should I switch care providers...again??

[dds07]

Long story, but I really need some support in making a decision! 

Personal background: I really want a natural, intervention free (unless medically necessary) birth and I want to have my baby with me following birth. 

Story begins with me starting OB care with a midwife in a hospital practice. I love the hospital policies they have and liked the midwives, however, I had multiple fairly negative experiences (with staff) that ultimately led me to leave the practice. 

I was very annoyed at that point and decided to go to a family friend who is an OB for care. I called him on his cell and he saw me that afternoon. 

Now, at 22 weeks, I have discovered that the only hospital my friend OB delivers at is widely known for NOT being mother-baby and for being intervention happy. They do 10,000 births/year, which gives them lots of experience, but maybe not much personal care and accomodation for individual requests. They have very strict policies and are not very flexible. For example: my Dr. says must have an IV, only clear fluids, can't leave the room, induction at 41 weeks. Only 2 support people in the room, but they will allow intermittent monitoring. 

When I said I wanted a natural birth, he said "Well, it is your pain!" Ok fine. He told me 95% of women there have epidurals, which makes me question their experience with natural births...he said I could move around, but that most women just want to lay on their backs when they are in so much pain (opposite of what I've heard/read about moving around in labor). 

And the big kicker is they have a mandatory "observation" period where the baby must go to the nursery for 1-6 hours. No guarantees on how long it might be, depends on how busy/how well staffed they are that day. 

His advice to me was "I encourage you to just go with the flow"...which I took as "don't be a problem and make things difficult, just do it our way". My husband (who refuses to take childbirth classes with me, but DID allow me to hire a doula), says much the same..."just let them do their job in peace".

The first hospital I was at was pretty much opposite, which is more conducive to a natural birth. 

So now what? Switch back? Go somewhere else? Stay and fight? Try to have another conversation with my Dr? I probably didn't make it abundantly obvious how important these things are to me. 

If this Dr. weren't a personal friend, I'd be gone. BUT how do I switch out tactfully from a friend? Or should I? Should I try to use that to my advantage and get what I want? 

He has said that unless he is called out of state for an emergency, HE will be the one delivering my baby. I'm to call him on his cell phone when I am ready to go to the hospital. 

Help!! I'm emotional and scared and nervous.

[starrlamia]

I would talk to the hospital, and let them know your concerns, you can refuse ALL of that, it is your choice and not theirs on how you are treated. However if it seems like it will be a huge battle and/or you are not up for it your best choice is to go to a different hospital. I'm sure your friend would be understanding of your decision if you explain it properly. Good luck, Im sorry you have to go through this!

[Yuba_River]

That is such a tough situation, but I would absolutely want to  switch to a different hospital/care provider. You don't want to go into your birth feeling like you'll have to fight for everything you want. I would just be totally up front with your friend--tell him you want a different kind of experience, it's nothing against him as a provider, but the hospital policies are very different from what you are looking for. 22 weeks is plenty of time to switch, and maybe you can find another provider who delivers at the hospital you like.  Good luck! 

[llwr]

I think the hospital policies reason given by PP is great and tactful.

I do think it's really important to have a provider you trust and that is comfortable and familiar with natural birth.  With hospital policies going against that, you've already got a strike against you.  It's really hard to fight for yourself after being in labor all night long.  (I've been there). 

Would you have to interact with any of the staff at the previous place when you're in labor?  You could always try your tribal area for recommendations or additional info about the first place.

[lizsky]

The not-mama-baby-friendly hospital sounds like everything would be a huge fight...it probably could be done, but I would look for a 3rd option if I were you.  

Just in case it makes you feel any better, I actually DID switch 3 times during my 1st pregnancy, and while its a bit of a hassle, it can definitely be worth it. I started with the OB I had been seeing for gyn visits, I switched to a MW group at 16 weeks once I realized the OB and her hospital were not natural-birth friendly.  I liked the MWs, but there were 9 of them, and their hospital policies included required heplock, no waterbirth, automatic induction at 41,3...I still felt uneasy so I decided to keep looking, and ultimately landed in a small MW practice at 20 weeks that uses a hospital with more flexible policies.  

It was a headache to switch my records over between 3 places, but really worth it.  The MWs were very supportive of my birth plans, and the hospital staff were too when I finally went into labor.  Nothing was a fight, and I really appreciated that.  No one ever tried to give me an IV/heplock, no one offered me pain meds, and I labored and birthed in the hospital's jacuzzi tub.  

I hope you find a provider & hospital that you feel peace with.  

[parsley]

dds07 - I would definitely suggest you switch if you aren't feeling like you're going to get the support you need at this second hospital or with your friend-OB.  If at this stage in pregnancy you already feel like you are fighting to get what you want acknowledged it seems like the situation will only get worse.  As pregnancy progresses there are lots of (real, manufactured, or imagined) problems... you want to be with a provider and in a situation where you know you will be heard and supported. 

With my DD I stuck with an OB I came to hate, at an office that was unpleasant, and in a hospital that was not mother-baby friendly.  I ended up with a scheduled c-section for breech baby, but even before DD was breech my OB was suggesting that I shouldn't count on a vaginal birth because things happen...  After my c-section, DD was cleaned up with DH right next to her and she was then given to me to hold while they finished up the sutures.   But, when we left recovery I was much more subject to hospital procedure as my dr. wasn't there anymore to overrule.  DD was taken to the nursery and it was only through DH knocking at the nursery window over and over again that she was finally released.  I think it was 2 hours.  I was so anxious and lonely and wanted my daughter!  And, I couldn't move.  During our stay, I was the only person in the hospital who kept the baby in the room with them and the nurses were admiring but skeptical-- they repeatedly asked if I wanted to send my baby to the nursery so I could sleep.  I had to fight to have "mandatory" tests done as quickly as possible but they were done in the nursery.  Not in my room.  It took 3 days before the lactation consultant (who I had requested right after birth) to finally come and see me.  And, she was awful. 

I offer all of these examples to suggest that it really matters where you give birth and your relationship with your provider.  OB-friend may be a good friend but he doesn't seem to have a vision of birth that matches yours.  I would blame it on the hospital to protect the friendship but I would definitely switch! 

[savithny]

So much of what happens at a hospital birth comes down to the hospital policies as much as the provider polices, and it sounds like you'd be dealing with a really unsupportive staff that is totally unfamiliar with what a natural birth process looks like.  

I birthed twice at a smaller hospital with CNMs.  The hospital, at the time, had an epidural rate under 50% (they didn't actually offer true labor epidurals when I had my first).   The L&D nurses were very supportive of natural birth and were familiar with how it can play out.   The hospital had a jetted hot tub for labor and  the nurses were comfortable with its use, and with using the waterproof doppler for FHR checks.   They had tools at their disposal like hot packs for back labor, rocking chairs, etc, and were good about suggesting things without being pushy about them.

II've not birthed with an OB, but its my understanding that you generally don't see as much of the OB as you see the L&D nurses, at least until its time to push.  That means that the knowledge and attitude of the nurses has a lot more to do with your labor than your OBs position on many things.