2nd Timers -- new practitioner or same as last time?

[willoLevin]

The "first appointment" thread got me thinking about this again. I have to decide whether to use our family doctor again or switch to the North Shore Birth Center.

I had a very good first birth in spite of the hospital setting. Because my doctor was so fully in agreement with my desires for low intervention and natural birth, everyone else worked to her direction. She says the nurses at the hospital know her and expect such "weird" choices as no meds, etc., from her patients. It helps to know how cool she is that, if she could afford insurance to do it, she would happily do home births.

My only complaints about DS's birth were:
1) too far away -- I was in transition in the car and 15 miles felt like the road to he** and back. Dr. has switched hospitals, but we're still driving a similar distance into Boston, with its possible traffic snarls.
2) separation after the birth -- not very long, and DH went with DS to be weighed in the nursery, but long enough that I got lonely. Dr. has since switched hospitals and tells me we could avoid any separation now.
3) double room! -- it figures I went into labor during one of those freak periods when EVERYBODY goes into labor. They use their double rooms about once per year. I picked that weekend to go into labor. Sheesh.

So I know the Birth Center will solve the first two problems for sure. It is 7 miles away heading away from the city, and they won't separate me from the baby at all. The whole rooming issue is obviously quite different since you don't stay too long in a birth center anyway.

We went with our doctor the first time for a few reasons.
1) I know and like her already.
2) I knew she would be the one in the room with me for the birth. She schedules her own vacations and cancels office appointments around her pregnant patients. She attends the whole labor, not just "catching" the baby. At the birth center, you get the midwife who is on call. This is my BIGGEST FEAR about the birth center--what if I don't like the birth attendant I get? Arg!
3) DH was nervous about complications and felt more comfortable with being in a hospital.

So I am very drawn to the idea of the birth center, but I'm not really compelled to make a change, either!

I've made an early first appointment, so I'll get a better sense of the birth center's midwifery practice in a little over a week... Anyone have any words of wisdom, ideas, or extra questions I should ask?

Thanks!

--willo

[jstar]

i think your doctor sounds pretty awesome.

i've decided to try a new practictioner this time but if i don't like it i may go back to the ob i used last time. i really liked him and had a happy hospital birth. the thing i didn't like about my birth was that he was with another patient at another hospital and i had to wait ~2 hours for him to come over and break my waters. i tried to go natural but got an epidural at 8.5 cms. but once i was fully dilated the bag just wouldn't break. and since i had an epidural they didn't consider it 'urgent' and the nurse couldn't break it. once he came over he broke the bag and i started pushing about a half hour later. for that waiting time period though my husband was FREAKING out and wanted to kill the doctor.

now the up and downsides of this were....i went with a doctor that is just a single practice guy because i *wanted* to know who would deliver my baby. the downside being....you have to wait if he is with someone else. and i picked the hospital that he does not do most of his deliveries at. he also knew i was adamently against episiotomy and didn't do one even though i had bad tearing and lots of stitches.

so i decided to try a midwife this time so i would have someone there for my whole labor and made an appointment at the midwife clinic associated with the hospital that i like. but it is one of those groups where i won't know who i will have during labor. so i think if i meet a bunch of them and dont' feel comfortable i may just go back to my ob and hire a doula to be there in labor. i liked the hospital a lot so i don't want to go to another one. i had a birthing suite to myself and it was all nice and modern and clean. i visited a friend at one of their other hospitals after her birth and thought it was kind of gross and decrepit and she labored in a different room and stuck her in a little tiny room afterwards. i like the labor and stay all in one room by yourself with lots of room for family thing. also we didn't have a separation until i wanted to go to sleep. they weighed him right in our room and didn't take him away to bathe him until several hours later when i wanted to get some sleep.

so as you can see i'm still torn i'm just going to see how my appt goes at the midwife clinic. i'm really nervous about rolling the dice who will attend my birth.

[wombatclay]

Well, the Family practive doctors I used last time were wonderful. I was hoping to get Dr. Ellyn and I did (though Dr. Jamie is a great guy too, I was hoping for a "girl doc")

Their family practice is wonderful, very crunchy, close to my house, and dd and I still use them as her ped and my primary care givers.

However, I had a c/s with dd (long story...see the vbac thread here if you're curious) so I'm "too high risk" for a family practice doctor (they can't do surgery and their insurance wont cover vbacs). So no matter what I need a new care giver for this time round.

I'm meeting a new doctor (a husband wife OB/GYN team) nezt week and I'm pretty excited. They share the building with my previous care providers and they are considered VERY vbac supportive and pro-mama/baby. Since they use the same reception desk as dd's pediatrician I picked up my "intro paperwork" last week when I was making dd's 18mo appointment. I've been filling it out and it's really amazing...

Questions include things like "How do you feel about your body? Satified?Proud?Disgusted?Disappointed?Other?" and "What is your work/study/life purpose right now?". Plus there's a section asking about how you would like your care managed...how involved in decision making do you want to be and what is your personally medical philosophy? (though they put it much nicer than that.

So I'm hoping this will be a good interview. It sort of has to be since there's only one other practice that takes VBACs and I relly don't like the midwives there...they're very cold and unfriendly (which suprised me since I expect midwives to be more open and approachable!).

Anyway, there is only one hospital around here and it's very mama/baby friendly. There is no nursery so all babes room in full time, they have tons of lactation consultants working round the clock so if you need someone at 3am (like I did) they're only a call button away, they are totally supportive of alternative birth philosophies, love working with doulas, have a whirlpool tub and all sorts of labor toys, and a great VBAC success rate too. Of course, they have one of the lowest c/s rates in the state and I still got one...so I'm not counting any chickens this time round!

So the hospital is good (I almost can't wait to go, they really pamper you as a new mama and the food was decent! With a toddler running around I'm thinking of it almost as a mini-vacation. Someone else to do the laundry and cook the food and me and the new babe just get to snuggle and decide what we'd like form the room service menu. ) and I'm keeping my fingers crossed about this new care provider.

[OTMomma]

We have moved since baby #1 was born, so I have to have a different practioner. Last time we used an OB and had a hospital birth, and there were a lot of things I don't want to do again, so this time I am planning to use a midwife and have a homebirth.

[Jilian]

I lived in Boston when DS was born and I'm in FL now so I'll obviously not be using the same Midwife I LOVED the Midwife who attended DS's birth and if I still lives in the area I'd ask if she did homebirths too (He was born at Brigham & Women's - HUGE hospital). But it works out nicely this time around because I am friends with a local homebirth Midwife so I will use her.

[shockels]

We're definitely not going with the same homebirth midwife this time. I loved my prenatal care, but when it came to the birth there were a lot of things I was disappointed in afterwards. I ended up transferring to the hospital and I think that might have been avoided if there has been some earlier suggestions to try and change DD's position.

We've interviewed another HBMW that we liked VERY much. I respected her so much and really liked her style. A friend of mine who works L&D said that she was really well respected at the hospitals too. So we will either go with her or just stick with the hospital MW's. They did a great time last time when I transferred and I trust them. I just really don't like the idea of getting who ever is on call. That's the worst part of hospital birth.

[willoLevin]

Originally Posted by Jilian

I lived in Boston when DS was born and I'm in FL now so I'll obviously not be using the same Midwife I LOVED the Midwife who attended DS's birth and if I still lives in the area I'd ask if she did homebirths too (He was born at Brigham & Women's - HUGE hospital).

Jilian--

Do you have your midwife's contact info still? I'm in the Boston area.

How did you like Brigham & Women's? My doc sees patients there, but doesn't do her preggo moms care there because she feels it is so huge and so crowded that it can get a bit like a production line. At least, that's what she said in 2003.

[willoLevin]

I just had an email from the Birth Center that I'd *like* to consider. The midwife wrote that have certain minimum levels of hemoglobin and hematocrit a woman has to have to give birth there. Naturally, she didn't say in the email what those levels are. Grr!

I wrote back with my test results from DS's gestation in 2003, so maybe by Monday I'll know if there is any possibility of my going there. My levels were (and no doubt are now) lower than normal, because my genetics make it so, but I'd like to know how close my "normal" is to their cutoff point.

Am I crazy, or is there really no reason to possibly switch to a midwife-in-hospital if I'm going to a hospital anyway and I already know and trust my non-invasive family doctor?

Of course, I could use a different practitioner at the hospital near the birth center (which is 8 miles closer to my home than the hospital where my doctor does OB care in the city.)
:
--willo

[wombatclay]

Originally Posted by willoLevin

Am I crazy, or is there really no reason to possibly switch to a midwife-in-hospital if I'm going to a hospital anyway and I already know and trust my non-invasive family doctor?

You'll get lots of opinions on this, but for me I think the individual is a lot more important than the "job title". There are midwives who are amazing and midwives who aren't. There are doctors who honor women and those who don't. The job title can give you a hint about what a person's philosophy is, but it's the person who is going to be attending you...not the job title.

If you love your doctor, don't change just because you think you should have a midwife. But that said, it can't hurt to explore your options...you might find an amazing and wonderful care provider who is absolutely perfect!

[Shell_Ell]

You know, I'd go with the "if it ain't broke, don't fix it" mentality. If things worked out well last time, then maybe that's who you should stay with. This Dr sounds pretty good to me!

I'm switching midwives (from a freestanding birth center last time to a homebirth midwife this time) because I wasn't happy with my experience last time. I knew after my son's birth that we'd have to decide what to do the second time, and it took alot of soul searching to finally make the decision to homebirth. We honestly went through every option (OB/hospital with a doula, CNM's in hospital, etc) and ended up here. I think when you know, you know. Just because something sounds better on paper doesn't always mean it's better for you and your baby. I am all for choosing what makes you most comfortable!

[Shell_Ell]

Originally Posted by wombatclay

There are midwives who are amazing and midwives who aren't. There are doctors who honor women and those who don't. The job title can give you a hint about what a person's philosophy is, but it's the person who is going to be attending you...not the job title.

If you love your doctor, don't change just because you think you should have a midwife. But that said, it can't hurt to explore your options...you might find an amazing and wonderful care provider who is absolutely perfect!

I agree!

[Ks Mama]

Different practitioner this time for several reasons. Primarily, because we are in an entirely different state (first time around I delivered in a hospital 45 minutes away - that was the CLOSEST hospital!). Secondarily, yet related, is the fact that midwives in this state must have a doctor accompanying them if you decide to deliver in a hospital (which I want), and where I live, I could only find ONE practice within a decent distance from me that even had ONE midwife able to deliver in the local hospital, and that practice requires that you see ALL the doctors for prenatal as well... and they are all MEN! Thirdly, I had a C-section first time around, with my wonderful midwife at my side in the hospital through the entire very long labor process, then my wonderful doc took over at the end. The local birthing center who does have midwives (next state over, but still close by) will not take VBACs at their birthing center.

So.... I am at a practice of all female docs and will deliver (hopefully VBAC) at a hospital less than 10 minutes from me!! Edited to add:: We're planning on having a doula this time in lieu of a midwife who would be able to be with me for my entire labor/birth process.

[Jilian]

Originally Posted by willoLevin

Jilian--

Do you have your midwife's contact info still? I'm in the Boston area.

How did you like Brigham & Women's?

I PM'd you the name of the MW and my ecperience with B&W.

[willoLevin]

I forgot to mention that our doula has moved too far away.

When I asked my husband his opinion on the whole birth center vs. same doctor question, he said, "I don't care, as long as that lady is with us again!"

He meant our doula. (Even though she was also our Bradley childbirth class teacher for months, he can never remember her name. But he liked her being there!)

I think I will hire a doula again regardless of where I go. Actually, I think I would need a doula MORE in the midwifery practice where I get whoever is on call than with my doctor!

And, while dr. told us the first time that her patients don't usually need a doula since she is always there with you, I still tell every woman I know to be pregnant that hiring a doula is the smartest thing she can do for the birth. Not because the dr. was deficient. Just because... well... having a doula helped. Who doesn't want the easiest possible birth?

If anyone needs a doula in CENTRAL/WESTERN MASSACHUSETTS, that's where the doula I liked so well moved to. I'm thrilled to refer her to people.

--willo

[mommamin]

I had an OB the first time, this time I am going in with a midwife who has rights at the hospital...however, I am still thinking about a homebirth! i am going to make a couple calls tomorrow. I am just afraid DH will not be on board with it. I looked for birthing centers but everything is at least 40 mintues away and I afraid that is/will be too far!

[Jilian]

I agree that every pregnant woman deserves a doula, that is the reason I work on a sliding scale or even volunteer at births where I know I'm really needed but the parents cannot afford a doula. I'll certainly be hiring a doula to be at this birth. If you need help finding a doula you could always check out www.cappa.net and www.dona.org for a listing of doulas in your area. I'm really sad about having to put my doula business on hold within the next few months because of pregnancy.

[sally Z]

i am staying with the same midwife i had for dd homebirth. Ther are things i would do differently but i think she will be fine. I don't really like her backup midwife who came for the 2nd stage but hey i will say she can come and sit in the corner until/if needed

[Ks Mama]

Originally Posted by mommamin

I looked for birthing centers but everything is at least 40 mintues away and I afraid that is/will be too far!

FWIW, my first birth, we were 45 minutes away from the hospital... unless you have really quick labors, I don't think time away from the hospital is that much of an issue. For me, I wish I had waited even LONGER to make the trip - I waited about 9 hours before going in (wish I had listened to my midwife who urged me to stay at home as long as possible), then delivered 22 hours later - ugh!

Do whatever you're comfortable with, but I don't think 40 min is that long (unless, and here's my caveat, and personal bias, you are planning an unattended home birth and are higher risk - that for me would be too much risk in an emergency).

[willoLevin]

(Long) distance to hospital scares me because I remember how much I *HATED* that drive, which was probably optimally short (around 25 minutes) due to Sunday morning lack-of-traffic.

Of course, I labored at home until I was sure I needed to go, and had a knowledgeable doula there to help me decide when to go. (Not just DH, who instantly forgot we wanted to labor at home a while and was ready to head for the hospital the minute my water broke. )

I think I was in transition by the time we were driving to the hospital. My son was born within two hours of our arrival there.

Plus my total time from water breaking (with no labor pains yet) to DS's birth was around 11 hours. I will probably still have plenty of time to get to the hospital with this one, but... what if I'm one of those women who goes from nothing to pushing in no time flat? (DH says this is wishful thinking, but I don't want to have a baby in the car!)

--willo

[wendimarie]

I had an OB with my first and will *never* go to another OB much less the same one.

I have a wonderful midwife that I will be using this time.