I’m curious about people’s experiences having given birth in various setups - hospital vs certified nurse midwife attended birth center vs hospital specifically in a midwife unit vs home birth (which I personally don’t expect to do, but discussions thereof are welcome).
My situation and concerns in particular, looking for advice?:
CW for weight details and C-section statistics
I was trying to reason out studies from medical journals, as some seem to put the risk of c-section at my BMI (just north of 35 at time of conception, who knows what it will be at time of birth) between 40 and 56 percent (!!!) and others around 24 percent.
If I need a C-section I’m fine with having one, but the idea of it being basically a coin flip as to whether I get one as a matter of course due to my weight freaks me right the fuck out.
I know that in the US where I live, birth centers have a much lower rate of C-section because it’s not a default - they will definitely send you over to the hospital for the c-section if it’s warranted. But I also hate the idea of not already being IN the hospital if it is warranted.
Also I want the drugs. All of the drugs, the best drugs. So there’s that.
An option I have heard of is midwife-staffed wards IN hospitals but I’m really struggling to find these.
I went through a clinic (The Women’s Clinic of Northern Colorado) that had a doctor’s side and a midwives side for prenatal appointments. Patients get to choose which side of the practice they prefer, unless they have medical issues like preeclampsia.
With the midwives, I had appointments with all 4 of them throughout my pregnancy so I knew all of them. Then whoever was on call when I came in was the one who was there during delivery. With both of my kids I bled after delivering the placenta, and the doctor on call from the clinic was called in to help.
I loved working with the midwives - the appointments were twice as long, and there were only 4 of them to meet, vs 12 or 13 doctors. I also liked that if/when there were issues, the doctor was someone the midwife already knew and worked with. The midwives also did my in-hospital checks after delivery.
I had an epidural with my first, and nitrous for the second, because she came way too fast for an epidural. The nitrous was definitely helpful, but I would not have made it if I’d been in labor for 20 hours like the first time. I’m so glad it was available though! Way way better than nothing.
So, I had births in two different hospitals and in a free standing birthing center in Pittsburgh (which is no longer operating.)
I liked the birthing center a lot. I liked the midwives. I liked that it was minutes from the hospital in case of emergency.
But I had already had two babies and the second one was very quick, so I as pretty confident about the whole process.
Drugs were not an option at the birthing center, which was okay by me because I’d already had a baby without any pain meds and was not worried about that.
And I am not generally a worrier, at least about that kind of stuff. I knew that the birthing center really screened what patients they took - you had to be low risk and if problems occurred in your pregnancy you were transferred back to the MD route.
I would not, personally, have chosen a home birth. I do believe that they are safe if you are low risk, the midwives are well trained, and the process of transferring you to the hospital in an emergency is well planned. However, I have a close friend who had the worst possible outcome with a home birth - it was a lay midwife who did not transfer her in a timely manner.
Have you looked into doulas? I wished I had had someone with me besides my dh (who was kind of a wreck) for my first labor which was long and slow and not in a particularly supportive hospital. So I hired one for my dd and she was (I hear) pretty great.
Ooh yes, someone not your husband is nice, lol. My sister was there for most of my labor with my first, and she was so helpful. Also she understood what I meant when I said things like “more in, less out!!!” about pressure on my legs, which doesn’t even make sense to me anymore, haha.
I did with my last pregnancy and booked super early and then had a loss, and so I’ve been waffling this time. I kind of want one but also money isn’t the non-issue it was a year ago. And the doula I hired last year kind of ghosted me? So um
But also I feel like an experienced doula who has been in the area a while would be really good at helping navigate this and finding a provider that fit my desires and worries best.
My mom also may be at my birth but she’s a nurse and guaranteeing she can get someone to cover for her and rush out at the first sign of labor is iffy.
Also, the main reason that I went to the birthing center is that you could go home 6 hours after birth. You could stay for 24 hours if you wanted to, but they would release you if you did all three of these things -
-feed the baby
-eat a meal yourself
-get up, pee, and take a shower.
I thought that being in the hospital the first two times was pretty useless. The first time was 3 days and the second time was about 18 hours, and I did not find it restful.
Of course being home with two kids and a newborn was not all that restful either, but at least it was my own bed.
I think the things I’m concerned about aside from pain management in a birth center include, basically, how much of an increase in risk is there, if any, to me and baby’s health and safety. The number 1 part of my birth plan is “highest chance that everyone lives,” so if that chance is going to drop I need numbers.
So it does look like for my concerns, hospital birth is absolutely the way to go. Which makes the questions then do I switch to a midwife that attends births at a hospital (it looks like I can find a few through my insurance), and do I hire a doula – that seems to be another factor that can decrease the incidence of c-section.
I definitely recommend interviewing and asking around a few in your area. If you have other health professionals in “womens health” like a womens PT or whatever, ask them, they will hear from their other clients about people who are good.
I am working in a different system, but I went for a private hospital with intent to deliver without medication and then ramp it up from there as needed. I saw my OB or the midwife who worked with him on an alternating schedule. Pre-covid, both had plenty of time for me. Post-covid, everyone was rather short and stressed. I delivered vaginally and stayed for 3 days in hospital, which was one reason we picked the private over the public system. Public I could have been sent home within a few hours of delivering, and I didnt feel comfortable as a first time parent who was weak from a bad pregnancy that I could care for the baby. The second baby that additional medical support was even more important to me. I am not someone who is walking around right after delivering, even though my labours were short and unmedicated for the most part (i tear and the local anaesthetic for the stitches is great). So the “go home early” can be a plus or minus depending on whether you think you’ll be supported better or more comfortable at either place. I could barely hold my second baby and needed people to swaddle, bring her to me, take her to the hospital’s nursery so I could rest, and appreciated regular checks on my stitches as I was panicking about them.
I saw midwives who were affiliated with a local hospital, and there was a midwife side and an OB side. Since I ended up needing All the Interventions it was a great place to be, but I still got to labor naturally with a midwife for 12 hours before any meds etc and they were all lovely about birth plan, goals, so forth.
One thing is look at your hospitals rates. I was able to look up individual hospitals. Some in the area had like 19% c/s rates, some had like 45%. Patient demographics play in here a ton obviously, but also finding those stats and the number of births at each give place where you live is a good thought. A hospital is not a hospital- they are far from monoliths. Generally OBs who are in a split practice with midwives will be more holistically oriented than your average OB, as well.
Local moms groups are a surprisingly good place to start for resources. If you’re having trouble finding details on the hospitals, ask people who are local
I switched my hospital at around 32 weeks (delivered at 36). So I had almost no knowledge of any of the doctors in the practice. We did hire a doula, but mostly for support for my husband because he was afraid that he’d be freaked out. She gave him practical tips and talked him through things a bit but she almost missed it, and I barely knew she was there (which was what I wanted). The doctor who delivered this child was in my room for about 45 minutes while I was pushing and then I never saw her again (ever in life lol). I was glad I hadn’t chosen my hospital based on a certain provider that I liked.
The second time around after moving to a new state, I got to use a midwife through the hospital. I skipped the doula this time, and I think the midwife and the doula would have been sort of redundant. I loved my midwife though, and ended up being super fortunate that she was on call when I went in to have the baby. I didn’t really like this hospital otherwise.
I have no idea what my BMI is, but it’s definitely overweight. No one mentioned C-section to me at any point. That’s anecdotal obviously, but like BJ mentioned the hospital statistics are probably a pretty good indicator of whether they tend to lean that way as a habit, if that is concerning to you. I had the same feelings - I didn’t really want to be cut open but was open to it if the labor went that way. I haven’t had a c-section, but I did have one vaginal birth that tore, and one that didn’t and…recovery kind of sucks either way. Try not to spend too much brain capacity on vag vs. section because when you get there you have literally no control. Spend a lot of time meditating on the fact that your body is awesome, your ancestors have been doing this for millions of years (or whatever woo gets you in the right head space), and that when the time comes you and GM will make the right/safe/healthy choices. Wishing you all the best!
ETA: I was very happy to stay in the hospital for 3 days the first time. The nurses helped with everything, we got lots of pampering and free diapers, and we had instituted a NO visitor policy with our family well before, so it was a blissful little few first days together. The second time we bugged out at the 24 hour mark because I just wanted to get home to my other kiddo.
No visitors in the hospital was the best thing I ever did.
Oh yeah, I came back to say - do go over the hospital’s general policies with one of their doctors/ midwives. Then you can ask them WHY they do things one way or the other, and get a feel for if they will talk you through it, and treat you as a person, or just a birth to get over with. That’s more valuable regardless of how it actually goes and generally results in lower trauma for the birthing parent and new family overall than how the birth actually plays out. Informed consent is the goal!
For both of my births I used midwives at a hospital. They were absolutely wonderful and I would totally recommend them! I also didn’t have as many choices as others because i live in a pretty small city. We have 2 hospitals(one I wouldn’t touch with a 10 foot pole) and no birth centers. So my choices were a home birth or hospital.
I wanted to have a med free birth with the ability to change my mind later. Spoiler I changed my mind both times. My first labor was 30 hours and I had a friend who was training to be a doula there. It was super helpful the first time around. The second time it was just me and dh and we felt really good about that.
Alright, here with a question about order of operations. It seems like OB/GYNs will only deliver at one hospital, right? So, if you have a hospital preference, you work backwards from that to find your doctor?
I have a strong preference for (1) OB/GYN at a hospital that is (2) not catholic. @BiblioFeroz I remember you mentioning this, I don’t know if there is an option near us? Happy to drive if I need to.
Just popping in here to say that while I can’t really contribute to most of this conversation, if anyone wants to chat about a scheduled C-section experience, feel free to ping me or ask here.
@Bernadette in my experience OB/GYNs we’re only attached to one hospital. We briefly considered trying to change to a different hospital but I wasn’t willing to switch OBs.
That’s how it works in my area. Also, the L&D nurses are the people who are actually with you the whole time, often help you with pushing, etc. IMO they are the ones who make or break (hopefully make!) the experience, along with the postpartum nurses. So I’d ask around for opinions on the experience of delivering at a given hospital, and use that to decide where you’d want to deliver.
At some point I’ll have to decide if I want to do another scheduled c-section or try for a VBAC. The nice thing about the scheduled c is that my usual OB-GYN did the operation, and it felt fairly relaxed (you know, as much as major abdominal surgery can possibly be relaxed…)
I think so. Do you have Kaiser? If baby is premature you HAVE to go to St Joe’s because of the NICU . Almost all the choices are Catholic and I gave up. Cuckoo was early anyway so I would have wound up there anyway.
But with a lot of practices, you just get who you get. IME I have never been able to choose who delivered my baby, even when I thought I could!
I know that the ones that say Lutheran are actually still Catholic. I think there was one that wasn’t, although if I remember right it was like an hour away at rush hour. I am sorry I don’t remember which one it was! I’m sorry, none of this is very helpful.
Thanks! No all good to know, we have not Kaiser. My concern is less about who delivers the baby (my birth plan is hopefully no one dies and I am truly setting no other expectations) and more just not wanting to deliver somewhere that is actively working against my human rights I am not trying to have my last name attached to a Supreme Court case about how nurses in catholic hospitals don’t have to attend to gay people, or be on the news because there were complications and they wouldn’t help me because they prioritize the baby and I died, or whatever. My last name is too hard to spell for that!
I think I know which hospital you mean that says it’s Presbyterian but is actually catholic. I’ll keep looking into it!
. Almost all the choices are Catholic and I gave up. Cuckoo was early anyway so I would have wound up there anyway.
I am not trying to have my last name attached to a Supreme Court case about how nurses in catholic hospitals don’t have to attend to gay people, or be on the news because there were complications and they wouldn’t help me because they prioritize the baby and I died, or whatever. My last name is too hard to spell for that!