Tarreymere Posted March 13, 2011 Share Posted March 13, 2011 The official 'Standard of Care' according to the American College of Obs and Gyns (ACOG) is 'thirty minutes from decision to incision' in emergency cases and that is for women who are already laboring in the hospital. So even in a hospital setting faced with a woman experiencing an acute emergency the doctors and the hospital think they are doing very well to get you in the OR and to start operating within thirty minutes. Honestly it can take longer in most cases. It takes the doctor on call. and the anesthesia doctor or nurse practioner on call and the OR people on call, time to get in the car and drive to the hospital if they are not there (and especially if your hospital is not in a big city those people are not likely to be in the hospital at night unless they are called in) and time to get ready for you and set up the OR. It is not always the case that there will be an OB doctor already in the hospital. Plus, even if you have a relationship with one OB doctor there is no guarantee that the doctor you know will be on call if you need him after hours. He may be 'covered' by a completely different doctor. The OR is not already set up for an emergency c-section because a lot of the stuff they will need is sterile and can't be set up ahead of time. The doctor to take care of the newborn has to be called in because they are almost never in the hospital after hours. If the birth center calls the hospital as soon as they decide to send you, the hospital will have plenty of time to do what they need to do and will be able to take care of you just as quickly as if you had labored in the hospital all along. Also, the midwives are very careful to monitor women for signs of any developing problems so that there is no need to rush you anywhere at the last minute. If they think that you are going in a direction that might lead to needing to be in the hospital they will usually be able to tell you that before it becomes an emergency. Quote Link to comment Share on other sites More sharing options...
phathui5 Posted March 13, 2011 Share Posted March 13, 2011 I had my second and third babies and would happily do so again if a freestanding birth center were available. I'd vote yes, go with the birth center. Quote Link to comment Share on other sites More sharing options...
Tarreymere Posted March 13, 2011 Share Posted March 13, 2011 Oh, and I just have to tell you that even if you are in labor in the hospital it is not likely that an OB doctor will also be in the hospitall just waiting for you to deliver. Your OB doctor will be home tucked in bed waiting for a phone call from the nurses to tell him or her to come in once you start pushing. So don't think that a hospital = doctors, because that is very much NOT the case! The OB nurses monitor you for problems and phone the doctor if they detect any.....just like the midwives (who are usually experienced OB nurses before going to midwifery school). There is always a doctor in the ER at least, but in my experience if they do set foot in OB they hover anxiously around the doorway asking the OB nurses what they can do to help until the OB doctor gets there. I think that ER docs must be trained to think OB patients have cooties or something because in my years of travel nursing as an OB nurse across the US I have never seen an ER doc who wouldn't rather run in the opposite direction when confronted with a pregnant woman. And again, the OR staff does not live at the hospital nor do any of the other folks that make that magic c-section happen. They all have to drive in and set up. The only thing the birthing center doesn't have is an OR, they have all the drugs and things the hospital does, and it is the OR and the OR staff that NEED that thirty minutes to be ready for you. Quote Link to comment Share on other sites More sharing options...
LittleIzumi Posted March 13, 2011 Share Posted March 13, 2011 Oh, and I just have to tell you that even if you are in labor in the hospital it is not likely that an OB doctor will also be in the hospitall just waiting for you to deliver. Your OB doctor will be home tucked in bed waiting for a phone call from the nurses to tell him or her to come in once you start pushing. So don't think that a hospital = doctors, because that is very much NOT the case! The OB nurses monitor you for problems and phone the doctor if they detect any.....just like the midwives (who are usually experienced OB nurses before going to midwifery school). :iagree: With my regular hossy birth, after I was "complete" they waited over an hour after calling the first doc before he finally told them he couldn't come, period. So they had to find another one. Without the epi I would have given birth with some surprised nurse, lol. Quote Link to comment Share on other sites More sharing options...
Bird Girl Posted March 13, 2011 Share Posted March 13, 2011 Many of the complications and unnecessary interventions that people worry about happening to them in hospitals involve things that can be unpleasant and painful, but usually aren't emergencies. Getting an IV that you don't want, having an irritating monitor strapped to your belly or your baby's scalp, pushing out a baby on your back, or feeling like the doctors or nurses don't respect your wants or needs are irritating and inconvenient. When things go wrong in a homebirth, or under the care of a midwife with much less training (Certified Professional Midwives lack the high level of training and medical understanding that Certified Nurse Midwives are required to have), then those things tend to be very serious. Hemorrhage that happens before the birth, or that doesn't respond to uterine massage and injectable pitocen can cause maternal death in fewer than five minutes. Shoulder dystocia that isn't resolved in fewer than four or so minutes begins to damage the baby's brain. Group B strep infections that go for several hours without treatment can cause sudden, fatal septicemia. Delivering a baby who needs expert resuscitation calls for experts who practice their skills regularly, and who have performed dozens of resuscitations, not a few dozen. Fortunately, these kinds of outcomes are rare. However, if one of them should happen to you, it may make you glad to be in the hospital, rather than under the care of people who have never seen or are untrained to deal with this type of problem. I know that for my family, I would rather deal with the discomfort and inconvenience of a hospital birth than the consequences of needing emergency medical treatment and not being able to get it. At the hospitals where I delivered my first two children (and will deliver my third), the "decision to incision" time was five minutes, which gives a good chance of preserving brain cells under hypoxia. But each pregnant woman must decide what she will and won't put up with. Most women who have homebirths or birth center births won't face serious complications, and so can enjoy their comfortable surroundings. Quote Link to comment Share on other sites More sharing options...
vonfirmath Posted March 13, 2011 Share Posted March 13, 2011 I had my first baby at a birthing center with a CNM about a month ago. I was much more comfortable going there than going to a hospital. However, both my apartment and the birthing center were about a minute from a fire station (and the paramedics) and there were three hospitals within ten minutes of the birthing center. I also trusted that my CNM would quickly pick up on any possible complications and get me where I needed to be -- she had a LOT of experience, including hospital experience. My first son was born in WA, at a birth center in a hospital under the care of a CNM. I LOVED that. I am doing the closest I can here (In TX it is harder to get this but Austin does have one hospital with a birth center that allows midwives to preside) I am not comfortable going completely med-free, and needed an induction with my son so a hospital is the best place for me to be. As well as where I am most comfortable. Quote Link to comment Share on other sites More sharing options...
Bird Girl Posted March 13, 2011 Share Posted March 13, 2011 "Oh, and I just have to tell you that even if you are in labor in the hospital it is not likely that an OB doctor will also be in the hospitall just waiting for you to deliver." I have to say, this may be true is smaller, rural hospitals. But none of the hospitals in my metropolitan area have un-staffed labor and delivery departments. There are several OBs and at least one board-certified anesthesiologist in the department all the time, 24/7. I delivered my first child on the Fourth-of-July holiday weekend and my second on the Memorial Day weekend in two different hospitals, and in both cases, they were fully staffed. I would say that if you live in an urban area, you will not be waiting for an OB to be roused from off-site--there will be someone working right there in the department whenever you deliver. Quote Link to comment Share on other sites More sharing options...
LittleIzumi Posted March 13, 2011 Share Posted March 13, 2011 "Oh, and I just have to tell you that even if you are in labor in the hospital it is not likely that an OB doctor will also be in the hospitall just waiting for you to deliver."I have to say, this may be true is smaller, rural hospitals. But none of the hospitals in my metropolitan area have un-staffed labor and delivery departments. There are several OBs and at least one board-certified anesthesiologist in the department all the time, 24/7. I delivered my first child on the Fourth-of-July holiday weekend and my second on the Memorial Day weekend in two different hospitals, and in both cases, they were fully staffed. I would say that if you live in an urban area, you will not be waiting for an OB to be roused from off-site--there will be someone working right there in the department whenever you deliver. I was waiting well over an hour in a decent-sized college town. If there was OB on staff they never mentioned it. Quote Link to comment Share on other sites More sharing options...
amy g. Posted March 13, 2011 Share Posted March 13, 2011 I gave birth to number one at St. David's in Austin. The nurses had asked the Dr. on call to stay close. She didn't. The nurses were running through the halls, looking for her, when Dd was born completely unattended, and resulting in tears bad enough to need reconstructive surgery 6 weeks later. I delivered Ds in the Houston Medical Center. I had to try not to push for over an hour while I waited for my doctor to get there. ds was born after the first push. My water births at the birthing center were blissfully calm and not stressful in comparison. Quote Link to comment Share on other sites More sharing options...
ChandlerMom Posted March 13, 2011 Share Posted March 13, 2011 (edited) The official 'Standard of Care' according to the American College of Obs and Gyns (ACOG) is 'thirty minutes from decision to incision' in emergency cases and that is for women who are already laboring in the hospital. So even in a hospital setting faced with a woman experiencing an acute emergency the doctors and the hospital think they are doing very well to get you in the OR and to start operating within thirty minutes. Honestly it can take longer in most cases. It takes the doctor on call. and the anesthesia doctor or nurse practioner on call and the OR people on call, time to get in the car and drive to the hospital if they are not there (and especially if your hospital is not in a big city those people are not likely to be in the hospital at night unless they are called in) and time to get ready for you and set up the OR. It is not always the case that there will be an OB doctor already in the hospital. Plus, even if you have a relationship with one OB doctor there is no guarantee that the doctor you know will be on call if you need him after hours. He may be 'covered' by a completely different doctor. The OR is not already set up for an emergency c-section because a lot of the stuff they will need is sterile and can't be set up ahead of time. The doctor to take care of the newborn has to be called in because they are almost never in the hospital after hours. If the birth center calls the hospital as soon as they decide to send you, the hospital will have plenty of time to do what they need to do and will be able to take care of you just as quickly as if you had labored in the hospital all along. Also, the midwives are very careful to monitor women for signs of any developing problems so that there is no need to rush you anywhere at the last minute. If they think that you are going in a direction that might lead to needing to be in the hospital they will usually be able to tell you that before it becomes an emergency. Depends on the hospital. My first 2 pgc and births were totally uncomplicated. My third was not. I wanted to go MW but decided to go with a CNM which was awesome. When things got difficult, I'm sure an OB would have pushed for a c-section, but the CNM did all sorts of things I hadn't even read about in any books to help manage the delivery (boluses to refill the uterus to take pressure off the cord, for example). Things seemed ok, then turned south at the last moment (pushing). Since the CNM expected the baby to be "blue" she had the RN push a little button and within 90sec I had a complete NICU team, a Peds team and an OB with her team IN MY ROOM (26 Drs and nurses in all). The OR was literally across the hall from my room and I if things went south I don't think it would have taken that OB 30min to cut me open (nice she was there since she was up to speed just in case). My CNM completed the delivery, the NICU team had to help the baby perk up (APGAR went from 2 to 9), but by 5min after we were all fine and the baby was nursing. Soooo, I HATE hospitals and push to be discharges ASAP (often 16hrs pp) but I'm glad I chose a big hospital(Univ with a med school) and the CNM. Nice to have the high level NICU as backup just in case, and the CNM for amazing quality of care. YMMV Edited March 13, 2011 by ChandlerMom Quote Link to comment Share on other sites More sharing options...
snipsnsnailsx5 Posted March 13, 2011 Author Share Posted March 13, 2011 Thank you all again for all the advice! I really am listening to it seriously. In fact I keep going back and forth with my decision. I think the best thing to do, is really discuss it with my DH, tour the birthing center and meet the midwives, and then pray about it. :) I know there are many factors in hospital vs birthing center births. However for my specific situation here is what I'm looking at: * This will be my sixth delivery. Even in two deliveries which were induced, I always have short, complication free labors. * I've delivered large babies too (9lbs 10 oz being my larges) with no extra effort on my part. * I am well informed about both options and the risks of both. * The birthing center has a great reputation and I've talked to friends who've personally used it and had nothing but good things to say. * The birthing center is only 1.5 miles from the hospital. * I've had two med-free deliveries, so I know what to expect and that I won't panic. * My OB clinic rotates OB's, so when I go into labor on my own, I will only get the OB that is on call that night. * I've witnessed at Dr. appt's with my OB that even if her patient goes into labor when she's the on call OB, she will stay at her office and continue to see patients because she has a computer feed to the hospital that shows the laboring patients contractions and if she's needed at the hospital yet. The OB clinic is the same distance from the hospital that the birthing center is. * If I go into labor during off hours, the hospital calls the OB (I don't think they are there, because we called the OB on-call number ourselves before and they said they'd "meet us there" in about 15-20 minutes). I'm sure there are other OB's that are there, but the OB clinic that I go to has about 6 OB's that rotate shifts. Unless they are already there for another patient, then they wouldn't have a reason to be at the hospital until they are called in. * In the four deliveries that I had at this hospital (the first one was at a small rural hospital elsewhere), the nurses did 90% of the work. The OB only came in when it was time to push. Even when the baby was showing decels in a few cases, the nurse just had me change positions and then try oxygen - the OB didn't get involved. In one of my deliveries, the OB was sleeping the entire time, and when the nurse came to get him he saw that my pushing wasn't very effective yet so he just said he was going back to sleep and to have the nurses page him when it was closer to time. He barely got there as the baby was being born. So the nurses were the ones there for nearly all of the pushing as well. So those are just some of the factors to consider that relate directly to my decision. Like I said, I know in general, there are many factors and "what ifs" to consider. However, since I'm making this decision for myself...those are my factors. :) Thanks again!! Quote Link to comment Share on other sites More sharing options...
LittleIzumi Posted March 13, 2011 Share Posted March 13, 2011 Thank you all again for all the advice! I really am listening to it seriously. In fact I keep going back and forth with my decision.I think the best thing to do, is really discuss it with my DH, tour the birthing center and meet the midwives, and then pray about it. :) :thumbup1: Quote Link to comment Share on other sites More sharing options...
Heather in OK Posted March 13, 2011 Share Posted March 13, 2011 I am not going to read through all seven pages of debating noise so if any of this is repeated information, my apologies. The very first thing I would tell you to do, if you haven't already, is have your husband meet with the midwives. Let him ask them his questions. I have found that many times when men (or the client's mother, or a MIL, or a sister, etc) are skeptical, having the chance to ask on their own really helps!! For most it's enough to reassure them. Have him write down what he is fearful of and have the midwives tell you exactly how they would handle that situation. THey can deal with some complications, but if a hospital is required - they have to call an ambulance first, and then the hospital is about 10 min away. If its a real emergency...every second counts. I'm assuming you are in a freestanding birth center. Please keep in mind that the majority of complications can either be prevented or handled outside of the hospital. VERY rarely is there an emergent situation. Would I be taking too big of a risk? IMO, no. Go with the decision that gives you the most peace. Quote Link to comment Share on other sites More sharing options...
UnsinkableKristen Posted March 13, 2011 Share Posted March 13, 2011 Many of the complications and unnecessary interventions that people worry about happening to them in hospitals involve things that can be unpleasant and painful, but usually aren't emergencies. Getting an IV that you don't want, having an irritating monitor strapped to your belly or your baby's scalp, pushing out a baby on your back, or feeling like the doctors or nurses don't respect your wants or needs are irritating and inconvenient. When things go wrong in a homebirth, or under the care of a midwife with much less training (Certified Professional Midwives lack the high level of training and medical understanding that Certified Nurse Midwives are required to have), then those things tend to be very serious. Hemorrhage that happens before the birth, or that doesn't respond to uterine massage and injectable pitocen can cause maternal death in fewer than five minutes. Shoulder dystocia that isn't resolved in fewer than four or so minutes begins to damage the baby's brain. Group B strep infections that go for several hours without treatment can cause sudden, fatal septicemia. Delivering a baby who needs expert resuscitation calls for experts who practice their skills regularly, and who have performed dozens of resuscitations, not a few dozen. Fortunately, these kinds of outcomes are rare. However, if one of them should happen to you, it may make you glad to be in the hospital, rather than under the care of people who have never seen or are untrained to deal with this type of problem. I know that for my family, I would rather deal with the discomfort and inconvenience of a hospital birth than the consequences of needing emergency medical treatment and not being able to get it. At the hospitals where I delivered my first two children (and will deliver my third), the "decision to incision" time was five minutes, which gives a good chance of preserving brain cells under hypoxia. But each pregnant woman must decide what she will and won't put up with. Most women who have homebirths or birth center births won't face serious complications, and so can enjoy their comfortable surroundings. I completely agree. I was much more neutral towards homebirths/birth centers until a week and a half ago when a friend of mine had her uterus rupture during her labor with her third child. It was supposed to be completely low risk and she had no problems that led anyone to think otherwise and had previously had extremely easy uneventful births. She ended up coding for over 30 minutes (not an exaggeration, her doctors held on longer than normal) and had a complete hysterectomy and lost almost all of the blood in her body. The doctors said it was less of a rupture and more of an explosion. Had she not been in a hospital for this birth she (and maybe the baby, who came out unresponsive due to the almost complete rupture) would have died. As it stands, she is currently coming out of a week long coma. Obviously this is NOT NORMAL. Not even remotely. It is entirely out of the realm of expected. However, it still happens. Alternately, my best friend just had her third child at home, and had the most amazing, wonderful birth ever. There was only a mild problem of the baby having the cord wrapped around his neck twice, but the midwives handled it perfectly. Homebirths and center births are usually wonderful. I agree that you just have to take your own experiences and weigh them against the unexpected. You will certainly make the best choices for you and your family, no matter what :001_smile: Quote Link to comment Share on other sites More sharing options...
ktgrok Posted March 13, 2011 Share Posted March 13, 2011 No way. I know too many families that have had tragic outcomes. I would not take the risk. Bill Bill, if you are giving birth their will be much bigger issues than where the event happens, lol. In all seriousness though, when it isn't your body being effected by possible drug complications, surgical complications, etc it is hard to know how you would really feel. I'm not dismissing your concern, just wanted to mention that it's one of those situations you really have to have been in yourself to fully appreciate. Quote Link to comment Share on other sites More sharing options...
ktgrok Posted March 13, 2011 Share Posted March 13, 2011 I completely agree. I was much more neutral towards homebirths/birth centers until a week and a half ago when a friend of mine had her uterus rupture during her labor with her third child. It was supposed to be completely low risk and she had no problems that led anyone to think otherwise and had previously had extremely easy uneventful births. She ended up coding for over 30 minutes (not an exaggeration, her doctors held on longer than normal) and had a complete hysterectomy and lost almost all of the blood in her body. The doctors said it was less of a rupture and more of an explosion. Had she not been in a hospital for this birth she (and maybe the baby, who came out unresponsive due to the almost complete rupture) would have died. As it stands, she is currently coming out of a week long coma. Obviously this is NOT NORMAL. Not even remotely. It is entirely out of the realm of expected. However, it still happens. Alternately, my best friend just had her third child at home, and had the most amazing, wonderful birth ever. There was only a mild problem of the baby having the cord wrapped around his neck twice, but the midwives handled it perfectly. Homebirths and center births are usually wonderful. I agree that you just have to take your own experiences and weigh them against the unexpected. You will certainly make the best choices for you and your family, no matter what :001_smile: How scary. I do wonder though, how many women have their uterus rupture BECAUSE of things done to them in the hospital? I've never heard of a case of a catastrophic rupture in an unscarred uterus that wasn't related to either pitocin or cytotec. My sister had horrible complications with her labor, and the baby had problems, all of which were the result of drugs they gave her. Quote Link to comment Share on other sites More sharing options...
ktgrok Posted March 13, 2011 Share Posted March 13, 2011 Many of the complications and unnecessary interventions that people worry about happening to them in hospitals involve things that can be unpleasant and painful, but usually aren't emergencies. Getting an IV that you don't want, having an irritating monitor strapped to your belly or your baby's scalp, pushing out a baby on your back, or feeling like the doctors or nurses don't respect your wants or needs are irritating and inconvenient. I know that for my family, I would rather deal with the discomfort and inconvenience of a hospital birth than the consequences of needing emergency medical treatment and not being able to get it. At the hospitals where I delivered my first two children (and will deliver my third), the "decision to incision" time was five minutes, which gives a good chance of preserving brain cells under hypoxia. But each pregnant woman must decide what she will and won't put up with. Most women who have homebirths or birth center births won't face serious complications, and so can enjoy their comfortable surroundings. With respect, the issue isn't just of avoiding discomfort or inconvenience at the risk of safety. The issue is one of safety as much as anything else. MOST of the problems faced on a day to day basis in the hospital are caused by the hospital. Yes, they end up handled because as you pointed out, they have lots of practice. They have lots of practice because they cause the problem so often. Uterine rupture, Strep B infections, fetal distress, cord prolapse, and maternal hemmoraghe, infant respiratory problems, etc are often caused by standard hospital procedures. Many women choose home birth because of safety issues, not despite them. I just wanted to clear that up, as I get tired of people assuming I chose a homebirth because of the ambiance or something. HOnestly, I'm in labor, I don't care what the heck the surroundings look like. I do care that the local hospital has a 48 percent c-section rate, and that a local woman a few years ago ended up a quadruple amputee because of a staph infection she contracted in the hospital after her c-section. As others pointed out, there are risks both places, it is about what risk you are more comfortable with. Quote Link to comment Share on other sites More sharing options...
Renee in NC Posted March 13, 2011 Share Posted March 13, 2011 (edited) Many of the complications and unnecessary interventions that people worry about happening to them in hospitals involve things that can be unpleasant and painful, but usually aren't emergencies. Getting an IV that you don't want, having an irritating monitor strapped to your belly or your baby's scalp, pushing out a baby on your back, or feeling like the doctors or nurses don't respect your wants or needs are irritating and inconvenient. When things go wrong in a homebirth, or under the care of a midwife with much less training (Certified Professional Midwives lack the high level of training and medical understanding that Certified Nurse Midwives are required to have), then those things tend to be very serious. Hemorrhage that happens before the birth, or that doesn't respond to uterine massage and injectable pitocen can cause maternal death in fewer than five minutes. Shoulder dystocia that isn't resolved in fewer than four or so minutes begins to damage the baby's brain. Group B strep infections that go for several hours without treatment can cause sudden, fatal septicemia. Delivering a baby who needs expert resuscitation calls for experts who practice their skills regularly, and who have performed dozens of resuscitations, not a few dozen. Fortunately, these kinds of outcomes are rare. However, if one of them should happen to you, it may make you glad to be in the hospital, rather than under the care of people who have never seen or are untrained to deal with this type of problem. I know that for my family, I would rather deal with the discomfort and inconvenience of a hospital birth than the consequences of needing emergency medical treatment and not being able to get it. At the hospitals where I delivered my first two children (and will deliver my third), the "decision to incision" time was five minutes, which gives a good chance of preserving brain cells under hypoxia. But each pregnant woman must decide what she will and won't put up with. Most women who have homebirths or birth center births won't face serious complications, and so can enjoy their comfortable surroundings. My last hospital birth was with an intern who had been delivering babies for about 6 months. *I* knew more about having babies than she did! All she did was catch the baby (and she and the other intern were SHOCKED at how fast he came - they had never delivered someone who was on baby #7.) All of the doctors that I saw at UNC hospitals were interns or residents, which meant that they had no more than 5 years experience. Yes, they had supervising physicians, but they were NOT in the hospital at all times! The midwife that delivered 2 of mine has been delivering babies for more than 30 years - at home, at birthing centers, and at hospitals. She delivered babies in Appalachia for years where there were no OBs! The CNM that delivered #5 was later hired by Duke University medical school to train medical students in how to deliver babies!:lol: I do agree with the emergency medical treatment being close by - that is why I wouldn't do a homebirth (we were 45 minutes from a hospital that could handle emergencies.) At the birth center I used, the time from emergency to C-section was the SAME as if you were in the hospital. The hospital was notified when there was a labor in progress and if something went wrong, they would have you transported and in the delivery room being sectioned in much less than 30 minutes (which is standard.) There is no way you could be decision to incision at that hospital because the doctor couldn't even get from the cafeteria to the operating room in 5 minutes.:tongue_smilie: Really, though, being onsite wouldn't have cut the time by much at all. As I said, though, I have had babies at the teaching hospital twice, a military hospital, a small town hospital, and the birthing center. All have their positives and negatives and if either the baby or myself were at risk, we would be at the teaching hospital in a second. ETA: The birth center I used administered antibiotics to women with Group B Strep (including 3 of mine.) They had oxygen, a crash cart, etc. There were CNM's, though, so they could write prescriptions, order tests, etc. Edited March 13, 2011 by Renee in FL Quote Link to comment Share on other sites More sharing options...
DawnM Posted March 13, 2011 Share Posted March 13, 2011 I would not choose a birthing center. I did have some major complications with my first that were not caused by the hospital and could possibly have died had I not had medical attention immediately. Dawn Quote Link to comment Share on other sites More sharing options...
happypamama Posted March 13, 2011 Share Posted March 13, 2011 I had my first baby in a freestanding birth center (and then my subsequent babies at home), and I loved it, really couldn't have asked for a better experience. It's a lot like having a homebirth in someone else's house and combines the best of both hospital and home, IMO. They had more medical equipment available than at home (though my one set of homebirth midwives did carry oxygen), but they also had an ambulance on speed dial and a protocol to follow should hospital transfer be needed. (In their case, the hospital was across the street.) Typically, with the early release, they do check on you frequently, with calls and phone checks and such. CNMs are trained to look for problems, and they did intermittent fetal monitoring and other checks to be sure the baby and I were doing well. They told me that there was very nearly always some indication of a problem before a problem actually happened, and that even a hospital couldn't prevent all problems. Things do happen sometimes, unfortunately, regardless of where you birth, so you need to choose where you will be the most comfortable. I really encourage you and your DH to talk to the birth center midwives about their emergency protocols; perhaps that will put your minds at ease. Also, wrt the water birth, I would definitely make sure the MWs allow water births and not just water labors, before you make your decision. My MWs at the birth center did not allow water births, and neither did the MWs who attended my first homebirth (who also ran a freestanding birth center). Quote Link to comment Share on other sites More sharing options...
Veritaserum Posted March 13, 2011 Share Posted March 13, 2011 How scary. I do wonder though, how many women have their uterus rupture BECAUSE of things done to them in the hospital? I've never heard of a case of a catastrophic rupture in an unscarred uterus that wasn't related to either pitocin or cytotec. My sister had horrible complications with her labor, and the baby had problems, all of which were the result of drugs they gave her. Yep. My cousin had a uterine rupture with her first baby because her doc kept upping the pitocin. The rupture went unnoticed until baby started having real trouble and she was finally sectioned for "failure to progress". The reason why progress was slow was not due to "inadequate" contractions. The problem was that the baby was fully posterior with a flexed head. My midwife would have diagnosed that very early on and would have put my cousins into positions that might have changed the baby's position. Posterior with a flexed head is not usually compatible with a vaginal birth, so if position changes didn't work, my mw would have transported for a c-section without rupturing my cousin's uterus first. My cousin is lucky that she didn't lose her baby or her uterus. It was a horrifically traumatic and painful experience. She knew something was wrong, but no one took her seriously. My baby's heartrate tanked after my doc broke my water to "speed things up" (I was 3 cm at the time). The cord was getting pinched because there wasn't water to cushion it anymore. I got an amnioinfusion and her heartrate steadied, but I could have gone in for a c-section that would have only been necessary because my water had been broken artificially. A c-section is major abdominal surgery that carries significant risks for both mother and baby. I am perfectly willing to have one if needed, but it makes sense to avoid anything that would increase the risk of needing one. To the OP: I researched the heck out of my options, made a decision, and prayed about it. I did that for each baby (aside from my first). I felt peaceful about my decision each time. There is no "right" answer except for the one that is right for you for this birth. :) Quote Link to comment Share on other sites More sharing options...
Ginevra Posted March 13, 2011 Share Posted March 13, 2011 I'm so so sorry for your loss. But I did want to explain that all accredited birth centers have fetal monitors, and home birth midwives do as well. I had a homebirth and my baby's heart rate was monitored every 15 minutes, according to the guidelines, and more often, after almost every contraction, during pushing. I just didn't want people to think that birth center or homebirth means no monitoring. i think i had more in my home birth than my hospital birth. I'm sure it's late in the thread to clarify this now, but I meant continual fetal monitoring. They did check my baby's heartbeat with a doppler twice. Once with a heartbeat and 15 minutes later when there was none. I was bleeding and they were debating about the bleeding while my baby died. If I had arrived at the hospital bleeding, perhaps I could be one of the people who complain about how I was whisked off for an immediate caesarean that "was probably unnecessary." See, people talk about "unnecessary" interventions, but one can never be certain that an intervention was unnecessary if the baby lived and the outcome was fine. I do not appreciate the demonization of doctors and hospitals that one sees in anti-hospital-birth discussions. An experienced doctor has seen babies and mothers die in labor, knows that it happens, and acts to prevent that. I have never met a single doctor who seemed eager to perform a c-section. I'm sure not all doctors make decisions for altruistic reasons, but neither is it true that they ALL decide about c-sections based on money or insurance. Quote Link to comment Share on other sites More sharing options...
Heather in OK Posted March 13, 2011 Share Posted March 13, 2011 Certified Professional Midwives lack the high level of training and medical understanding that Certified Nurse Midwives are required to have You couldn't be more wrong. Quote Link to comment Share on other sites More sharing options...
ktgrok Posted March 14, 2011 Share Posted March 14, 2011 I'm sure it's late in the thread to clarify this now, but I meant continual fetal monitoring. They did check my baby's heartbeat with a doppler twice. Once with a heartbeat and 15 minutes later when there was none. I was bleeding and they were debating about the bleeding while my baby died. If I had arrived at the hospital bleeding, perhaps I could be one of the people who complain about how I was whisked off for an immediate caesarean that "was probably unnecessary." See, people talk about "unnecessary" interventions, but one can never be certain that an intervention was unnecessary if the baby lived and the outcome was fine. I do not appreciate the demonization of doctors and hospitals that one sees in anti-hospital-birth discussions. An experienced doctor has seen babies and mothers die in labor, knows that it happens, and acts to prevent that. I have never met a single doctor who seemed eager to perform a c-section. I'm sure not all doctors make decisions for altruistic reasons, but neither is it true that they ALL decide about c-sections based on money or insurance. Wow, i can't believe they didn't immediately transfer you! And honestly, although I'm sure it doesn't help, I didn't have continuous fetal monitoring at my hospital birth. General they don't do continuous fetal monitoring early on it labor unless you are on pitocin or have an epidural or other risk factor. I had 20 minutes on the monitor every hour when I was in the hospital, which is still the standard of care according to ACOG. At home it was shorter periods, but more often, which would probably catch things sooner. And in the final stages of labor it was after every single contraction, and sometimes during them. I don't think that anything I said makes things better for you, obviously, but wanted to clarify that being in the hospital doesn't necesarily mean things are monitored more closely or that they are caught sooner. And although I agree that not all doctors are motivated by greed or fear, I've had too many tell me to my face that they would require me to have a c-section because of their insurance mandates, although they believe a vaginal birth would be equally safe. Also, there is no medical reason that almost every hospital in the greater orlando area has a c-section rate around 40 percent. There has to be something driving it other than medical need. Quote Link to comment Share on other sites More sharing options...
Ginevra Posted March 14, 2011 Share Posted March 14, 2011 Wow, i can't believe they didn't immediately transfer you Well, to me it fits with their philosophy not to immediately transfer me. They are not supposed to act as though everything atypical that happens in labor is an imminent catastrophe. In my case, it was an imminent catastrophe. I don't think that anything I said makes things better for you, obviously, but wanted to clarify that being in the hospital doesn't necesarily mean things are monitored more closely or that they are caught sooner. No - I understand that, that it doesn't necessarily mean that. But I do think the hospital would have addressed it differently the moment I arrived. It might have produced a better outcome. It might have produced a worse outcome. There obviously is no way of knowing. What I regret is that when I was considering a birth center birth, I shut my ears and eyes to anything "negative," rather than truly assessing the facts - that anything can happen and it can happen to me. I even read a story about a placental abruption in a homebirth, in which the baby died and placental aclevia (sp?) in a birth center birth in which the mother almost died, but I pushed it out of my mind, how that could never happen to me, how I'm low risk and there was no reason at all to think everything could go tragically, terribly wrong within my super-fast labors. My labor was only 3 hours long, but that was an hour too long for my daughter. I was only ten minutes away from a major hospital, but that was ten minutes too far away. I wish I had never heard of the birth center and I wish people who raised objections would have raised them more forcefully, although of course at the time, I just wanted them to kiss off with their ugly stories. For sure, there are people who have had horrible hospital births who say they would never have another for that reason. But to be frank, none of them buried their baby. I imagine it happens, but I have not witnessed it. All of the horrible hospital birth outcomes I know of (emergency hysterectomy, emergency c-sec, etc.) DID still save the life of mother/child. But I had no intervention, no c-section, no anything, but buried my child. In retrospect, I would take the unwanted horrible intervention if it would let me have my daughter. So, that's my off-load for the day. Quote Link to comment Share on other sites More sharing options...
JVA Posted March 14, 2011 Share Posted March 14, 2011 I haven't read any of the responses so I may be repeating things here. Most of the time, things go perfectly normally at birthing centers/home births. All of mine needed intervention to have children born ALIVE and healthy. Our neighbors daughter delivered her baby and started to hemorrhage uncontrolably. If she'd been at a BC, she probably would have died because she need transfusions and serious intervention. Unexpected things CAN happen- the midwives just need to be VERY experienced and willing to transport. The best situation would be for a midwife to be able to deliver in a hospital. Midwives give such WONDERFUL, personal care. Quote Link to comment Share on other sites More sharing options...
Allearia Posted March 14, 2011 Share Posted March 14, 2011 A friend who had her child in a birthing center told me that when the baby was born and didn't appear to be breathing they called the ambulance to transfer the baby immediately. When the ambulance arrived the baby was fine but they were required to take the baby anyway, so she was separated from the baby and it took a long time before she was able to go see the baby and since she wasn't admitted to the hospital her baby was in it was much harder to stay with the baby. I don't know how common this scenario is but may be something to look into. Quote Link to comment Share on other sites More sharing options...
Tarreymere Posted March 14, 2011 Share Posted March 14, 2011 Depends on the hospital. My first 2 pgc and births were totally uncomplicated. My third was not. I wanted to go MW but decided to go with a CNM which was awesome. When things got difficult, I'm sure an OB would have pushed for a c-section, but the CNM did all sorts of things I hadn't even read about in any books to help manage the delivery (boluses to refill the uterus to take pressure off the cord, for example). Things seemed ok, then turned south at the last moment (pushing). Since the CNM expected the baby to be "blue" she had the RN push a little button and within 90sec I had a complete NICU team, a Peds team and an OB with her team IN MY ROOM (26 Drs and nurses in all). The OR was literally across the hall from my room and I if things went south I don't think it would have taken that OB 30min to cut me open (nice she was there since she was up to speed just in case). My CNM completed the delivery, the NICU team had to help the baby perk up (APGAR went from 2 to 9), but by 5min after we were all fine and the baby was nursing. Soooo, I HATE hospitals and push to be discharges ASAP (often 16hrs pp) but I'm glad I chose a big hospital(Univ with a med school) and the CNM. Nice to have the high level NICU as backup just in case, and the CNM for amazing quality of care. YMMV You will only find that kind of care in a large hospital in a major city. I seriously wish I could have made a NICU team appear out of nowhere more than once, but most of the places I worked didn't even have a NICU, let alone a NICU team. In fact, in most hospitals that I was assigned to it was a big deal to have anesthesia in house after hours, and these were not small rural hospitals but hospitals in medium size cities like Erie Pa. or Martinsburg WV. Quote Link to comment Share on other sites More sharing options...
Bird Girl Posted March 14, 2011 Share Posted March 14, 2011 You couldn't be more wrong. No, sorry, this one is a fact. There are no industrialized countries that accept midwives with the low level of training and education that characterize Midwifery Education Accreditation Council certified programs. In every other industrialized country, midwives achieve the equivalent of a BSN degree. In the US, Certified Professional Midwives do not have the training to pass the nursing board exams or practice medicine in any other context. Certified Nurse Midwives are another matter entirely. They have the equivalent of a post-bachelors degree in midwifery in addition to their bachelors of science in nursing. They are trained to understand medical science, and are competent to practice in a wide range of medical contexts. Quote Link to comment Share on other sites More sharing options...
Tarreymere Posted March 14, 2011 Share Posted March 14, 2011 Sometimes things still happen, even in hospitals. I had one lady who came in in labor with a full term pregnancy and was doing fine. She was about four centimeters dilated and her contractions were really just starting to hurt. I got her settled on the monitor, took her vitals, and went out to the nurses station to do her chart. There was a CNM in house who was literally sitting at her bedside talking to her when the lady suddenly had a seizure (no history of seizures, no drug use) and stopped breathing. The CNM hit the emergency call switch and pretty much the entire hospital staff ran into the room to help. We did CPR on the lady on the way to the OR and were able to bring her back, but lost the baby. No idea why that happened. I can never forget that, because it was so unbelievable. The grandmother was in the room the whole time too, and she said that if she hadn't been there she would have thought that the whole thing was caused by us (hospital staff) not paying enough attention to her daughter, but geez, we were right there doing all the right things and still had that happen. Another lady came into a different hospital I was working at, also with a full term pregnancy and having contractions. She went into the bathroom to pee and put on a gown, and her water broke. The door to the bathroom was open and she told us that it felt like something was 'sticking out'. The other nurse looked and it was the cord. We practically threw the lady on the bed and the other nurse was on the bed with her trying to keep the baby's head off the cord. We had to call in the doctor, anesthesia, and the OR staff, and made the incision for the c-section well within the ACOG guidelines, but the baby was clearly pretty badly affected by hypoxia and was transferred to another hospital with a NICU. If you don't live in a major city you probably don't have the choice of a birth center or a large hospital anyway. If you do have a choice, I would check to see if the birth center is staffed with CNMs not CPMs, and ask about their emergency protocols and what kinds of emergency treatments they can do on site, and how fast they can transfer a most serious emergency. I do like to see CNMs in the hospital, if they are allowed to practice as CNMs and not like OBs so if you have a birth center attached to a hospital or a hospital OB center run by CNMs that is a great option. I do think that OBs are more likely to consider a c-section as the first option just because they are surgeons, then to consider alternatives to surgery. They are a lot less inclined to just sit and wait with a situation that doesn't warrant surgery but is moving too slowly for them. A lot of OBs I have known have the private opinion that a c-section should be an elective surgery and that women should be able to choose to have one if they want instead of laboring. If you are not a fan of c-sections unless they are absolutely life-saving and necessary, it is important to keep in mind that your OB or the OB covering for your OB may well think that having a c-section is in your best interests even if you don't agree with their philosophy. An interesting survey that I wish I had a link to showed that on a poll most female OB docs would choose to have a c-section over a vaginal delivery, and I thought that explained their tendency to look for reasons to section other women. If you live in a medium sized city or a rural area you are pretty much stuck with what kind of care is available in your area. A community hospital does not have a NICU or other specialized care, does not have OB doctors or OR staff in house after hours, and most hospital deliveries occur in this kind of setting. Quote Link to comment Share on other sites More sharing options...
Oops, duplicate account :/ Posted March 14, 2011 Share Posted March 14, 2011 Well, to me it fits with their philosophy not to immediately transfer me. They are not supposed to act as though everything atypical that happens in labor is an imminent catastrophe. In my case, it was an imminent catastrophe. Bleeding should mean instant transfer as far as I'm concerned. So, so sorry mama. :grouphug: No - I understand that, that it doesn't necessarily mean that. But I do think the hospital would have addressed it differently the moment I arrived. It might have produced a better outcome. It might have produced a worse outcome. There obviously is no way of knowing. What I regret is that when I was considering a birth center birth, I shut my ears and eyes to anything "negative," rather than truly assessing the facts - that anything can happen and it can happen to me. I even read a story about a placental abruption in a homebirth, in which the baby died and placental aclevia (sp?) in a birth center birth in which the mother almost died, but I pushed it out of my mind, how that could never happen to me, how I'm low risk and there was no reason at all to think everything could go tragically, terribly wrong within my super-fast labors. My labor was only 3 hours long, but that was an hour too long for my daughter. I was only ten minutes away from a major hospital, but that was ten minutes too far away. I wish I had never heard of the birth center and I wish people who raised objections would have raised them more forcefully, although of course at the time, I just wanted them to kiss off with their ugly stories. For sure, there are people who have had horrible hospital births who say they would never have another for that reason. But to be frank, none of them buried their baby. I imagine it happens, but I have not witnessed it. All of the horrible hospital birth outcomes I know of (emergency hysterectomy, emergency c-sec, etc.) DID still save the life of mother/child. But I had no intervention, no c-section, no anything, but buried my child. In retrospect, I would take the unwanted horrible intervention if it would let me have my daughter. So, that's my off-load for the day. There are moms who believe their baby would have survived if it wasn't for the unnecessary hospital interventions or medical neglect. It's so, so sad, but the stories are there as well. Sorry if that is 'tacky' to say. Quote Link to comment Share on other sites More sharing options...
Oops, duplicate account :/ Posted March 14, 2011 Share Posted March 14, 2011 Sometimes things still happen, even in hospitals. I had one lady who came in in labor with a full term pregnancy and was doing fine. She was about four centimeters dilated and her contractions were really just starting to hurt. I got her settled on the monitor, took her vitals, and went out to the nurses station to do her chart. There was a CNM in house who was literally sitting at her bedside talking to her when the lady suddenly had a seizure (no history of seizures, no drug use) and stopped breathing. The CNM hit the emergency call switch and pretty much the entire hospital staff ran into the room to help. We did CPR on the lady on the way to the OR and were able to bring her back, but lost the baby. No idea why that happened. I can never forget that, because it was so unbelievable. The grandmother was in the room the whole time too, and she said that if she hadn't been there she would have thought that the whole thing was caused by us (hospital staff) not paying enough attention to her daughter, but geez, we were right there doing all the right things and still had that happen. Another lady came into a different hospital I was working at, also with a full term pregnancy and having contractions. She went into the bathroom to pee and put on a gown, and her water broke. The door to the bathroom was open and she told us that it felt like something was 'sticking out'. The other nurse looked and it was the cord. We practically threw the lady on the bed and the other nurse was on the bed with her trying to keep the baby's head off the cord. We had to call in the doctor, anesthesia, and the OR staff, and made the incision for the c-section well within the ACOG guidelines, but the baby was clearly pretty badly affected by hypoxia and was transferred to another hospital with a NICU. If you don't live in a major city you probably don't have the choice of a birth center or a large hospital anyway. If you do have a choice, I would check to see if the birth center is staffed with CNMs not CPMs, and ask about their emergency protocols and what kinds of emergency treatments they can do on site, and how fast they can transfer a most serious emergency. I do like to see CNMs in the hospital, if they are allowed to practice as CNMs and not like OBs so if you have a birth center attached to a hospital or a hospital OB center run by CNMs that is a great option. I do think that OBs are more likely to consider a c-section as the first option just because they are surgeons, then to consider alternatives to surgery. They are a lot less inclined to just sit and wait with a situation that doesn't warrant surgery but is moving too slowly for them. A lot of OBs I have known have the private opinion that a c-section should be an elective surgery and that women should be able to choose to have one if they want instead of laboring. If you are not a fan of c-sections unless they are absolutely life-saving and necessary, it is important to keep in mind that your OB or the OB covering for your OB may well think that having a c-section is in your best interests even if you don't agree with their philosophy. An interesting survey that I wish I had a link to showed that on a poll most female OB docs would choose to have a c-section over a vaginal delivery, and I thought that explained their tendency to look for reasons to section other women. If you live in a medium sized city or a rural area you are pretty much stuck with what kind of care is available in your area. A community hospital does not have a NICU or other specialized care, does not have OB doctors or OR staff in house after hours, and most hospital deliveries occur in this kind of setting. And then there is this. Babies do die and it is sad reality of life. It is part of the reason that my sister will not work in the maternity ward when she finishes her nursing degree. I don't understand it personally, but even the fact that most babies live and it's a happy ending, she just can't cope with the thought of a baby (or mother) losing their life. My aunt is a hospice nurse and they have talk extensively about it. Quote Link to comment Share on other sites More sharing options...
ktgrok Posted March 14, 2011 Share Posted March 14, 2011 Well, to me it fits with their philosophy not to immediately transfer me. They are not supposed to act as though everything atypical that happens in labor is an imminent catastrophe. In my case, it was an imminent catastrophe. Ah. I see. I think there is a broad range of philosophies with different midwives, which is something the OP should keep in mind when talking to the staff at the birthcenter. I think some are quicker to transfer than others. I guess i was lucky in that my midwife believed in transferring early, if it looked like there was a chance things might go south. one of her conditions for taking me on was that i would agree to transfer quickly if she felt i should, and i trusted her enough to agree. It sounds like not all midwives are like that. Maybe because mine is also a paramedic, and has a good relationship with her backup doctors. The OP needs to determine the policy and philosophy of her potential caregivers. Quote Link to comment Share on other sites More sharing options...
Joanne Posted March 14, 2011 Share Posted March 14, 2011 OP, my personal history with birthing: DS#1: fully medical pregnancy and birth in Houston hospital Miscarriage: only one follow up appointment; no earlier visits or medical consult DD#1: In hospital, with midwife,completely natural in suburb of Phoenix. However, in a routine u/s, necessary so that my MW could keep her hospital and back up privileges, there was a false-positive event that gained medical momentum and effected my life and pregnancy for 90 days. (US tech and Dr. felt her brain was developing asymetrically). It was poorly handled, and the terrible. DS#2: At home, intentionally and accompanied by dear homebirthing friend and 2 qualified midwives. I hate the extremes on both sides of this issue (similar to the extremes on vaccines). Informed pregnancy and hospital birthing OR informed alternative settings pregnancy and birthing is important. What I try to encourage moms to know is that the birth starts at conception. The interventions, the tone, the culture starts long before the first labor pain. I didn't choose a homebirth for the "cozy" or comfortable rooms, so having a cozy/comfy room in a hospital wouldn't do it for me. I chose my MW birth in a hospital and the homebirth because the research - for me - suggested it was safer. I believe a case could be made for making another choice. You are clearly informed and ready to make the best pregnancy and birthing decisions you can to the extent allowed as your situation unfolds. Looking forward to the birth announcement! Quote Link to comment Share on other sites More sharing options...
snipsnsnailsx5 Posted March 14, 2011 Author Share Posted March 14, 2011 There are moms who believe their baby would have survived if it wasn't for the unnecessary hospital interventions or medical neglect. It's so, so sad, but the stories are there as well. Sorry if that is 'tacky' to say. It wasn't unnecessary hospital intervention, but my mom did lose a baby to medical neglect. She had the RH factor but have becomed "sensitized" (right term?) because she didn't realize she had a m/c and didn't get the rho-gam shot. The OB was supposed to closely monitor the baby's "levels" of some kind, (blood count I assume since the effect of this is that baby's become severely anemic since their blood cells are being attacked). The OB was monitoring the baby and had all the results that were saying baby was getting into danger zone, but even at 37 weeks wouldn't induce. The baby died the next week. And yes my parents sued, and won. :( They went on to have two more babies, who did survive because they were induced early before they became too anemic. So medical neglect from OB's does cost babies lives all the time. :( So so sad. My thoughts and prayers to all those mommas who've had to deal with this, of any kind. *hugs* Quote Link to comment Share on other sites More sharing options...
snipsnsnailsx5 Posted March 14, 2011 Author Share Posted March 14, 2011 Thank you all again so much for your stories, insight, etc. :) My DH really isn't comfortable with a birthing center. He has good points, which we brought up here too. I think then that we're going to compromise and I'm going to use a CNM who delivers in the hospital. :) Quote Link to comment Share on other sites More sharing options...
SweetBean Posted March 14, 2011 Share Posted March 14, 2011 (edited) Wow, where are you, lol? Here they're standard, medical, plastic & metal & beeping monitor equipment-filled hospital rooms. Only the freestanding birth center rooms look like that here. I had my kids at Yale Medical Center in New Haven, CT. I have no complaints whatsoever. Furthermore I had no IV or meds. and was able to walk up and down the hall with my second birth. My oldest was born 15 minutes after my arrival at the hospital, and was delivered by the nurse midwife. (No time for walking.) I have precipitous labor which results in fetal distress. It is a wonder that I made it to the hospital. I was sitting on the edge of the seat in the car on the way to the hospital. Dh was actually thinking about stopping to help me. I couldn't speak; it was just one long contraction. Praise God I made it to the hospital, the midwife did a vacuum extraction, and the NICU team was in the room to work on DD the moment she was born. They checked her over, but she was just fine. "Oh, and I just have to tell you that even if you are in labor in the hospital it is not likely that an OB doctor will also be in the hospitall just waiting for you to deliver." I have to say, this may be true is smaller, rural hospitals. But none of the hospitals in my metropolitan area have un-staffed labor and delivery departments. There are several OBs and at least one board-certified anesthesiologist in the department all the time, 24/7. I delivered my first child on the Fourth-of-July holiday weekend and my second on the Memorial Day weekend in two different hospitals, and in both cases, they were fully staffed. I would say that if you live in an urban area, you will not be waiting for an OB to be roused from off-site--there will be someone working right there in the department whenever you deliver. This definitely wasn't the case at Yale. They were fully staffed with specialists. You can have a natural birth if all is going smoothly, and if something comes up they pick up the red phone, and in seconds a team of specialists is in the room. Since my first delivery was precipitous, they figured my second would be as well. They offered to schedule an induction at the hospital to avoid my delivering on the highway, and possibly losing my child due to distress. I scheduled a delivery, but then cancelled it. It just didn't feel right to me. My water ended up breaking 2 days before my due date, and I wasn't really in labor. They sent me to the hospital anyway, given my history. I arrived at 10 PM, at around 7:30 AM, I was in labor but not intensely. My OB had stayed the night on the unit, but came in at that time to say he was going home, and introduced the other OB from the the practice who was there to continue on with me. My OB never left the room. I suddenly went into precipitous labor and DS was born just moments later. He presented sunny side up, all 9 lbs. 2 oz., and 22 inches of him were being forced into the birth canal at an ungodly rate. I was told to pant through the contractions and not push. It didn't matter; my body does the pushing involuntarily. DS was in distress, and was delivered immediately by forceps extraction with no anesthesia. It was the most unbelievably out of body painful experience you could imagine. But my DS was born alive and well. Absolutely perfect! The neonatal team was there to check him over but he was breathing on his own. I learned later that my OB is a world renowned expert on forceps deliveries. He trains the Yale students, and DS and I could not have been in better hands. Nobody wants to have a delivery like that, but if you need it, you are glad that it is available. There wasn't even time for me to be anesthetized or prepped for a C-section. They just pulled him out, and safely I might add. Edited March 14, 2011 by SweetBean Quote Link to comment Share on other sites More sharing options...
coffeegal Posted March 14, 2011 Share Posted March 14, 2011 I think then that we're going to compromise and I'm going to use a CNM who delivers in the hospital. :) I've never gone this route, but a bunch of friends have and they all had a wonderful experience. :001_smile: Quote Link to comment Share on other sites More sharing options...
ktgrok Posted March 14, 2011 Share Posted March 14, 2011 No, sorry, this one is a fact. There are no industrialized countries that accept midwives with the low level of training and education that characterize Midwifery Education Accreditation Council certified programs. In every other industrialized country, midwives achieve the equivalent of a BSN degree. In the US, Certified Professional Midwives do not have the training to pass the nursing board exams or practice medicine in any other context. Certified Nurse Midwives are another matter entirely. They have the equivalent of a post-bachelors degree in midwifery in addition to their bachelors of science in nursing. They are trained to understand medical science, and are competent to practice in a wide range of medical contexts. This varies by state. Here a CPM attends 3 years of school, then spends another year attending biths with another midwife. 3 years of school plus what is basically an internship is hardly a low level of training!!! Quote Link to comment Share on other sites More sharing options...
Bird Girl Posted March 15, 2011 Share Posted March 15, 2011 The problem is that the "three years spent in school" are not spent in nursing school, taking courses like anatomy and physiology. They can be spent taking classes in "homeopathy" and "plant-based medicine." The internship year can be spent shadowing a person who performs 3-6 births per month, which will mean that someone can qualify as a CPM having seen as few as 36 births--far fewer than a nursing student sees during their six-week labor and delivery rotation--and that's before they begin midwifery training. I am not saying that because someone is a CPM, they are necessarily vastly under-trained and under-experienced. I am only pointing out that the CPM designation can be earned by people who are vastly under-trained and under-experienced, and would not be licensed to practice midwifery in any other industrialized country in the world. The CPM degree does not require and nor does it signify an adequate level of training to practice midwifery in any other first-world country. Quote Link to comment Share on other sites More sharing options...
ktgrok Posted March 15, 2011 Share Posted March 15, 2011 (edited) The problem is that the "three years spent in school" are not spent in nursing school, taking courses like anatomy and physiology. They can be spent taking classes in "homeopathy" and "plant-based medicine." The internship year can be spent shadowing a person who performs 3-6 births per month, which will mean that someone can qualify as a CPM having seen as few as 36 births--far fewer than a nursing student sees during their six-week labor and delivery rotation--and that's before they begin midwifery training. I am not saying that because someone is a CPM, they are necessarily vastly under-trained and under-experienced. I am only pointing out that the CPM designation can be earned by people who are vastly under-trained and under-experienced, and would not be licensed to practice midwifery in any other industrialized country in the world. The CPM degree does not require and nor does it signify an adequate level of training to practice midwifery in any other first-world country. Wow, that is not the case here at all!!! The classes ARE things like anatomy and phsyiology, etc. Some of the schools are actually located on college campuses and share classes. And then they have to attend a certain number of births as the assistant, and then more births while supervised. I forget the number but it was much higher than 36! Also, I will argue that a nurse that has seen hundreds of hospital births still has zero knowledge of what a natural, umedicated labor looks like. My ex is a nurse, and on his OB rotation he didn't see a single woman that didn't get pitocin. Not one. And only a few that were without an epidural. So hospital birth experience doesn't really translate to birth center or homebirth practice. ETA: I just checked and the requirements to be licensed in my state are stricter than the requirements to be a CPM, apparantly. Edited March 15, 2011 by ktgrok Quote Link to comment Share on other sites More sharing options...
Bird Girl Posted March 15, 2011 Share Posted March 15, 2011 "Also, I will argue that a nurse that has seen hundreds of hospital births still has zero knowledge of what a natural, umedicated labor looks like." What are you talking about? Are you under the impression that an unmedicated labor uses a different set of organs? Do you think that the perineal tears stitch up differently, or that the baby's heartrate should be a drastically different number? What a ridiculous claim! Do you think special training is needed to watch a birth with less medical attention? Bizarre! If you are interested in reading about the various levels of training and courses that qualify for MEAC accreditation, the link is here: http://meacschools.org/accredited_schools.php#SID7 Quote Link to comment Share on other sites More sharing options...
amy g. Posted March 15, 2011 Share Posted March 15, 2011 When I was almost at term with my second child, we went to tour the hospital where my OB had an office. We walked to the nurses station, and showed them our forms, and started telling them that I wanted another unmedicated birth. They flat out told me, "No way. You'll never get that here. Every woman gets pitocin and an epidural." They also said that no pediatrician there would work with us if we had an unmedicated birth. I was really in shock, and could not figure out why they would even care. The nurse said that 2 nurses can sit at the nurses station and watch the monitor and slow down and speed up each labor so that everyone gives birth in order. An unmedicated labor is more unpredictable. They would need a nurse for each laboring woman, and that would be too expensive. We went back to my OB who had already approved my birth plan. he said, "Oh, yeah, this place is horrible. Sign in at West Houston instead." We did and everything was fine. I'm just so thankful that they told us the truth. My dad's girlfriend has been a Nurse Midwife for 30 years. She was at a teaching hospital here, but ended up moving to Portland because she said that she would see the clients, and she was supposed to agree with whatever they wanted, knowing full well that once they got to the hospital they would be given every intervention available. I'm not addressing this to the OP. I think you made a great informed choice. I'm just saying that unmedicated births ARE different, and a nurse in the hospital might not have ever seen one. Quote Link to comment Share on other sites More sharing options...
Ritsumei Posted March 15, 2011 Share Posted March 15, 2011 "Also, I will argue that a nurse that has seen hundreds of hospital births still has zero knowledge of what a natural, umedicated labor looks like." What are you talking about? Are you under the impression that an unmedicated labor uses a different set of organs? Do you think that the perineal tears stitch up differently, or that the baby's heartrate should be a drastically different number? What a ridiculous claim! Do you think special training is needed to watch a birth with less medical attention? Bizarre! If you are interested in reading about the various levels of training and courses that qualify for MEAC accreditation, the link is here: http://meacschools.org/accredited_schools.php#SID7 No, the basic organs are the same, the stuff you mention is the same, but there's much more to the equation! When you've got a medicated birth with all the monitors & so forth, the nurses don't even have to come into the room to do a basic check: they just look at the computer out at the nurses' station. They gain experience with the medications and what is "normal" when all the women have epidurals. The do NOT see women moving around, they don't learn about the non-drug type of pain relief, they don't know what to expect from a woman who is not tied to a bed, they don't know what's going on without the "reassuring" ping of the monitors... it's just not the same. Even little things can be a big difference: when I gave birth to Raven last July, he was a bit early than we were thinking, and I hadn't had my group-B strep test yet, so I had to have the IV & antibiotics. The nurse first tried to put that thing in the side of my wrist rather than the top of my hand like they usually do. I have no idea what was going through her mind when she tried that, but I'm sooo glad it didn't work! I was doing an unmedicated birth, and needed to move the wrist, which simply would not have been possible, had she gotten it in where she first tried. That sucker woulda been ripped right out of there, cuz I could barely tolerate it in the hand. I couldn't have used the hand at all, had it been in the wrist, and I needed it to support myself in the various positions I was in. I was very restless & active at the end of labor. I was putting lots of weight on my hands, and it needed to be evenly distributed. Nurses that are not used to unmedicated, mobile birth just aren't going to think of that sort of thing. And it's the little things like that which can make it or break it for so many women! (Not everyone is as ornery as me, to be willing to tell 'em to take that sucker OUT & get it right!) And that was in a hospital that's got a jacuzzi in each room, and exercise balls available for everyone, and is generally extremely friendly to unmedicated birth. We have a high Hmong population here, and my family practice doctor joked that you can tell when a Hmong woman is about to deliver "because she breaks a little sweat." I guess they just don't use the medications, culturally, and it's not that big a deal to them. He said it's pretty amazing. So the unmedicated births aren't as rare around here as they are in some places, and our hospitals are way better than some I've read about. But still, you get dumb stuff like that IV in the wrist, and it could make a big difference- and it's the nurses that are the main care providers through the main portion of labor, so they have a HUGE impact on the overall outcome. Myself, having read as much as I have, I'd go with the midwife at the birthcenter. But, that being said, it's a situation where you HAVE to educate yourself. Midwives are usually inclined to longer appointments - take advantage of that & ask TONS of questions. Read everything you can get your hands on. Educate yourself on the risks of both the birth center & the hospital. I'm convinced by the position that says that there are more risks to birthing in a hospital than at home, provided that you have both competent care and a good back-up plan and an uncomplicated pregnancy. If any of those were missing, though, I'd just stay at home as long as possible, then be assertive at the hospital - and I expect that my DH will also be assertive (he's good at that). DH and I talked a lot about what we wanted with both pregnancies. Then he ran interference so I didn't have to deal with anybody any more than necessary. That's what we wanted: it was sacred, private space for us, and I DON'T like an audience. Particularly an audience of strangers. So he played the buffer for me. And it worked for us. Tour them both. Know your options. Know your risks. Know your providers. Talk to the doctor, talk to his partners, talk to the nurses, talk to the midwives. Go ahead and take up some of their time - they'll get their money out of you when the time comes! Ask how they feel about Bradley: if they look at you like, "Huh?" then maybe that's not such a good place... Quote Link to comment Share on other sites More sharing options...
ktgrok Posted March 15, 2011 Share Posted March 15, 2011 (edited) "Also, I will argue that a nurse that has seen hundreds of hospital births still has zero knowledge of what a natural, umedicated labor looks like." What are you talking about? Are you under the impression that an unmedicated labor uses a different set of organs? Do you think that the perineal tears stitch up differently, or that the baby's heartrate should be a drastically different number? What a ridiculous claim! Do you think special training is needed to watch a birth with less medical attention? Bizarre! If you are interested in reading about the various levels of training and courses that qualify for MEAC accreditation, the link is here: http://meacschools.org/accredited_schools.php#SID7 I'd have to look into it more, but most of the schools in my state are not listed on there anyway. We have different standards I guess, but I know that getting licensed in my state is NOT easy. And the certifying exam that all CPM's have to take does cover things like what is a normal heart rate, etc. Heck, I know that and I am not a midwive. As for labor and birth beind different in an umedicated birth, um, yeah, it's totally different. The organs are the same, but they work differently. A nurse that has only seen drugged women, that can't move or even feel their contractions, is NOT going to have any experience in using labor positions to change the baby's position, for instance. Not to mention she will have a totally skewed view of normal. How can you know if labor is progressing normally if you have never seen a labor that wasn't augmented by pitocin? It is totally normal, for instance, for an unmedicated woman to have a "stall" at 4 cm for many hours, then to progress rapidly from there. If you have only seen women on pitocin, and always seen women sectioned for "failure to progress" if they stall, how would you know this is normal? If you have only seen women deliver on their backs how would you know the best position to get them in for pushing based on the position of their baby and the speed of the labor? Learning to stitch up a perineum is easy, learning ways to help the woman avoid tearing in the first place takes a lot longer and is a skill most hospital based staff just don't have. I'm not disparaging nurses. My mother is a nurse, my best friend is in nursing school,and I was married to a nurse. And they would agree with what I am saying. Edited March 15, 2011 by ktgrok Quote Link to comment Share on other sites More sharing options...
Pretty in Pink Posted March 15, 2011 Share Posted March 15, 2011 I just wanted to say that birth centers and home birth midwives can give the same drugs to stop bleeding. They carry pitocin with them for just that purpose. Right, I know that. I don't think I was clear. With my second delivery I heard the midwife instruct a nurse to order blood. Thankfully, my bleeding finally slowed and I did not end up needing that blood. I don't think you can get a blood transfusion at a birth center. Maybe I am wrong? Quote Link to comment Share on other sites More sharing options...
ktgrok Posted March 15, 2011 Share Posted March 15, 2011 Right, I know that. I don't think I was clear. With my second delivery I heard the midwife instruct a nurse to order blood. Thankfully, my bleeding finally slowed and I did not end up needing that blood. I don't think you can get a blood transfusion at a birth center. Maybe I am wrong? No, they wouldn't give a transfusion. But the idea is that the midwife would call the hospital to alert them you need blood, and transfer you there. The goal is to have them finding and getting the blood ready while you are on your way there. More than likely the drugs will have worked and you will have stopped bleeding by the time you get to the hospital, and will not need the transfusion, but you don't wait to find out. You transfer in case you do need it, and then if you don't, great. Quote Link to comment Share on other sites More sharing options...
SweetBean Posted March 15, 2011 Share Posted March 15, 2011 Either medical care varies greatly from one location to another, or there are some harsh misconceptions about hospital births being stated in this thread. When I went through nursing school over 20 yrs. ago, and did my maternity training in both a birthing center and hospital settings, there was already a move toward natural child birth. The same was true when I had my own children. When I labored at the hospital, not only were my wishes for no medication respected, they were encouraged, and I was given assistance with alternative ways to control pain. Quote Link to comment Share on other sites More sharing options...
LittleIzumi Posted March 15, 2011 Share Posted March 15, 2011 Either medical care varies greatly from one location to another, or there are some harsh misconceptions about hospital births being stated in this thread. When I went through nursing school over 20 yrs. ago, and did my maternity training in both a birthing center and hospital settings, there was already a move toward natural child birth. The same was true when I had my own children. When I labored at the hospital, not only were my wishes for no medication respected, they were encouraged, and I was given assistance with alternative ways to control pain. It varies tremendously. There is a hospital down the hill that has nearly a 100% epidural rate. (I heard it WAS 100% at one point but then a friend of mine birthed there naturally using HypnoBabies so it can't be that anymore, lol.) Eeeeeek. Whereas there is a hospital up the highway a bit that is known as the extremely natural birth friendly hospital with jacuzzis! My hossy birth was at another hospital here between the two, where they had one single natural birth friendly room. It had a tub & an exercise ball. The other rooms did not. They just had a bed & monitors. When I came in & said I was with the midwives they put me in the happy room :lol: but with at the same hossy my first birth with an OB, although I said I was hoping for a natural birth they had me lay down on the bed with the monitor & an IV & not move. Yeah. That makes it nearly impossible to go natural, IMO. And then when I got an epi with that one dd's heart rate tanked & wouldn't go up with changing position or oxygen & it was scary for a bit (last ditch effort, the nurse reached up & manually massaged her scalp & that woke her up. Eeeeeeck. Of course no actual doc came to see or help, because my doc wasn't there & ended up not even coming & they had to call a different doc in the practice.) With the midwives I went over what I wanted with them & went into the hossy with a birth plan & told them I wasn't getting an IV or constant monitoring, didn't wear the hossy gown, stayed on the birth ball for the paperwork & then hopped in the tub. The midwife told me if they gave me any hassle to have them call her & she would set them straight, LOL. S Quote Link to comment Share on other sites More sharing options...
Lawana Posted March 15, 2011 Share Posted March 15, 2011 Either medical care varies greatly from one location to another, or there are some harsh misconceptions about hospital births being stated in this thread. When I went through nursing school over 20 yrs. ago, and did my maternity training in both a birthing center and hospital settings, there was already a move toward natural child birth. The same was true when I had my own children. When I labored at the hospital, not only were my wishes for no medication respected, they were encouraged, and I was given assistance with alternative ways to control pain. How fortunate for you with regards to the bolded. Around here, unmedicated births are highly discouraged. I had pitocin with the first, but no epidural or pain meds because during the hour between the epidural being ordered, and the anesthesiologist walking into the room, I had progressed from 4cm to 10cm and was ready to deliver. (How many times do you turn down the "ready for an epidural?" question.) For the second, I knew if I could go through pitocin augmented contractions (yikes) without meds, I could stand normal contractions. I was with my stepdaughter during her labor and delivery and it was just awful. She was induced with pitocin because that was what the schedule dictated, even though she came into the hospital in the early stages of labor, and would in all likelyhood progressed on her own in time. She had wanted to go "natural", but after hours of screaming through contractions finally relented to having an epidural. The nursing staff made it abundantly clear that they had no patience or availability to help with a "natural" birth. Quote Link to comment Share on other sites More sharing options...
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