Birthcenter or Homebirth

[TheMommy]

 I still have a great deal of time to think (I'm due Aug. 28th), but I'd like to choose my MWs soon, and one practice does ONLY HomeB. and one does only BIrthC./Hosp.  My son was born in a hospital with MW in attendance.  I labored but could not birth in water b/c the hospital did not allow it.  It was a 12 hour labor with no meds and nothing complicated (other than the stitch up, which I've described in another forum). So I like to think that I am likely to have another uncomplicated vaginal birth.  

Option: Birthcenter with CNMs. This is, unfortunately, not a free-standing birth center, but one located in a "separate wing" of a hospital that also has a traditional maternity unit. I would be delivered there by one of the two midwives who deliver there. At this time the doctors do not use this facility at all. Of the women who give birth there, 50% do so in water (which is what I'd like to try) and their c-section rate is 3-5% (though I'm not sure how they get that number, it is probably b/c certain women are not admitted to the birthcenter due to breech presentation, etc.). So far, I've liked the MW I've spoken with on the phone, but due to the WEATHER (argh!) we've had to cancel appointments 2 weeks in a row, so I've not met her in person. This practice of MW works with an OB practice and also sees patients who plan to deliver in the traditional hospital wing. However, if I choose to use the birthcenter, I would be guaranteed a MW delivery, unless surgical intervention were required. One big advantage is that this would be the MUCH more affordable way for me to try to birth naturally in the water. There is also a part of me that might feel more comfortable with knowing that if something went awry, I would still be attended by the MW that I knew and the hospital stuff is right there.

Option: Homebirth with CNMs. We've met with one of the midwives and she seems great. The other one we talked to on the phone seemed good, but kind of pushy when I told her we were deciding between home and a birthcenter. But not too pushy. One main reason I'd like to give birth at home is b/c I'd like my son to not feel like "mommy left" and came home with someone new. I've heard that it's nicer for older kids to feel like they are a part of the birth, even if he's out of the house during the more intense parts. One disadvantage is that although our insurance covers the birth, the midwives have additional fees and the tub rental would be a significant cost. It is my esitmate that if our homebirth went smoothly (no transfers, which would incur a hospital care co-pay as well) it would be about $800 more than the birth center. My only other concern is that in the event of an emergency transfer (which is unlikely, but something someone planning a homebirth probably has to think about) my MW would no longer be able to attend the birth in a technical capacity, since the closest hospital does not give our MW admitting privileges (stupid system!). This means my birth has the potential to go from a MW home delivery to an OB-I've-never-met delivery if anything unexpected comes up. That would stink. My concerns about the mess have been addressed in an earlier post I wrote. I have to say that I do not know right now what I'd be more comfortable with-- what would make me relax during birth and give my body a chance to labor as it should. I do not have a fear of hospitals, and I can't say that for birthing, I feel most comfortable at home. Maybe I would. Maybe not! I've never tried!

Sorry this was so long.... If you have any thoughts, let me know! Em

[MegBoz]

Hm, tough! Well, it sounds like both are genuinely good options, so that's great!

The stats for the BC are fantastic! 3-5% CS rate, wow! Although that makes me think... are they super strict with who they allow to birth there? For example, would you be 'kicked out' if you went to 42W? How about if you were GBS+ and refused antibiotics? I'd ask a lot about what sort of things would risk you out. Clearly there are some things, like pre-e, that legitimately require hospitalization, but if there were other things where you personally don't feel hospitalization is necessary, but their policies "risk you out" then that's something to consider.

IMX, HB MWs are much more laid back about this sort of thing. Of course, I'm seeing a CPM for my HB who happens to be illegal in Maryland (although legally licensed in Virginia - so stupid!) So she has no laws restricting her practice. Not to say she'll attend anyone at home, of course! But the fact that there are no hard-and-fast rules is really nice. I would HATE to have 42-weeks looming over my head!!

Also what about PP care? How long do you have to stay? What is the PP care like? I had my DS in a NCB-friendly hospital & was generally happy, but I was GBS+ & no time for antibiotics- which required a 48 hour stay, which I decided not to try to fight. (My own pedi was on vacation anyway, so I would have been fighting the house pedi for earlier discharge.) The food was dreadful (& not enough!) & the bed uncomfortable & people were constantly coming & going. Nothing major, not that bad, just not pleasant. Home would have been so much better!

How old is your DS? Mine is 2.5 and I also like the idea of him being present so it is less of disconnect' about where this new family member came from. I posted about it on the HB forum because I'm still torn about having him present at all. One MW said that under about age 4, she has found it doesn't impact kids all that much - and they can comprehend that the new baby is the same baby you've been talking about in Mommy's tummy even if they didn't witness the birth.

Sounds like meeting the BC MW will really help finalize the decision. As I said, they both sound good!
 

Personally for me, my hospital had 3 MWs, one of whom I really disliked. They now have 3 more - so that's 6! Way too much gamble! I also don't like that the nurses are all total strangers - and they pay a big part of your care. Whereas with my HB, my MW has only one apprentice & she has been at all my prenatal apts.

I also did all my laboring at home with DS (accidentally!) and I can't imagine the intensity of transition in a strange place with strangers coming & going. So the peace of my own home turf was a huge decision factor for me personally.

[TheMommy]

Thanks, MegBoz-- 

I wonder the same thing about the c-section rate, but I'm also a huge worrier, and since I know when I ovulated, I personally wouldn't want to go past 42 weeks.  I terms of PP care, they say the mother usually goes home within 6-12 hours of the birth, which is pretty good.  Yeah I HATED the food at my last hospital-- ick! I was gluten-free at the time, which made it worse, but one meal they served me was rice with marinara sauce.  Come on.  That's nasty!  At the BC the suites have private kitchenettes so we can bring our own food, and I'll have a lot of meals frozen and ready to go.  (Not that we will need a lot of meals, but we'll have something on hand).  Yeah, I would hate to drive to the BC in transition, especially since I like to labor in the tub for the whole time.  I think I'd actually like to do as much laboring at the place I will birth (so if the BC, I'd actually like to check in before things really heat up).   So many people say that to labor at home is best, but I liked laboring at the hospital with my doula and MW last time around (I know that's an uncommon preference!).  But, like you, I would dread a car ride while in transition.  I will get to meet the BC MW tomorrow.  I hope it goes well, or at least it makes my decision whether to do HB or BC a lot more clear to me.  I wonder if my son, who will be 2.5 years at the time, will be welcome at the BC.  He loves to look at the pictures with the birth stories here and say "mama in the water! baby in the water!" and point out the midwife.  It's really cute.  But he may not think it's so cute when mommy's making all those labor noises!   I'm torn on how to involve him with the birth.  Overall, he's a really cheerful and "easy" little guy when it comes to saying bye-bye to mommy or daddy and being with an aunt or grandparent or friends.  He loves people, so I'm not so worried about that, just worried that he will not like it if I bring home a "new baby."  Probably a concern for either birthing place.  

Thanks for listening!

Emily