Freaking out - 30 wks and I don't like my OB practice

[turtledove]

and would like to consider a midwife assisted birth. There are no midwives in any of the practices that deliver at my hospital. That leaves me with a homebirth, or potentially a birth center birth- assuming someone would take me at this point in my pregnancy. I say potentially a birth center birth because the BC is scheduled to open 6/1 and I am due 6/8. Oh, and my insurance would not cover it (whereas it covers 100% of a hospital birth).

Did anyone switch to midwife/homebirth this late in the game? I now feel like I am completely unprepared to go that route, but am not sure I want to deliver with my OB practice. The other OB practices that deliver at my hospital are not any better, so I would stay with my current practice before switching OB practices.

My OB's have a pretty high C-section rate. If you google their practice, they are rated about 2.5 out of 5 stars. Most people I know in my area go to this practice. Of the people I know, they are either ambivilent or don't like them/have had a bad experience. They are a practice of 5 female doctors. Two of them I like fine (including the one who delivered DD). One I really don't like, one I haven't met, and one I have only seen once and that was when I was pregnant with DD (over 5 years ago). Their practice is absolutely horrid to deal with. Everyone (other than the Dr's) is rude, inconsiderate, they always run late, and always brush you off. I almost left the practice when I was pregnant with DD because I had an absolutely horrible experience when I thought I was miscarrying with the OB nurse coordinator. They only schedule you with a doctor every other visit unless you are high risk (which I am not), otherwise you see a nurse. I had to call the after hours doctor line the other day when I was experiencing numbness in my arm. The Dr. didn't really listen to what I was saying about my symptoms before telling me I had carpel tunnel. I just really felt disregarded.

I don't know if it is the hormones making me question everything now, or just fear that this experience is not going to go how I would like it to go. Where is the line between gut feeling and insanity?!?!

[SnuggleBuggles]

In my prenatal yoga class (aka natural birthing brainwashing central :)) there were several woman that switched in their 2nd and 3rd trimesters. Not unheard of. I figure it's your birth and you are stuck with the experience and memories forever.

The midwives that will be at the birth center, where are they currently working? Do those practices look ok? I wouldn't bank on the BC opening on time. There are always delays on those things. But, a hospital birth with one of the midwives from there by your side could still be good.

Is there another hospital in your area that might have more choices?

There's a lot to be said for gut feeling. It wouldn't hurt to get all your options and see what you can do.

Beth

[ohsara430]

Do you have any other hospitals in your area? Are there midwives associated with any of the other OB practices? I completely get your uneasiness with your current practice. I switched from a practice of 8 women to a solo practice male OB when I had DD. It was quite a change but I was so relieved that I did, I liked knowing who would be there to deliver and liked his overall philosophy and patients and birthing.

You could try calling the birthing center/maternity floor of the hospital you are planning to go to and ask who they would recommend as a dr. You'll have to tell them what you are looking for though. You could also consider hiring a doula. They usually have lots of insight about different doctors and practices and can really help advocate for you during labor and delivery. Our doula during DD's birth was worth her weight in gold. She had lots of great info beforehand and during labor and delivery took great care of DH & I (I was in labor for over 48 hrs before delivering DD b/c she was mispositioned).

Ultimately I would tell you to trust your instincts. There's no harm in checking out other options, it's not too late and you might as well see if something else would be a better fit your family.

[brittone2]

nak-
It isn't too late.

With DS1 I started w/ a practice of OBs and switched to midwifery care part way through my 2nd trimester. That meant driving 45 mins to the hospital they delivered at. I realized their practice and hospital had policies that I considered not to be evidence based, and I spoke w/ a very experienced doula who gently clued me in that what I was looking for in a birth experience was going to be tough to get from that hospital and that practice. I'm forever thankful to her for that!

WIth DD, I was at a FSBC. Great experience. COntinued to see them for well woman care when not pg.

With my pgcy with DS2, I was at the FSBC but really, really wanting a homebirth. I would have gone that route from the beginning but DH was in grad school and money was tight, etc. I ended up switching at 36-37 weeks into a homebirth CNM practice LOL. CNM from a local hospital practice was opening her own homebirth practice (had done 10 years of homebirths previously in a different state) and we were her first catch in her new practice. Dh came home one day w/ an article in the paper about her practice opening, and it just felt right to at least talk to her. My insurance paid for a big portion of our HB with her, and I'm so glad we ended up going w/ her.

I loved my FSBC experience but I am glad I had a homebirth with baby #3. The things that helped me feel better about switching that late in the game were that I was low risk/uncomplicated history so nothing that my midwife needed to really "get up to speed" on, and the fact that I still hadn't seen 2 of the 6 midwives at the birth center at 36 weeks. A few other mws I had only met 1x. It wasn't as if I had forged a major bond w/ many of them. I ended up having several visits w/ my homebirth MW before labor, which actually meant more visits than I would have had with several of the midwives at the FSBC.

IMO, it wouldn't hurt to talk to the other practitioners. Get a feel for whether they have openings, whether insurance might pay. Some midwives will barter or allow payment plans or a sliding scale. See if any of the practitioners are even a good fit for your needs.

[Beckylove]

I definitely understand your frustration. I am in an area with few options. 1. An OB hospital birth, where they have very restrictive policies. OR 2. A lay-midwife homebirth.

I have had three different OBs for 4 different pregnancies and have decided that they are all pretty similar in my area, much like it sounds in yours. Not necessarily bad-- but they all follow the same CYA hospital policies and just are not what I had hoped or envisioned for my upcoming birth.

But I cannot overcome my apprehension and do the full midwife/homebirth route. So I am choosing to stick it out with my OB.

I am educating myself and my husband about what I would like and would not like to happen during labor. And we are preparing ourselves to stick to the plan. I don't have to consent to something I don't want to happen. I want a med free birth and I won't be talked into pitocin to speed things along. I will change positions/move around as I feel the need to. My husband and I are prepared to advocate for what we want during this birth experience, even if it means that we are perceived as being "difficult".

I don't think this is the best option, but the best of what is available. If I could get a CNM or be in a birthing center, that would be awesome, but that is not an option where I am.

Have you considered a doula? That might be helpful in your case-- someone who is completely on-board with your hopes for birth, who could help advocate for you. I am looking into it, but having trouble finding someone experienced who I feel I can trust.

I definitely understand your frustration. This is my thought process as I mull through similar issues, FWIW. I would love to know what you decide and good luck!

[Edensmum]

It isn't too late. Trust your gut, if you don't feel good about them, don't put yourself in their hands. I switched twice and then decided to go the Farm in Tennessee with my last pregnancy because I just could not find a decent fit. I was a VBAC hopeful in a very unsupportive city though. We paid out of pocket for our midwife care at the Farm, but when we thought about the things we spend money on, wedding, cars, stroller, why is our health and safety not even more worth that? That's how we made peace with it.
It's stressful to be pregnant and change care providers. Take a deep breath, relax, and trust you instincts. Find someone on the same page as you and get a doula to help you with all of this.
Good luck.

[alirebco]

I switched from an OB practice to a midwife/freestanding birth center at 28 weeks. I am so happy I did too. My appointments are not just 5 minutes, they're so helpful, and I'm excited that I don't have to give birth in the hospital (I hated it the first time).

We also considered homebirth but would have to pay out of pocket and it was too much $$ for us at this time.

[llama8]

Instead of going the midwife route, you could always find another OB. I absolutely love my ob. She never rushes you out, allows extra monitoring for peace of mind, and tries to follow what I want. My hospital has private rooms and gourmet meals. It is super family friendly.

Maybe because I am on my 2nd slightly high risk pregnancy, but midwives and birthing centers/home births make me a little nervous. I like to know a level 3 NICU is available immediately if I needed it (I haven't yet).

I have heard too many friends/acquantances have a little complication at birth (ie: breathing problems) and the baby needed the NICU for a few days to survive when it was unexpected.

[misshollygolightly]

Have you considered hiring a doula to be present during (and advocate for you) during your OB-assisted, hospital birth? If you hired a doula, you could be confident that she would be there so you'd at least know and feel good about one of the people involved (even if the OB happened to be one of the ones you don't care for). She could help guide you through the labor/delivery and discourage any unnecessary medical interventions. Above all else, I think it might give you the peace of mind you're looking for. Even if your insurance doesn't cover a doula, it would surely be less expensive to hire one and have an insurance-covered OB and hospital rather than pay entirely out of pocket at the midwife birthing center that may or may not be open in time.

[Katigre]

ITA with a pp to trust your gut. I switched providers with DD at 31.5 weeks pregnant - I absolutely did the right thing. It just took me that long to really listen to my instincts and get into gear ; ). I switched from a decent hospital-based ob/midwifery practice to a homebirth midwife and it was the right thing for me to do.

Switching was no big deal, really. I would just act fast b/c many providers say that 32 weeks is their limit for switching easily (which I can understand). I started by emailing/calling all the other birth providers in my area and then interviewed one and we clicked well and I went with her.

[Katigre]

I have heard too many friends/acquantances have a little complication at birth (ie: breathing problems) and the baby needed the NICU for a few days to survive when it was unexpected.
FWIW, my homebirth midwife was trained in neonatal ressucitation and had equipment with her to oxygenate and stabilize a newborn in need of transport to a NICU. Homebirth plans always include a transfer plan if mom's or baby's health needs it.

[Multimama]

I haven't read all the other responses, but I was just talking about this with a homebirth midwife the other day, so i thought I'd post. She said that it is completely normal to change from OB to homebirth or vice versa up until 28 weeks and that midwives usually have no problem accepting you even for awhile after that so I think you should be fine to switch. She said that it *can* get harder to switch to an OB later in your pregnancy from a midwife because of their concerns with liability, insurance, etc. If you don't feel good about this practice, I would definitely switch to someone you do feel comfortable with.

[brittone2]

FWIW, my homebirth midwife was trained in neonatal ressucitation and had equipment with her to oxygenate and stabilize a newborn in need of transport to a NICU. Homebirth plans always include a transfer plan if mom's or baby's health needs it.
:yeahthat:

My homebirth midwife had the same equipment available that was available at FSBC, which is the option I used with DD's birth. Both the midwives at the FSBC and the homebirth midwife were trained in neonatal resuscitation, have oxygen available, can stabilize mom/baby in an emergency.

[ashleybama24]

I would 100% switch if you are feeling aprehensive. I switched to a group of midwives when I became pregnant with my son in 2009 and have never been happier. They are on call 24/7, they know me, my family, my pregnancy and I didn't get stuck with a stranger when I had my son. In fact my midwife never left my side when active labor kicked in! I felt so taken care of throughout both my pregnancies (I'm 23 wks now with #2) and am thrilled you are considering this even so late into your pregnancy!

Even if your insurance doesn't cover it, it may still be cheaper than a hospital birth. Women all over the world have babies at homes....I'm not sure why we still insist on going to a hospital here in the US...we aren't sick.

[daisymommy]

I would absolutely do whatever you need to switch. Pay out of pocket to get the care you want if you have to. I had a horrible hospital birth experience with baby #1 that emotionally haunted me until I had a positive experience to heal it (DD born in birth center, drug free, and then baby #3 born at home really wiped the slate clean of all that emotional baggage I carried around all those years). Yes, it affected me that much. And DS was not able to breastfeed as a direct result of the whole experience as well.

I honestly feel that my birth center and home birth experiences were safer than my traditional hospital birth was. So many unsound, un-needed interventions were pushed on me and my son.

The midwives I worked with take mothers up to 1 month before their due date, as long as they pass the "risk-analysis" health screening. So it's possible you could still go that route!



the Farm in Tennessee

:eek: No way! I'd love to hear about that experience someday!

[turtledove]

Thanks ladies, I really appreciate all of the support! After we put DD to bed last night, I cried to DH about how I was feeling about everything. He was a little taken aback (probably more by the tears than anything), but told me to look into whatever I felt was best. He knew that I had not been happy with the practice and especially the one doctor. I don't know how he would respond if I chose homebirth, but I think he would ultimately support me if that is the route I wanted to take.

There is a midwife practice that is very close to me that was recommended by a friend of mine. They mostly do homebirths, but they are the ones opening up a birth center on 6/1. I sent an email to the MW explaining my situation and that I would like to meet with them. I'm not sure they even take people this late in the game, or if this is the route I would like to take, but I figure I owe it to myself to look into it. There are three midwives (CPM) in this practice. The one who started the practice is an RN, CPM, and Naturopathic Doctor. According to the website they have all births attended by a midwife and a birth assistant - "a student or apprentice who is certified in neonatal resuscitation and CPR". Their hospital transfer rate is 5%.

The hospital I delivered DD at has a Level III NICU. I don't really have issues with the hospital. I didn't like my L&D nurse, and one of the after care nurses wasn't the best. I had some really nice, helpful nurses there too. I had a private, spacious room, and the food was really good. My labor didn't go quite as planned, and I think the anesthesiologist was a sadist, but I don't feel "tramuatized" by the birth. Ultimately, I was handed a healthy baby girl, and I didn't have a c-section or an episotomy (my two biggest fears). I don't know why I am freaking out so much this time. There are no midwives at this hospital. The next closest hospital also has a Level III NICU (which is strange b/c when I delivered DD I would have sworn this hospital was only a Level II). I do know that there are practices with midwives who deliver at this hospital, but I haven't heard anything about the practice/doctors/midwives. There is another hospital that is a bit further away that is where all the "high risk" babies/moms are born/deliver. This is where your baby would be transferred if the local hospital NICU was unable to provide the level of care that they needed. I don't know if there are any midwives that deliver there - I would assume so since it is so large, but once again nobody has recommended a practice.

I live in the suburbs of a metropolitan area that has awful traffic. During rush hour, it could take me 40mins to get to the closest hospital (20 mins no traffic), Hospital 2 could take me 1.25 hours (35 mins no traffic), and Hospital 3 could take 1.5+ hours at the height of rush hour (50 mins no traffic). If I was high risk, or there was an issue with the baby, I would deliver at Hospital 3, as they are prepared for pretty much anything. If I choose the birth center, and it opens in time, it would be between Hospital 1 and Hospital 2, and could conceivably take about an hour to get there in rush hour (25-30 mins no traffic). It is over the county line, so any hospital transfer would (I am assuming here) go to Hospital 2.

I am going to meet with the midwife before I make a decision. I'm just not sure what the right move is for me. If I decide not to go the midwife route, I may look for a doula and just stay with my current practice. I'm just so confused, but feel slightly better now that I have at least reached out to change something - regardless of what I ultimately decide.

Thanks again ladies, I really appreciate it. If anyone wants to add anything about overcoming fear of not having a hospital delivery, or comment on anything I've written, feel free!!

[ashleybama24]

I would look into the other midwives groups that also delivers at a hospital. Check out all your options even if you don't have referals to that practice.
I know here in Texas midwives have to be CNM's and registered with the state so even if they deliver you at home they are very very qualified.


I just know so many friends that have OB's they don't love and get forced into deliveries they aren't happy with or C-sections and it makes me so sad when it's usually not necessary. This is your birth and you should have the right to have it any way you want!

[fordtraktor]

Given that traffic situation, I would consider a doula and your or another OB practice.

First, the insurance thing would matter to me. A lot. I would rather have the money to put in a college fund for the baby. But admittedly, I am not as focused on the birth experience as many so your priorities might differ and that is OK, everyone has things that are important. But when I'm thinking about money decisions I always weigh what else I could be doing with the money and it helps guide my decisions.

Did I understand correctly and it will take an hour from the new MW practice to the hospital? An hour (in traffic) is not an acceptable transfer time if something goes wrong. Five or ten minutes, maybe. An hour is way, way too long.

[Multimama]

Did I understand correctly and it will take an hour from the new MW practice to the hospital? An hour (in traffic) is not an acceptable transfer time if something goes wrong. Five or ten minutes, maybe. An hour is way, way too long.

I think she means it would take her an hour to get to the birthing center. I can't imagine they would build a birthing center that wasn't a reasonable transfer time away from a hospital. Right?

[turtledove]

I think she means it would take her an hour to get to the birthing center. I can't imagine they would build a birthing center that wasn't a reasonable transfer time away from a hospital. Right?


Correct. Assuming no traffic, 10 minutes to Hospital 2, 15 minutes to Hospital 1 (maybe less depending on how fast you are driving, and how you hit the lights).