Is it crazy to consider birthing alone in a hospital?

[PotreroHill]

I'm a single mama 35 weeks along with my first baby. I have mild preeclampsia, so I'll be induced in 2-3 weeks. My initial plan before being diagnosed with pre-e was to UC. However, since I'm considered high risk I decided to birth in a hospital.

For me, birth is a personal, private affair. I feel that I'd be more comfortable alone in labor and birth. I've wondered if having a friend be present during labor and delivery would stall my labor as I wouldn't be able to relax and concentrate as well as I would alone. I do have a friend who's been really supportive during my pregnancy who I know would love to be there. I love my friend to death, but at times I get annoyed by her. She is a bit of a know it all and talks a lot. I just don't know if I can handle her being there during my labor. On one hand, she'd be a good support with helping to remind the staff of my birth plan. But, I also worry that I'll grow irritated at her during birth.

I've also considered just hiring a doula. Money is a little tight, but I think I could swing it. I wonder if I'll be able to relax around a doula though?

Any thoughts and/or advice?

[Maluhia]

Depends on the hospital.

Kaiser? I think you could go alone pretty well since they have good midwives on staff.
Anywhere else? A doula. If your friend annoys you now, she'll really annoy you in labor and you can SAY something to a doula and it's not personal vs. a friend.

[mwherbs]

find a doula although you feel that birth should be private, being in the hospital is in no way a private experience, I think you should have someone in your corner that is helpful and aware of what you want-
what is the induction plan? if you have a low Bishop's score maybe you would want to use something for cervical ripening before they start the induction with pit-

[kltroy]

I would have SOMEONE around. Could be a friend, a doula, your mother... whoever you feel most comfortable with. Women were meant to be with other women during birth. It's been proven over and over again that simply having another woman present in the room speeds up labor and lessens your need for pain relief. If you invite your friend, have a clear talk with her about your expectations for the birth and make sure she's game. If you use a doula you will have this discussion anyway. You may think that having another person with you is going to prevent you from relaxing, but IME once you get far enough into active labor, you will be off in your own world and will be very focused on yourself and less concerned about what's going on around you, unless it's really intrusive. Also, what will you do if things don't go exactly as planned? If you need to be induced? If decisions come up and you want someone to talk them through (even if you don't care about her opinion, sometimes it helps to reason through with someone). I think the benefits of having someone clearly outweigh the risks of NOT having someone.

[Mamabeakley]

As a doula, I'd be totally fine with someone hiring me to be a guard dog - i.e., help nurses etc. stay away as much as possible. I'd be fine being told to go sit in the hall/corner and remind people you want your privacy. Not all doulas would feel this way, sure, but I would.

[PreggieUBA2C]

Some info not usually shared about pre-e:

It is not statistically significant in lowering birth weight in term babies born after 37 weeks. http://aje.oxfordjournals.org/cgi/co...ract/155/3/203

If your pre-e is mild, why such a hasty induction? Since it cannot be known ahead of time whether or not you'll develop further symtoms, I'm just not sure why an induction makes any sense. If your bp were skyrocketing, then I get it. If your kidneys were giving out, then of course. But the induction itself causes so much stress that it could cause further serious symptoms that you may not otherwise have experienced. And then you are straight to c/s and I am not the person to talk to about that being an acceptable course of action and experience....

I guess I would monitor my bp and edema and go when I went into spontaneous labour unless I had reason to go earlier. But that's what I would do. I personally think the induction is a greater risk than waiting for either a worsening of symptoms to indicate the need for action, or preferably, spontaneous labour.

In any case, if I was in a position to have to be in a hospital, I would deliberately have the baby alone after continuing to refuse internal exams and continuous monitoring. I would let nurses check my bp, but that's it, and I don't have white coat syndrome, so I would have no trouble enforcing that.

If you become shy with hcps, I would definitely have someone there with you who is willing to tend your needs entirely. I would be willing to be a support that doesn't enter the room for a friend. Would your friend leave you alone to labour and also advocate for you? If she's shy with hcps, then I wouldn't ask her either and I'd go with a 'proven' doula. I would need more than her own testimony of her behaviour with drs to be sure if she indeed could advocate (for anyone in that role).

I would trust my dp. He'll tell them where to go if need be and how to get there. I can't think of anyone else though. Even my otherwise very confident midwife and friend was too shy to speak up when I needed her to during my c/s's. It was my dp who stood up for us and required proper action. The problem was that there were many times when he wasn't allowed in the area I was, but my mw was and she couldn't speak up. When my dp was present, he was vocal.

So I don't think you're crazy to go it alone, unless you are just trusting that your birth plan and expectations will be respected. If you are going in trust, then I'd say bring an advocate because I have heard hundreds of hospital birth stories and never one where a birth plan and expectations were respected without an advocate and even then, it is very difficult ime.

[pumpkinhead]

I don't think this is something you can know until you're actually there. I was hesitant to ask my mother to be in the delivery room with me, but I'm now very glad I did. I thought I would be uncomfortable with my MIL there, but looking back, I would't have cared.

I was very able to tune out the world around me and just exist in my world of concentration for the most part. THings that I never thought would have annoyed me did and things that normally annoyed me did not. My support people were there for me when I needed them, did the things I asked them to do but otherwise left me alone. This was absolutely ideal for me. I'm very glad they were there in a way I couldn't have known beforehand.

I think you should have a frank discussion with your friend and explain your concerns. Explain that there may be a time in which you'll ask her to leave the room and that you mean no offense by it. If she's understanding of that, I'd ask her to be there with you.

For me, being completely alone would have absolutely stalled my labour. I needed them there. I didn't need them to touch me or talk to me, but just knowing they were there was soothing to me.

[Belia]

I would have someone there who is in your corner, just in case. You never know what hospital protocols could come up that you may need to push back against.

I would not go with your friend, as you describe her. I would hire a doula and be very clear about what you sense you will need at that time. A doula will not be so emotionally invested in you like a personal friend- ie, you won't need to worry about hurting her feelings, etc. But it will be someone there, focused 100% on you, just in case you need a friendly face.

[Grace and Granola]

Originally Posted by Mamabeakley

As a doula, I'd be totally fine with someone hiring me to be a guard dog - i.e., help nurses etc. stay away as much as possible. I'd be fine being told to go sit in the hall/corner and remind people you want your privacy. Not all doulas would feel this way, sure, but I would.

This is exactly what I was thinking. If you talk to the doula upfront and make sure you find one that would agree to this. Then just have her be that guard dog and then if you do need her for something, she's there.

[MegBoz]

Originally Posted by pumpkinhead

I think you should have a frank discussion with your friend and explain your concerns. Explain that there may be a time in which you'll ask her to leave the room and that you mean no offense by it. If she's understanding of that, I'd ask her to be there with you.

Exactly what I was going to say! Literally, she could hang out outside your room, and only step in if a nurse insists on coming in (so you aren't alone with strange HCPs, but have someone who is "in your corner" in your room when HCPs need to step in.)

If you have hesitations about her ability to do that, then I'd spring for a doula. I would want someone "in my corner," even at the best hospital. (And, again, I'd make sure the doula was fine with staying outside the room if I so desired.)

[JTA Mom]

Originally Posted by PreggieUBA2C

Some info not usually shared about pre-e:

It is not statistically significant in lowering birth weight in term babies born after 37 weeks. http://aje.oxfordjournals.org/cgi/co...ract/155/3/203

If your pre-e is mild, why such a hasty induction? Since it cannot be known ahead of time whether or not you'll develop further symtoms, I'm just not sure why an induction makes any sense. If your bp were skyrocketing, then I get it. If your kidneys were giving out, then of course. But the induction itself causes so much stress that it could cause further serious symptoms that you may not otherwise have experienced. And then you are straight to c/s and I am not the person to talk to about that being an acceptable course of action and experience....

Because with pre-e there is NO connection between severity of symptoms and outcomes. Some women have mild pre-e, start seizing and lose their babies. Other moms have severe pre-e (grams and grams of spilling protein, headaches, etc) and never seize. They don't necessarily link together.

The problem with pre-e is that it can go from okay to bad on a dime. There's not enough time to do anything. Once a mom starts seizing, the SHTF. I had mild pre-e and NO symptoms. Other than high BP. But I was spilling protein. No headaches, no visual disturbances, no pain in my lower right side, etc.

Pre-e is very, very serious. If left unattended it can cause serious, irreversible damage to multiple organs. Very recent, cutting edge research actually points towards it being a placental problem. From what I understand, in a lot of pre-e cases, the placenta starts failing early due to not being imbedded correctly/deeply enough. Baby sends out hormones to increase blood flow, causing the increase in BP. However a nasty side effect of that hormone is that it starts shredding the blood vessels, leading to edema and increased protein in the system.

In this case, a c/s can be totally warranted. Both baby and mom's life are in danger. And the only cure is delivery. Yes, inductions can lead to a higher c/s rate. But this is truly one of those rare cases where c/s isn't the bad guy.

Ami

[PreggieUBA2C]

Originally Posted by JTA Mom

Because with pre-e there is NO connection between severity of symptoms and outcomes. Some women have mild pre-e, start seizing and lose their babies. Other moms have severe pre-e (grams and grams of spilling protein, headaches, etc) and never seize. They don't necessarily link together.

The problem with pre-e is that it can go from okay to bad on a dime. There's not enough time to do anything. Once a mom starts seizing, the SHTF. I had mild pre-e and NO symptoms. Other than high BP. But I was spilling protein. No headaches, no visual disturbances, no pain in my lower right side, etc.

Pre-e is very, very serious. If left unattended it can cause serious, irreversible damage to multiple organs. Very recent, cutting edge research actually points towards it being a placental problem. From what I understand, in a lot of pre-e cases, the placenta starts failing early due to not being imbedded correctly/deeply enough. Baby sends out hormones to increase blood flow, causing the increase in BP. However a nasty side effect of that hormone is that it starts shredding the blood vessels, leading to edema and increased protein in the system.

In this case, a c/s can be totally warranted. Both baby and mom's life are in danger. And the only cure is delivery. Yes, inductions can lead to a higher c/s rate. But this is truly one of those rare cases where c/s isn't the bad guy.

Ami

So why don't they just c/s right away? Are they just hoping that the mum and baby will make it to 37 weeks, but risking that they won't? It just seems arbitrary, which is why I asked.

I agree that it is very serious though and after I posted, was reading about the theory that it has to do with insufficient implantation of the placenta.

I think that both the induction and c/s are very risky, but in the case of the baby not receiving adequate nourishment, it's likely too late to be wishing things were not as they are, right?

It certainly does show up some lob-sided obstetrics though. I had two coerced c/s's for healthy babies, both f whom were made less healthy by the c/s and then here are women and babies who really need this intervention and it seems the OBs are not nearly as hasty to cut them as they were me and others like me. So strange. They take their time when it's actually warranted but rush into it when it's not...

Thanks for your patient reply.

Op, I hope all goes very well for you and your baby.

[JTA Mom]

Originally Posted by PreggieUBA2C

So why don't they just c/s right away? Are they just hoping that the mum and baby will make it to 37 weeks, but risking that they won't? It just seems arbitrary, which is why I asked.

I agree that it is very serious though and after I posted, was reading about the theory that it has to do with insufficient implantation of the placenta.

I think that both the induction and c/s are very risky, but in the case of the baby not receiving adequate nourishment, it's likely too late to be wishing things were not as they are, right?

It certainly does show up some lob-sided obstetrics though. I had two coerced c/s's for healthy babies, both f whom were made less healthy by the c/s and then here are women and babies who really need this intervention and it seems the OBs are not nearly as hasty to cut them as they were me and others like me. So strange. They take their time when it's actually warranted but rush into it when it's not...

Thanks for your patient reply.

Op, I hope all goes very well for you and your baby.

It's because of the risk factors. 37 weeks is term and when the risk to the baby drops a lot. A good OB will NOT let a woman get past 37 weeks. There's not much more decrease in risk past that and the increased risk of letting the pre-e continue to worsen is just too much.

And they watch you like a hawk once you are diagnosed with pre-e, so if your symptoms are worsening, they will take your baby early. Michelle Duggar, from the TLC show, had severe pre-e and they took her baby at 25 weeks. So it really depends. On a pre-e forum I've visited, women with incredibly severe pre-e were even induced before viability because the mom's body was literally shutting down. It's scary and with pre-e, there's just no way to tell.

They induce because, again, the risk to mom and baby are less than instant c/s. This is only if she has elevated proteins though. Once there are markers indicating organ damage (liver and kidney specifically) they will do an instant c/s. One of the mom's in my ds2's DDC went in for a blood draw and they found elevated levels indicative of severe HELLP (severe pre-e with multiple organ failures). They didn't induce, just rush her to the OR.

My only symptom of pre-e with my son was high bp at 36 week appointment. 140/90, so not even that high. No other symptoms, I felt fine. My OB though had me do a couple NSTs. Those were fine. For peace of mind, she also had me do a 24hr urine collection. This is much better than the dipsticks, because with those, if you are well hydrated, you can fool them into not seeing elevated proteins. The 24hr one counts all the protein excreted.

My protein was 500, with a cut off being 300. So completely mild. But the OB on staff wasn't taking any chances, so I got called in as soon as the results were in, since I was 37weeks and 1 day along. I totally get the anger towards unnecessary c/s. In my case, I think it was a mismanagement of labor that caused me to not progress fast enough for them, so I did end up with what I view as an unnecessary c/s.

What annoys me is how little research there is into this disease. I mean 10% of all pregnancies end up with pre-e. And because of all these variables, severity of protein, other organ markers, baby's vitals, etc it really is to the individual OB as to treatment plans. I mean, 1 in 100 women get pre-e, isn't that a large enough population to fund studies for?

Ami

[SeattleRain]

Originally Posted by JTA Mom

It's because of the risk factors. 37 weeks is term and when the risk to the baby drops a lot. A good OB will NOT let a woman get past 37 weeks. There's not much more decrease in risk past that and the increased risk of letting the pre-e continue to worsen is just too much.

And they watch you like a hawk once you are diagnosed with pre-e, so if your symptoms are worsening, they will take your baby early. Michelle Duggar, from the TLC show, had severe pre-e and they took her baby at 25 weeks. So it really depends. On a pre-e forum I've visited, women with incredibly severe pre-e were even induced before viability because the mom's body was literally shutting down. It's scary and with pre-e, there's just no way to tell.

They induce because, again, the risk to mom and baby are less than instant c/s. This is only if she has elevated proteins though. Once there are markers indicating organ damage (liver and kidney specifically) they will do an instant c/s. One of the mom's in my ds2's DDC went in for a blood draw and they found elevated levels indicative of severe HELLP (severe pre-e with multiple organ failures). They didn't induce, just rush her to the OR.

My only symptom of pre-e with my son was high bp at 36 week appointment. 140/90, so not even that high. No other symptoms, I felt fine. My OB though had me do a couple NSTs. Those were fine. For peace of mind, she also had me do a 24hr urine collection. This is much better than the dipsticks, because with those, if you are well hydrated, you can fool them into not seeing elevated proteins. The 24hr one counts all the protein excreted.

My protein was 500, with a cut off being 300. So completely mild. But the OB on staff wasn't taking any chances, so I got called in as soon as the results were in, since I was 37weeks and 1 day along. I totally get the anger towards unnecessary c/s. In my case, I think it was a mismanagement of labor that caused me to not progress fast enough for them, so I did end up with what I view as an unnecessary c/s.

What annoys me is how little research there is into this disease. I mean 10% of all pregnancies end up with pre-e. And because of all these variables, severity of protein, other organ markers, baby's vitals, etc it really is to the individual OB as to treatment plans. I mean, 1 in 100 women get pre-e, isn't that a large enough population to fund studies for?

Ami

Its funny you mention this because the National Institute of Health is actually doing a study on pre-e. I know this because I was randomly selected to be a part of this study through my OB's office. The study has consisted of a blood test, a really in depth food study that I had to fill out by 20 weeks, and a 1 hour interview (which I was supposed to have tomorrow but I incidentally had a little scare so I had to go into my OB's office and I missed it). After I give birth, I agreed to donate my placenta to them for dissection and observation, as well as give them access to my medical records (limited to this pregancy).

I just thought you'd be happy to know that they ARE putting money into these studies. Thanks for all you info on pre-e, I've learned alot.

[majormajor]

another reason to have someone there with you is so that if for some reason you and baby need to be separated after the birth, you'll have someone that can stay with baby to make sure all of your preferences are adhered to (regarding things like feeding, testing, vax and whatnot), and to relay information to you.

any chance you can contact a doula organization to find someone who's a doula-in-training and willing to work for free? you can also try calling the L&D floor where you're delivering or patient services for some leads here.

good luck and congrats!!

[Lucy Alden]

While you may believe birth is personal and private, in the moment you may actually want someone there. Since this is your first its really hard to tell what you will need when the time comes. Having a “guard dog” doula or very close friend ensures that either a. you will be left somewhat alone or b. you’ll have support should you decide you want it.

Not to mention, feeling like you are the only one advocating for yourself may slow or completely stop labor. And being able to advocate for yourself while in transition may be downright impossible.

Originally Posted by majormajor

another reason to have someone there with you is so that if for some reason you and baby need to be separated after the birth, you'll have someone that can stay with baby to make sure all of your preferences are adhered to (regarding things like feeding, testing, vax and whatnot), and to relay information to you.

And big time . It's hard when you have a vision of how or where you'll birth but for whatever reason aren't able to. Good for you for doing what's best for you and your babe.

[JTA Mom]

Originally Posted by SeattleRain

Its funny you mention this because the National Institute of Health is actually doing a study on pre-e. I know this because I was randomly selected to be a part of this study through my OB's office. The study has consisted of a blood test, a really in depth food study that I had to fill out by 20 weeks, and a 1 hour interview (which I was supposed to have tomorrow but I incidentally had a little scare so I had to go into my OB's office and I missed it). After I give birth, I agreed to donate my placenta to them for dissection and observation, as well as give them access to my medical records (limited to this pregancy).

I just thought you'd be happy to know that they ARE putting money into these studies. Thanks for all you info on pre-e, I've learned alot.

I am happy at this news! I think it's been a long ignored problem in obstetrics, and a dangerously ignored one at that. I mean, how many other diseases occur that often in a given population yet are still 'unknown' in terms of early testing, progression of symptoms (as in finding out what makes one woman seize and not another at the same protein levels, for example), etc. Hopefully a lot more will be learned and by the time my son may have kids, they'll have figured it out and it won't be any riskier than having gestational diabetes is now.

Ami

[cristeen]

Originally Posted by Maluhia

Depends on the hospital.

Kaiser? I think you could go alone pretty well since they have good midwives on staff.
Anywhere else? A doula. If your friend annoys you now, she'll really annoy you in labor and you can SAY something to a doula and it's not personal vs. a friend.

Don't assume this. I had my first in a Kaiser hospital - there were no midwives in sight (and particularly for pre-e, they may not be allowed) - that particular hospital does not have MWs on staff. I had a horrendous experience, and really wish I had had a doula in addition to my DH and BFF who were there. As it was I refused to go back to Kaiser with my second even for prenatal care and paid out of pocket because of the horrible experience.

That being said, yes, I do think it's crazy to consider birthing alone in any hospital. Unless you feel like doing everything the medicos tell you to.

[PreggieUBA2C]

Originally Posted by JTA Mom

It's because of the risk factors. 37 weeks is term and when the risk to the baby drops a lot. A good OB will NOT let a woman get past 37 weeks. There's not much more decrease in risk past that and the increased risk of letting the pre-e continue to worsen is just too much.

And they watch you like a hawk once you are diagnosed with pre-e, so if your symptoms are worsening, they will take your baby early. Michelle Duggar, from the TLC show, had severe pre-e and they took her baby at 25 weeks. So it really depends. On a pre-e forum I've visited, women with incredibly severe pre-e were even induced before viability because the mom's body was literally shutting down. It's scary and with pre-e, there's just no way to tell.

They induce because, again, the risk to mom and baby are less than instant c/s. This is only if she has elevated proteins though. Once there are markers indicating organ damage (liver and kidney specifically) they will do an instant c/s. One of the mom's in my ds2's DDC went in for a blood draw and they found elevated levels indicative of severe HELLP (severe pre-e with multiple organ failures). They didn't induce, just rush her to the OR.

My only symptom of pre-e with my son was high bp at 36 week appointment. 140/90, so not even that high. No other symptoms, I felt fine. My OB though had me do a couple NSTs. Those were fine. For peace of mind, she also had me do a 24hr urine collection. This is much better than the dipsticks, because with those, if you are well hydrated, you can fool them into not seeing elevated proteins. The 24hr one counts all the protein excreted.

My protein was 500, with a cut off being 300. So completely mild. But the OB on staff wasn't taking any chances, so I got called in as soon as the results were in, since I was 37weeks and 1 day along. I totally get the anger towards unnecessary c/s. In my case, I think it was a mismanagement of labor that caused me to not progress fast enough for them, so I did end up with what I view as an unnecessary c/s.

What annoys me is how little research there is into this disease. I mean 10% of all pregnancies end up with pre-e. And because of all these variables, severity of protein, other organ markers, baby's vitals, etc it really is to the individual OB as to treatment plans. I mean, 1 in 100 women get pre-e, isn't that a large enough population to fund studies for?

Ami

Wow. That is crazy. I am glad there is a study now though. It seems it's about time given the numbers you shared!

So that makes sense then, to wait just until 37 weeks with monitoring and then try to get things going artificially because it's still better than c/s, but accepting that c/s may be necessary. It's been good to learn about this since the last time I really looked into it, I was reading Dr. Brewer's book 7 yrs ago, and since I've never had any indicators, I guess I didn't consider that it's fine if everything goes well, but in the event that it doesn't, what then? Now I know.

Thanks again for the info.

[honeybee]

There's no such thing as birthing alone in a hospital. There will be nurses and other staff. I don't see how someone who is there for YOU, as opposed to just being there as another day on the job, is going to be any worse. I, personally, would bring your friend along or hire a doula. You need advocates for you... especially if you're going to be induced. It sounds like your friend could probably handle you getting irritated with her if it helps you out overall. And you will need someone to guard the door and keep everyone else OUT of your room as much as possible. And if you talk to your friend or doula beforehand, you can tell them you would like them to just be quiet and sit in a corner, or outside the door, or whatever. And you'll want someone around to fetch water for you, or sneak you food, or whatever.