When to go to the hospital when its 1.5 hr away + Doula Question - Mothering Forums

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#1 of 3 Old 09-17-2013, 01:17 PM - Thread Starter
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First Question:


I started out planning to birth at a free standing birth center 1.5 hours away but am now looking at having a hospital birth for mostly financial reasons thanks to Medicaid not paying my midwife her full fee. I was left with 1200 owed when I have to borrow gas money even to get to the appointment sometimes.


I wasn't worried about getting to the birth center too early since she is a CPM and not operating by a clock, but I AM worried about getting to the hospital too early. I'm actually still trying to decide between two hospitals. One is just at an hour away and my friend had a natural birth there (Augusta Medical Center in Fishersville, Virginia). The other hospital is right next to the birth center so its 1.5 hours from me (Rockingham Memorial in Harrisonburg, Virginia).


I've spoken to a few doulas and they tend to recommend RMH over AMC saying its far more natural birth friendly. I still don't want to get there too early, nor "too late". In my head I want time to adapt to my environment before I push out the baby, but I realize I might not be worried about adapting when the time comes. And certainly probably not able to get comfortable with the environment, but still I'd like to get somewhat settled in....


This is my first baby so I am not sure what to look for as far as getting ready to go. If I lived five or ten minutes away it'd be one thing, living this distance I have to plan ahead an hour and a half!


I thought about renting a hotel room near the hospital in early labor and laboring there in a jacuzzi, but my friend suggested this might be a germ issue. I am not super uncomfortable with the germs in the hospital tub, even though I know they could easily be worse. And obviously I wouldn't think twice about my own tub. Somehow though laboring in a strange tub in a hotel seems a bit.. iffy... But does that sound like a decent option? It would also give my parents or my boyfriend's family a place to stay while I give birth. Also, if I hired a doula, she could meet me at the hotel whereas if I stay at home until I go to to the hospital, I would have to just meet her there since it would add well over an hour to her commute to come here first considering my location compared to the hospitals.


This sort of brings me to my second question:

My partner is not informed about natural birth, nor to be honest, is he that interested in learning about it. He will probably be supportive of me as best he is able, and I know he will be comforting to an extent, but he will not remind me of why I'm avoiding pain medication nor will he know the best ways to help me avoid giving in to wanting them. In fact, he may suggest I use them though I plan to tell him to please refrain from telling me that. I definitely need a doula!

If I do go with Rockingham Memorial as the hospital I choose, they have volunteer doulas on hand. I've spoken with two Doulas not at the hospital, and both are charging 200. One is a student working towards certification but she's already a hypnobirthing teacher and has quite a bit of birth work experience. The other is experienced but no longer attends birth as a doula due to fibromyalgia. However, she will attend as a coach for other people at the birth and guide them in ways to help (positions, counter pressure, etc). She would obviously still advocate, just be hands off due to physical limitations. So, I need to decide between hiring one of them or using the volunteer doulas. I am more or less unemployed so 200 is actually quite a bit of money for me at the moment, but I could probably manage it somehow. However, a volunteer doula would be great because I could then use that 200 for things like cloth diapers or a breast pump or some other essential. I wouldn't meet the hospital doula before the birth though, nor would I know anything about her prior to the birth. They are trained by the hospital, but I assume their loyalty would still be to the birthing woman. Anyone have experience with a volunteer, hospital trained doula?

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#2 of 3 Old 09-18-2013, 11:05 PM
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Both births I have had to travel an hour to the hospital.  The first time per our childbirth class we waited until contractions were regularly 5 minutes apart, about 1 minute long each, and I had to stop what I was doing and breathe or moan through them.  I got to the hospital at about 2 cm, they admitted me, and I had DS 12 hours later. 


The second time we went earlier as we thought things might go faster, so we went when contractions were 5-10 minutes apart and I could talk through them.  I was at 3 cm, spent a few hours there, did not make any progress, so they sent me home to rest.  We tried to get a hotel room close by but had no luck.  Went back to the hospital the next night when contractions were regularly 4-6 minutes apart and I had to breathe through them.  I was then at 4 cm, they admitted me and I had DD 3.5 hours later.


A long car ride in active labor is fairly unpleasant, but doable.  The drive in early labor was no problem.  I think the hotel room might be a good option in your case.  Even if you don't want to use the tub you could use the shower which I find nice and relaxing in labor.  You could also nap on the bed.  And then your doula could be there and help you decide when to head to the hospital.


I agree a doula is a good idea for you.  We used a doula for my second birth and it was really nice, also gave DH a break so he could rest.  Is there no way to meet the volunteer doulas ahead of time?   I think it's important to make sure your personalities are compatible and that you can relax in their presence, not be annoyed by them.  If you really have no way to meet them beforehand then I would go with one of the paid ones. 


Good luck!

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#3 of 3 Old 09-19-2013, 09:45 AM
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I was part of a hospital doula program. I would recommend hiring a doula if you can manage it. I think these programs fill an important niche in helping women who find they need the extra help during labor, but they can't replace a doula who gets to know you and your preferences prior to birth and can be there for you before you go to the hospital.


A hospital-trained doula's loyalty should be with the woman. However, if they're hospital-trained, their view of how things should go may be influenced by that training. Some, maybe most, will have done extensive research and have their own views. Others may follow the hospital party line, whatever that is. A hospital doula is also going to be more concerned about toeing the line than an independent doula - an independent doula can be blacklisted from a hospital, but it's much more likely for a "troublesome" hospital doula to just be skipped over. You'll also find a lot of volunteer doulas who are using the volunteer experience as a bridge to some medical-oriented career, so they may be coming from a more medicalized viewpoint.


Even if there is a way to meet the doulas ahead of time, you likely won't be able to pick and choose which one is at your birth - it'll be whoever is on the schedule for that day. Usually a volunteer will be on-call only on a few days a month, because few people have the freedom to drop everything in their lives at any given time for a volunteer position. You should also check and see how good their coverage is. The program I participated in is apparently well-covered now, but there was a lot of time where it was very hit or miss. Also, what is their expected response time? It could take a good hour or more after you arrive at the hospital for a doula to get there, which may be too long, especially if you're waiting as long as possible to come in.


If you do go with a hospital doula, I'd suggest making a birth plan and having a copy specifically for the doula. We walk in there with no idea whatsoever of what you want, and, especially if you labor elsewhere for as long as possible before going to the hospital, you may not be in a good headspace for communicating your desires. 


As for laboring in a tub at a hotel - you could disinfect it or use a liner (which would mean you couldn't use the jets, but I don't get the impression that most women laboring in the water are all that into jets anyways). Realistically, germs aren't a huge concern - water doesn't actually travel up the vagina to any significant extent. But I'd at least disinfect, especially if your water breaks prior to labor.

DS born 6/03, DD1 born 9/06, DD2 born 10/10, DD3 born 4/14.
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