Hospital or Home: How Did You Decide Where to Birth Your Baby?

As I creep towards the halfway mark of my second pregnancy, I’m confronted by questions around which I’ve been tip-toeing: Where, oh where, will my baby be born? Should I go the hospital route again? Should I get my homebirth on this time?

Between my heavy crush on the idea of birthing my baby in the intimacy of my own home and the biting admonitions of a certain blogging skeptical obstetrician, I’m kind of, well, lost. I know what I want, and I know what I absolutely do not want, and I’m feeling a bit uptight and weary about the ability to marry the two.

You see, I got a whole lotta love for my first birthing experience. It was  empowering, awe-stoking, and filled with support and respect. My birth plan was honored nearly to the letter (there was a small hiccup with my request for delayed cord clamping), and even if I could I wouldn’t change a single thing about how my unmedicated, doula-assisted, Hypnobabies-bolstered hospital birth unfolded. (Okay, maybe I could have done without the stubbornly posterior bebe and the third degree tear.)

2012 National Rally for Change in St. Louis, MO, advocating for informed consent and evidence-based maternity care.*

But what I recognize about my hospital birth is this: the circumstances of my hospital birth experience aren’t du jour. In fact, I don’t think it’d be improper to describe those circumstances as exceptional. I worked in the women’s and children’s care center in the hospital where I delivered my son. Day in and day out for years preceeding my pregnancy and my son’s birth, I worked elbow-to-elbow with those professionals–the L&D/postpartum care/NICU nurses, lactation consultants, obstetricians, neonatologists, and pediatricians– in the position to care for me and my baby.

When the time came for me to choose an OB, I already had a pretty sound understanding, based on my professional experience, of which ones I didn’t want anywhere near my vag. When I had questions about how experienced my nurse co-workers were in supporting a patient aiming for an unmedicated birth, or how receptive they would be to the presence of my doula, or if I would be able to take my placenta home with me, I simply walked a few short strides from my office to that of the L&D nurse manager, plopped my pregnant rump down across from her, and asked my questions. When I had questions about breastfeeding resources and support, all I had to do was wave over one of my fantastic lactation consultant colleagues, and they eagerly shared their insight. I had a ton of support and intel at my fingertips long before I was wheeled up to L&D rockin’ 9cm of righteous dilation in my amniotic fluid-soaked yoga pants.

I will openly admit that I enjoyed an uncommon measure of comfort, privilege and preferential treatment birthing my baby and recovering amongst my hospital friends and co-workers. I do not hesitate to credit my unique circumstances for much of the ease I experienced navigating hospital birthing care. The biggest takeaway from my birth experience was this: the relationship you have with your care providers is integral, immeasurable, and irreplaceable.

Happy birthday, my sweet boy

I left that employment for stay-home mamahood, and our family has since relocated out of state to St. Louis. While I understand that each pregnancy and birthing experience is unique, I am acutely aware that the level of care and support I received in the past simply cannot be replicated here. And I have deeply felt reservations about a hospital birth this go ’round.

I’m currently under the care of an OB who as a reputation for supporting patients who desire a less interventive birthing, but I’m full of uncertainty about the hospital where she delivers. Sure, I could switch care providers; I could select an OB who delivers at a hospital with a better rep. Even still, I am nail-biting my way around the implicit fact that a hospital birth here would involve a few things on which I do not wish to compromise. (For example, I want my son to be integrated, when appropriate, into the birth experience of his sibling. And I do not want to be seperated from him for any great length of time, and especially not overnight. We’ve never spent a night apart.)

All signs seem to point to homebirth. Except, you know, those angrily flashing ones on the blog of a certain skeptical obstetrician. I fell down that rabbit hole, reading post after post about the inherent irresponsibility and acute risk of birthing your baby anywhere but a hospital. My cage? Rattled.

I interviewed a highly and repeatedly recommended certified professional midwife here in my neighhborhood, and I left feeling a bit lighter about the prospect of a homebirth. I am considering transferring to her care. In the coming days I will be following up with my insurance company to ascertain the extent of my benefits for an out-of-hospital birth. If nothing was covered at all and I needed to pay the full cost out of pocket, the math shows that I’d be spending just a couple of hundred dollars more than what I paid for my OB and hospital birth with my son. Cost, as I understand it at this point, is not a deterrent.

There is a birthing center scheduled to open this fall about an hour’s drive from where I live in the city. I’ve spoken with the certified nurse midwife heading up that effort, and she, too, was lovely and resourceful. Still, I’m uncertain about the idea of driving an hour away to have my baby. But maybe it’d be worth it?

Help a hormotional pregnant lady out: Did you struggle with the question of where to birth your baby/ies? What helped you confidently forge a decision? What resources/reading did you find particularly helpful?

*Wanna know more about informed consent and evidence-based maternity care? Check it out here.

Rhianna blogs from her adopted hometown of St. Louis, and never before has she missed her former hometown (and its awesome nurses) as much as she does right now. Things keeping her awake at night: crane-kicks to the kidneys courtesy of her bedsharing toddler; in utero dance party courtesy of wiggly fetus; and the anxiety surrounding the place in which the two will meet for the first time.

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17 thoughts on “Hospital or Home: How Did You Decide Where to Birth Your Baby?”

  1. I, too, had an amazing wouldn’t-change-it-for-nothing hospital birth the first time around. As far as your question, if I struggled with my decision to homebirth this second pregnancy, no way. I know how my body is during pregnancy and labor and it simply will do well in any setting.

    Plus, *ahem* contractions in the drive to the hospital were horrendously uncomfortable. So. There. 😉

    1. I think my professional experience is really coloring my inability to fully embrace the idea of a homebirth. Working on antepartum, with perinatology and in the NICU, I was surrounded by all of the high risk outcomes for pregnancy and birth. Even though I have no high risk indicators personally, and despite my understanding that these outcomes are the exception, I still waver on the homebirth idea. Which makes me wonder: if I can’t fully embrace it, if there is even the smallest hint of fear of a bad outcome, will I be too inhibited to have my baby at home? Just makes me wonder.

      I lived within walking distance of the hosptial where I delivered, so I was in the car for maybe 5 minutes for the drive there, and YES, contractions in the car were zero amounts of fun. 😉

  2. We moved from St. Louis in the middle of my pregnancy and were super happy about the hospital situation that awaited us in Boston. We had a perfectly competent OB (who was my GYN for years during grad school), but when we arrived in MA realized how much we had been missing. We loved the mid-wife/OB combo at the hospitals and how all of our requests and concerns were taken into consideration. Because we were renting, we didn’t feel comfortable birthing at home and I was weary of how my body would do during the process. We chose hospital and I would do it all again. I had a Glorious (notice the capital G) pregnancy. The birth, however, was a hairs width from a C-section after 24 hours of labor when our daughter was presenting face first. I am thankful for being at the hospital and for our midwife who fought hard with the doctors to allow me to continue with a vaginal birth. I would birth there anytime!

    Long story short…if you were rocking it the first time and aren’t comfortable with the STL hospitals (most are great, but very medicalized because of socio-economic reasons) then go with the birthing center. Just check MO law to make sure that if something goes wrong you can be transferred to a medical facility. Although we all have birth plans and wishes, it all comes down to bodily common sense and weighing the risks. I know that I will never birth at home. Am I ok with that? Hell yes!

    1. Thanks, Stephanie. 😉 Why do I always forget the STL connection?

      If I were back in my old city, I’d birth in that same hospital again. No question.

      I guess I should have elaborated further in my post, but I didn’t want to get to technical. From what I’ve learned so far, there is only one CNM who delivers in any of the hospitals here…and she only delivers one day a week. In VA, where I previously lived, CNMs delivered (under the coverage of an OB in their practice) in the hospitals all the time. There are even some family doctors here who provide maternity care and deliver in the hospitals. I was so surprised to learn how differently things work here. STL is straaaange. 🙂

      The birth center, as I’ve been told, has two hospitals within minutes of its location, and there is an OB at both who has agreed to acceptt any transferring patients from the birth center. There is also an MD supervising/covering the CNM. They’ve been working on opening the birth center for years–lots of legwork and partnershilp building has been established, it appears. If it were just a tad bit closer, this would be a no brainer for me. I’d be getting my birth center birth on without all the thumb-twidding and chin-stroking.

      I suppose I should be thankful to have these options at my fingertips at all (although I wish some of the options were more optimal, obviously).

      Thanks for your support, lady!

      1. We had to drive 30 miles to the nearest hospital for Stella’s birth (which was VERY similar to your experience) and many people from around here drive 90 miles to a more birth friendly hospital (that allows water births, etc)… though i had such a good experience with my midwife at the local hospital, I’m thinking that we might do that again. My point is that driving an hour to a birthing center isn’t that crazy to think about. People who live in the boonies (like me) do that all the time!

        However, I think you have decided on a home birth now, and I am SOOOOO excited for you!! I would love love love to do that, but I don’t know if I’ll be able to convince my husband of that (since the closest hospital is 30 miles away in case of the need for a transfer). We shall see… i live in a pretty “granola” part of CO, and there are a ton of home births done here, so I might get my way. 🙂

  3. I think that if we have any control over the outcome of our labor, it is how well we are able to surrender to the process, letting go of anxiety and our desire for control. Thus I think this decision can only be rightly made through knowing yourself well and feeling confident and safe with whatever choice you do make. I don’t think there is one answer that fits everyone.

    What I would focus on is doing your best to find the medical and emotional support you need. Be as comfortable as possible and strive to mentally let go of the things you just can’t control. In the end, its not where you give birth but how comfortable you are giving birth where you are.

    I think the safety of home birth depends on the midwives you choose and their relations with the local hospitals. Either way, the hospital has to be friendly to respecting your decisions because there is always the chance of needing your care transferred if you become high risk.

    1. Yes! This: “In the end, its not where you give birth but how comfortable you are giving birth where you are.” I know that once I make a decision I will fully commit to it and any further additional self-advocacy/education/comfort-finding. It’s just the getting there–the soul-searching–that gets me all worked up.

      Wise words. Thanks for sharing!

    2. I totally agree with the idea of, ultimately, needing to be where you are going to be most comfortable surrendering to the process of labor to have the best birth possible. Since you had a great hospital experience before, I’d imagine that is a good starting point if you decide on that route again– bonus!
      I had a home birth after planning initially to find an OB and go the hospital route. From my experience during my L&D rotation in nursing school I had reservations about how things were handled in L&D, even though the hospital we were at was one of the ‘best’ in terms of being family friendly, utilizing midwives, lactation consultants, etc. From what I have heard from many mommas I’ve met since is that the experience in any hospital can be very hit or miss, depending on the staff present at the time you go into labor (and when you’re finishing up- which is likely to be entirely different)! All that to say, I’m not sure how much I would rely on general hospital reputation to expect a good experience again. I imagine it would help tremendously to have a great doula or midwife with you to advocate for you, especially if anything unexpected comes up. I know that would be crucial for me- hurty contractions every few minutes don’t help much with clear thinking . Labor just doesn’t seem like a time where you’ll be in the mood to be worrying about extra stuff. =)
      The reasons I didn’t and still wouldn’t choose a birthing center were primarily those of comfort and utility. If you’re not going to be in the privacy and comfortable space of your own home, why drive anywhere in the middle of labor (and now knowing how bad contractions are I REALLY would want to avoid that) just to be somewhere that’s not a hospital with all the sophisticated medical back-up right at your fingertips?
      Home births with certified midwives have great outcomes- better than most hospitals- for low risk pregnancies. It would solve the problem of how to involve your first kiddo without all the hassle. I guess I’m all about keeping things as hassle free (for me!) as possible. I loved my home birth experience. It sounds like you kinda want to go that route for #2? I’m interested to hear more about where your thought process leads you!
      Best, Elizabeth

  4. Wish I had it in me to birth at home … but I guess I’m too much a product of “the system” … I’m too scared! Part of me wishes I’d have one of those super fast “oh no, look the baby just fell out at home!” moments like on that show where the women didn’t know they were pregnant. Like you, I have never left my son overnight and that, right now, is one of my biggest concerns about the upcoming birth. It is not normal for him to be away from me for more than two or three hours tops … and that is only with dad (with whom he is very securely attached). Thankfully my husband “gets it ” when it comes to attachment and has even suggested bringing a pack-and-play so he can room in with us (not sure if this will fly … have to check policy). I’m so interested to know what you will choose!

    1. It really is my issue about being separated from my son that’s gumming up my decision-making. I have great, trusted local in-laws who would be delighted to care for my son overnight, but I WANT him to be with us. This is as much a milestone and huge moment for transition for him as it is for us, you know?

      Thanks for sharing your similar concern! I hope it works out that you are able to bring a PnP to the hospital with you! If there is another thing hospitals can do to promote baby-friendly practices, it’s to make the birthing experience more inclusive for siblings. I mean, yeah, obviously it is not appropriate for a toddler to be bounding around a room when a mother is laboring–who could relax into her labor with all that going on anway?) But there are some hospitals that do not permit overnights for siblings under a certain age. Even with an additional parent/caregiver present! How family-UNfriendly is that?

      1. Oh – and I wanted to say that I was there when my Mom gave birth to my brother (I was 9). I only have vague memories of it, even though I was in the room, b/c he was born at like 2am and I was tired. How funny is that? I love that even 30 years ago, my mom was fighting a very standard NON-family friendly system and doing her own thing. (insisted on no epidural, my dad and myself being there, etc)

  5. I decided very early in my pregnancy (my son is now 7 months old) that I did NOT want to give birth in a hospital. Of course, at the time I lived in Northern Illinois; all of the hospitals nearby that my insurance covered had c-section rates upwards of 30% and I believe they all required continuous fetal monitoring during labor, which would also likely mean an IV, which meant that moving around and trying different positions was probably “out.” My only birth center option was about an hour and a half drive away, over the Wisconsin border. Still, this was my tentative plan until I was connected with a midwife a little closer (45 minutes away) who primarily did home births but was in the process of opening a birth center. By the end of my pregnancy, I had become comfortable with the idea of either one, and seeing as how the birth center was not ready when I went into labor… I had a beautiful home birth after about 15 hours of labor. It helped that I had a smart, capable midwife who I had every confidence in; I knew she wouldn’t hesitate to transfer me if she felt it was best. It also helped that there were multiple hospitals within a 15 minute drive. One of the biggest helps for me was reading positive birth stories from women who had birthed at home; Birth Without Fear and Mama Birth are great sources of positive birth stories of all kinds (not just home births).

    1. Holly, it is really meaningful and reassuring to read about your experience! I will definitely check out your suggested reading! Thanks for sharing them!

  6. Rhianna….how is that you always write about the (nail-biting) topics that I’m currently losing sleep over? I think your concerns over birthing at an unknown hospital are completely valid. I would assume that one of the reasons you felt so comfortable birthing at your last hospital is because you saw those surroundings, day in and day out, as your place of employment.

    Fear of the unknown and factors beyond my control are the issues coloring my decision, and I would assume yours as well. As I wrote in a blog post earlier this summer, the hospital my husband works for does not provide midwifery coverage, and they have one of the highest c-section rates in the city. They are on their way to baby-friendly status, which while an excellent sign, is more indicative of their stance on breastfeeding and not necessarily natural birth. But lady, I tell ya, I had some serious complications with my last birth and without the extreme diligence and expertise of my midwife, would have been sliced and diced by an OBGYN for sure. My trust and confidence is in the midwife who my insurance does not cover. Should I go with whom I trust and deal with the medical bills later? Or do I try another midwife and homebirth? Midwives, like OBGYNs are not all created equal. Try to find the most natural-leaning OBGYN I can? I’ve heard one name floating around, and it’s a male. While I’ve had a male OBGYN before, after having female midwives, I’m not sure I can go back.

    All this rambling is to say…I’m with ya, sister, and I’m not even pregnant yet! My heart goes out to you in this decision making, and I just hope that the right answer will come to you. I know it will. Trust your instincts, they are your best tool in making this decision.

    Keep us updated on your decision making!
    Kate

  7. I chose the hospital closest to our house because I too never spent a night away from my child. I had no choice but to ge to the hospital because of the GD, but I doubt I would have been comfortable birthing at home.
    Reading about how things are in US, I was surprised to find out that what women are planning and not really getting back there, in Germany is standard care. They encourage you to go the natural way, they wait with the cord clamping, the baby is put on your breast immediately after birth, they try to avoid giving formula because it might interfere with breastfeeding, etc. c-sections are used only when medically advisable. I do not know how it was before this, but I know that now I had my midwife and my doctor by my birthing pool and they helped me have the greatest moments of my life.
    If they can do it here, why cannot they do it in the US as well?
    Ironically, it is a French doctor who started promoting this natural approach to birthing, Michel Odent, and he did it in UK. Both countries have currently lower rates of natural births and breastfeeding than their germanic or scandinavic peers. Which is a shame.
    I strongly recommend you to read Call the Midwife – not for your enlightment, but entertainment. It is really a heart-warming, tender, sweet book about midwives in the 50s in East End London. It makes you want more babies. It even made my husband want more babies! 🙂 Lovely book indeed. The tv series is also not bad.
    I hope that you get a great second birth. Remember that it is true it lasts less than the first. And it is easier somehow (but it still hurts, don’t worry :-)). Thinking of you.

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