WWYD? - Choosing OB

[mom2fussy]

I'm almost 13 weeks pregnant & trying to decide about which OB/GYN to use and if I should hire a doula.

With DS, I was in labor for 4 hours. I was NOT happy with my hospital experience for many reasons, but it could have gone much worse. My OB warned me that the next DC could easily come faster than that since my first one was so quick.

My DH is against a home birth, so that's out. I have no other family nearby (all out of state), so I don't have anyone else to help.

We have VERY good insurance, as long as we use an approved hospital. We live about 10/15 minutes from the nearest hospital, and that's where the OB's office is located as well. There are only 2 OB groups that deliver there, and one of them has much better recommendations/reviews than the other. The "better" office has 5 doctors, who rotate on call. I've met 2 of them so far & am not too thrilled with them.

One option I'm considering is a birthing center that's 35-45 minutes away (depending on traffic). But it'll cost almost $1000 more than the hospital & $$ is very tight for us. I'm also afraid I might not make it there in time when I'm in labor, and it would be a pain to travel that far for any pre-natal care.

So I'm considering using a doula at the hospital, and then I'd at least have someone there "on my side"...

But also debating if I should go to a different hospital that's farther away, and at least have more choices of OB offices that deliver there...

Anyone have any thoughts or want to point out something I haven't thought of??

[MissMorgan]

I chose my obgyn like this:
chose the hospital I wanted first - took tours, asked questions, etc - because really the nurses that are there determine a large portion of your care. The doctors are generally not there for very long. Then I asked for a list of doctors that delivered there and looked for recommendations for any of the doctors on the list.
The hospital we picked ROCKS! (SERIOUSLY!) AND! I found an amazing like minded natural doctor that I am 100% comfortable with.
Also, just so you know i've changed care providers 3 times this pregnancy so dont be afraid to change things if you're not as comfortable as you'd like!

[AmyKT]

Find out the c-section rates and induction rates of the practices you're looking at. Also of the hospitals. Beware of doctor ratings. Many people rate a doc highly when they think he/she "saved my baby's life" by performing a c-sec that may not have really been all that necessary. One of my best friends feels this way about her doc even though he caused the section by inducing her a week ahead of her due date.

A doula is always a good idea. I birthed my first with a CNM group at a very natural-birth friendly hospital, yet I still had a doula. She was able to explain things to me and kept me on course with my plan to birth med-free. My doula happened to be a former L&D nurse which was great because she could speak both languages -- that of care provider and patient.

[umsami]

I would hire a doula regardless of where you give birth. If money is tight, a lot of times you can get a volunteer doula for free. (Somebody who has completed training, but needs to attend a certain number of births to become certified.)

I would also tour the birth center, as well as any other options that there might be in your area. You're still pretty early in your pregnancy, so there's plenty of time. You can also ask for recommendations in Finding Your Tribe... or even ask a doula in your area which hospital/OBs she likes.

I agree with checking on c-section/induction rates--as well as talking to the L&D nurses. They too may have recommendations.

[mom2fussy]

ALL great ideas.

How would I check on C-section/induction rates? I've heard that either hospital I'm considering (that my insurance will cover) have higher-than-average rates, and I've always wondered if that's true.

The problem with a dr's office that has numerous doctors - like all around here seem to do - is that you get whoever is on call the day you deliver. Even the one office that has midwives still rotates them in the "on call" rotation.

[lillymonster]

I am using a hospital over 45 minutes away. There is are 5 within a 30 minute drive, but I am going to the further one because they have no nursery (baby rooms in, other hospitals have nurseries and my baby was taken away from me for over 7 straight hours right after the birth for "baths", "shift changes" and "tests" and I will not let that happen again) I saw her maybe 3 or 4 times while there, and I had to fight hard to see her those times, and I was nursing!

Also going because it's one of the only 3 hospitals that will do a vbac, all of the 3 are about 45-50 minutes away, but this has a branch office for appointments closer to me. I have no idea how fast I will labor since I was induced last time, so this might get interesting.

I am using a doula - she will be 90 minutes away. So I am hoping she can make it or have a back up that is closer

I remember the local leader of ICAN said she laughs when people complain about a 45 minute drive when she has heard of women traveling an hour or more or moving to another state to go to a doctor or hospital that will help them with the birth they want. That kind of put it into perspective for me.

So beside looking at c-section rates, I also look at how they are after the baby is born - do they go to the nursery? do they allow testing in the room? how is the hospital pediatrican if yours doesn't have privilages? (the one I had was horrible) Do they have a decent lactation consultant? Will they let you check out early? How is check it? (I ask again because my OB let me leave early but the nurse said I would be back with a dead baby because I was leaving to soon after my csection)

And just to add...I want on the tour, which was all nice and pretty. I got to the room, and there was black mold in the shower, blood on the floor (before I went into labor) and my bed didn't work so I was stuck in one position.

[AustinMom]

Originally Posted by mom2fussy

ALL great ideas.

How would I check on C-section/induction rates? I've heard that either hospital I'm considering (that my insurance will cover) have higher-than-average rates, and I've always wondered if that's true.

The problem with a dr's office that has numerous doctors - like all around here seem to do - is that you get whoever is on call the day you deliver. Even the one office that has midwives still rotates them in the "on call" rotation.

Call the main hospital number and ask for the labor and delivery floor director or manager. They can give you the stats on what the hospital CS rate it, how many are repeat (show you if they encourage VBAC choice) how many VBACs there are, how many CS are primary CS (moms with no scarred uterus, whether that be their first or 8th baby) induction rates, etc. I did this for every hospital in our city and found out a lot of great info. They may pull the "well, it depends on your OB..." BS, but as PP said, you don't see your OB much, it's usually the nurses, and usually the nurses you have to 'fight' with.

HIRE A DOULA! Especially if you are in the hospital. I'm a Doula myself, planning a homebirth with a wonderful wonderful MW, and I still have a Doula coming to our birth. A Doula takes on a much larger and more important role during a hospital birth because your OB is not typically going to go over all your options, and typically makes recommendations based on practice not on research. HIRE A DOULA!

You may be able to find what is called a Monatrice, they are a Doula who does medical stuff, like check heart tones, vaginal exams, etc. So, your Monatrice can come to your house when you feel you are in labor, and then check your progress, and go with you to the hospital, and IF you have the baby before you get to the hospital, it's a little less 'scary'. You have a trained professional there.

[XanaduMama]

If you're talking about the Chapel Hill Birth Center (and I'm sure you are), and decide not to go there (it is AMAZING--you should at least go on a tour and meet the midwives), you might consider the UNC Midwives (who work out of the UNC hospital in CH). They're CNMs, so your insurance would likely cover them. The UNC Family Practice doctors (who back up the homebirth CNM in the area) are apparently good too.

35-40 mins is not very far at all, IMO. Definitely worth it for the birth you want & deserve!

Personally, though, I'd try again to persuade your dh about a HB! Make him watch The Business of Being Born. Having had one hospital birth (Durham Regional) and one HB, I can tell you that there's absolutely no comparison.

[aloneinid]

I would either try to convinced my DH of a homebirth (you have lots of time) or use the birth center. The extra money will be more than worth it to have a good experience. As you know, the memories of your birth will be with you for a lifetime. As for not making it in time, my first birth was 4 1/2 hours long and my second was 18 hours! I drive an hour each way to my midwife appointments and drove that far for a birth center birth with my first. I was there in plenty of time and am so glad I avoided the hospital.

[Ianthe]

For my #2, I paid out of pocket for a midwife and her BC. It was totally worth it. If you don't get the answers that you want from the hospital and OBs, please don't let money hold you back from the birth that you want. I was 45 mins away from my birth center, and because I did hypnobirthing, my contractions didn't hurt and the drive was just fine.

ETA: With my first, my labor was 8 hrs, with my second it was over 24 hours. So it's not always faster the second time around.

[terra-pip]

I have a CNM who delivers at the hospital...it's the clinics practice that women see one other care provider of their choosing so that if your primary was unavailable you would know who the back up is. I like that the OBs are not "on call" here, because there is one OB I've never met and one I really don't like...so I really love that my MW or my OB that I chose will be with me no matter what. If you can find a practice like that it is ideal. My first was born at a birthing center with three MWs who were on call...you saw all three in rotation during your prenatals and I loved all three of them. I would totally check out the BC if I were you..they are wonderful places that need a lot of support and I wish there were more like them.

You could ask the MW there about a payment plan or sliding scale etc. At the BC my first was born they would work with any family that had financial restraints and wouldn't turn any mother away. If the environment is nice at the BC you may even feel comfortable going there earlier and laboring there.

I felt like I was in a very comfortable home at my BC. A real bed and real bathroom and kitchen. A cozy waiting room where I labored with family around until I wondered back to my room...I basically had the run of the place.

Really consider it if you're not liking what you're finding in the hospitals or OB practices and HB is not something you want to choose!!

[mom2fussy]

THANK YOU for your thoughts & info, everyone!
DH mostly leaves the decisions about baby-related stuff to me, but $$ is a big factor for him. I talked to the BC today & it sounds like we *might* be able to get it approved w/our insurance after all. I have to fill out the forms & stuff to find out. Here's hoping!!

XanaduMama - No, we're not in the Chapel Hill area. I'm referring to the birthing center in Ft Mill, SC.

[pollyanna123]

Originally Posted by aloneinid

I would either try to convinced my DH of a homebirth (you have lots of time) or use the birth center. The extra money will be more than worth it to have a good experience. As you know, the memories of your birth will be with you for a lifetime.

I just have to ditto this, because I feel the same way. My dh was against homebirth before he knew all the statistics about it. After we actually researched it, he did a complete turnaround.

I had my DD at a birth center- that's another great option. I don't think the 35-45 minutes away is a dealbreaker at all. My SIL had her 3rd child at a birth center that was over an hour away from her house. When she was in early labor, she and my brother headed there and did a lot of the labor at the birth center. Not as ideal as a homebirth, IMO, but it worked out great for them.

As for the extra $$, I know how you feel and it is tough. Money is very tight for us too. We paid $2,000 more for each birth we've had than we would've paid at a hospital. I had amazing birth experiences both times and I've never regretted a single penny that we sacrificed for out-of-hospital birth.