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Planning a natural hospital birth, but want to stay home as long as possible. I have few...

post #1 of 12
Thread Starter 
I started out at a birth center, switched to the hospital for a few reasons (none were medical reasons, pregnancy has been awesome).. and then at 34 weeks wanted to switch back to the birth center. That didn't work out due to the midwife being pregnant, losing two assistants and therefore taking on fewer clients meaning she's now booked for January. Poo!

I contacted a home birth midwife, and everything was great with that except medicaid won't pay her and the out of pocket cost is too much for us to swing in a short amount of time. Its important to me that my midwife be paid, so I chose to just stick with the hospital.

Now, I have a good relationship with three out of five of the nurse-midwives, and those two that I don't have great relationships with aren't bad relationships... one I've only met once and the other we just don't bond super well. I guess it was that she was pushing pertussis vax on me that sort of turned me off a bit.

I can labor in the tub at the hospital, but not deliver in it. I have a birth team in place, but there is one more person who is important to me to be there, and the hospital had a two person limit. They're already "allowing" (ha) me three, so I'm reluctant to ask for another! However, the people I have chosen all have an important role in my birth and all understand that role might change in birth and/or I might even ask them to leave. Rae took hypnobirthing with me and is acting as doula, she will not take shit from anyone, she knows my birth wishes well, and she will help keep everyone in line (keeping them calm to keep me calm). Tree had a natural birth at this same hospital so her encouragement means a lot. Kathleen is the "spirit" to this birth... her role is harder to define but she's equally important. Then there is the baby's father, and I probably don't need to explain his role!

So, understanding that only three of those four can go with me.. that I wish to avoid interventions.. that I want to get there as late as possible (especially depending on the on call midwife).. that I am GBS+ but I prefer observation to a full dose of antibiotics (I will not refuse them if I do get there early enough for them, I just hope to get there past that point)... my questions are:

Is a birth pool useful if I'm not planning on staying home the entire time? I was looking at an affordable, inflatable pool. It's only about a 40.00 dollar purchase, but the set up of it and so on might be more of a hassle than its worth. Is water in early labor beneficial or is that more of something I'd want in active labor and won't really get either way (I'm "allowed" to push in the tub at the hospital.. I wonder how often oopsy waterbirths happen???)

I'm just over an hour from the hospital. I want to get there literally as late as I can. What should I look for in order to gauge when I should go in? I have a nurse friend who might be able to check dilation for me, she's also certified in advanced pediatric life support so in case I get to the point I refuse to move having her on call might be a good idea anyway. But besides having her check dilation (which she might not be available to do) what is there to go by? I've heard that generally waiting until you no longer feel you can move (or that you want to move) is a good idea because that point is probably transition. Well... I'm an hour away! So does this still apply? That sounds like hell in a car, honestly.

Hoping someone can offer me some advice! I'm not opposed to an UC, but I would transfer into the hospital after due to my GBS status because I am not comfortable with home observation of the baby. And being January, I think going to the hospital before birth might make a bit more sense than waiting until she's already here.
post #2 of 12

You might want to ask your midwives or pediatrician what they are looking for during the postpartum observation period with a GBS+ mom. This article lists the symptoms, which parents are capable of watching for:

 

http://www.nlm.nih.gov/medlineplus/ency/article/001366.htm

 

As far as the birth tub at home, it's not a bad idea, but if you have a tub you can also just use your own tub for labor.

post #3 of 12

I would wait as long as you are personally comfortable with hanging out, or until you have the urge to push, at home.  The tub is likely to be worth the investment in time and effort if your labor is long.   Its going to be around 24 hours so most likely, no rush.  

 

I waited at home with my first for a long time, and it turned out, she was breech, and the hospital had no trained breech delivery people on staff so it was a C-section for me.  But because she'd been in there getting good labor hormones for hours, she had almost none of the problems most C-Section babies have (breathing issues, low circulation at birth).   I am so thankful that, even if I didn't get the birth I would ahve wanted if I'd been near a breech care povider (or known how to go about contacting one, while in labo of all things), my baby got the best birth possible because I waited at home.  So so glad I hung out past the whole contractions-getting-stronger / 411 guideline.  

 

That said you do have an hour drive, maybe if it works out you try to spend some of your early light labor time in the city, or get near the hopital and walk alot.   That way you have options besides spending the last hour closing in on transition in the car.

post #4 of 12

r.e. the GBS: If you are interested in more "expectant management" with that, you need to make it clear to your CNM prior to getting there.  Otherwise it might be a panicky get-the-IV-in-and-get-a-dose-before-she-delivers kind of mayhem.  There is no "too late" with antibiotics for GBS.  So if you would want antibiotics only if your water was broken a long time, or if you had a fever, or even if you outright refuse them-- make it clear beforehand.  Some pediatricians may give you a hard time if you are known GBS positive and refuse antibiotics (although usually so long as you stay 24 hrs after the birth they are less fussy about it), might be a good thing to address with your planned pedi now so you're not getting into an argument when you should be enjoying your baby moon.  

 

Our local hospital doesn't allow water births but does allow laboring in the tub.  If they couldn't get mom out of the tub they would drain the water.  Is this your first baby?  It's hard to "oops" too much with a first since most 1st time moms push an avg of 2-3 hours.  

 

I think for a lot of people getting to the hospital when you are first in truly active labor is good so you can settle in to your birth location and not be all frantic at the end.  And even though "4cm" is usually used for active labor in a hospital, it probably isn't.  Probably closer to 6 for a lot of women.  So, Maybe once your contractions get to be good and regular, no more than 4 minutes apart, then wait another 2 hours or so.  That gets you pretty firmly into active labor, if you have an average labor.  Of course, all this is guessing.  Not to be too vague- but listen to your body- and feel when your body tells you to go, whether that matches your pre-conceived plans or not.    

post #5 of 12
Thread Starter 

Thank you all so much. This is super helpful information. I will keep that time line in mind, knowing that its just a rough estimate but its still the best I've got so far.

 

I did ask the midwives what would happen if I got there too late for antibiotics and she seemed calm about it.. said they do get women fully dilated and ready to push and they just observe the baby unless the chosen pediatrician prefers a blood draw on the baby. She said missing the antibiotics is rarely a problem either way. I don't mind having them (I don't think they're the best solution, but I am comfortable with them all the same) and did specify I want my IV capped off. So, I guess I'm not super worried about that. I could see though where in a lot of situations it would be chaotic, so I will mention to my midwife again that I am planning to get there possibly past the point they would be able to administer them without limiting my mobility. And in that case, I would prefer to decline them.

 

I'm still debating on renting a hotel room near the hospital so I can labor there as long as possible. The hour drive is what was complicating things mostly, and that my labor support people are coming from opposite directions.. I'd like a centralized place we could meet. My boyfriend was concerned about us renting a hotel (preferably a jacuzzi suite) and it being false labor. Whatever, hah.

post #6 of 12

Just to play devil's advocate: you might be more comfortable *not* waiting until the very last minute. I don't know what your hospital is like, but many of them have tried to make the maternity areas comfortable and pleasant. There might be some benefit in being able to settle in and get your bearings, meet the nurses/staff, and relax a little before things get intense. I would personally not have enjoyed an hour long car ride while in heavy labor! Something to consider anyway… Hope it all goes well, either way.

post #7 of 12

Rainbow, you sound soooo much like me! I would love to pull into the hospital feeling pushy. Although I have thought about what others said about settling in and not having to drive during transition. (We have a 40 min. drive.) Ideally that would be the way it works out. I'm just afraid of being on the clock. What if I stall at a certain dilation for 4 hours? At home, no big deal, but I'm afraid of them pushing augmentation even though I'm seeing CNM at a natural-friendly hospital. I have also wondered about having a birth pool just for laboring at home. Those huge blow up kiddie pools look so much more comfortable than my tiny enamel tub and shower.

 

Your support team sounds wonderful. If you really do show up last minute they may be to distracted to notice the extra person. I think I would rather have everyone with me at home and maybe in the car ride. It is just going to be me, my DH and our doula. The doula would be able to check me if I insisted and I hope to be 7 or 8cm before we leave the house. But I hadn't realized that FTM push for several hours! Wow! I guess in that case we could just wait until I feel pushy. hmmmm

 

I am so excited to see how everything works out for you. Have you made any more plans since your last post? Wishing you the best!

post #8 of 12

You might want to read about the "emotional signposts" of labor; they can be a helpful tool in figuring out when to go.  Bradley method recommends waiting until transition.  I have heard several naturally minded doulas say that it's better to go earlier and nest and get comfy so not to have to transfer in transition and I very much agree.  I would go as soon as I have to be quiet for the contractions and notice I am getting rhythmic in my activity; that is active labor for me.  (Well, that is what I would do if I was going to wait for active labor; because of our history, I'll be going in early labor.)  I have had two babies, older DD in hospital, younger DD was supposed to be in hospital but was an unplanned home birth.  One minute I was on the phone saying I was going to come in, and noticed shortly after that I felt pushy.  Five minutes later I was pinned to the floor with the force of my contractions and was not able to move.  I don't recommend intentionally waiting to feel pushy to anyone who has the opportunity to avoid it.  Too much that is precious rides on luck.

 

If your hospital is NCB friendly and you have CNMs and your friend had a good experience there, sounds a lot like mine.  I've had very positive experiences there, was able to labor alone with my first, had a tub, ball, no pressure for meds, very respectful nursing and OB staff.  And I walked into the hospital in labor with my oldest young, poor, no prenatal care b/c anxiety.  about 10 hours of very hard labor, pushed for almost 3 hours, had my baby and all was well. 

 

If you have the pool set up and then you have to leave, is there going to be time to drain it?  Or can a neighbor come and drain it for you?  I've heard about pools springing leaks, and you def. don't want to come home to that.

 

Is there anyone who lives close to your hospital who would let you spend your early labor at their house?  Could all four of your support people come and rotate out of the waiting room?  Then they can rest and you can have all of them there.

post #9 of 12
I can't imagine spending an hour in the car in transition. Did you say this was your first? I know in my labor I made large jumps from contractions ten minutes apart to six to four to two quite quickly, although I had labored the entire day before about every ten to fifteen minute contractions. For me I honestly don't know when I would have gone in. I went from thinking it could be many more hours to oh shit! It's gonna be minutes! I however had a planned unassisted birth and was quite grateful I never needed to make that decision. Maybe you should think about a hotel room or something to labor in. That's just such a long drive...
post #10 of 12
Just a thought...I ended up giving birth in an u/s room when I arrived pushy with my last LO. It really stunk and has really pushed me to consider a homebirth this time.
post #11 of 12

My first was a natural hospital birth. You sound like you have given it a lot of thought and are well prepared with a lot of support, which is awesome. 

I agree with what some others have said that driving an hour during the transition phase of labor would have been impossible for me... transition was tough with my first. I too wanted to stay home as long as possible, and in my personal situation there was a balance to getting there with time to settle in. and although the "average" first labor is 24 hours, MANY people do not follow that statistic. Mine was about 8 hours and i only pushed for about 20 mins. EVERYONE is so different. 

I was GBS+ and at my particular hospital at the time (in 2011), they had a policy that I needed to have IV antibiotics at least 4 hours prior to delivering or there would be additional medical interventions on my newborn baby after he was born. This would definitely be something to check in advance with your particular hospital/midwife. 

With my second, also a natural hospital birth, i labored most of the time in the tub, but they too had a policy of no water births. while i would have liked it, it still worked out fine for us. 

 

Good Luck Mama! 

post #12 of 12

The OP has presumably had her baby by now since she was at least 34 weeks when she wrote this post and that was almost 2 months ago (how'd it go, OP?). But I have a couple of comments for others who might find this thread. I waited to go to the hospital until I could barely stand it, with my first birth. Being in the car and going through triage with nasty contractions 2 minutes apart was awful, and it was only a 20 minute drive for us. I would not have wanted to do an hour of that; I'd more readily opt for meeting up with your people closer to the hospital or just going to the hospital earlier in the process. With my second labor we left the house when contractions were regular but not too painful or close together, and making the transfer at that time was much easier. (And he was born within 2 hours of us getting there anyway.) Second labors tend to go faster, though, but still, I'm no longer in favor of the "wait until the last second" thing after how frustrating and painful that was with my first. If labor has been clipping along, then going a little earlier rather than later probably isn't bad; you'll keep progressing once you get there, and it's lack of progress that's really a problem. You can also call your hospital midwife when you are in labor and discuss with her whether you should head in or wait a little while based on how you are feeling at that time. In my first labor I touched base with my midwife in this way a few times before heading in. 

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Mothering › Mothering Forums › Pregnancy and Birth › Birth and Beyond › Planning a natural hospital birth, but want to stay home as long as possible. I have few questions! (distance to hosp, gbs+ and should I have a birth tool at home?)