Birthing Center vs. Hospital

At the beginning of this pregnancy, I was obsessed with whether to go back to the Birthing Center or to a hospital. I have back-burnered the decision for awhile, because it was making me crazy. Besides making a pro/con list, I haven’t actually committed my thoughts to “paper” yet, so I am going to go ahead and do so.

A little background –my first child, my son Max, was born at St. David’s North. I was interested in the Birthing Center during that pregnancy, but my husband was nervous about the idea of being outside a hospital. I could see that and it was the first time for both of us, so we found a highly recommended OB who also had midwives in her practice. We hired a doula, wrote up a birth plan, and went from there. I had hopes for a drug-free birth, but was by no means certain I would pull it off. I had read about the dangers of epidurals, even though I knew plenty of babies who had been born safely with them. I wanted to play it safe and, I admit, I just wanted to see if I could do it without drugs. That was the straight-A student talking who took Latin in high school just because everyone said it was near impossible to get an A in it and I wanted to prove them wrong. I proved them wrong then and I did it again when I gave birth to Max. No one was more surprised than me when I made it through without any drugs. I was also very proud, but I remember thinking after his birth, “It is really sad Max will be an only child, because I am NEVER doing that again.”

It was an “easy” birth. Active labor was only about 12 hours and I pushed him out in 10 minutes. I did tear, but it wasn’t too bad. Stitching was no big deal. Most of the nurses I encountered were very nice. The midwife who caught Max was very nice, too, although she really only showed up near the end, so I don’t remember much about her part in it.

There were definite pros to this experience. Everyone was pretty hands-off and left me, my husband, and the doula to work through it unless we asked for help. No one pushed pain meds on us.

There were definite cons as well, though. They did get pushy at times. They insisted on putting the fetal monitor on me once an hour for 20 minutes. No continuous monitoring just like we asked, right? However, nurses get busy and sometimes couldn’t come back for more than 20 minutes to take it off. So, I ended up tethered to that thing more often than not and it made me nuts. Then, of course, there was one glitch in the baby’s heart rate and they insisted continuous monitoring was necessary. They found a portable one with batteries, thank goodness, but it was unnecessary and annoying.

I also did not like that Max had to be taken to the nursery for the Vitamin K shot and other newborn procedures. They did give us several hours with him before that and my husband went with him, but, quite frankly, I was confused and bewildered and exhausted and wanted my husband and baby by my side. Period. They also called me from the nursery and insisted he was diephretic and needed formula right away. They were only doing me the courtesy of asking what kind. I was confused and exhausted and just said, “Enfamil.” Later, I was pretty angry they didn’t just bring him back to me to try to nurse again.

They also worried about temperature fluctuations he was having and kept insisting on taking him back to the nursery to be under a heat lamp over my objections. My mom finally had a throwdown with the floor nurse after they refused to bring him to me and demanded to know if it was medically necessary for Max to be under the heat lamp. They admitted that no, it wasn’t, the same thing could be accomplished by holding him and sharing our body heat. I was too scared to insist he be brought to me, because, as a first-time mom, I was scared I was wrong and something bad would happen. I was very glad my mother stepped in. They brought him back, we all took turns holding him, and his temperature was just fine.

They also insisted on a hep lock. This did turn out to be a good thing, because I needed fluids after the birth. But they left it on practically the whole time I was in the hospital, even after the IV was no longer necessary. It was very uncomfortable and interfered with positioning during breast-feeding. Again, we had to demand that the nurse go ahead and take it out as they had promised to do.

They also tried to force Pitocin on me after the birth to encourage the placenta to come out. It had only been a few minutes since Max was born and the nurse was just about to inject it into my IV, despite the fact that I was saying no, loud and clear. The placenta can take up to thirty minutes to come out after birth and there was no reason for a rush. So, I am here to tell you that doctors and nurses WILL try to force things on you and ignore your wishes. Luckily, the placenta popped out while we were arguing about it, right before she injected the Pitocin against my will.

Finally, everyone started completely ignoring me after Max was born. He did have meconium on him and they had to suction him and make sure he didn’t inhale any. But even after that was taken care of, no one in the room would answer me when I asked when I could see him. I said several times, loud and clear, “When can I see him?” and was met with utter silence by the nurses and midwife who were still in the room. My husband finally asked and they answered HIM. Hmph. Max had to be whisked away right after birth because of the meconium, so I was very anxious to see and hold him.

Lucy was born at the Austin Area Birthing Center on Duval. Although some of the midwives were “crunchier” than me, I enjoyed the less medicalized, hands-off approach. I was poked and prodded MUCH less at the Birthing Center. (Of course, the three-hour glucose test made up for that in one fell swoop.) When Lucy was born, we once again had a doula and I was an experienced mom who knew what she wanted. And the midwife in attendance respected that. She was very hands-off. I said I wanted to get in the shower, she was fine with it. I wanted to get in the tub, she said fine. (Most hospitals in Austin don’t even allow birthing tubs.) I wanted to get out of the tub, she said fine. I said I thought it was time to push, she said I could try a little one. Then, she checked and advised holding off a little bit longer. When I said I was ready to get on the bed and push, she checked and, sure enough, I was ready. They checked me periodically with a Doppler to make sure the baby’s heart rate was ok. Every time, she looked up, smiled, and said, “Happy baby.”

I had issues with clotting after Lucy was born and the midwives handled it swiftly and with a mixture of natural and medical methods. They told me everything they needed to do and gently persuaded me when I was frustrated and tired of having things done to me. They got the bleeding to slow and there was no need for a hospital transfer. They kept us a few extra hours and let us go home.

The facilities were beautiful and comfortable. They were minutes away from St. David’s if a transfer was needed. I know people who have been transferred from there and it went quickly and smoothly. The midwife accompanied them and stayed at the hospital to make sure everything was ok.

Lucy was with me every second after her birth, except for when grandparents were admiring her and they were doing unpleasant things to get my bleeding to slow down. She, Chris, and I all got to catch a nap in the (comfortable) bed together after everything finally settled down.  Once again, I did say to Chris, “We’ve got our boy and our girl, that’s good, right? We can be done?” Chris said, “Speak into the recorder.”

I will say that some of the medical procedures were more uncomfortable than they needed to be. The midwife was not as adept at stitching as the midwife who attended Max’s birth was. Also, none of them could place the IV after the birth and had to call in a midwife from the South location after several attempts were unsuccessful.

I tried going to the Birthing Center for well woman visits, but my troubles with postpartum birth control sent me back to an OB. One of the doctors from my previous OB’s office had started a new practice and I went back to her. Once we decided to try for this baby, I went to my OB to get my IUD pulled. Turns out they have a new doctor on staff and she was available sooner, so I made an appointment with her. She questioned my decision to get pregnant again so soon after Lucy’s death. A subsequent phone encounter did not improve my opinion of her. Plus, they deliver at St. David’s and if I do go back to a hospital, I ain’t going there. So, I chose a new OB for now.

The fact is, I think I would pick the Birthing Center in a second, but for two reasons – I am hesitant about going drug-free again and I am a little worried about bleeding after. I have only seen the PA at my new OB’s office so far. She was very nice, but it is still such a different experience. For one thing, I had forgotten about how appointments at a busy OB’s office take for-freaking-ever. For another, it is just so “one size fits all” sometimes. Not to mention, they gave me a big bag of booklets and pamphlets to read. I wasn’t going to bother, but I broke down and skimmed them today. Big mistake. They are full of the usual “don’ts” and terrible “what-ifs”.

I like feeling in charge during my births. My body knows what to do and has already done it twice. But I do have some “fear of the known”. You can tell yourself birth is only one day (give or take) in the parenting journey. But it begins to loom very large in the last few weeks when you are staring right at it. It’s easy for me to say I can do it again right now when it is so far away, but when I really remember it, it gives me pause.

But I don’t know what an epidural is like. Maybe the devil I know is better. It can hurt going in and I don’t know how it will make me feel or if it will make it hard to push. I don’t want to feel as if my autonomy during birth has been completely stripped away. Maybe it wouldn’t feel that way. But my previous experiences have been so different. Maybe it isn’t broke, so I shouldn’t fix it.

Boiled down, here are the hospital pros and cons:

Pros

Epidural availability

More safety if bleeding happens again?

Ostensibly a few days to rest before I go home to reality

New doctors deliver at Seton Main, which is supposed to be great

More ultrasounds with OB. I get to see the baby more often and possibly discover gender sooner.

Cons

I would have to be away from Max and he has some trauma and separation anxiety surrounding his parents being away at hospitals.

Risk of infection in hospitals

Babies taken to nurseries

They don’t let you eat during labor, no matter how early a stage it is.

St. David’s doesn’t let you have your placenta without a court order. I’ve been told Seton Main lets you have it without a problem. I hope that’s true.

Pushing with epidural might be difficult. There might be complications.

I could not get a decent nap or night’s rest in the hospital. Of course, I’ve gained a lot more experience living and sleeping in hospitals since then.

Birthing Center Pros

Placenta easily obtainable and one of the midwives knows how to encapsulate it safely.

Beautiful, more homelike setting with necessary medical equipment

More hands-off, less monitoring, poking and prodding

Baby stays with parents

You go home sooner. This is better for Max and for my comfort level probably. I hate for him to have to meet his new sibling in the hospital and then leave.

Baby could be born in the same room as Lucy probably, which would be sweet and symbolic.

Water birth option

We have a coupon for $350 off our next birth. (Yes, really.)

Shorter appointments, more older sibling-friendly

They have a game plan in place to stop the bleeding faster, based on the previous experience.

I would see their perinatologist (who is supposed to be wonderful) for a Level II ultrasound.

Cons

No epidural available. I have experienced increasing anxiety as the birth approached both times. This has been worsened by the fact that both of my children came ten days after their due date.

Not so adept at basic medical skills.

Possibly more danger with bleeding

I’m not as crunchy as some of them are.

 

It will be interesting to see how this pregnancy and birth unfold.

 

 

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3 Comments

  1. Debi Shaw said,

    July 29, 2013 at 8:40 pm

    I was young age 22 when I had my first.. Never even offered an epidural.. You have ALOT of thought into all this.. I commend you.. For me, ignorance was a bit of bliss…. Lol. I had her, I loved her, I enjoyed her and now I am a nana to a wonderful baby boy.. Yes, she had an epidural.. All was fine…..

  2. kittymomma said,

    July 29, 2013 at 8:48 pm

    Thanks, Debi. Yes, I almost wish I didn’t have so many choices sometimes! But I’m sure all will be fine no matter what.

  3. Erica said,

    July 29, 2013 at 10:35 pm

    I got my placenta after delivering at Seton Main last October. I had to give the office a heads up. They insist on holding it for 24 hours so that it’s available for testing, if needed, after birth. They keep it in a freezer and released it to us. But we were having problems reaching them once we were released from the hospital. It ended up being 4-5 days because 1) it was the weekend so people weren’t working in the office and 2) we couldn’t get a hold of the ONE person who signs/releases the placentas. It all ended up fine though.


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