Experiences with hospital birth centers?

[annablue]

Can anyone share experiences with hospital birth centers? Obviously they're all going to be a little bit different; but what can I expect? Do they have similar policies to the hospital (i.e. must deliver in a certain time, trying to push you into drugs and Pitocin, etc.) Because I want to avoid that, while still having the security of knowing I'm in a hospital. I'd be using a midwife, though.

[*MamaJen*]

Birth Centers attached to hospitals have some advantages over being in a traditional hospital delivery room, but at the end of the day you're still buying the hospital ticket and taking the hospital ride. I think a lot of women get lulled into thinking they can have a natural birth in a hospital birthing center and find themselves fending off a lot of unwanted interventions. You still have to go through triage, you still may be dealing with non-evidence based policies like time limits for laboring, and so on. I've heard a lot of stories of women who were planning a nice natural waterbirth in the hospital birthing center, but wound up having to deliver in L&D for some pretty unacceptable reasons, like the birthing center not having been cleaned since the last delivery there.
That is good that you'd be using a midwife, but if I were you, I would have a serious conversation with her about what kinds of hospital policies I'd be facing. I'd also read up on the safety of homebirth or free-standing birth centers. There are a lot of good studies out there showing the safety of homebirth for low-risk pregnancies with a qualified midwife.
It's possible to have a natural birth in a hospital, but it takes luck and hard work. If you really want a natural birth, you'd be better off at home or at a freestanding birth center.

[lotus.blossom]

I used a hospital birth center for my first. Quite frankly I felt misled by the appearance of it. It seemed to line up with everything I wanted for my birth, but in the end I was on a clock, they broke my water to speed up labor, wouldn't let me unto the tub when i wanted it, and ultimately I ended up with a transfer and c/s. If I had stayed home longer I may have had a better experience, but when labor started they told me 2 out of 3 rooms were filled and I was so scared of not getting a room that I went too early.

My second was a homebirth (and eventual transfer and c/s)

And if I have a third I will be trying for a hospital vba2c. I'd be interested to see if the hospital setting will be my "magical" birth. Since my other two were not.

[MegBoz]

Originally Posted by *MamaJen*

Birth Centers attached to hospitals have some advantages over being in a traditional hospital delivery room, but at the end of the day you're still buying the hospital ticket and taking the hospital ride.

As always, great post & I agree completely.

I don't even really like the phrase "Hospital birth center." To me "Birth Center" equals "Freestanding birth center" if you can get an epidural & a CS, it's still a hospital. Just because you may have to change rooms or go down a hallway doesn't really change that fact - it's still a hospy birth.

To find out if they're truly NCB friendly, I always advocate asking very open ended questions & gauging reaction. So... rather than, "Are you OK with not breaking my water since that's what I want?" ask, "When do you typically break a woman's water?"

Instead of "Can I forgo pit?" ask, "When do you consider it necessary to augment labor with pit?"

In other words - gauge how they normally practice - and see if that is compatible with your wishes... don't ask if they're willing to deviate from their norms to accommodate your wishes. Cuz in that case you're setting yourself up to battle while in labor - the LAST thing any laboring mama needs to deal with!

[CI Mama]

Here's what I experienced with a birthing center within a hospital.

My labor began with water breaking and with a regular contraction pattern establishing right away. I wanted to get to the hospital early for a whole variety of reasons, and I did. Getting through triage and getting set up in our room was no big deal. Then my partner, my doula and I got to work. The first 12 hours of my labor the hospital was very "hands off." I really only remember them showing up every few hours to check my blood pressure. They also brought me towels, barf bags (I started vomiting regularly several hours into my labor), and funny mesh underpants & pads since I was still leaking amnio fluid everywhere.

I was free to move as I wished. I moved around a lot, chanted & sang during contractions, listened to music, ate food when I wanted to (and promptly barfed it back up again), sat in the tub for awhile, rested when I wanted to rest. I didn't feel any over-interference from the hospital.

About 12 hours into my labor, it was interrupted. The disruption had nothing to do with the hospital, and everything to do with my lawyers. It's a long story that I won't go into here, but basically, it was everything you don't want a disruption to labor to be (emotionally wrenching, cerebral, separated me from my partner, etc.).

At that point, my labor faltered. My contractions would rev up and slow down. They would slow down, so I would lay down to relax, and then they would rev up. I would get uncomfortable, so I'd get up and move around, and the contractions would peter out. I lost focus, I was exhausted (I'd been awake for over 24 hours at that point), and I couldn't keep any food down.

About 18 hours into my labor, they checked my cervix for the first time. I was dilated 1.5 cm. They let me continue to labor how I wanted...on a birthing ball, doing yoga poses, whatever I wanted. I wasn't monitored and frankly they just weren't paying much attention to me. My doula did request a breast pump to see if nipple stimulation could get my labor back on track, and they never brought it. We had a very cranky nurse with us at that point and I think she just didn't want to be bothered.

About 20 hours into my labor, I needed help. It was my choice to start pitocin. It did start a "cascade of interventions" and I did end up having a c-section about 33 hours after my labor began. I did not feel "pushed" by the hospital at any point. I felt trapped by my exhaustion and my body's inability to recuperate and get a 2nd wind.

I wouldn't say my hospital experience was perfect, but I did feel respected and cared for pretty well. Although my labor didn't progress they way I wanted it to, many of the things I wanted in my labor still happened. I was not confined to a bed until I was too exhausted to get up anyway. I moved, used mantras and chanting, and stayed tuned in to my body through a very long and difficult labor. When I needed help, I took what the hospital had to offer.

Once my daughter was born, they didn't bathe her. They gave her to my partner to hold while I was being stiched up, and then they passed her to me. I got to hold her skin-to-skin and to offer the breast for the first time shortly after coming out of the OR. She was never offered formula in the hospital and she "roomed in" with me & my partner.

Sorry for rambling on and on about my own story, but I wanted to share my perspective on a hospital birthing center birth. I think it would have been very possible for me to have a positive, unmedicated, vaginal birth at the hospital birthing center if circumstances had been different.

[nia82]

It really belongs to the hospital, but their general attitude is more pro-natural birth and they usually work with midwives and obgyns.
I had DS in such a setting. Overall it was great compared to a hospital maternity ward... THey had tubs, just I arrived at a day that everyone went into labor so I got the last LDP room that only had a shower (that stinks!). We had a nurse to ourselves the entire time, she was very supportive, helped out with the birthing ball, hot compresses for my back - she sort of was like a doula. Yet there are certain rules like in a hospital you have to deal with (intermittent monitoring, blood pressure readings etc). The only time they asked for an internal exam was upon admittance and I was ok with that back then (wouldn't do it again as my water had broken before labor!).
My midwife arrived when I was ready to push and it was overall fine, just the obgyn who supervised her didn't allow me to push upright - and I was in no condition to fight, nor was my husband. It was the one big thing about my birth that really went wrong.
DS stayed with me the entire time, the nurses took no issue with refusing the vitamin K shot and found the oral stuff totally cool, didn't mind not doing the eye goop, didn't care for hep B shots and totally loved that we didn't circ DS. It was a certified baby friendly hospital birthing center so we saw IBCLCs within the hour of birth. They helped us out tremendously. So DS always stayed with us, body to body contact was strongly encouraged, breastfeeding too (never had a drop of formula despite his bad latch and SNS feeding and such), encouraged natural birth (they didn't have an anesthesiologist on staff)... It is way better in my experience than a hospital, but far from being as great as a homebirth or freestanding birthing center birth.

[AlexisT]

Very much depends.

There are hospital BCs where you CANNOT get epidural or CS. (You're transferred to L&D if this is necessary.) These still tend to be more restrictive than FSBCs. They have hospital liability issues to deal with. BUT, you will not be bothered about epidurals, the CNMs/OBs who attend know their patients want a natural birth, etc.

Ultimately, the name "birth center" doesn't mean much. Some birth centers are renamed L&D. Some are distinctly different from standard L&D. You need to know your hospital and its policies.

[jennica]

I chose a hospital birth center with midwives for Ds's birth. I was told that if the birth center was full, I would just deliver in a L&D recovery room and it would be just the same as a birth center birth. That was a total lie. When I checked in they sent me to triage (which wasn't supposed to happen) then to an L&D room (which wasn't supposed to happen). With the L&D room I was not allowed a tub (the reason I chose the hospital in the first place), I was treated by a midwife, but not midwife nurses. The L&D nurses stay with the room and they were mean and not happy about having a midwife patient who wanted a natural birth. I was subjected to all the interventions one would expect of an OB in an L&D room - though they were instead forced on me by the midwife. After the birth, the nurses took Ds off the bed and never let me hold him (he was totally fine). They never attempted to help me with breastfeeding (though they had wanted me to sign a contract barring my doula from doing so) and I didn't breastfeed for 3 hours after the birth when I transferred to a birth center room for recovery and was then under the care of the midwife nurses. Also, while still in the L&D room being stitched up, they tried taking DS to the nursery because it is standard procedure for the L&D rooms to take your baby away from you and keep them in the nursery. I wouldn't let them take him, and everyone was very mad at me for that, including one of the midwives who was helping the doctor stitch me up from episiotomy.

My advice is to ask as many people as possible how often birth center patients deliver in L&D. Also, find out what the hospital policies are for the L&D section of the hospital, because if you end up there you will want to know about how they do things. For example, if they take baby away right away, or don't support breastfeeding, or don't allow baby to stay in your room with you, you may not want to take the risk of ending up in that situation and having to fight. It is not a good idea to fight in labor. I wish I had known there was such a huge discrepancy between the birth center's policies and the L&D policies and that I had a pretty good chance of ending up in L&D (it happened a lot at the time I had Ds). Had I known that, I would have just delivered at a regular hospital with better policies overall. This time I'm planning a homebirth.

[Mother Cake]

Originally Posted by MegBoz

To find out if they're truly NCB friendly, I always advocate asking very open ended questions & gauging reaction. So... rather than, "Are you OK with not breaking my water since that's what I want?" ask, "When do you typically break a woman's water?"

Instead of "Can I forgo pit?" ask, "When do you consider it necessary to augment labor with pit?"

In other words - gauge how they normally practice - and see if that is compatible with your wishes... don't ask if they're willing to deviate from their norms to accommodate your wishes. Cuz in that case you're setting yourself up to battle while in labor - the LAST thing any laboring mama needs to deal with!

My favorite set of open ended questions (from a friend on the Childbirth Reading Room). They're written for a birth attendant, but could be modified to find out the policies at a hospital or birth center.

How do you view your roll at a birth?
What have you been trained to do during labor & birth? Have you changed through your practice?
What do you expect of your clients/patients?
How do you feel about the presence of other family members? Doulas?

[*MamaJen*]

Originally Posted by jennica

I wouldn't let them take him, and everyone was very mad at me for that, including one of the midwives who was helping the doctor stitch me up from episiotomy.

Go in for a midwife attended birth center birth, get an epesiotemy. Talk about a bait and switch.

[hotharmony]

I had a wonderful hospital birth center birth and I am planning my second in October.

I agree that you have to be very active about finding other people who have delivered their and asking for their experience. I would also still hire a doula and take childbirth classes focused on natural childbirth.

If its the right thing for you then I think that's great.

[taren]

d

Edited by taren - 9/2/11 at 10:07am

[SublimeBirthGirl]

Where I live, a hospital my call its maternity ward a "birth center" but that doesn't mean anything. It's still just a hospital maternity ward with very little in common with a true birth center.

[Sudonk]

The hospital "family-centered birth center" near me has a 53% c-section rate and madatory separation of mom and baby following the birth. Definitely do your homework before believing the hype.