WWYD regarding early July delivery and OB options?

[Liziz]

I've put off this decision for too long because it stresses me out so much....please share your thoughts on what you'd do!

I have military healthcare and for DD, I got my OB care and delivered DD at the military medical center in town. While OB experience left a bit to be desired (inconvenient drive to the office, didn't get to always see same provider, poor staff support/attitudes, hard to get appointments), I was always happy w/ the clinical quality of my care and didn't worry about it too much. The hospital for delivery was great -- we had a great experience, no complaints, very nice facility, etc.

I'd deliver there again, except -- I'm due in early July and the military medical center in town is a BIG teaching hospital. July is the craziest month for teaching hospitals, especially early July. DH is a physician so we've witnessed it firsthand -- I've always said I want nothing to do with hospitals in July. I have every reason to expect a routine delivery without any issues -- but you never know. It affects both changes in the OBs staffing the hospital, as well as the anesthesiologists, pediatricians, and any subspecialist. So, which of these options would you choose?

Option 1: stick with the military medical facility. It's known, you like the hospital, and chances are things will go smoothly so there's no need to worry so much. (AKA: known entity but could be crazy)

Option 2: go to civilian hospital #1 -- I have good recommendations from several friends about OBs that deliver at this hospital, but hospital itself gives me some pause: don't allow rooming in (requires baby to go to nursery for several hours); I've recently heard that nursing staff is to some degree at odds/frustrated with administration, which is sometimes apparent in less friendly attitudes towards patient care. (AKA: good OB choices, not sure about the hospital)

Option 3: go to civilian hospital #2 -- I have zero recommendations for OBs that deliver at this hospital, and haven't loved any of the options I've looked at (not bad, just haven't loved them). However, I know someone who delivered there and LOVED it (her OB isn't an option anymore). Hospital supports rooming in, which is important to me. Hospital gets really good marks for excellent attentive and engaged nurses. (AKA: unknown OBs, but good hospital)

On one hand I feel like I should choose based most on OB, because I'll see that person more than a 1-2 day birth and delivery. But on the other hand, I feel like the birth and delivery is the most important part of the whole thing. I also realize I'm stressing about this much more than I should, and that I just need to go with something and I'll end up with a lovely baby -- but I just can't do that!

[SnuggleBuggles]

The birth experience matters a bunch to me. I've been lucky to have 2 really good experiences. I'd rule out civilian hospital 1 due to lack of rooming in. That policy may be the tip of the iceberg for other policies that might also be less than ideal for you. Have you looked at midwives at all (CNMs) that deliver at hospitals? You can still have pain meds etc with one. They just usually offer a different level of support and participation in birth. Between the other 2 hospitals? I lean non military bc you didn't love the practice but I can see that the unknown is stressing you out. I moved before pregnancy #2 and picked a place out of the blue. Unless I really know the person has my same birth and prenatal philosophy, I don't care much for the recommendations of others. I went that route with ds1 in the beginning and it was totally the wrong fit. Keep researching. Give yourself 1-2 more weeks to find someone for that hospital. If you can't, just stick with the military option and call it a day. Good luck!

[klwa]

Honestly, based on what you're saying, I'd go with the military hospital.

I wouldn't want to go to civilian hospital 1 because of the poor nursing experiences, as well as the rooming in policy. The only other one I'd consider is civilian hospital 2, IF you can get good recommendations for an OB.

The nurses, in my experience, are more important than the doctors during labor. And while I did SEE the doctors regularly during my pregnancies, unless there was a problem, most visits were "Hi. You shouldn't be gaining that much/you need to gain more! Well, see you in a month." The nurses were the ones to stay in the room with me, make sure everything was going okay, and call the doctor when it was time. If the military hospital has good nursing staff, it's a no brainer to me, even if things do get wonky in July. (And, hey, maybe baby will be a little early or a little late & it won't be during the worst of the craziness!)

[AngB]

I've had some really bad military healthcare experiences. And I would hate just seeing random doctors. So I am going with option #3. Maybe find some natural birth minded friends (doulas) for OB recs? Even if you don't actually want a natural birth, they usually recommend fairly good doctors and medical professionals.

[JBaxter]

Remember you can toss anyone out of your room you want. Be vocal. :D

[Katigre]

I'd go with #3 and then find a midwife/OB who attends there. I chose my birth providers based on the facility where I wanted to give birth.

[jam224]

I would go with option 1. I delivered DD at a military hospital and DH is a doctor too. July is a crazy time, but the new docs won't be alone. I think especially because you delivered there before and had a positive experience, it's your best option.

[Philly Mom]

I agree with number 1 and I agree that the nurses are the most important people in delivery. I understand the concern about July but every baby I know born in July was born at a teaching hospital. My kids were born at a teaching hospital too (first one in early August) and I liked that there were so many people attending to me since my OB only came in at the end.

[abh5e8]

I would go with option 1. I delivered DD at a military hospital and DH is a doctor too. July is a crazy time, but the new docs won't be alone. I think especially because you delivered there before and had a positive experience, it's your best option.

well, true that new interns will be supervised...but remember, residency finishes in June, so all of those brand new attendings (ie. the docs in charge of the interns) are also new.

i'd go with option 3 and start asking around for good OB/midwife recommendations. no rooming in would be a deal breaker for me and I would avoid a teaching hospital at all costs in July.

[jam224]

well, true that new interns will be supervised...but remember, residency finishes in June, so all of those brand new attendings (ie. the docs in charge of the interns) are also new.

Attendings may be new to the hospital, but they're not inexperienced.

[trcy]

I voted for 1, but was torn between 1 & 3. If you can find an OB you like, 3 would also be good. I am not sure I would want to deal with finding a new doctor, but I am kind of lazy these days. Lol.

[westwoodmom04]

well, true that new interns will be supervised...but remember, residency finishes in June, so all of those brand new attendings (ie. the docs in charge of the interns) are also new.

i'd go with option 3 and start asking around for good OB/midwife recommendations. no rooming in would be a deal breaker for me and I would avoid a teaching hospital at all costs in July.

Why would there be all new attendings? Most places hire a new attending every few years; wouldn't op be with her OB group?

[abh5e8]

Oh no, not all will be new. But some will be every year. Just wanted to point out its not just the residents and students who are new in July.

[Liziz]

Thanks for all the feedback! You've helped validate some of what I'd already been thinking (done -- I'm eliminating civilian hospital #1 from my options!). I also had the chance to talk to one of the physicians I work with and trust a lot -- she's civilian now, but was former military and has seen both sides (and had her babies in a military facility, too). She really reassured me that I can make the call on who I want treating me/delivering, etc. Said that in July the staff expect to be more involved, and that especially b/c my husband is a physician working in the same facility (but it's huge, he doesn't know anyone in the OBGYN department...and he's always super reluctant in any situation to ask for special treatment, so I have to drive it), felt really confident no one would be annoyed with me if I asked for the staff physician (vs. new intern, etc.).

Also, for those who reminded me it's more about the nurses, again -- good call, you're right. I had much more interaction with the nurses when I had DD than I did with the physicians. I think I'm likely going to stay with the military facility. Somehow, the unknown is really the most stressful part to me, especially b/c my experience with DD at the military hospital was so positive. I'd be really annoyed to switch then end up having the new baby at the end of June and feel like I didn't actually "need" to switch!

[Liziz]

Oh -- and I guess I should also comment that in my first "very positive" birth experience with DD ... I didn't actually see a staff physician the entire time (birth or recovery)! A third-year resident and a chief resident delivered DD. So it's not like I'm against resident participation in the birth at all....mostly I'm just going to be clear this time around (and make sure DH is prepared in case I'm in a daze) that the intern doesn't get to learn stitching tears on me or anything like that, if it comes to it!

[AustenFan]

Sounds like you've already decided, but I wanted to chime in that 1 or 3 were my choices, though I voted 3 because I've had bad experiences with teaching hospitals throughout my life. To encourage you about changing doctors, I've had four children and one miscarriage, each in a different state with a new doctor who I met on my first pregnancy visit each time. And it was fine. With DS, I had the same doctor my entire pregnancy, then he went out of town the day DS was born, and a perfect stranger delivered him. That really upset me at the time because it was my first time, but I've gotten so much more chill with each delivery. So all of that is to say that if you went with a new doctor, you are no longer a newbie, so the relationship that you may or may not have established the first time might not be as important to you this time around. I personally go with experience over bedside manner--DD3's OB was totally old school, gruff, saw him for less than 5 minutes a visit, but there were complications in her delivery, and he saved her life. Obviously nice AND experienced is probably the ideal (DD1's OB was both), but if I have to choose, I always go with experienced. Totally agree that great nurses are key!

[AnnieW625]

The hospital where I had DD1 was a large hospital who had a RN nurses training program with a local college so I had nurses coming in and out with the supervising nurse throughout my labor and each one of them asked if they could be there, and most of the time I said yes as I didn't see the harm. They were quiet, respectful, and didn't intervene, just observed. I had DD2 at a private hospital and there were no training nurses, which was fine as well.

I grew up in a smallish city with one hospital and medical practice so had I stayed there I would have had one of three or four OBs. I moved to a city with 500k+ people so I had a plethora of options. I was in a med. group with rotating obs so that was good for me, I saw someone a few different times when I was pregnant. Their supervising OB at the hospital ended up being on call when I had DD1 and he delivered her just fine and I didn't know him at all. With DD2 my assigned OB, (who I could have changed if I didn't like him, but he was fine) was on call until about 30 minutes before I had DD2 and he estimated I would be in true labor by 10 am, but I ended up having her 30 minutes later and was delivered by a resident. The hardest part of that delivery was being stitched up as the only time I had ever had stitches once when I had DD1 and I didn't feel it because I had an epidural, and DD2 was med free. I don't feel like I received less care because I had a resident deliver the baby.

I know I am probably the lone person here to think this, but with Dd1 the hospital still took the babies to the nursery for some needed tests and the first night they took her for a few hours so I could sleep. I was eternally grateful for that time because I had been up for 30 hrs. by the time DD1 was born, and almost 32 by the time I got to the room as we hung out in recovery when we were getting used to breast feeding. They knew I was breastfeeding as well so they brought her back as soon as they knew she was getting hungry. I still bonded a bunch with DD1 in the hospital. With DD2 it was 100% room in and while I was fine with that I only stayed for one night and I kind of regret that. I had to bring DD2 back to the doctor 24 hrs. later to do the bilirubin test, which if the nursing staff had told me would be done the next day before we were discharged I would have stayed another night, but most of the nurses had heavy accents and were hard to understand so something was definitely lost in translation. The hospital also had a stupid extended flu season that year due to swine flu so DD1 couldn't visit so that was part of the reason I wanted to go home after one day, and I even had a private room.

I think you need to keep your options open and keep looking, and I might try civilian hospital #2, but would probably stick with the military hospital because you had a positive experiences there. Good luck.

[Kestrel]

Military hospital was my vote. However, my voice of experience says - put it in writing. Some of the not-so-good parts of military life is that we rarely saw the same doc twice. So - keep good records, and carry copies yourself. Also, write a birth plan, even if you think you don't need one. Don't count on the staff to remember anything specific about you, but the military runs on the written word - they're usually pretty good about checking written instructions.

[Pear]

Separating mom and baby for anything other than an emergency is not ok. I would not go with option 2

[american_mama]

I favor birth experience over the OB experience, so I would go with choice #3. I think that in labor, the nursing staff and the hospital policies matter greatly, and the OB is the least important part of the whole thing (unless you start to need the OB because the unexpected occurs). For instance, having attentive nurses who support your style of birth is good, but so does a hospital policy that has tubs in the labor room, birthing balls, and eating during and after labor. Breastfeeding support comes from good nurses, but also the hospital commitment of training those nurses well and having a lactation consultant on staff at the hospital.

If you start to need the OB, in my opinion, that's why you are in the hospital in the first place. They are trained, you are in the hospital. You probably don't care tons if the OB is a stranger if you really need him or her.

I have always felt my prenatal visits with OBs were pretty quick and not that meaningful, so having a set of warm prenatal visits would not matter as much to me as the birth experience.