Trying to decide between hospital and birth center

[gavada]

I recently found out that I'm pregnant and am now trying to figure out where I would prefer to give birth.  I love the idea of a home birth or a birth center, however, I worry as this is my first and I have no clue how labor will affect me.  I worry most about not being able to handle the pain. I'm currently decided between a couple of midwives and I have complete confidence in their abilities.  I think I'm more lacking in my abilities to handle the pain.

I also worry about traffic.  We live in Northern Virginia so it's a constant battle.  I live about 60 miles from my OB, 60 miles from one of the birth centers and about 20 miles from the other.  I do worry with a hospital birth of all the unnecessary interventions but I like the idea of having everything right there in case anything goes wrong.

I guess I'm just looking for input/guidance from the more experienced. :)

[akind1]

How natural birth friendly are the local hospitals? If either or both seem to be willing to work with you on that, maybe that would be a good option - that way you'd have pain control if you need it, but wouldn't be pressured into it.

[Brighids Flame]

To some extent it depends on the specific hospital and birth center. However, if you know that the birth center is natural-birth friendly/woman-centered, or if your hospital has midwives that you can use, I highly recommend going with those options instead of a traditional OB-led birth. This is my first pregnancy too and I'm having a hospital birth (due to a medical condition), but using midwives instead of OBs. The difference in care between the midwife I'm seeing and the OB I saw (to get "permission" to use the midwives) is shocking.

The midwife has respected all of my testing refusals, my request to delay trying to hear the fetal heart tones with doppler, and my desire for minimal ultrasounds. She even changed my EDD to reflect my late ovulation based on my charting.

The OB was polite, but was insistent about tests and procedures I WILL be having. She didn't seem well-informed at all about natural birth (and specifically water labor and water birth), and was operating under the assumption that I would want all the interventions available. And she insisted that we listen for the heart tones, even though there were no indications that the fetus was progressing abnormally. I protested, and tried to explain that since it was so early, I didn't want to try to hear them and fail and be stressed out wondering if my fetus was okay. She agreed, but then came in at the end of the appointment and said "I'm just going to try to listen to the heart, because we just really like to hear it. If I can't find it, I'll go find someone who can, and if they can't find it we'll just do an ultrasound!" Then she smiled, as though the threatened cascade of interventions was all I needed to make me feel better.

We were lucky that we did hear a healthy heart that day, but it solidified my desire for a birth without mainstream OBs! If you can go to a birth center that is woman-centered, or use midwives, I highly recommend it. Woman-centered care is SIGNIFICANTLY better than OB-centered care.

P.S. If you do decide to do a hospital birth, I recommend getting a doula to help you advocate for the type of birth that you want. I'll be hiring a doula in case I end up getting transferred to OB care last minute.

[gavada]

Oh wow. Yeah that is exactly what makes me nervous with the hospital setting.  My OB is fairly new to me so I haven't quite been able to tell how natural friendly she is actually going to be.  I am leaning more towards the midwives. I just need to over come that fear of pain.  My husband is being surprising supportive of my desire for the birth center and midwives but he also thinks its crazy not to use pain meds if they're available.  I think that he'll be supportive of me until I start to waiver and then my feeling is he'll be very supportive of the pain meds.  That's part of the reason I was also looking into getting a doula - to help keep both of us on track.  Just a matter of finding one I like now.

[lizsky]

Congratulations on your pregnancy!  I'd encourage you to do everything you can to find out more about your current care providers as well as other ones within a distance from your home that feels comfortable to you.  I am a somewhat shy person, so it took some courage for me to be pushy with my questions, but I'm really glad that I did because it helped me learn that the original OB I was with when I got pregnant with my daughter was the type of Dr who would try to hurry up my birth using interventions rather than letting me labor in peace.  I also learned that the hospital the OB was affiliated with, was not friendly to natural childbirth.  

I did a lot of asking around (in person and on these forums), went on a bunch of hospital tours (I wasn't looking for a homebirth and the birthcenters are all over an hour away) met with several midwife groups before I finally settled with a small midwife group at around 20 weeks.  I really liked how patient and flexible they were and I also liked it that the hospital they deliver at allowed waterbirth and was friendly towards natural childbirth.  (I ended up having a very positive experience- I never felt rushed, no one pushed interventions, and I had a peaceful, drug-free waterbirth- I'm seeing these MWs again now that I'm pregnant with #2)

I'm up in Baltimore, so I'm not as familiar with your local options in NOVA (I do know many people love Special Beginnings birth center near Annapolis, and there's another group in Alexandria that gets mentioned a lot), but the Maryland/DC/NOVA subforum is here and you could ask for recommendations: http://www.mothering.com/community/f/81/maryland-metro-d-c-area-delaware  There's also a ton of info if you browse the archives, and I learned a lot by just searching hospital names and midwife names.  

As far as pain management goes, I'd encourage you and your husband to read a few books together (I really liked the Birth Partner by Penny Simpkin), and look for a natural childbirth oriented class that you could take together.  My husband and I read a few books together, took a comfort measures workshop, and hired a doula, and I think all of that helped me cope with contractions once I was actually in labor. Regardless of whether you choose an epidural or not, knowing how to use other natural comfort measures will keep your options open, and give you coping techniques that you can use during early labor before you arrive at the hospital/birthcenter.

[alexis2233]

I think that both are good options. And you should see how close the birth centers are to a hospital, as well how midwife friendly the hospitals are. If the center is close to a hospital you should be able to go to the hospital if needed. Or if your hospital is open to natural remedies and mothers choice you may feel more comfortable having the options right there.