Pros and Cons of Birth Center Birth & Logistics post birth

[Anonymous]

I have just found out we're expecting #2, and for various reasons want to try for a natural birth this time, and am debating between a birth center birth or a midwife assisted hospital birth - in particular I'm looking at the DC Birth Center. While I'm not against home births, I really don't think my husband would get behind that, and I also don't feel attached to the idea, so I don't think it's the right option for us.

So I'm hoping folks will have some wisdom to share about the following:

1) How did you decide between the hospital and a birth center?

2) How can I explain midwife / birth center care to my husband so he can feel comfortable with the idea? I think he really has that sense of hospital = professional, competent care, and I'm not sure how best to educate him on that front.

3) If you went the birth center route, how did you arrange for the post-birth care / help you need to have at home?

Thank you!

[Anonymous]

Many years ago we went with Birthcare in Alexandria. The midwives gave us references to scholarly papers that showed that home births were safer due to less likelihood of needless medical intervention. Don't know what the research is like nowadays (this was 15 years ago) but the scholarly papers were quite convincing.

[Anonymous]

1. We did a hospital birth with midwife for our first. All went smoothly, so I was comfortable choosing a birth center with midwife for our second.

2. Talk to midwives with your husband. Read "Ina May's Guide to Childbirth," which has lots of good information about midwives and natural childbirth. In many parts of the world (such as the Netherlands," midwives are the standard medical supervisor at a birth. And when a major intervention, such as surgery, is necessary, any midwife will happily hand over the task to a surgeon.

3. I'm not sure what sort of post-birth care you're thinking of specifically. I went home from the birth center the same day I gave birth and I didn't have any need for help other than what any new mom coming home would want--people to help get groceries, do laundry, etc. I felt great, and it was lovely to sleep in my own bed. It was also nice not having to have a night away from my young first child. Again, since it was a second birth, I felt more confident that I would know if anything was going wrong with me or the baby.

[Anonymous]

1) I read the statistics that say birth center and home births are as safe for low-risk women/babies as hospital births are, and with dramatically lower intervention rates. I toured both, and the hospital stressed me out a bit, and the birth center made me happy (cheesy but true). I have worked in hospitals, so I've seen the sausage being made, so to speak, and thank god they exist, but I didn't want to go there if I didn't have to. The birth center had friendlier policies, more comfortable space, and a more personalized approach.

2) I took my husband to the orientation at the birth center. The midwives are very used to hand-holding nervous husbands. But what really sold him was his brother the OBGYN telling him it was fine, no big deal.

3) I went home about 12 hours after the birth. My parents and husband helped out at home, with food and errands and stuff like that. We took the baby to the pediatrician at 2 days and at some point I went to the midwife for a postnatal check-up (maybe at 3 days? can't remember.) When I wanted some lactation help, I asked the lactation consultant at the pediatrician's office (so happy they had one!) or called the one I'd taken a class with while pregnant.

Hope that helps!

[Anonymous]

I have not yet birthed at the DC Birth Center but at 28 weeks am switching there from OB's and hope to birth at the birth center rather than the hospital. Like you my husband was nervous about the idea of not having the baby in the hospital, but I think he is starting to come around. In addition to the sound advice of all the PPs, I would also recommend watching the Business of Being Born with your husband. I think that seeing some of the statistics in the documentary about how common midwives and out of hospital births are in other developed countries helped him turn around some. There are also articles out there that show that hospital births with a midwife are just as safe as home births, so maybe you can find some of those. Also, tour the birth center with him; the rooms are quite nice. Here is other information that I think helps (and that you will learn from the midwives):

1. The midwives will only accept low risk pregnancies at the birth center. If there are issues, you have to use the hospital.
2. The midwives continually monitor you during labor. Again, if issues arise, they will transport you to Washington Hospital Center. Most importantly, their transport will get you there in 7-10 minutes.
3. Same goes for baby - if there are problems, they will get the baby to the hospital ASAP. (Though from my understanding, because of the continual monitoring and only taking low risk patients, that is very rare.)
3. They have lots of medical equipment at the birth center. They just hide it well so the room still feels comfortable. Oh, and while you can't do a water birth, they do have jacuzzi tubs that you can labor in!

The great thing about the midwives at the DC Birth Center is that they work with Washington Hospital Center, so even you get transferred there, you are still "their" patient. Also, from what I have learned, they are one of the rare groups that visits the mother and baby AT HOME the day after the baby is born to make sure everything is ok and to do some of the intial check-ups with the baby. (They also won't let you leave the birth center after you have had the baby until you can pee and shower.)

I think for your part, you have to find a pediatrician that will accept out of hospital births and I believe they recommend you see the pediatrician within about 2-3 days of the birth. If you are having a boy and want to have him circumcised, many people recommend finding a mohel. There was a thread about that just the other day, so you can look at that if it pertains.

Sorry if this is a bit rambling.

[Anonymous]

Don't mean to take this off topic, but this could be helpful to others, as well well. Which specific pediatricians are you using that are ok with out of hospital births?

I'm going with a hospital birth with an early check out (sanctioned by OB) but I need to find a pediatrician who will embrace this as well. Any suggestions?

I love my OB and really feel good about our decision to birth in a hospital, but know I want to go home ASAP afterwards, for better rest and care and fewer germs and disruptions. I'm am worried that my early check out will be hindered by lack of pediatrician approval or reluctant nurses.

Any suggestions for a pede?

[Anonymous]

Others have given great advice, here is my 2 cents. I had DS #1 with the DCBC midwives two years ago. I wanted to use the birth center, but unfortunately my blood pressure went over 120/80 during my last week, so I had to go to the hospital (there was really no reason for me to have had to go there bc. my BP was not that high and I did not have any signs of preeclampsia, but because this is a CNM practice supervised by OBs, they have to be super, super cautious). I cried for three days when I found out this was the way it was going to be because I was positive that I would not be able to have a natural birth in a hospital. So, my answer to (1) is that I didn't have a choice, but when I thought I did I chose the birth center because I believed that my chances of having a natural birth were higher there. Which I still believe is true.

(2) There are several books he can read that would be helpful, but a book may be a bit much. I would have him visit the website www.pushedbirth.com to get a pithy introduction to some of the reasons why routine hospital interventions are not in the best interest of mothers and babies. BoBB is also good, as long as he will understand that a transfer does not signify failure, but rather means that the system is working the way it is supposed to -- midwives are trained to identify complications early and transfer care when they arise. Also, when you go on the tour of the DCBC, whichever midwife is leading it will be able to give him information that should set his mind at ease. But the first step is understanding that for a low-risk pregnancy, the hospital is a dangerous place to be unless you are attended by midwives; having a natural birth with an OB happens from time to time, but is pretty rare.

FWIW, the DCBC midwives are fabulous. I think their hearts lie with out of hospital birth, but they are great in the hospital too. It was ONLY because of them that I was able to have the natural birth I wanted despite having to go there. They really had my back and did everything they could to enable me to have a natural birth, particularly proactively briefing the doctors on how well I was doing so that they stayed away from my room and keeping me from going to the hospital until I was well into active labor. Good luck with your pregnancy and birth, and congrats on transferring to DCBC -- I can honestly say it was the best health care experience I've ever had.

[Anonymous]

In response to the question regarding the pediatrician that will support out of hospital birth, I just delivered at the DCBC a week and a half ago and we are using Kensington Pediatrics. We also interviewed Dr. Janet Adams in Silver Spring and she said that she would also be supportive of an out of hospital birth.

I couldn't say greater things about the DCBC. I loved all the midwives who we met with during our prenatal care and the two that were on call for my delivery were really wonderful. We also really liked the doula who was on call on the day of our birth (even though we didn't meet her until the day of the birth) As for post-birth logistics, we had my parents in town for the birth. While we were at the birth center, they cleaned our apartment and got things in order for us. Over the next few days, they made sure we had food to eat, helped around the apartment, and held the baby while I took naps during the day (it can be hard to sleep with the baby next to you for the first week). They had to return home after 4 days, but my husband is home for 2 weeks and my MIL is nearby and on call for help when needed. My mom is also coming back for a week when my husband goes back to work next week.

When you have a natural birth, recovery time tends to be faster since there are no drugs to work out of your system. Also, I found that being at home in my own bed made it really easy to relax and get good rest after the birth -- there were no nurses coming in to poke or prod me or the baby. Finally, one of the midwives will make a home visit the day after the birth and will check out you and the baby. And, their lactation consultant will contact you in the week after you give birth to check in to see how breastfeeding is going.

Good luck with your decision! Whether you have your baby in the DCBC or at the hospital, the midwives are fantastic.

[Anonymous]

I don't have time to read all the responses - but perhaps you and your husband could watch The Business of Being Born together. That movie is great at explaining how birth came to be a hospitalized setting...and shows how a midwife is a great resource.

[Anonymous]

Anonymous wrote:Don't mean to take this off topic, but this could be helpful to others, as well well. Which specific pediatricians are you using that are ok with out of hospital births?

I'm going with a hospital birth with an early check out (sanctioned by OB) but I need to find a pediatrician who will embrace this as well. Any suggestions?

I love my OB and really feel good about our decision to birth in a hospital, but know I want to go home ASAP afterwards, for better rest and care and fewer germs and disruptions. I'm am worried that my early check out will be hindered by lack of pediatrician approval or reluctant nurses.

Any suggestions for a pede?

I got a list of peds from my Bradley Method teacher with names in DC, VA and MD. Where do you live? I'll let you know if there's a name on the list near where you are.

[Anonymous]

Regarding a pediatrician accepting of out-of-hospital births: I am pregnant with my first and went to an info session at Capitol Medical Group last week. One of the other mothers-to-be said she was having a home birth, and the ped giving the info session (Dr. Jones) said "great-- I wish more people would [have home births]." So I gather that this practice is accepting of non-hospital births.

[Anonymous]

OP here -

Thank you all for the responses - they've been really helpful. And I actually did see BoBB recently, but think my chances of getting my husband to watch it with me are slim. But I think if *I* read up on everything so I can actually succinctly present my reasoning to him, then we should be good.

I'm also glad to hear that husband / parents present was enough in-home help for those first few days.

I should also note that, while I did get an epidural with #1, I had a relatively quick labor and it didn't go in until it I was already 8 cm, and otherwise I had minimal interventions. Obviously each pregnancy is different, but if #2 is like #1 I think my chances for a natural delivery are good.

And I, too, am interested in advice on pediatricians for out of hospital births, and with lactation consultants on staff. Though our current ped is in the K st office that houses the Breastfeeding Center, where I'm sure I'll be going again!

[Anonymous]

OP - my husband sounds much the same as yours. Before our first OB appointment, I flat-out insisted that he watch the B of BB with me so that we could ask informed questions together of the doctor. He was really impressed by what he saw and now we're exploring a DC birth center birth also. And this is a guy who is really "western" in his approach to medicine, healthcare, pretty much everything!

Anyway I would love to hear more about other ladies' experiences at the DC birth center. I'm a little trepidatious (and afraid of insulting my OB if I decide to transfer, to be honest - I know how dumb that sounds but I'm an incurable "pleaser") but I feel like this really might be the best thing for us.

Be well, all!

jd

[Anonymous]

another absolutely ringing endorsement of the DC birth center here. used them for our first child. loved everything about it. the midwives spent so much time with me and answered every last question i had. it's clear they love their job and aren't worried about getting people through the door b/c of insurance quotas. and when i went into labor, they gave me such great care. i cannot say enough good things. my husband was also slightly concerned about birthing there until we did it. and now he says he can't imagine doing it any other way. will definitely use the Center again for any and all future pregnancies. wonderful, wonderful, wonderful.

if you're at all concerned about birthing there other than a hospital, i think the PPs definitely hit all the points that assuaged any of my fears. they do continuous IN PERSON monitoring -- not relying on machines from down the hall as they try to juggle multiple patients. there are 2 midwives with you from the moment you walk in the door. and they are very very careful to keep you only so long as you remain low risk. they are incredibly skilled at what they do and i had the utmost faith in them. and to the OP -- i have to admit to having been a bit scared of telling my OB that i was going to switch to midwives, so i totally understand. i assured her it had nothing to do with her, that i loved the care she provided but i just couldn't see myself being comfortable in a hospital. and i told her that i was nervous about using one of the other doctors in her practice, since there was no guarantee she'd be the one on call when i went into labor. the other two docs in her practice have notoriously high c-section rates, so i told her that was part of my decision too. she totally understood and was very supportive. i think she could tell that i was being very honest and felt like i was betraying her (so ridiculous, i know!). at any rate, i didn't look forward to the conversation, but knew that i had to ahve it b/c i was going to have the birth that i wanted even if i was, like you, an incurable pleaser. good luck to you!!!

[Anonymous]

OP again -

Thanks to all who responded. I have made an apt with the Birth Center midwives, and am excited about that. And have also gotten some great tips from here on how better to explain things to my husband. I think having been through this once in the hospital, he should at least have some frame of reference when I point out the differences.