Manhattan midwives, birth centers, etc - Mothering Forums

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#1 of 16 Old 06-24-2013, 08:03 AM - Thread Starter
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So I had my first child with Midwifery of Manhattan at the St. Luke's Roosevelt birthing center.  I've just become pregnant a second time, and I would like to think about my options with providers asap because I know that midwives can book quickly in Manhattan (we live downtown).  

 

My experience last time was fine, but not great, for a few reasons:

The requirements of the birth center drove me nuts: For example, the diabetes screening was awful, and there was no way to decline it and still give birth in the birth center, even though I offered to to finger stick tests after meals for a week instead (I have problems with low blood sugar, so a fast followed by a huge infusion of pure sugar, which I never consume normally precisely because it makes me feel sick, and then being forced to sit there for hours while my blood sugar bottoms out is really, really awful.  The specialist who saw my results of the test thought there had been a mistake at the testing center because the numbers were so low, and it took me about a week to feel back to normal after the test.)  Another issue was that they required me to do an ultrasound at 37 weeks and again at term because I am on thyroid supplementation for hypothyroidism, even though my thyroid blood tests had all been within normal range throughout the pregnancy (I asked the specialist point-blank if I was at any higher risk of problems since my numbers had always been within normal range, and he said no, but then said that it was hospital policy anyway and I couldn't avoid the test.).  I managed to get them to waive my having to go in every week at the end for a stress test, but only after a lot of pushing.  And the problem with making me do the ultrasound at 37 weeks was that they they "discovered" that the baby was big (well duh, my husband and I are both 6'2", so of course our baby is "big"), and I was only allowed to birth in the birth center because I scheduled my ultrasound at term for 40w5d and gave birth at 40w2d, so they had no ultrasound evidence of the big baby.  As it turns out, my daughter was in the 99th percentile for height and weight (because she was a "tall" skinny baby), but only in the 50th percentile for head circumference, and there were no complications - in fact, the labor went relatively quickly for a first time labor.  So, that's probably too much information, but the gist of it is that I really don't want to go through the same problems this next time around.  But I'm not aware of an alternative to the St. Luke's birth center other than homebirth, and I'm not sure that I want to go that route.  I really like the idea of a birth center that is inside or next to a hospital in case of emergencies, but I'm afraid that this comes at the cost of being forced into a bunch of unnecessary testing, and risked out for things that aren't really risks.  

 

With Midwifery of Manhattan, my favorite midwife moved away, and there is still one midwife there that I just don't communicate well with (she's perfectly nice, and I'm sure she is very capable, but I just felt that we were so totally on different wavelengths that I felt that she never understood anything I was trying to say, and perhaps she felt the same way about me).  Because in that practice you are stuck with whomever is on call at the time, I feel vulnerable to the chance that the midwife I get may not be one that I really get along well with.  Also, with my last labor, the midwife was held up delivering another baby while I was left in the monitoring room on the main birthing floor for 3 hours, attached to monitoring equipment in a tiny space where I kept bumping my head when I tried to move, and with the nurses helpfully telling me to be quiet.  I ended up just laboring with the midwife for an hour or two before pushing.  So that wasn't great.  

 

So I was hoping that some of you might be able to make recommendations?

Does anyone have better ideas about alternatives to the St. Luke's birthing center?

Any midwife recommendations (where one might have options about where to birth, depending on what route I decide to take)?

 

(I also thought about hiring a doula, as then maybe it would not matter as much how much I love the midwife, but I hate to spend that much money on help for just one day or one evening, when I know I can get through it myself if I need to....)

 

Thanks for taking the time to read my post!


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#2 of 16 Old 06-25-2013, 01:03 PM
 
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I am wondering the same! I am pregnant with my first and feeling a bit lost as I try to find a caregiver to start with. I would like to find either a birth center or consider a home birth, but SLR doesn't make me feel right in my choice somehow, and I'm having trouble navigating my choices with midwives - how do I choose one over another, and how does insurance work with them? I would love any feedback regarding great experiences with midwives and home birth in Manhattan!

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#3 of 16 Old 06-25-2013, 07:24 PM
 
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I had originally planned on going with Midwifery of Manhattan but I wasn't that impressed with the experiences of two of my friends who used them. The midwives themselves got great reviews but in both cases the care got transferred to physicians and the results were not ideal (vacuum extraction, a lot of damage to my friend's bodies, etc) and I'd heard mixed reviews about St. Luke's itself.

 

Personally, even though my "politics" lean towards midwife I decided to look at other options and met with the doctors at Village Obstetrics, I was pretty impressed with them. Granted, I am only a six-seven weeks into this process but I feel very confident about VoB -- they aren't midwives, but it felt to me like they were kind of midwives in doctor's clothes, if that makes any sense.

 

On the downside, it is expensive as they are out of network, but I have a goal of coming out of this pregnancy in one piece and I feel like they'll help me do that.

 

I met with them for a free consultation when I found out I was pregnant, just to chat and find out if I wanted to be with the practice. I met with both doctors for half an hour, I wasn't charged for anything, and they answered all my questions and were very personable. I was really impressed with their attitude towards birth and their attitude towards me! Never in my life has a doctor been willing to meet with me just to see if we were a good fit -- and certainly not for free! They agree there are way too many C-Sections, they are okay with me opting out of sonograms and all in all I just really trusted that they were on the same page as me.

 

Like I said, it is still early days for me but so far I like them a lot.


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#4 of 16 Old 06-25-2013, 07:25 PM
 
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oh, and I know that although VoB doesn't do homebirths they will coordinate your care with your homebirth midwife if that's the option you choose, so that's kind of awesome.


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#5 of 16 Old 06-28-2013, 07:50 AM
 
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I had an amazing homebirth in April with Stacey Rees of Clementine Midwifery. Her office is in Williamsburg (literally a block away from the L) but I'm pretty sure she works in Manhattan as well. I really can't recommend her highly enough.

Good luck!
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#6 of 16 Old 07-05-2013, 06:56 AM - Thread Starter
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Thanks for the replies, CupofJoe and MimiNYC - sorry for not thanking you sooner, but I seem not to have been regularly receiving emails about thread updates this last week, and so I didn't know that you guys had posted!

 

CupofJoe, thanks for the recommendation.  They look like a nice practice if one wants to go the OBGYN/hospital route.  I'm conflicted because I would really prefer not to be in a hospital, and I think I would be more comfortable with a midwife (but then there is always the issue of who the backup doctors for the midwives end up being if you have any complications...).  

 

MimiNYC, thanks for the midwife recommendation - I haven't totally ruled out homebirth, but I'm just not sure I would be comfortable with it for myself.  I find this very hard to predict ahead of time, and I don't want to find out it doesn't feel right at the last minute and then panic. :)  I also feel that while I have read a fair amount about homebirth (before pregnancy number 1), I'd feel that I really need to go over the research literature in detail to make sure that it was the right choice for me, and the thought of that right now just feels so overwhelming, with a bunch of travel, a FT job, and a 2.5 year old, plus pregnancy nausea and exhaustion.  Home birth wasn't an option the first time because we were literally moving into a half-renovated apartment the week before my daughter was born, so there wasn't the space (or the certainty of where we would be!) ahead of time.  I really don't know how to make this decision, because I really don't want to birth in the normal L&D floor of a hospital unless there is a really good medical reason to do so, but I'm not sure that I personally will be comfortable birthing at home - I wish we had more options!

 

If anyone else has any further advice about birth location or providers in Manhattan (we are downtown, if that matters), I'd be grateful - I figure the more information I can get the better!

 

 

(avsm7, as for insurance, I think it really depends on the midwife practice.  Some are in-network, so it should be the same as going to an OB.  Others are out-of-network, but if you have out-of-network benefits, the out-of-pocket costs may not be too high, depending on your policy.  If you don't have out-of-network coverage, I would definitely try to find an in-network midwife practice.  The cost of the hospital or birth center, any blood tests or sonograms or other tests, etc are all billed using your regular in-network insurance.  Most of the midwife practices I've seen require you to pay some kind of out-of-pocket deposit up front, around $500, if you are out-of-network.)


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#7 of 16 Old 07-08-2013, 06:56 PM
 
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OP, unfortunately the options in NYC suck if you don't want to deliver at home. It's either hospital, St Luke's, or the free standing birth center in Brooklyn.
I originally considered homebirth (assisted at the homebirth of my niece 10 yrs ago so have been comfortable with the idea of it long before I even met DH) but then decided our dinky railroad apartment that loses hot water easily and has paper thin walls may not be the most ideal setting for a birth. I looked into the Brooklyn birth center and it looked yukky to me. Looked into St Luke's and was reaaaaaally turned off by their risking out of their patients. A week past 40 weeks (or was it even 5 days?) and you have to deliver in regular L&D. Or that the birth center is so popular women often get stuck in triage while rooms wait to free up. I couldn't imagine being 40 weeks pregnant spending those next 6 days stressing out about not going into labor (a time when I should be relaxing and bonding with my unborn baby) only to have to deliver in L&D at the end of it all.
So I went back to the idea of homebirth. I also found myself desiring the overall type of care that a homebirth mw would provide (hour long prenatal visits in my home, a lot of choice on my end) that I wouldn't get from a hospital mw. Sure you have more choice with a hospital mw than an ob but not as much say as I knew I'd need and get with a hb mw.

Anyway so I had a homebirth and even though my labor lasted 4 days and I pushed for 7 hours (not a typo)I had an amazing and rewarding experience that is never trade in.
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#8 of 16 Old 07-09-2013, 06:41 AM - Thread Starter
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LoogieJane, thanks for the response.  Yes, I was afraid that there weren't really any other options out there other than the ones I was aware of, but I was hoping that there might have been something that I have overlooked...

 

I totally understand where you are coming from.  I myself keep circling back to HB, but I just don't think I will be comfortable with it.  I've looked up whatever statistics I can find, and I just don't feel like there is enough reasonable information out there for me to make a decision that I would feel comfortable with.  I guess that I feel that while there are a bunch of other risks in the hospital, I would be well-informed enough (and willing enough to fight) that I could stave off most of them (although I'd really prefer not to have to go through all of that when I am in labor).  Ug.  I really, really, really wish there were more options.  I really don't understand why there are not.  :(

 

I mean why on earth do they need to risk out people from the birth center for any reason other than a true risky complication?  It's not as though it would take any longer to go one floor up on the elevator from the birth center to a surgical suite in obstetrics than it would take to go from a regular L&D room to that same surgical room, so if anything it seems like criteria for the birth center should be more relaxed than for HB, not less...  I really don't understand - it just seems irrational.  


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#9 of 16 Old 07-15-2013, 09:19 PM
 
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Hi there,
Your experience at SLR birthing center echoes my friends'one and my impression.
On the top of it if the birthing center happens to be full when you arrive in labor, you end up in the regular L&D and this for me is not acceptable...
I'm due mid August for our 3rd baby, it will be my 2nd HB, but first HB in NYC.
Kristen Leonard is my midwife and I'm super happy with her. She is in Brooklyn, Park Slope but she is coming to my place for each prenatal visits and she has clients all around the city. Long story short I couldn't be happier with her but I understand that HB is not so far your preferred option...I don't think she offers other ways to birth but home births... Same with Cara Muhlahan, whom I have seen for well woman visits and IUD, she seems wonderful too (and on vacation around my due date wink1.gif) and she is closer to you in East Village.

And I agree that it does suck that we don't have much of other options.
I wish you the best of luck in your search!
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#10 of 16 Old 07-15-2013, 09:44 PM
 
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Oh and I forgot. At the beginning we thought her costs would have been out of pocket, but after discussion and arguing with human resources (self funded plan, the NYS law doesn't seem to apply) we finally got insurance coverage as primary provider.
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#11 of 16 Old 07-16-2013, 09:37 AM
 
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I had a home birth in the east village with Valeriana. She is based 40 minutes outside Manhattan but takes appointments in the city every Monday. My delivery was long and I pushed for a really long time, but I felt safe the entire way through. Any future kids will be born the same way. Also, Val has an assistant who is a doula. Highly recommend them both.
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#12 of 16 Old 07-17-2013, 10:32 AM
 
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I used Cara if you want to ask my any questions. She was the best midwife for the type of labor I had- 4 days long with 7-10 hours of pushing. Antibiotics every 8 hours for gbs, water broken the whole time. She has very good medical knowledge. And she is so gentle with a needle. Her billing person handled most of the dirty work with insurance.

Sophie that is great you finally got coverage! I hear the self funded plans are tough to work with.
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#13 of 16 Old 07-17-2013, 10:46 AM
 
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Cww, i know you wouldn't feel comfortable with HB because you're looking for stats and whatnot but for what it's worth in all the births I speak to women about I never hear bad stories about the hb's like I do the hospital births. I hear some good hospital birth stories and then some nightmare ones. And I hear similar complaints to yours about slr.

If you really don't want to deliver in a hospital setting you might want to try talking to equal amounts of people who have delivered at home vs hospital and just hear their stories. Maybe that would give you better info than stats.

Not trying to push you into anything but at least from what you're saying about your last experience it kinda sounds like homebirth could provide you with the amazing experience (from prenatal to L&D to postpartum) you're looking for.
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#14 of 16 Old 07-24-2013, 06:43 AM - Thread Starter
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Thanks, SophieNYC, StellaNYC and LoogieJane for your responses and recommendations.  I can really understand why people go for HB, but after some reflection and going back to read again, I just feel like it doesn't feel right for me at this time.  If we were in a country with an established HB setup, where transfer to the hospital was already setup as a part of standard practice for emergencies, and if we had well controlled studies in the US, and if it didn't require a ton of wrangling with the health insurance company to get it paid, I would probably go for it, but I just feel that with these barriers at this time, I'd rather be in the birth center (or in an L&D room with a provider who will make that room as close as possible to the birth center as a last resort).  

 

In terms of midwives, I've decided to go with Barbara Sellars who also delivers at the birth center, because it seems that at least some of the things I didn't like about last time would be better with her practice: apparently she has permission for all of her patients to bypass triage where I got stuck for 3 hours last time waiting for the midwife, and there is little chance of her being held up delivering another baby because she only takes 5 people per month.  She is also the only one in the practice, so I will have plenty of time to get to know her before the delivery and barring emergencies will know that she is the one who will be at the birth.  It seems that I will only have to do the 2 hour glucose test this time, instead of the 3 hour (which I'm still not nuts about, but which is at least an improvement), and she does it in her office.  I'll be trying to put off ultrasounds until as late as possible, to see if we can avoid the "big" baby problem this time, since I'm sure this baby will also be larger than average (I actually unearthed a research article that estimated for every 1" of mother's height, a "normal" birthweight could be expected to go up by 120g, so for me at 10" above the average woman, my baby should be 1200g larger than the average baby, and my daughter was only about 1000g above average.  Furthermore, there is plenty of research evidence showing that risks of complications for both mom and baby actually go down with the height of the mother - this is usually used as a reason to give short women C sections, but no one seems to use this for the other logical conclusion, which is to redefine what a "big" baby is for taller women.  I would write up a formal argument and a summary of the research literature if I thought that the people at SLR would listen, but I don't see the point - I think my best bet is just to try to avoid the ultrasound until I would be risked out for being too overdue anyway if at all possible.)

 

I also talked with Barbara about how things go in L&D if either there isn't room or you get risked out of the birth center.  She said that if you get bumped out of the birth center because of space or staffing issues (i.e. not risked out), then they can invoke exactly the same rules in the L&D room as the birth center, and that if you get "risked out" but otherwise have an uneventful "normal" birth, the main difference is just that you have to spend one night in the hospital afterwards.  That is the main thing that I am unhappy about - since you are stuck in a shared room (unless you are willing to shell out an extra $900 for a single night, which we really can't afford), you have no help with the new baby (since all relatives must go home between 10pm-8am), the baby can't be in bed with you but has to be in those awful plastic bassinets, and you are likely to be woken repeatedly by someone else and their baby - sort of my idea of hell right after having given birth.  But only one night I can stand if I have to, and I will just keep my fingers crossed that it doesn't come to that.  

 

Anyway, that's what I've decided for now.  It's not perfect, but I think I will be happier with Barbara than I was with MOM (not to say anything bad about MOM - they were very supportive in a number of ways, but I think having one midwife who I feel really comfortable with in terms of her experience and our ability to be on the same page will work better for me than being in a big practice.)   Just keep your fingers crossed for me that I don't get risked out somehow this time... :)

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#15 of 16 Old 06-30-2014, 12:42 PM
 
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Hello, we are trying to get into the Roosevelt birthing center but recently discover that it was not for sure. I have a strong fear of hospital, needles, scissors.... So the idea to be send to the normal L&D because there is a chance not to have any space at the birthing center, with the extra monitoring and losing the ability to move around and have doctors around really freak me out.
Did it happen to anybody ? How did it go?
thanks for your help
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#16 of 16 Old 09-10-2014, 07:28 AM - Thread Starter
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I just wanted to come back and post an update. I was very happy with Barbara, and I was lucky to be able to birth in the birth center (I didn't get risked out, and it wasn't full when I went into labor). The birth itself went well. We were able to go straight to the birth center and meet Barbara there, and both Barbara and the nurses were great. For anyone looking for a provider, I was very happy with Barbara because I felt that she was calm, supportive, non-judgmental, and had a less interventionist perspective, but she was definitely going to make recommendations for interventions or changes to a plan if she felt it was medically justified. She also seems to really care about making things comfortable (e.g. giving the diabetes test in her office, meeting you directly in the birth center or the L&D room so that you can skip triage in the hospital, asking you about your questions and preferences, etc). She was also very responsive to email/phone questions whenever I needed to contact her throughout the pregnancy. I would definitely recommend her.

lysis, I know it has been a while since you posted, and I was lucky enough with both of my births to be able to be in the birth center, so I can't speak to the experience of having to be on the L&D floor, but I had a similar worry about that and so I talked with a lot of different people about this. Here is what I think, based on those conversations, in case it helps: I think what really makes the most difference is that you get a provider (midwife or OBGYN) who really will provide the kind of experience that you want. I think if you have the right provider, they can ensure that you have more or less the experience that you want whether you are in the birth center or the L&D floor. They wouldn't be able to override the L&D rule that you have to stay overnight for at least one night, and they wouldn't be able to provide a tub like you have in the birth center (you may or may not care about this - I didn't use it in my second birth, and only briefly in my first), but I think almost anything else about the experience will depend upon the philosophy (and experience) of your provider. I think if your provider already has a fundamental philosophy/approach that is similar to yours, and if they have enough experience in the particular hospital (so that they know how things work there, they are respected there enough for them to be allowed to do what they want, and they will do things their way in the delivery room), then I think the experience in the L&D area will be similar to what you would get in the birth center. (I don't know if this helps, but all the nurses that work in the birth center also work on the regular L&D floor as well. They were all really great, at both of my births.) For me what mattered most about the birth center experience was just that I was pretty much left to my own devices, that my midwife knew what I wanted and respected it, and that I didn't have to spend the night on the L&D floor but could go home after the birth. So I think most of this would be replicated in the L&D with the right provider. I don't know your specific situation, but if I were in your shoes, I would probably have a longer conversation about this with my doctor or midwife, and if I wasn't happy with how that went, I would look for an alternate one.

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