best hospital-based midwife groups in South Jersey/Philly?

[indigosky]

Hi,

I'm planning a homebirth (my 2nd), but will be in South Jersey (Cherry Hill area) for Thanksgiving at 36 weeks pregnant. My midwives say they're comfortable with that if I am, but they've assigned me to have the names of some hospital-based practices that I would feel comfortable going to in the unlikely situation that I went into labor while in the area of Thanksgiving. They say that at 36 weeks, it would be too early to try for a homebirth, so I should instead find a good hospital-based midwife practice.

I'm not planning to have any relationship with this practice in advance -- it's more that if my water broke and labor started, which hospital should I head to where I'll be able to request midwives, where the staff will be comfortable honoring my wishes for a low-intervention birth?

Recommendations?

[dlm194]

I'm not sure that any hospital has covering midwives that would attend a random birth.  Maybe Pennsylvania Hospital in Philly? They have a big midwifery group.  If you go to www.icanofnj.com, you can check out area hospitals birth stats which includes c-section and epidural rates, as well as # of births attended by midwives. 

[indigosky]

The link to the ICAN site with all the statistics is great! Some definitely emerge as winners! Is there an easy way to get equivalent data for Philadelphia or PA hospitals?

Thanks!

[dlm194]

http://www.portal.state.pa.us/portal/server.pt?open=514&objID=809799&mode=2

Hopefully that link works for you.  Just scroll down to find method of delivery.  At least that gives you an idea of what hospitals to avoid and which are probably fairly decent!  :)

[indigosky]

Thanks. Does PA not collect the same hospital-by-hopsital info that NJ apparently does about episiotomy rates, % of women with epidurals, % of midwife-attended births, etc?

What I'd love to figure out from the statistics is, given that if I just showed up I'm not likely to have much control over my care provider, which of the Philadelphia hospitals have nursing staffs who are accustomed to supporting natural, low-intervention births? And which have higher percentages of midwives (possibly, but not necessarily, the same thing), which may increase the chance of my being able to get one as a "drop-in"?

[tbone_kneegrabber]

Pennsy has a large midwifery group.  They also have a birthing suite (well they did 4 years ago when ds was born, they keep threatening to close it due to funding so I can't actually speak to right now).  Their policy used to be that everyone was assigned to the midwives unless there was a reason to go to an OB.

I had a really great experience laboring in the birth suite (and eventually delivering in labor and deliver)

[indigosky]

Two clarification questions:

The hospital with the big midwife group that everyone is referring to is Pennsylvania Hospital, right? Not the Hospital of the University of Pennsylvania? It seems very confusing since from what I can tell, Pennsylvania Hospital is also part of the U. of Penn? (Or do I have this all mixed up?)

Second, if Pennsylvania Hospital has this large midwifery group that many people seem to be fond of, why is their cesarean rate 38%, significantly higher than the national average? Are the midwives still such a small percentage of all the births that take place there, because it's huge and there are many high-intervention OBs?

Since I won't have the "protection" of an advance relationship with a provider I've selected, a cesarean rate that high overall scares me... I'm realizing that maybe the institutional attitudes and assumptions may matter more than the number of midwives.

Thoughts and insights?

[klk197]

Pennsylvania Hospital (aka Pennsy) is the institution referred to here and its at 8th and Spruce Streets in Center City.  It is part of the University of Pennsylvania Health System, but not the Hospital of the U of P which is in West Philadelphia/University City--Yes, so confusing!

There is a recent thread discussing the C rates of Philly hospitals with links that you may find helpful: http://www.mothering.com/community/t/1325857/hahneman-or-pennsylvania-hospital-for-delivery

What the data doesn't show, however, and I think was overlooked in the above thread/link, is the population this hospital serves.  Unfortunately, not every mother is prepared as the average Mothering reader.  Pennsy is in a rather posh neighborhood, which can be deceiving.  It is also located in the 2nd hungriest Congressional district in the country, and this reverberates in many aspects of community life.  Just blocks from my home are families living in extreme poverty.  I ride public transportation almost daily, and there are advertisements inside busses and subways urging pregnant women to seek prenatal care.  The local public school around the corner is home to children who speak 16 different languages in their homes, and many are the children of illegal immigrants.  I choose to live here because it is a dynamic, yet challenged, community.  

I didn't understand how this would impact the hospital until I gave birth there myself--and in my case I had a great experience with a midwife, but now know how its potentially difficult for many other families.  I was the only native-English speaker my postpartum nurse was caring for--she told me this to apologize for returneing to my room at the exact time she had promised (for a non-urgent issue) and much was getting lost in translation.  I was also delayed being discharged because much of the nursing staff was busy trying to communicate to another new mother that she needed a car seat to bring her newborn in a car to go home.  I can only imagine how communication troubles alone contribute to labor and delivery problems, and possibly compounded by poor prenatal care/health or cultural beliefs. . . Among my own demographic, "high risk" pregnancies are related to age, previous Cs, blood pressure, etc; yet in the greater community many other factors are at play contributing to less than ideal deliveries and the high C rate.  The hospital is actively working to reduce the C rate--the laborist model is part of their strategy--but there are broader social issues that the hospital can only be a small part in solving.

Good luck, and of course, this is just the view from where I stand. . . 

[dlm194]

I don't think Pennsy's c-section rate is too far off from the suburban hospitals though. Why would a poor woman or a woman who doesn't speak English be more likely to need a c-section?   In NJ, you are better off in the inner city hospitals.  They have the lower c-section rates (e.g. Cooper) even though they are also the ones with the best NICUs.  The midwives at Pennsy tend to have a good reputation but my aunt was pushed into 2 c-sections with them about 8 and 15 years ago.    There are a lot of them though so who knows if the midwife she had is still there. That being said, it doesn't matter where you go.  You need to be educated on birth (which, as the pp mentioned, you probably are since you are posting here!) and know when to call the care provider on their BS.

[indigosky]

I'm definitely educated on birth -- I'm an experienced, certified doula who's attended MANY other women's hospital births, and had a very uncomplicated homebirth with my own first. So I'm totally prepared to call staff on BS. However, if I were to wind up in a hospital far from home because something wacky happens near the end of my pregnancy, I'd rather not have to battle the nursing staff to have the kind of birth I'd like!

Which hospital do you think has nursing staff that are most comfortable with a very low-intervention, probably drug-free birth: Hahnemann, Einstein, or Our Lady of Lourdes in NJ? I think I've probably narrowed it down to those three. I wish PA provided data on rates of epidural use and episiotomies. I'm not too concerned about being "tricked" into things (I'll be yelling, "I do not consent! I do not consent!"), but they do seem like helpful indicators of hospital culture. Especially the culture of the nursing staff, which in my experience often has the biggest impact on how the hours of labor go.

[MrsMike]

Originally Posted by indigosky 

I'm definitely educated on birth -- I'm an experienced, certified doula who's attended MANY other women's hospital births, and had a very uncomplicated homebirth with my own first. So I'm totally prepared to call staff on BS. However, if I were to wind up in a hospital far from home because something wacky happens near the end of my pregnancy, I'd rather not have to battle the nursing staff to have the kind of birth I'd like!
Which hospital do you think has nursing staff that are most comfortable with a very low-intervention, probably drug-free birth: Hahnemann, Einstein, or Our Lady of Lourdes in NJ? I think I've probably narrowed it down to those three. I wish PA provided data on rates of epidural use and episiotomies. I'm not too concerned about being "tricked" into things (I'll be yelling, "I do not consent! I do not consent!"), but they do seem like helpful indicators of hospital culture. Especially the culture of the nursing staff, which in my experience often has the biggest impact on how the hours of labor go.

Stay out of Hahnemann and Einstein. I don't have much experience with Einstein, just what I've heard from others. I know a few people who work at Hahnemann, directly with maternity, and it's not the place you want to be for a peaceful and intervention-free birth. There are L&D nurses there who are very critical of the whole natural birth movement and they WILL fight you. Plus, the quality of care isn't the best, depending on what night you are there.

[AlexisT]

I don't know how much this affects the stats, but the high risk mothers I've known in Philly seem to prefer Pennsy--and the CS rate for them is always high, everywhere. I'd be interested to see CS stats for the MFM group vs the midwifery group. (For that matter, I've seen stats skewed in the other direction: providers and hospitals that have outstanding statistics because they handle few complications.)

Disadvantaged populations often have higher rates of complications. More hypertension. More diabetes. More teen pregnancy. More poor prenatal care and social factors affecting pregnancy and birth. I've seen both extremes in communities like this--midwifery based programs aimed at the low risk, which have low CS rates, and lots of high risk pregnancies resulting in high rates of intervention. You have to go by reputation and not make assumptions that everyone is dealing with the same patient pool.

[dlm194]

Originally Posted by AlexisT 

I don't know how much this affects the stats, but the high risk mothers I've known in Philly seem to prefer Pennsy--and the CS rate for them is always high, everywhere. I'd be interested to see CS stats for the MFM group vs the midwifery group. (For that matter, I've seen stats skewed in the other direction: providers and hospitals that have outstanding statistics because they handle few complications.)

Disadvantaged populations often have higher rates of complications. More hypertension. More diabetes. More teen pregnancy. More poor prenatal care and social factors affecting pregnancy and birth. I've seen both extremes in communities like this--midwifery based programs aimed at the low risk, which have low CS rates, and lots of high risk pregnancies resulting in high rates of intervention. You have to go by reputation and not make assumptions that everyone is dealing with the same patient pool.

That argument sounds good but doesn't actually pan out when you look more in depth at hospitals.

Cooper Medical in Camden has a 26.7% c-section rate.  They have a level III NICU and are located in a poor area (not far from Pennsy).

St Barnabas and Monmouth Medical are in the same health care system in NJ.  They both have level III NICUs and handle high risk births.  St Barnabas has a 45.6% c-section rate while Monmouth Medical has a 24.9% c-section rate.  Makes no sense. 

I kind of have to disagree that you go just by reputation.  People are "wow-ed" by technology and advanced NICUs.  There are many people in North Jersey who think you are crazy NOT to birth at St Barnabas.  But if you want a natural birth, they aren't exactly what you are looking for.

That all being said....  my sister had a baby at Our Lady of Lourdes.  Her doctor started talking c-section  while she was pushing b/c the baby was posterior.  Her nurse got aggressive and brought in the squat bar and wrapped a towel around it.  I think her nurse probably saved her from a c-section.  But that's one good nurse.  My sister was also induced for reaching 41 weeks (heaven forbid!!!).

My personal suggestion (assuming you have time) is to drive up to Capital Health in Trenton and birth there.  The covering group is Obs and midwives (not sure if you could request a midwife but it doesn't hurt to ask!).  Almost 40% of their births are attended by midwives so it is a midwife-friendly culture.  They probably won't bat an eye if you refuse interventions.  They have wireless monitors there so if you need to be monitored you can still walk around and use the showers/tubs, etc.

[AnastasiaM]

I am seeing midwives from Pennsylvania Hospital, and am planning to deliver there.  I do not like doctors, and simply do not go to them for the most part.  I have incredbly high anxiety about medical issues. 

I've only been in twice, but the two midwives I saw were TERRIFIC.  They were gentle (I had never had an internal exam before; they did one the first time, and I can't IMAGINE having some of the doctors I've seen in the past do that); gave me tons of information, were very supportive, and explained everything; they gave me choices about a number of procedures, and discouraged me from having any of the unnecessary tests done (which I wouldn't have wanted anyway, but it was nice to hear them say that).   I came away feeling 100% better about everything.  I do still need to ask alot of questions, because I have only recently been reading more about birth and want to be sure that I will have the options at the hospital that I need.  However, I also feel that anything-can-happen-anywhere: no guarantees that everything will go smoothly, no guarantees about who will be on-call, etc., and at some point I needed to stop making myself sick and relax a little bit. 

I was very, very concerned about the 1 in 3 caesarean rate at the hospital however.  While I want to do whatever it will take to keep my baby alive, having a c-section is about the worst fear I have (never had an operation or stiches for anything, other than dental work; for some reason I'm totally okay with any amount of extensive dental work); and having an epidural sounds pretty horrifying as well.  I asked about the rate last appointment, and the midwife told me that for the midwives, the rate is more like 15% for a first baby, and after you have one vaginal birth, that goes way down.  She also explained that because Pennsylvania Hospital has such a specialty in obstretrics, they see alot of high-risk mothers.  Which makes sense to me, because I know people in the area with major problems who chose Pennsylvania for that reason. 

I'm still a little nervous (been reading Ina May's book and wishing I could go to the Farm!), but I feel ALOT more positive than I did at the beginning. 

[AlexisT]

By reputation, I don't just mean NICUs and so on--I mean women's experiences delivering there, their reputation for being mother-baby friendly, etc. where I am currently, the hospital with the better CS rate (terrible VBAC, though) is the one with the outdated policies on L&D.

Stats do matter--aside from really unusual cases like the CHOP delivery unit, the units with really high CS rates tend to be practicing in ways that inflate that rate, and there's really no justification for these 45-50% rates some NJ hospitals are posting. But I've seen too many flaky figures to ever pick a hospital on stats alone. Pennsy's stats are higher than I would like to see, but I think it's a more complex situation and you can't make assumptions about how you would fare. (there are hospitals where I would not say that, btw... Though you can always be surprised; a friend had twins vaginally at Hackensack recently!)

[indigosky]

Originally Posted by dlm194 

My personal suggestion (assuming you have time) is to drive up to Capital Health in Trenton and birth there.  The covering group is Obs and midwives (not sure if you could request a midwife but it doesn't hurt to ask!).  Almost 40% of their births are attended by midwives so it is a midwife-friendly culture.  They probably won't bat an eye if you refuse interventions.

Interesting recommendation. The rate of midwife-attended births sounds great, and 38% of their vaginal births are unmedicated, which is very high comparatively. But according to the numbers I got from one of the links someone provided above, Capital Health's c-section rate is 34%, higher than the national average, and higher than Our Lady of Lourdes (33% and very close to where I'll be), Einstein (30%), Cooper (also very close, 27%), and Hahnemann (26%). Capital also has a higher episiotomy rate than Lourdes and Cooper.

If I were going to travel that far, I think I'd be inclined to choose South Jersey Hospital, which would be about the same distance for me. South Jersey has a slightly higher percentage of midwife-attended births, roughly the same c-section rate, a lower rate of episiotomies, and the highest rate of unmedicated vaginal births in the state (57%). Is there any reason why Capital would be a better choice than South Jersey?

You're absolutely right, whoever said it could drive one crazy to make the decision based on stats alone -- they make no sense, especially in areas with so many hospitals! Where I live (many fewer hospitals), the stats seem to be more predictable -- the hospitals with higher percentages of midwife-attended births have dramatically lower c-section and other intervention rates.

[dlm194]

I don't  know much about South Jersey so I can't really help there.  I had a baby at Capital health. I was a VBAC with an extremely long labor and I had no interventions pushed on my by my midwife or by the staff.  The staff didn't bat an eye about wanting to go without drugs.  I know the back up doctors there have been pretty comfortable with midwives which is a plus.  I know the midwives have positive things to say about the back up doctors.

To be honest, I'm kind of guessing that you are only going to go to a hospital in the area if you have a real issue.  In that case, most of these points will be moot anyway. 

ETA:  I think the South Jersey hospital you are talking about only has a basic nursery.  Probably not the right place to be with an early baby.  You'd want at least a level II NICU

Edited by dlm194 - 10/9/11 at 9:18am

[breastmama]

As far as a hospital, I didn't see anyone mention Elmer hospital...they do water births there (that's where I'm planning on birthing) and I'm guessing they have a list of midwives you can contact. It's about 45 minutes from Cherry Hill so I'm not sure if Philly is closer but it's an option

http://www.sjhealthcare.net/content/Elmer_MaternityCareCenter.htm

The midwife practice I'm going through is called Gentle Beginnings, which is about a mile or so from the hospital...

[dlm194]

Isn't Elmer the South Jersey hospital the OP is referring to?  I'd really caution about going there with a preterm baby.  I think you'd want at least a level II NICU.

[indigosky]

Yes, South Jersey Hospital is the same as Elmer (at least that's my understanding).

I would be 36 weeks around Thanksgiving (which is what I'm planning for). Is that earlier than would be safe to give birth there? I'll admit I don't know a lot about various levels of NICUs, and various degrees of prematurity. My DD1 (and all my mom's babies) were born at 38 1/2 weeks with easy, uncomplicated births.