Splitting hairs between freestanding birth center and home birth. Thoughts?

[askins]

By all accounts I have no real business writing this post (yet). My babes are 13.5 months apart and my daughter is almost 7 months old... and I have sworn off TTC for at least a year, if not two, if not forever.  But....  I can't get this stuff out of my head.  I am partially coming here to organize my thoughts so that I can stop obsessing about it (ha!), partially to get commiseration from some like-minded people, and partially to honestly ask for some advice about how you would make the decision.

Both of my babies were born naturally at a freestanding birth center with CNMs.  DS had a land birth, DD had a water birth.  I had FANTASTIC, transcendent experiences.  Wouldn't do a thing differently either time.  The birth center is 30-35 minutes away from my house in no traffic (and both times we went there in the wee hours), and is 2 blocks from a wonderful full-service urban hospital with docs supportive of the CNMs and the freestanding birth center.

While I love the birth center, and I'm happy with the care we receive from the CNMs there, I HATE (should I say it again?  HATE) that car ride in while I'm in labor.  The rest of my labor both at home and at the birth center goes great, as long as I am walking, swaying, upright, mobile.  But that half hour in the car KILLS me.  My labor with DS was 15 hours long end to end, so that half hour was a relatively small percentage of the total time.  But my labor with DD was only 3.5 hours end to end.  The car ride was almost 15% of the whole event!  Not to mention, we left the birth center 6 hours after we got there - it did feel like a pretty pointless trip into town.  If my third labor ends up being even faster, I really really really don't want to have the baby on the roadside.  I would love to have a home birth (a) to eliminate that car ride and (b) to just be able to hang out at home.

Here's the tricky part: my house is listed by Google as being 25 minutes from the nearest hospital, not counting traffic.  Within the desired 30 minute radius! you might say.  Well, yes, but I also live perched on the side of a hill with some rough terrain, and up a canyon with no cell phone service, etc.  There is also no place to land a helicopter here, so that's not an option. 

With DS's birth, I thought, well, it's my first time, I'm not quite sure how it will go.  I was new to the whole "natural childbirth with midwives" thing.  I was uncomfortable being this far away from the hospital.  What if it snows?  (And indeed, we got a dump of snow the week after he was born - the first week of May.)  The birth center seemed like the best of both worlds.  DD was a surprise pregnancy, we didn't find out until I was 17 weeks along, so I felt the need to make a swift decision about prenatal care.  After such a great experience, the default of going back to the birth center seemed like (and was!) a great choice.  I didn't give much thought to doing anything differently. 

Now of course, I can't stop thinking about how awesome it would be to have a home birth.

One more complicating factor: each one of my births had an issue.  With DS I had a post-partum hemorrhage (1250ccs, controlled with pitocin, methergine, angelica, and abdominal "massage").  I had a prophylactic shot of pitocin after DDs birth and had no hemorrhage.  When DD was born though, she didn't start breathing right away and needed some oxygen.  Both of these issues were handled deftly by the midwives at the birth center, and I did not need to transfer to the hospital (though we did discuss it with my PPH).  I realize that homebirth midwives carry all of the supplies used to handle those complications and would likely have had the same result.  But it's not like I've never had a reason to think about hospital transfer, either.

I have looked at the websites of some home birth midwives around here - there is a CNM that does homebirths in my area.  There is also a CPM who lives very near me and is familiar with the rugged terrain issues.

So.  After that long-winded explanation here is the summary....

Home birth pros:

 - No 30 minute drive in active labor! Ugh.

 - I expect a fast labor next time.  Why not just hang out at home and let help come to me?

 - I have two kids now.  Seems like an easier proposition to keep them at home.  Also they will (hopefully) be of an age where they may be interested in attending the birth.

Home birth cons:

 - 25 minutes from nearest hospital, which includes some rugged/remote terrain.  Especially a concern in the snowy season.

 - I have had reasons to get close to needing a hospital transfer, which makes it a bit more likely that that 25 minutes is going to matter.

And that's pretty much it for the pros and the cons.  The birth center has all the pros of a HB except that it requires a 30 minute drive and my kids would need a dedicated care person there with them (this is also obviously preferred for a HB, but not required.)

How would you make this decision? Am I overthinking it? (Yes.)  Should I just forget about the home birth thing and go with what I know works?

*sigh* Hopefully this will help me stop having crazy home birth dreams....

(I realize that I am completely lucky to have to make this choice between a totally awesome birth center and a home birth.  I wish every woman had these options to struggle with.)

[LeighPF]

I consulted my HB midwife pre ttc with #3 (who is planned on being my first HB) to see if I liked her/the practice. It was free.

It seems that doing the same would make things much clearer for you.

One of the things driving a HB for me is not getting in a car (or doing the triage/check in my hospital brith center requires).

[IdentityCrisisMama]

I don't think deciding between the two is splitting hairs at all. For me a birth center birth would not have been a large enough benefit over a hospital birth to make me want to strongly choose a FSBC over the hospital (which has some advantages, imo).  

Other pros in the homebirth category for me would be: 

• maternal comfort
• the message of "I'm ok" that comes from being in the comfort of my own home 
• avoiding the shock of transitioning to another somewhat unfamiliar location
• limiting the exposure of more than one environment for the baby 
• living in the place where your baby was born - so cool! 
• avoiding one more car ride and gear schlep 
• having everything you think you may need without having to think about packing and etc. 
• having the entire contents of your refrigerator! 
• general increased control over the evironment 
• family and friends can come and go with a bit more ease and comfort 
• not leaving and returning with the new baby for other kids 
• being able to check on your older children after the birth 
• other kids being there to participate in some of the birth 

Other pros from the birth center 

• possible break for mama from household obligations 
• ease of arranging visitors (visitors tend to think they can come once you're "home" which can be complicated in a HB) 

[mamacrosland]

When I was trying to decide, I was quickly reminded that there is no reason to pay extra to have the same equipment that is used at home.  If you need a break from other children or don't have a house that you feel comfortable birthing in, I could understand.  Otherwise, there's really no reason to choose a birth center over a homebirth :-).  And I have had friends use both and were much happier with the homebirth!

Of course, you would have to choose what you feel is best!

[phathui5]

I liked my two birth center births because it was like having a home birth at someone else's (clean) house.

I had my last two babies at home because I've gotten to where, more than I don't want to drive to somewhere in labor, I really don't want to pack up and come home after we have the baby. I want to already be at my own house postpartum.

[salr]

For me, based on what you described, I would pick home with no questioning on my part. 

It sounds like you've thought through what issues you might be likely to have, and you have solutions to those (midwife with medical supplies).  So logically, you have it well thought out. 

What I see missing a bit is your comfort level with each option.  If you logically knew that you'd most likely be fine at home, but still felt compelled to go to a birth center because that alleviated your worry, then I'd say think on it some more, and maybe you'd find the birth center the best solution.  But the only point about your emotional needs is that you REALLY don't want a car ride.  I think birth in general goes best when the mom is comfortable. 

I see you leaning towards home birth but wanting to make sure you're being responsible.  To me, the solutions to possible problems you listed are totally acceptable and based on risks and benefits I would be totally comfortable with a home birth. 

I like IdentityCrisisMama's list of other benefits to having a baby at home.  I would be way more tense going away from home where I didn't have as much control over the environment, food, visitors, etc.  YMMV, which is why it's such a personal decision.