Choose the hospital or the OB?

[aeterna]

So, for a few reasons I have accepted the fact that my planned homebirth is very likely not going to happen, and I'm planning on a hospital delivery (though laboring at home as long as humanly possible). 

But my OB's office only delivers at one specific hospital, which isn't particularly known for natural-birth-friendly practices, we'll say. =P Very "traditional" L&D, lots of pushback about stuff like refusing pre-emptive IVs or wanting to eat/drink/stay out of bed during labor, etc. No birthing tubs, no midwives on-staff, strict time progression requirements, etc. Pretty much everything I didn't want in a hospital/birth. Yay.

So I'm considering going to another hospital which is better-suited to my preferences. The downsides to this are: 1) it would be a little further away (about 30 minutes rather than 15-20), and 2) I'd be taking my chances with whatever OB happens to be on staff. No opportunity to build rapport, express preferences, etc. My insurance will have the same coverage regardless of hospital selection, and this hospital has midwives on staff as well as birthing pools available, and a generally more natural-birth-friendly attitude.

However. I LOVE my OB, but there are about 12 OBs in his office and I've had much less luck with his colleagues. So far I've met 4 or 5 other OBs and have actively disliked all of them (I don't take well to being patronized, strong-armed, or judged within the first 60 seconds of a meeting)... and of course they share on-call duties so it's really "OB roulette" as to which OB would be delivering me, anyway. For this reason, I'm tempted to ignore the second concern, and just go to the hospital which is more likely to give me a less-stressful birthing experience, as I'm likely to be get stuck with an OB I don't like, anyway. (Although I will at least have been able to express my preferences / have them on file with whatever God-syndrome'd OB ends up being on-call when I go into labor, so I guess that's something.)

So, ladies... what would you do? Stick with the devil you know, or throw caution to the wind and bet on the devil you don't?

[wendizbaby]

I would definitely go with the hospital!  No question.  My OB was in a practice and I got the WORST of all 6 of them and he didn't affect my birth one bit.  It's all about the hospital and the nurses on staff.  They will be with you 80% of the time and the doctor will show up, catch the baby, deliver the placenta and you'll never see him/her again.  Besides, your chances of getting your OB sound very small anyway.  My birth was so wonderful because I had such a wonderful nurse.  

[mamaecho]

Def switch hospitals. The doctor is truly only there if there's a problem most of the time, so does it really matter? Plus on top of that, your chances of getting the OB you want is slim :( BUT a supportive hospital can really change things for the better! Good luck mama!

[Mom31]

Totally go with the good hospital they are who really matters- the staff there.Hands down. Sorry about your HB not working out.

[semmel84130]

Go with the hospital. As a PP said, most of your labor will be with the nurses. Also, OB Roulette is stressful. I switched practices at 26 weeks because I didn't want to deliver at the hospital they were affiliated with. The concerns were similar to yours with a generally "sitdown, shut up, do what we tell you" vibe. I loved my new OB, but there was one of his associates who actually made me cry at an appointment. Stressing that she'd be the one on call when I went into labor was horrible. Having a general culture supportive of natural birth and breastfeeding also helps if things do go awry and you end up needing any interventions. So, for example, I ended up with a forceps delivery, and the baby had meconium in the water in the end. But as soon as I was stabilized and the baby was checked out, the nurses brought the baby and laid her on my chest, skin-to-skin. A LC came to the recovery room to help me nurse within the first 45 mins. Rooming-in was the default, and every baby whose mama wanted to breastfeed had a big symbol on it so that the nurses knew not to give formula. It was a very positive experience for me, even though I had inteventions that I would have hoped to avoid. Also, it's worth noting that the L&D nurses (and my OB) really worked with me to try and help me avoid intervention that they knew I didn't want - so when the time came, I could really know in my heart that it was a necessary thing.

[LilMomma83]

Yep - another vote to switch hospitals...I've had 2 hospital births and I didn't see the OBs/midwives (1 of each from my practice was there) much at all...it was the nurses that were spending time with me...thankfully I had awesome ones :-)

[aeterna]

Thanks, ladies. That's kinda where my gut was leading me, but I wanted to make sure I wasn't just subject to some hysterical last-minute 35-weeks-pregnant-panic or something. xD

[BennyPai]

I'm just going to chime in with everyone else:  go with the better hospital!

Best wishes for a peaceful birth that goes as much your way as possible. 

[blastomom]

I'm in the same boat!  I haven't stressed over much at all this pregnancy, but now I'm starting to panic about showing up at the hospital only to find that the on-call doc from my OB's practice is cut happy and hesitant to work with me on my second VBAC.  I had to fight every step of the way for my last one and while I did luck out and have one nurse who was clearly in my corner, the hospital itself is not very normal-birth friendly.

[Mizelenius]

Hospital!  I had an OK OB, but she was a solo practitioner who did not believe I'd have a baby so fast .. .so she did not bother to show up until I was just about done pushing.

Did not like the hospital staff AT ALL.  Very medical, gave me a hard time about not wanting an epi, etc.

My advice to people is always to stay at home as long as possible, though since it's your 1st I don't know.  With my 1st I went in too early but only because I was bleeding excessively/could not feel the baby move.  (I ended up hemorrhaging after the birth.)  When they suggested pitocin (I was not in any danger and neither was the baby-- no need) I was ready to leave.

Even with MWs (I only had MWs at the hospital after that) you barely see them, at least IME.  The hospital staff makes a bigger difference!

[aeterna]

Yeah, I definitely want to stay at home as long as possible... I think I might be fighting DH over it a little, because I'll want to err on the side of "delivering in the car on the way" and he'll want to err on the side of "getting there in time for you to get pain meds if you need them." He's SUPER supportive of my desires, but he's cautious by nature and I think he will probably stress a little if I am exhibiting obvious pain symptoms, just because he loves me and he will hate to see me in pain with limited options for him to help alleviate them, y'know? =)

So how do you decide when it is "time" to go? I've heard two major schools of thought (and while I'm perfectly comfortable saying "I'll go when I feel like I need to go," I think he will be happier if he has some sort of objective benchmark by which to gauge the situation) and I'm uncertain which is a better guide. There's the "go when you start making faces during contractions" guideline, and there's the "go when your contractions are _____ minutes apart and lasting at least _____ minutes" guideline. For the experienced mamas, which do you feel is a better gauge for the "right" time to go?

[LilMomma83]

I go when I get to the point I have to stop everything and focus on contractions...usually about 2 hours past that point actually, but, I have long labors. I think my hospital is a lot more comfortable than my house though given all the "amenities" and endless hot water, so that plays into my decision. Also I HATE having contractions in the car and hate it even more when I'm checking into the hospital; so that's a factor too.

Hmm...so really I just go when I feel its right - usually an hour or so past when my DH suggests it hehe

[wendizbaby]

I went a little late....could barely walk and the drive over was torture.  My hypnobirthing teacher suggested going earlier so that you can stay in your "zone" when things get tougher.  I do remember my contractions slowing down a bit, though when I got there...probably from the stress, so I don't know if I'll go any earlier.  Like LilMomma suggested, they do have a lot of amenities...especially the unlimited warm water.  I ran out of warm water after being in the tub once and I was really pissed about it.  I stayed in the tub until I was really cold and couldn't go back in.  I would like to be a little more organized when I get there too....make it the atmosphere I want to birth in instead being so far in labor that I don't care.  

[Mizelenius]

Like I said, I think it's tough since it's your 1st about when to go.  I am always a little worried myself! 

I think it's different for everyone-- the intensity of the cx and also the progression of labor.  And, of course, it can differ (sometimes by a lot) in each labor.  So, ultimately, listen to yourself.  Don't listen to DH or to me. :)

For me, I feel cx  distinctly  (as annoying/uncomfortable as Braxton Hicks are, this is a very different feeling).  It is NOT necessarily painful when you feel them.  I actually never refer to my cx as painful . . .I think of them based entirely on intensity.  Based on that, let's say I know I am having them but they are not intense at first, though they absolutely catch my attention.  When they are 5 minutes apart very regularly (definite beginning and end), then I call the midwife.  Cramping can also be cx that are regular (I know this because I was monitored with my 1st), but unless I feel the definite beginning and end-- I don't worry about those.  

Once I call the MW (this is when they are 5 minutes apart very distinctly), I don't necessarily leave right away, but I am ready to go.  Depending on how far the hospital is, I decide.  My last labor was very short and the hospital is at least 20 minutes away (plus getting in the car, making sure the kids are taken care of, etc.) so I will probably leave fairly soon.  For me, it is definitely time to go when they are 3 minutes apart.  3 minutes means things will be happening soon. 

Again, everyone is different, but while I may have to stop what I am doing and concentrate during cx (even at 5 minutes), it is not painful.  It requires concentration-- which is why I like to be left alone, but in a good way.  It is only at the very, very end when they are super intense for me, but thankfully this period has been extremely brief.  In my last labor, I never got to the overwhelming point of intensity.

When those cx start coming, welcome them.  Talk to your baby, imagine your baby descending, and honor that special time of bonding.  It's always bittersweet-- I am so excited to meet the baby but sad that the bond we have had (that for 9 months, the baby has been all mine!) is done.  Listen to your body, and respond to its messages.  :)

Originally Posted by aeterna 

Yeah, I definitely want to stay at home as long as possible... I think I might be fighting DH over it a little, because I'll want to err on the side of "delivering in the car on the way" and he'll want to err on the side of "getting there in time for you to get pain meds if you need them." He's SUPER supportive of my desires, but he's cautious by nature and I think he will probably stress a little if I am exhibiting obvious pain symptoms, just because he loves me and he will hate to see me in pain with limited options for him to help alleviate them, y'know? =)

So how do you decide when it is "time" to go? I've heard two major schools of thought (and while I'm perfectly comfortable saying "I'll go when I feel like I need to go," I think he will be happier if he has some sort of objective benchmark by which to gauge the situation) and I'm uncertain which is a better guide. There's the "go when you start making faces during contractions" guideline, and there's the "go when your contractions are _____ minutes apart and lasting at least _____ minutes" guideline. For the experienced mamas, which do you feel is a better gauge for the "right" time to go?

[wendizbaby]

Originally Posted by Mizelenius 

Again, everyone is different, but while I may have to stop what I am doing and concentrate during cx (even at 5 minutes), it is not painful.  It requires concentration-- which is why I like to be left alone, but in a good way.  It is only at the very, very end when they are super intense for me, but thankfully this period has been extremely brief.  In my last labor, I never got to the overwhelming point of intensity.

Yes!  Everyone IS different!  My contractions were 3 minutes apart from the very beginning.  Obviously, I wouldn't go in at that point.  :)

I always say to people who haven't had kids...don't go in if you can take the time to look "cute" for the hospital.  When your makeup is smeared, you are in your jammies and your hair is a mess and you DON'T CARE....it's time to go to the hospital.  :)

[aeterna]

Originally Posted by wendizbaby 

Yes!  Everyone IS different!  My contractions were 3 minutes apart from the very beginning.  Obviously, I wouldn't go in at that point.  :)

I always say to people who haven't had kids...don't go in if you can take the time to look "cute" for the hospital.  When your makeup is smeared, you are in your jammies and your hair is a mess and you DON'T CARE....it's time to go to the hospital.  :)

Ha! This is probably pretty close to my assumption about when I'll go... I figure, regardless of guidelines, if I have the presence of mind to say "Well let me at least get in the shower and shave my legs first," then I'm probably fine. DH might just have to deal with that. xD

Maybe I won't tell him right away, hehehe... actually, considering we work opposite schedules, I will probably have to call him and specifically let him know when I think things are happening. So if that's the case, maybe I'll relax, shower, drink tea, try for a nap, whatever I feel like doing, and THEN call him. ;)

Just scheduled the walk-through of L&D for the preferred hospital! The coordinator was lovely but seems to think I will need to transfer to another OB who delivers at that hospital. I'm under the impression that I can just show up in labor and be admitted. I'll verify that, of course, but generally speaking - I don't HAVE to have an OB tied to a hospital to deliver at that hospital, do I?

Also kinda curious how that will work out with fees, etc, since I have pre-paid my OB for delivery services. Maybe I'll request a refund. 

[fnpmama]

You can show up in labor and just  be "admitted". There is a law that states they cannot turn away a pregnant woman in labor. But I think it is a much less than ideal situation.  You would need to be admitted through the ER likely because your OB practice is not "on staff" at that hospital.   You will get whomever is on call for "no doctor" patients.  This could be an ER or family practice resident not necessarily an OB depending on whether or not there are any residency programs at that hospital.  This might be fine with you.  For me it would make me uncomfortable.  You could get the on call OB/GYN from what ever practice is on staff who would have little to no access to your prenatal records and to be honest I think that could impact the quality of the care you receive from that doctor.  Not to mention that sort of thing makes doctors cranky and well, personally, I hate cranky doctors (sorry I am a nurse).

So, while I agree that the hospital not the OB actually makes a big difference in your labor/delivery experience.  I think it would be in your best interest to see if you can transfer to a practice on staff or with admitting privledges at the hospital you wish to go to.

OH and I would definitely ask for a refund if you prepaid for delivery services.  I didn't even know you could do this with hospitals, doctors and private health insurance.

Originally Posted by aeterna 

Ha! This is probably pretty close to my assumption about when I'll go... I figure, regardless of guidelines, if I have the presence of mind to say "Well let me at least get in the shower and shave my legs first," then I'm probably fine. DH might just have to deal with that. xD

Maybe I won't tell him right away, hehehe... actually, considering we work opposite schedules, I will probably have to call him and specifically let him know when I think things are happening. So if that's the case, maybe I'll relax, shower, drink tea, try for a nap, whatever I feel like doing, and THEN call him. ;)

Just scheduled the walk-through of L&D for the preferred hospital! The coordinator was lovely but seems to think I will need to transfer to another OB who delivers at that hospital. I'm under the impression that I can just show up in labor and be admitted. I'll verify that, of course, but generally speaking - I don't HAVE to have an OB tied to a hospital to deliver at that hospital, do I?

Also kinda curious how that will work out with fees, etc, since I have pre-paid my OB for delivery services. Maybe I'll request a refund. 

[Mizelenius]

Different again . .I actually put on makeup to get ready for the hospital.  I felt so calm and relaxed, even though we got lost on the way to the hospital (DH's one job . . .I told him ahead of time to figure it out).  That was my fastest birth, too-- first cx at 6:30, water broke at 7:30, and baby born at 8:30.  (Got to the hospital at 8:10.)

Originally Posted by wendizbaby 

Yes!  Everyone IS different!  My contractions were 3 minutes apart from the very beginning.  Obviously, I wouldn't go in at that point.  :)

I always say to people who haven't had kids...don't go in if you can take the time to look "cute" for the hospital.  When your makeup is smeared, you are in your jammies and your hair is a mess and you DON'T CARE....it's time to go to the hospital.  :)

[APToddlerMama]

Originally Posted by Mizelenius 

Different again . .I actually put on makeup to get ready for the hospital.  I felt so calm and relaxed, even though we got lost on the way to the hospital (DH's one job . . .I told him ahead of time to figure it out).  That was my fastest birth, too-- first cx at 6:30, water broke at 7:30, and baby born at 8:30.  (Got to the hospital at 8:10.)

Me too!  Shaved, plucked my eyebrows, vacuumed the house and showed up 7cm dilated.  This time I am shaving on a regular basis so that I don't have three weeks of hair to get rid of when I'm actually in labor.  I don't know why I care... There is something about being semi-groomed that makes me feel ready to give birth. 
 

[Mizelenius]

Originally Posted by APToddlerMama 

Me too!  Shaved, plucked my eyebrows, vacuumed the house and showed up 7cm dilated.  This time I am shaving on a regular basis so that I don't have three weeks of hair to get rid of when I'm actually in labor.  I don't know why I care... There is something about being semi-groomed that makes me feel ready to give birth. 
 

Me, too!