Teaching hospital better for high risk births?
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Anonymous
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I had a very severe postpartum hemorrhage after my first birth, which was at a local hospital that has a good reputation for childbirth. I received very good care once everybody realized what was going on, but they weren't weighing the chuk pads for blood, and the nursing staff (while incredibly caring and competent) didn't seem to have much experience with things like interventional radiology or intensive care. We also had to wait for an interventional radiologist to be called. But I survived with no lasting damage and am very grateful for the care I received.
We are thinking about trying for a second. We've had two preconception consults and been told that I am at higher risk for another postpartum hemorrhage (something like 15% chance), and that I would be closely monitored/aggressively treated for bleeding at any subsequent birth. My question is whether I should switch to an OB practice that delivers at the local teaching hospital if we do get pregnant again. I met with one doctor recently, and while I didn't like him as much as my old one, but he did say that the practice at this hospital is to weigh blood loss, which suggests that they follow best practices for preventing/treating PPH. I also wonder whether there's an advantage as far as access to things like interventional radiology. I also felt like he was somewhat cagey about giving me advice because I'm a lawyer (not med mal and not interested in ever being a plaintiff in anything), which was kind of a bummer too. Any thoughts appreciated. Thank you! |
Anonymous
| Absolutely 100% I would switch to a teaching hospital. They excel when the s hits the f. |
Anonymous
I have had mixed feelings about GW and switched to Georgetown the second time. I would go back to Georgetown. I’ve had friends deliver at Fairfax Inova - they deliver more babies annually (or top 5 in nation). Benefit there is they have likely seen everything. |
Anonymous
| I would go to Fairfax. |
Anonymous
| More people look at you at a teaching hospital. They tend to be better at problem solving. |
Anonymous
| I had a bad experience at a teaching hospital and there are honestly benefits and drawbacks to all hospitals. Sometimes it’s just luck of the draw of who you get and how they respond. If you’re at higher risk just interview some potential OBs to see how their hospitals would handle it and decide based on what you feel most comfortable with. |
Anonymous
| I delivered at two different teaching hospitals (one in DC and one in Boston) and had excellent experiences at both. The residents and med students I encountered were all highly competent and helpful in suggesting alternative approaches. I actually enjoy the teaching aspect because I feel like as a patient you get more attention and the attending is forced to slow down a bit and explain more complicated situations (both of my births and recoveries involved serious complications with extended stays for me and NICU time for the babies) and I learned details that I don’t think would have been presented to me in the same way if the doctors were only addressing me and dh. |
Anonymous
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RN here. It doesn't necessarily have to be a teaching hospital. Some are great places, others not.
What I would look for in a hospital is one that is high volume, has high risk OB and a robust nicu (not that I expect you'd need it but these programs all seem to tie together). Just having more patients circulate through would statistically mean they see these sort of emergencies more often, and the nurses are generally better equipped (think less rusty) to watch for it if it occurs. There is such a thing as lose it or use it and a smaller hospital may only see a PPH twice a year while those bigger places may see 20 a year. Statistically, the nurse attending to you has recently seen one or helped with one and knows the drill. Maybe it wasn't even their patient but just being there and watching while something goes on with another nurse and her patient (if you have time) helps keep those skills sharp. In that same vein, there's also generally more seasoned hands available to help out/step in in a larger hospital...multiple people who could attend to these kinds of emergencies in their sleep...if your nurse is over their head (sorry to say, some are better than others). Most units will have some sort of floater to help but that's a luxury in a smaller hospital. And these larger hospitals tend to have emergency people in other departments in house on call rather than needing to wait for them to get to the hospital or even possibly needing to transfer to a higher level of care, so everything should be able to be coordinated quickly. Time is of the essence in emergencies. That being said, I would expect that due to your history, any hospital will be on the lookout for this again regardless. |
Anonymous
Fairfax gets a lot of the highest risk cases and micropreemies. |
Anonymous
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I recently had a hemorrhage at GW.
My midwife quickly called in the OB team and man o man I have never seen a person take charge like the attending. I don’t remember everything but the attending walked over to me, introduced herself and said,”I am here to help you...I have got you.” She then proceeded to get a quick rundown of what was done and then started communicating with everyone. 1 person was writing on the board. 1 person was doing labs. 1 person was weighing everything with the bleeding cart (I would not want this job). There was a runner for blood. There was Someone to help my husband and baby. My midwife definitely took a backseat but was near my head comforting me. (I don’t remember all the people; my husband described the scene) I ended up getting 4 units of blood and a balloon in my uterus which stopped the bleeding. I met with a doctor from interventional radiology but did not have to go there. The OB doctor came back the following day and explained everything to me. My partner was so greatful because she had explained everything right after as well. I met with the doctor postpartum and she explained everything again and gave me a timeline of all that happened and reviewed risks for the next baby. I would 100% go to a teaching hospital. It may not be super swanky but Gw totally saved my life . |
Anonymous
GW was amazing with my baby and me (once the midwives handed us off). Would recommend GW OBs for sure. |
Anonymous
| OP here: Thank you everybody for sharing your thoughts and experiences! I really appreciate it. |
Anonymous
| I am an INOVA patient with one of their high risk groups and one thing I really liked is that the L&D nurses actually work with the high risk practices. They are very thorough and actually walk you through the possible scenarios for your delivery if you have a high risk condition. |
Anonymous
| PP here--Maternal Fetal Medicine at INOVA Fairfax Women's Hospital if it wasn't clear. |
Anonymous
| Absolutely go to a teaching hospital. Shady Grove did nearly everything they could to let my wife bleed out. PACU, ICU and radiology staff were not competent, confirmed by stories we heard from hospital staff weeks after the incident. She ended up needing to get flown up to Baltimore, very nearly losing her arm to complications as they were desperately trying to save her life. |