hospitals. Your home does not need to have a lot of space for a birth, which you could discuss here if you want; I've been to births in some startlingly small spaces, and there are probably women here who have given birth in startlingly small spaces, too.

If you want to be at home after your birth, a homebirth is the way to do that. Birth Centers, which will discharge at 2-4hr after birth, are an easy second place. Hospitals will typically not want to discharge before 12 hours, and will try to string you along until at least 24 (we have to do xyz before you leave, just wait for the ped...meanwhile 3 hours later...).

Hospital births with midwives can be great. Midwifery care, even when hospital-based, can be great. But when you have hospital policies there are ways that your MWs hands will be tied, and especially in states that require an overseeing OB, your MW might not be able to provide the kind of care you want. I think that's a sad commentary on the state of midwifery as an independent profession rather than a slam on CNMs, but the fact is that a hospital-based CNM can usually only bend so far before running into hospital policy or her overseeing OBs opinions, and is more likely to need to maintain a high volume clinic and practice to maintain credibility (and employment) in her hospital-based community.

[MegBoz]

I see you are in New Jersey. I do believe that state has the highest CS rate in the nation (or one of the highest).

So long as you & baby are healthy, you and your baby are both better off & safer at home. Period.

I know it's hard to accept. It's a weird thing for American's to wrap our heads around. Personally, I didn't get my head around it in time for my own DS' birth! Especially the fact that many HB MWs in Maryland are ILLEGAL underground CPMs! I couldn't wrap my mind around how a renegade illegal MW could be the healthiest choice. But it is the truth. (Not TTC yet, but I will be planning an HB with one of those "renegade" illegal CPMs whenever we have #2.)

Please, please, do not make decisions out of fear. Get educated. Get your DH educated. If AFTER reviewing all the research he still feels HB is too dangerous, then go from there. But make a decision out of logic, reason, & science. (Shouldn't we all make healthcare decisions based on logic, reason & science???)

I recommend starting with the movie Business of Being Born, then the book "Pushed" by Jennifer Block & also "Born in the USA" by Dr. Marsden Wagner.*** Very important because it clarifies how the HB research ACOG states is fatally flawed. Important facts to know when objectively evaluating the safety of HB.

Anyway, as for leaving the hospital early, the pedi discharges the baby. I was GBS+ (as about 1/3 of all women are) & didn't get ABTs. (I think that was the wisest choice, but that's a separate discussion). Hospital policy was to keep baby for 48 hours in order to monitor. (Which is idiotic, because early-onset GBS infection shows signs in baby within 24 hrs like 90-some% of the time, whereas late-onset can not manifest for 3 weeks), but anyway, that was policy & I just decided not to fight it.

Being in the hospital for 48 hours was kind of a bummer. My room was like Grand Central Station! People coming & going constantly. The bed was super uncomfortable & the food was dreadful -- didn't taste too bad, but dreadfully unhealthy! I was so deprived of fiber, protein & fruits & veggies! Thank goodness for DH bringing me stuff!

It wasn't really all that bad. I had some super nice nurses. & my room was spacious with plenty of seating for all my visitors. They only ONCE even tried to take DS out of my room to weigh him (although I've heard plenty of horror stories of babies taken for whatever check up & Mamas practically screaming to get them back.)

- which reminds me - it's not rocket-science to evaluate if BFing is working. the paranoia over infant weight loss kinda irritates me. Just monitor wet & dirty diapers, you can obviously FEEL in your breasts if milk has come in. You can look for signs of swallowing, etc. & even if you do spend 2-4 days in the hospital, you'll be taking baby in for a 1 week check-up at the pedi where he'll get weighed. Weighing a healthy, term newborn ever 4 hours is just stupid.

Anyway, when you evaluate hospital birth in the light of the truth... the fact that HB is as safe, without SOO MANY added risks, it just seems silly to have been there in the first place. Just, needless.

[holz]

Thanks everyone for the input! I've moved "The Business of Being Born" to the top of our Netflix queue

[crunchy_mommy]

Hey I just wanted to chime in with a bit of my own hospital experience...

I went on the hospital tours & everything seemed great, they seemed very open to natural birth & even had a squat bar etc. They said several times that the baby could stay with me at all times. I was excited that it seemed I'd be very much in control of things.

Well...

1 - I had an epidural. Long (personal) story, I've mentioned it in the Birth Trauma forum.

2 - They broke my water (without asking), started pitocin, and ended up doing a vacuum extract.

3 - The nurses were too busy learning some new computer program to hold my legs up when I was pushing (due to the epi I needed them to)

3 - I didn't get to hold my baby for a good hour or so (he had some breathing difficulty but only for a few seconds) and then I had a pushy obnoxious nurse who was trying to shove my baby onto my nipple and refused to leave when I said DH & baby & I wanted some privacy.

4 - They took the baby to the nursery and wouldn't bring him to me for 8 hours. DH followed him and then finally came back to sleep at 4am so baby was all alone in the nursery and I was laying in bed all alone crying because they wouldn't bring me my baby.

5 - We had to stay in the hospital for 3 days after he was born. They would not leave us alone, we had no privacy, baby was soooo stressed and so was I.

6 - If I had listened to them I would not be breastfeeding my son... they gave me every excuse in the book to use formula (he's not latching well, he's dehydrated, his blood sugar is low (they tested it and it was NORMAL), you don't have enough milk, etc.)

Soooooo I am not trying to scare you, I hope that's not what it sounds like!! But it was totally up to me to defend my choices for myself & DS. DH is wonderful but not at all assertive, and I was in so much pain and so stressed & wrung out that being assertive was so hard and at times hardly worth the effort. I would strongly recommend that if you give birth in a hospital, you have someone there at all times you will be your advocate (a doula, a midwife, DH if he's assertive enough, a friend or family, whoever)... Does that make sense? I'm saying, you basically have to go into it prepared for a battle (even if everything seems perfect on your tours!)

[poetesss]

depends on the hospital's policies, set up, etc. Go to your tribe subforum here and ask mamas in your area about the local midwives. I found a hospital birthing center (NOT a regular L&D) that turned out to be awesome, not much different from my freestanding birth center experience.

I didn't mind the 24 hour stay, because it saved us from running around to the pediatrician the first day, and getting the pku and hearing tests on our own. We just had it all done there. We looked at it like a hotel stay.

[nikirj]

Originally Posted by poetesss

I didn't mind the 24 hour stay, because it saved us from running around to the pediatrician the first day, and getting the pku and hearing tests on our own. We just had it all done there. We looked at it like a hotel stay.

Also ask about this. Most MWs I know of do a home visit at 24 hours whether you've had a birth center birth or a home birth, and do the metabolic screening (PKU) and newborn check at your home.

[Altair]

We planned a HB and needed to transfer after 60 hours of labor-- and I wanted to echo the above statement that the vast majority of HB transfers are NOT immediate emergencies, they are more level headed decisions and the transport is in a car. Baby and I were safe at every moment.

[Cheshire]

Birth cannot be controlled but it can be managed. I agree to talk with others in your area and get their first hand experience to help you pick a location and providers.

You and DH both need to be comfortable with the decisions you make because you'll both have to live with the outcomes, good and bad.

I've had three hospital births, all with MWs. The first was fine. The second went to hell in a hand basket during the last 30 min or so. Because we were at the hospital my son had a fighting chance. He later died but if we had been at home or at a birth center there would have been no chance for him. It was more than a case of basic resuscitation. He needed immediate blood transfusions.

With our third I went with an OB - her care was amazing. But, because my labor was so fast we barely made it to the hospital and she missed the birth. The MW on duty did the actual catching.

As others have said, do your research and remember that even after arming yourself with tons of information about birth it still can only be managed so don't get too caught up in the details of controlling it. Set up a flexible plan so you if anything comes up you can roll with it and make the best decision for you and your family.

Congrats and best wishes!