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Anyone decide to birth in the hospital voluntarily after planning home birth?

post #1 of 15
Thread Starter 
This is somewhat cross-posted from my DDC, but I'm looking for mamas that may have switched gears from home birth to hospital birth (without any medical reason to do so). 
I'm an OB nurse, pregnant with #2 (17 weeks).  I confidently gave birth at home 4 years ago, and have been present at several home births as well as (obviously) thousands of hospital births of all sorts within the last 10 years.  Since my first birthing, we've moved to an area with very little home birth midwifery care, and no hospital-based CNM care. I've been planning for a home birth with a CPM who lives 2.5 hours away from us. I've been present at a birth she attended, and she handled a difficult shoulder dystocia very well. She is experienced, having been a midwife for almost 25 years.  She has a good reputation with the clients of hers I've spoken with. She doesn't have an assistant, an apprentice, or a backup midwife.  I'm also getting tandem care from one of the OBs that I work with, mainly because I want to be known to them in case of a transfer, and because I wanted to obtain an anatomy scan to solidify my plans of birth place (e.g. in hospital with NICU if there were a major anatomical issue that would require immediate support).  I'm unsure that I'd continue care beyond the anatomy scan. 
Lately, I've been re-considering plans for home birth. Suffice it to say that I have concerns about the midwife in terms of distance, lack of assistant or backup and some recent judgement calls she has made with other local clients (one of which peripherally involved me...another long story).  I am less than confident in her care, and feel that it might impact my stress levels and confidence heading into birthing time.  My intuition is creeped out right now, and I'm trying to balance my intuition with my intellect.  I've heard no negative things from clients about my midwife, but she recently transferred a client to hospital after pushing for an inappropriately long amount of time.  I saw the client for lactation care and she shared her story with me, so I know it's not just hearsay. She was very happy with her care and glad that she'd hired the midwife and stayed home as long as she had before ending up with a cesarean birth.  But I feel that I look at everything through a pretty critical eye because of my professional experience...which sort of hamstrings me sometimes, because I try to just think as my own pregnant mama-self about my pregnancy and birthing, and not as my nurse self.  It's just not always that I succeed in this!  Maybe my intuition knows something my intellect doesn't?  I'd love to birth at home again and have a hard time thinking about a hospital birth, even though I know in my head that your birth space can be sacred no matter where it physically takes place.  I have an appointment with the MW on Monday. DH and I will go together, and I want to figure out a way to address my concerns without being vague or overly emotional. I've contacted a local doula who has experience with assisting homebirth midwives. She's new to the area, and has not met my midwife.  If she's comfortable, and we click, I think that it would go far toward easing my mind to have someone with me who knows birth/home birth. 
While I have no wish to have a hospital birth, there are no other midwifery options in our region that I'm comfortable with (the other two MWs are not CPMs and do not have good reputations for safe decision-making, IMO).  I could travel to my old midwifery team about 8 hours away, staying with my ILs until birthing, but that would exclude DH because he couldn't take weeks off of work,  and would be tremendously difficult to travel home with a newborn and a sore bottom.  So, my other option is to birth in the hospital that I work in; I'm going to discuss this with my midwife and the OB I've been using for tandem care (who is, as yet, unaware that I'm planning a home birth).  I'm hopeful that if I decide to birth in hospital, the OB will be able to work with what I have a strong preference for (minimal monitoring, as low-intervention as possible, early discharge, etc).  Since I work there, I'm hoping that if I decide to birth there, I can have a bit of carte blanche in terms of my care plan, of course within the bounds of what's safe and sane. I'm a bit worried about that path, as I'd decline just about everything prenatally and in labor, and have no wish to debate this with the provider(s). I have a few co-workers that I know I wouldn't fit well with, but in the grand scheme of things, it would probably be fine because I'll have support with me who can guard my birthing space (both physical and mental), and would definitely hire a doula.  I have an OB appointment on the 29th, and plan to discuss it with her then, although I feel a little anxious to disclose home birth plans knowing that it will likely be an issue at every subsequent appointment unless I declare that I'm birthing in the hospital. 
To those who've made it through this novel, thank you.  All thoughts, experiences and suggestions you choose to share are welcome and appreciated. namaste.gif
post #2 of 15

Yes, I did. My midwife was no longer practicing when I was pregnant with my last and I didn't find anyone else I was comfortable with so I went with the ob who had seen me after my miscarriage. My midwife who I love agreed to be my doula for that birth and I ended up with the cnm on call from my ob's practice for my birth. I had a very detailed birth plan in place and although we ended up with a necessary pit induction it went really well.


My previous births were planned homebirth, non-emergency transport during labor, transfer of care prior to labor with a baby who needed nicu, and then two more homebirths.

post #3 of 15
I'm almost 40 weeks pregnant(39.6) and still doubt my homebirth choice. My midwife is awesome and I feel safe with her, but there's a nagging voice in my head to go to the hospital.
post #4 of 15

I don't have experience with changing course, but read your post and just wanted to encourage you to follow your instinct/intuition.  It is grounded in all that you know from professional work as well as your own personal sense of knowing.  I would go with that.  Also, do you have to change courses yet?  Can you just continue shadow care with the OB, or do you need to decide soon?  You are only 17 weeks, so you have a long time to go yet.

post #5 of 15
Thread Starter 

Thanks for weighing in ladies! 


fruitfulmama, I wish CNMs were an option! I'm glad you had a good experience with your birth.  


alaskanmomma, Are you still pregnant? If not, I hope all went super-smoothly and you have your babe in arms. :)


nstewart, Thanks so much for the encouragement. I'm trying to sort all of my feelings out now.  I had an appointment with my MW yesterday where I could air out my thoughts; she responded well, and while it doesn't solve the distance or backup issue, I think we're on firmer ground now together in terms of what I expect from her with my care.   And, no, I don't have to change courses yet...I do have a great deal of time to think and consider, but I also have to pay the MW out of pocket, so need to include that in budgeting plans if we move much more forward (we've paid 1/3 of her fee so far).  My plan is to give myself as much time as I need, save up the fee and pay if/when I am sure. And continue shadow care in the meantime.  I will not lie if directly asked by the OB about home birth, but I don't plan to disclose that I'm considering it.  The only reason it may come up is because I suspect the OB knows I've had a prior home birth, since we work together and most of my colleagues have asked me about it (this is a truly tiny hospital). 


I appreciate your replies! Thanks. 

post #6 of 15

I had planned to have a homebirth last time around but it didn't end that way for a variety of reasons.  My state is currently a very un-friendly homebirth midwife atmosphere so I have decided to have a hospital birth this time around.  My previous homebirth CNM is no longer practicing and there is not a CNM that practices in Maryland and does homebirths.  There are very few CPMs who do but all are at least an hour plus away which I just do not feel comfortable with.  Many practice out of state then will come to your home for your birth.  I had to really think hard and decide that what mattered for me is finding a caregiver I feel comfortable with (CNM) and who supports my birth plan and I feel will be a supportive member of my birthing team.  The only thing I am a tiny bit worried about is I did go 42w6d with my son (and was induced) so I hope that the 42 week cut-off imposed by the hospital is not an issue. 

post #7 of 15

I'm in your DDC :)


My first impression is it sounds like you have a good head about you to "control" (in the right way) your birth should you decide to go to the hospital after all. I am glad you had a good meeting, and are willing to consider if it's the right thing for this birth, this time. I feel like I think similarly with evaluating each pregnancy for whether home birth is the right option, with being willing to change if necessary (one example being a health problem like you mentioned) for any particular birth.  Sounds like your comfortable moving ahead with home birth at this point, and with the way you seem to carefully consider things, I have no doubt you will change course if that is ultimately the right move for this birth.

post #8 of 15
Not pregnant anymore smile.gif had my daughter on Tuesday! I did end up with my home birth, and I am so glad I did <3
post #9 of 15
I was in your shoes, almost exactly, about nine months ago. I am also a labor and delivery nurse and had a beautiful, home water birth of my first daughter three and a half years ago. My second daughter was born three months ago, Feb. 1st, in the hospital I work at, after an induction for cholestasis, after which I experienced a seizure, went to the ICU and have now been diagnosed with a primary seizure disorder. Whew! Not exactly the easy multip birth I was envisioning!

We had such a lovely birth experience the first time around but really waffled about choosing home birth again for a couple of reasons. One was purely financial. Hospital birth is covered 100 percent while home birth is covered 0 percent. And, like you, I was fairly confident that I could easily incorporate my birth plan at work. People know I had a home birth before, can't say I don't know the risks for declining certain protocols, and its fairly common for our staff to have specific friends on deck, willing to come in and attend/work for their births. But I was really torn throughout pregnancy because I knew it wouldn't be quite the same, and I was self conscious about being loud, feeling at ease during labor, and a little worried that I would "cave" and get an epidural. (I happily support my patients who desire pain relief, but I was trying to avoid it.)

We finally decided on hospital birth, and my pregnancy was complicated by minor things like extensive vomiting (mild hyperemesis), and then my baby was breech from 36-39 weeks, but eventually flipped on her own the day before my scheduled version. And then, of course, in retrospect, I'm obviously glad I was in the hospital. My midwife was great at catching my itching as a sign of cholestasis and my induction when relatively smoothly, and while the seizure was treated as ecclamptic in nature in the hospital, it seems it wasn't actually, and according to multiple EEGs, I have probably always had a predisposition for seizures, it just took cholestasis and childbirth to trigger the first one.

All this backstory to say that, really, my hospital experience was also incredible, although different. I really feel like I had two home births, in the sense that I was so well cared for. I've been working at my hospital for 5 years, so I have a high level of comfort with my fellow staff, and they went above and beyond in taking care of me, my family, and my little daughter, especially when I had such a complicated postpartum period. They didn't blink an eye (at least in my presence) when my sister in law nursed her, while I had my MRI and CT, nor when I had friends bring in donor milk while I was in surgery for a dislocated shoulder the next day. They also made every effort to bring my daughter to me before and after surgery so I could nurse her myself.

The concerns you expressed about your home birth midwife would concern me too. It was a non negotiable for me to have two skilled attendants at my birth. I know how much team work is involved during an emergency, and for me, that was my deal breaker. My midwives the first time around also understood that I might have a lower threshhold than others for transferring, since I have seen so many births and outcomes, and we talked extensively about what I wanted to transfer for and what she and I were both comfortable with. Honestly, with the info that you gave me, I think the distance and the fact that she doesn't have a partner would be reasons that I would choose the hospital, but you know better than the rest of us what type of care is the standard at your hospital and what protocols you feel like you can easily decline or not. I'm really surprised to hear that you think you'd have to fight a lot for low intervention care, since they know you so well.

I don't envy you the decision---it was hard to make it, and I still strugged about whether it was the "right" one, my whole pregnancy, I still also have a lot of unresolved feelings about my birth in general, just because it was so medicalized (necessary, but still) and I have lots of holes in my memory of those first few days due to being post seizure, on fentanyl for my shoulder, on MGSO4, and post surgery too. But I love my daughter and we are both safe and healthy, and I was treated with respect every step of the way, so it fits my definition of a "good birth".

Good luck!
post #10 of 15
Thread Starter 

vegrunr, I think you're in my DDC...thanks for your response! I hope that dates are not an issue with this birthing for you. Have you thought about discussing with your midwife what would happen if you refused post-dates induction and agreed to twice weekly visits, testing, etc until, say, 43 weeks?


CookAMH, Thank you!  I had a decent meeting with the midwife, although it didn't solve the distance or assistant problem, at all.  I'm still considering, at this point. I definitely need time before committing to a path, and I'm sure it will become clearer as I continue to weigh it out.  I'm usually a really fast decision-maker for big things (cars, homes, etc) but this is totally different because it has so many safety and psychological/spiritual components for me and (I feel) for baby. The whole idea of hospital birth bugs me, but I have to be realistic in this situation, which is so very different from my first home birth situation.


alaskanmomma, CONGRATULATIONS!  I'm so glad everything went smoothly for you. Enjoy your baby moon. :) 


cileag, Congratulations on your new daughter! I'm sorry to hear you had a difficult postpartum course with the ICU/seizure situation. Scary! 

Thank you so much for your response; you're right! Very, very similar.  You brought up the financial aspect, which is definitely significant for us, too, as a one-income family (I'm contingent, so we can't count on my paychecks being anything reliable).  We've paid 1/3 of the $3000 midwife fee, and can do the rest with stretching, but there's also the consideration of hiring a doula, buying birth supplies, etc.  I keep thinking of all the things I could buy with that money that would make a difference to our lifestyle/family (a Berkey water filter! Malpractice insurance for my IBCLC work! Ceiling fans for our bedrooms! and not to mention maybe using some unpaid FMLA time for DH after the birthing).  


Okay, here comes the novel:

The first time around, I never had a second thought about investing in midwifery care and planning a home birth; quite the opposite, I was, for a time, near-paralyzed with worry that I'd need to transfer and show up amongst my co-workers. My CPM practice had two midwives and two apprentices, and there were always two NRP-trained people present at a birthing. One of my CPMs lived less than a mile from me. I had no worries and they had a tremendously excellent reputation in the community for safe, sane care and decision-making.


The whole thing is still something I'm considering, and I didn't have the guts to discuss birth plan issues with the OB at my appointment this week. She was frazzled-appearing and I just lost my nerve and felt there wasn't a good atmosphere or enough time.  She welcomed me to call her cell with any questions or concerns that come up, and I see her frequently when I work, so I think I'd like to just ask her for time to discuss this away from an appointment, and then get a little more formal if I choose to plan for a hospital birth. She did also assure me that she'd be willing to make arrangements to have herself or her other female partner come in if I'm in labor/birthing at a time when the male OB (long story, but he's not touching me unless there's an emergency) is on call. She did say that I was "family" and they'd take good care of me, so I think she at least cares. However, this OB once said to a laboring lady "Women who don't get epidurals are masochists." jaw.gif She was pregnant with #2 at the time, and I've since learned she had a really rough first time, and was frightened about laboring again.  She has since told me that she wishes she hadn't had an epidural with #2 because she think she could have done it without. 


Can I just whine that I wish there were hospital-based CNMs in my community?!??!?!?!?!??  What was I thinking moving here? ;)


While I am sure that many of my 14 RN co-workers know about my previous home birth, I don't think the OB partners do. I know that several of the other nurses think I'm a weirdo (albeit a pleasant wierdo) in terms of my nursing care priorities/preferences (immediate and sustained skin to skin, lots of one-to-one labor support, delaying baths, etc.  This is a tiny community hospital (200-ish births a year) and is, shall we say, a bit behind the times in terms of evidence-based birth care (especially as it pertains to mother-baby separation, breastfeeding support, etc).  Also present is the staffing factor--2 RNs per 12 hour shift, so it's not really as though I'd get my pick of personalities. I may be able to feel out someone being on-call for me (and there are a couple of people I like and trust who know how to work with unmedicated birth/"birth plan people"), but our management wouldn't pay that RN to come in specially for me. If it's a busy unit with more than one labor going on, I may have to share my nurse with other patients in labor.  Hence the plan to hire a professional doula no matter which path I choose, and if it's hospital birth, I'd just plan to have an RN to be in the role of monitor/vitals/recording, etc and not be disappointed by that, if that makes sense.  I'd be pleasantly surprised if it worked out otherwise.


I know that my wishes for postpartum care would be respected, but I think it'd be a little tougher in labor (there's still a few old-schoolers there who want the laboring woman in bed); most everyone is pretty persnickity about monitoring/charting/vitals.  The nursing protocols/MD orders are written for overkill, IMO.  I've had disagreements with other RNs when I wouldn't force BPs on a pushing low-risker more than q30 mins. The epidural rate at the hospital is in the high 80s-low 90%, and while I don't have concern that I'd "cave" and get an epidural, I am concerned that it's such the norm that I wouldn't get good care appropriate for a low-risk, unmedicated woman, KWIM? I think some pre-preperation with the OB partners would go far to help it go smoothly, and some chats with my RN co-workers would help too.  I'm not worried about refusing/declining but I am worried about having to do it while in labor.  Again, hence the doula.  I just hesitate because I know how awesome birth can be when properly supported and all goes well, and how chaotic/unsatisfying it can seem when there are monkey wrenches (whether organic or iatrogenic). I feel I have a much better chance for ecstatic birth at home with a CPM, but the small chance that we'd need a second set of hands and not have one available is big for me.  OTOH, having given birth before, I know that it's just a moment in time, albeit a big, important moment. What follows is really super important in terms of mothering and learning about this new person. 


I am sure that that no matter which path I'll choose, I'll have second thoughts and/or regrets.  I think I know that the home birth with one attendant is just never going to sit right with me; but there are so many things that feel off about hospital birthing too.  I think about all the local mamas who have worked with this CPM successfully, but they're not me, and not birth workers and probably don't have the experience that colors their decision making process. I feel that I'm leaning toward the hospital plan (today, anyway!) but giving more time to consider, for sure.  Send good vibes!

post #11 of 15

I planned a home birth in England and had to fight tooth and nail to get it because I'd had a previous operation on my uterus.  As it turns out I went to hospital.  I was 2 weeks overdue and bubs was in serious danger of arriving on what would be my deceased brother's birthday - for no other reason than that I went to hospital to be induced.  It might sound crazy but the thought of DS sharing a birthday with my brother who had died as a baby was deeply distressing to me; I wouldn't have been able to relax and enjoy DS without fear the moment I closed my eyes he'd die.  Sorry, this is very morbid.  The point being that although I was sad to lose my home birth, ultimately I made the right choice for my stress levels and sanity - which is exactly what you're trying to do.  You should always trust your instinct, if something doesn't feel right to you then don't do it,  If you're stressed in labour its going to be more painful and possibly longer and more complex than it needs to be. 

The only thing I would say is that even in a hospital that you yourself work in, you will have to be very on-the-ball about things you do and don't want (as you've said above) because people will do things on automatic pilot.  My midwife in labour was run into the ground (they had 5 midwives between a ward of 30 labouring women) and she just automatically snipped the cord as soon as he was born despite the fact I'd asked to remain attached and cut the cord myself greensad.gif.  I think because DH didn't want to cut the cord (too quesy), she just went ahead and did it without realising, apparently its unusual for a mother to cut her own cord?  I also had to practically leap off the bed to stop her giving him a Vitamin K injection which again, we'd clearly stated we didn't want for DS. 


post #12 of 15

Hi Haurelia, I read your post and I thought I would chime in. I was different than you are in someways but similar in some. My youngest is 15 so it's a while ago. I had a hospital birth with my first, homebirth with two CNMs with my second, then I became a labor nurse, and I had my third in the hospital. I was searching for how the mothering people were reacting to the AAP guidelines for homebirth and found this instead. I had come to the opinion after ten years of L and D that I didn't think homebirth was safe enough to have one or recommend it anymore. So it wasn't a struggle for me to have a hospital birth. I do know a lot though about wanting a different birth experience and what it's like to choose to have a birth at the hospital where you work. All three of my children were born unmedicated.


I don't have to tell you that all hospitals are different. But what I did was have a very good friend labor RN agree to come in as a support person. I wouldn't have used the word doula for her but that's what would have happened had they not been busy enough to ask her to work that day. She agreed only if I could be one to one, and they let her. It was great. I don't think I would have wanted a doula. I don't get the impression you may feel as "at home" where you work as I did, but I'd spent SO much time where I worked that I felt quite "at home" in a way. I left the hospital from L and D, we have a six hour early dc policy but he was actually only 4 hours old. It was getting late at night and all was done. I'm really glad we went home, even though we brought him in for his PKU the next day.


I may not be a homebirth advocate anymore but I support having the safest care at them. I agree strongly about the NRP guidelines being followed at a homebirth. I don't have to tell you how in a real emergency its teamwork that matters. So I agree on that. The easier part, for me, was that though I think there is just no way that a hospital is home ( even if you spend a lot of time at that hospital ), was that I was entirely willing to give up the home environment for the safety I felt at the hospital.


If you go the hospital route I'd have a heart to heart with the doctor. I suspect they will go overboard trying to make things work for you. In terms of the nurse, I would see if there is someone you can do what I did. It helped to know who would be there. I knew even if she couldn't be my "nurse" that she'd be there and the nurse assigned to me would let her do most of the hands on stuff and the other nurse would take a more secondary role. For me, a doula would have messed up the flow. But you know what will work best where you are. Also, just like you I bet care for moms who choose epidurals by supporting their choices, hopefully your doctors and nurses will support you in the choice you make. I know I chose things my friends would not have chosen, they knew I was making the decisions from an informed point of view, and worked hard to make sure I got what I wanted. Even though in labor I was willing to throw it all out the window at for awhile... it was really their support of my values than my own determination that helped me have an unmedicated birth with my third. I hear you though on mother/baby...so I went home. I don't like floating there anyway!


Good luck! I wish I could work with you I think you sound like a great nurse and a great mom!

(PS have you read the Safer Midwifery for Michigan site?)



post #13 of 15

My story is a bit morbid too...


I did a complete 180... I originally wanted a UC but got bullied around by 2 midwives so I switched to an OB. I was all gung-ho for a natural delivery in a hospital but as my due date grew closer, I felt less and less like going through a delivery of any kind. My MIL was terminally ill and we didn't know what was going to happen from one week to the next. I went through a few weeks of people happily telling me "it could be any time now, babies come when they want to, you know!" when I finally said "screw it" and scheduled a c-section. I didn't want any more unpredictable events, my poor DH was juggling me, his mom's surgeries and treatments and business trips and was pretty much going insane already... no one was in the mood for any kind of 48 hour natural labours... it was bad enough waiting through 13 hour brain surgeries. 


I think it was the best decision I could have made. We were all able to be there together to celebrate my son being born... my MIL even came to visit me in the hospital for once, she was able to hold her first grandson because they scheduled to hold off on the surgeries/treatments long enough for her to be able to do that, so I don't regret any of it. We're a very small, close family (just us and our parents) so it was really devastating to everyone what was happening, it was wonderful to have a break and something to celebrate. 


The hospital staff was great, even though I wasn't at home, it didn't matter, all my focus was on my son, (or on my phone replying to emails and sending pictures lol) so it really didn't matter to me where I was... I just kind of lived in my little nest for 36 hours. 

post #14 of 15
Is there a larger hospital, with more progressive practices that you could go to? It would be strange for me to consider birthing somewhere other than I work, but it does sound like the culture might be challenging to deal with. I work in an urban hospital with about 300 births a month, so it's hard to imagine only having two nurses on at a time! Since your home birth midwife is 2.5 hours away, maybe a hospital that's within an hour or so? If insurance would cover that, and you get a good doula to remind you to get to the hospital in time (I was not able to think clearly enough during my labor, and would worry now about a unplanned UC).
post #15 of 15
Thread Starter 

Thanks to crunchybrit, mamabearing and Escaping for your replies! I agree that stress/anxiety can impact the course of labor, definitely. I'd feel far more comfortable in my own home, to be sure, if I had two midwives or midwife and skilled assistant to attend. If that were the case, I wouldn't even be considering hospital birth! 


mamabearing, I have heard of the work being done by Safer Midwifery for Michigan, and have done a lot of reading about the legislation they're supporting, as well as the legislation intended to promote licensure of CPMs here in Michigan.  Do you live in MI as well? 


cileag, to answer your question...the other hospital birth unit that I could use is about 30 minutes from our home and does about 750 births a year, usually having 4-5 RNs on shift.  I worked there for about 6 months (and quit for multiple reasons), some of which pertain to the nursing care practices/teamwork at that hospital.  The practices are not more progressive than the hospital I work in, and can be more restrictive, depending on the provider (and include c-births being done in the main OR with the baby being sent to nursery for mom's recovery in PACU...up to 3 hours of separation!).  I've attended a friend there in a doula role (before working there) and, frankly, am sure my opinions and comfort level with that hospital were impacted by the care she received.  The practices are pretty comparable at each hospital; the smaller one that I work in is a lot more flexible and easier to imagine tailoring my care plan in. While I really do dislike the thought of birthing amongst co-workers (and the hospital option in general feeling ugh), the 5 minute trip to my workplace and the flexibility I could likely have there are definitely outweighing the longer trip and discomfort with the larger hospital.  I know I must sound like the biggest freaking over-thinker ever right now! And yes, I definitely would hire an experienced doula if I were to choose a hospital birth, that's for sure! 

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