Hospitals...

[Teejay]

Is anyone else nervous of hospitals?

I had my first (12 years ago) at home, without a problem.

However, because I am much older now, & far from my home country etc, I decided to go with a hospital this time -- the OB was/is pretty positive about natural birth etc.

Still, I can't get rid of my fear/suspicions, as the time approaches -- I have seven weeks to go! -- that it will all get "taken over", that they will do things that are unnecessary, that my birth plan will be ignored. I have no evidence for this, only my own worries.

What have others found?

Also, what did you do to eat while you were in the hospital? Were they able to provide vegan food? In my experience, hospitals are rarely good at this, though you would expect them to carry healthy food. (In most hospital cafeterias I've visited, even the fries/chips are cooked in animal fats -- you wouldn't think so!)

But what really worries me are unnecessary interventions in the birth process.

[Erin Pavlina]

I was nervous of hospitals too, when I was pregnant. We wanted a home birth but couldn't afford it. Same with the birthing center. Having our child in the hospital was the only option for us at the time. I just went fully prepared.

First of all.. they tried to get me to take antibiotics cuz I was group B strep positive. I declined for a host of reasons too long to go into here, but it took a lot of confidence to pull that one off. They backed down quickly when they realized I knew more about it than they did.

They tried to give our child vitamin K shop and antibiotic drops, etc., but we were ready with our declination and they honored our wishes.

Basically, write up a birth plan, and tell whoever will listen what your wishes are. And make sure your partner follows the baby when it is born. Your partner is responsible for making sure doctors honor your wishes. Be fully prepared is all I can say. Stand up to them. Sign a waiver if that's what it takes. Make them explain every procedure to you.

For me... I ended up with all kinds of interventions I didn't initally want. I was induced with Pitocin, and after enduring hard labor for 31 hours I finally requested (no, wait, I begged!) for an epidural. This led to all sorts of other interventions, but it was for the best at that point.

Anyway, my point is this... be prepared, know waht you want and what you don't want, be sure your partner is vocal and confident, and make sure your partner does not leave your baby alone with them for a second. You'll be okay.

[Erin Pavlina]

Oh yeah, and in regards to food...

I told them in advance that I was vegan and they said they could easily accommodate me. They were mistaken. They brought me mashed potatoes with milk in them. But I did get a vegan roll and green beans and corn that were vegan. My husband brought me the rest of my food after the mashed potato incident.

During the 2 days I was in the hospital I had a bagel with jelly for breakfast, and my hubby brought me sandwiches for lunch. I also brought juice boxes and trail mix and nuts and dried fruit for when I really needed something fast. Bring whatever you have to!

[Teejay]

Thanks, Erin. It's very helpful just to hear someone else's story.

I suspected we would have to arrange our own food. Even when hospitals say they can, there's usually egg or milk or something like that.

[5xblessed]

I have had 5 hospital births. It is the only kind covered by our insurance. I think you need to make it very clear to your practitioner what you will and won't do. I also think it is very important that your partner be vocal and willing to stand up for you in the hospital. Arguing while in labor is exhausting. However I have found that they don't want to argue with a very angry laboring woman and will usually do it your way if they have to. My strategy is usually not to go to the hospital until as late as possible. If contractions are light and you can talk wait awhile. I also do not stay in the hospital one minute longer than absolutely necessary. I always have to sign a waiver for that but the longest I've ever stayed was 10 hours. I would also definitely bring the provisions listed above and plan for your partner to bring you food. The closest I got to vegan food was an orange, an apple and some toast with jelly. Hope this helps and good luck. Congrats on the baby!
Lisa

[Teejay]

Thanks, Katharina and Lisa. I read your birth story, Katharina, and it was very moving. I would really dread that feeling of being left alone (apart from your partner, who sounds like he was a wonderful help -- my partner is very supportive too, so I will be counting on him) -- but the idea that you go through things just because there aren't enough staff is terrible. I was really spoilt with the homebirth because my midwife came to the house from about 9 am (my waters had broken at 4am, but no contractions) and walked me up and down a hill until they started at 1pm. She then stayed with me the whole time until my daughter was born at 8.40pm and for about 2 hours after that. Then she called by the next morning, and telephoned for a couple of days after that. I felt like I had a second mother. Also, throughout the pregnancy, she was available and helpful any time I had questions. I suppose I just had such a good experience that I can't imagine anything matching it.

Lisa, thanks for the advice -- I will just have to be very assertive and I must say my partner is very assertive too. I live about 1.5 hours from the hospital (I am in a rural village) so am really unsure about when I would leave to go there -- my first labour was fairly quick (seven hours) and the OB says that may mean it will be quick this time too.

The other thing I learned from your post, Katharina, is not to be too confident in appearances! The hospital I am booked into sounds very similar to yours in terms of birthing rooms, natural relief provision, etc, but I just have this suspicion that when the crunch comes they will still want to pull out the monitoring machines and epidurals and so on. I really treasure the fact that my daughter's birth was drug-free (I did a lot of yoga then and it was yoga breathing that made it all possible) and would hate to get manipulated into it through some doctor making us fearful under pressure.

Also: is this normal? If I deliver after 7.30pm, it won't be my OB at all! -- They said it will be some other doctor. It amazes me that we (or insurance) pay all these fees to see a particular dr. and they may not even be the one delivering. OK, so I know they can't stay up all night (though my midwife would have). But it still seems odd, to be among strangers at such a moment.

Lisa, you must have such a wealth of information after delivering 5 times! My mum had 7, but she's in my home country, not here, so I feel very distant from it all.

Thanks again, everyone.

[Fiona]

I had a hospital birth 3 years ago and pretty much managed to stick to the birth plan. My partner was a terrific help - he was well versed in the plan and the reasons why we didn't want certain interventions, so we managed to avoid most unnecessary things, although I did have some painkiller (Pethidine) towards the end (of the 36 hour labour!). My main goal was to avoid an epidural, because I felt this could lead to other procedures and problems.

Do be prepared though - sometimes it felt like the staff offered interventions just to speed things up and get the process finished as quickly as possible. So be clear about what you do and don't want (including planning for any complications) and you'll be fine.

I have a question for Erin - I'm 6 mths pregnant myself and last year had an early miscarriage followed by a Group B strep infection. I have been advised to have antibiotics at the start of the next labour in case the bacteria has reappeared and would be interested to know why you decided against it.

Thanks.


Fiona

[Erin Pavlina]

HI Fiona,

The reasons I declined antibiotics for Group B Strep. Hang on, this is going to be a little long.

They tested me at 8 weeks and found me to be positive for Group B Strep. 33% of women are. They wanted to put me on a round of antibiotics. I asked why? They said, because if my water broke the baby could get Group B Strep. Hello!!!! If my water broke at 8 weeks the baby wouldn't live anyway. Duh.

So I declined.

At 33 weeks they tested me again and I was still positive. They said they wanted me to take antibiotics again. I asked why and they said, "Maybe we can kill the bacteria before the baby is born so there is no chance the baby will contract Strep at birth." So I did a ton of research.

Here's what I discovered. I discovered that there is only a 2% chance that a baby born to a GBS positive mom will actually contract Group B Strep. If my baby was born GBS positive, she would get antibiotics to save her life, and these would be effective in over 90% of cases. So using the help of my math brainiac husband, we realized that the odds of her getting GBS infection and actually dying from it were less than a tenth of a percent.

Although it would be terrible for my newborn to have to get antibiotics, I realized that if I took them as a preventive measure, then she is STILL getting the antibiotics for something she probably didn't need. And to me that was worse. I decided against antibiotics during labor.

NOW, there are 3 exceptions to these statistics, and I decided that under the following three conditions, I definitely WOULD get the antibiotics. Listen carefully, cuz this is really important.

1. If you get a fever during labor, get the antibiotics.
2. if your water has been broken more than 24 hours and still no baby, get the antibiotics.
3. If your baby is born before 37 weeks (as in premature) definitely definitely get the antibiotics because premature babies have a 50% death rate from GBS.

Okay, so I decided that if any of the above three situations happened, I would get the antibiotics. None of them happened, so I didn't get them. But I didn't make the final decision until I had all those situations covered.

They sent 2 doctors in to bully me into getting the antbiotics because it was standard operating procedure. I told them everythign I told you above. They looked at each other and the male doc said, "Well, that's probably the best explanation of GBS I've heard since medical school. You obviously understand the situation clearly. We won't ask you again." He was pretty impressed. All thsi while on Pitocin with contractsion coming 1 minute apart.

I hope that explanation was helpful.

[Fiona]

Thank you very much, Erin. Your explanation was very helpful - I will now rethink the antibiotics.


Fiona

[frenchie]

Hi, I'm new to this board. I want to respond to give you some moral support. I am 5 weeks away from my due date, and have had to make the hard decision to have a hospital birth. We initially intended to do a home birth, but the finances were not there. We decided to take Bradley Birth classes, instead of Lamaze. The Bradley classes have given us the best education, and confidence in our decision to have a natural childbirth. My only fear at this point, is giving birth in a hospital.
I discussed with my Dr, the option of laboring at home as long as possible. He's very supportive of that idea, which was a relief. I would suggest that you keep your birthplan simple, yet firm. Don't go into the hospital with boxing gloves on. Refer to the nurses by their name, try to gain a respect with them. This will help with any attitude they may have about your birthplan. The more your partner does to help them, by supporting you, the better they will respond, and the more supportive they will be in return. The less they have to do, the happier they are. It's awful our medical industry has come to this. Also, as other people have stated here, your partner needs to stick by that baby's side, and make sure your wishes are carried out. Be prepared to be bullied. The best amunition, is education.
I know your fears, I feel them too! You are making a great decision for yourself, and your baby. Stand firm, this is *your* birth experience, and *your* baby. Good Luck!

[sophie]

Just interested- a couple of people have mentioned that a homebirth is expensive in the USA- why is that? is that because everyone needs to have health insurance, and I guess a homebirth isn't covered? How much does it cost to arrange a homebirth? What do people with no insurance do, or does everyone have it?
I guess I'm lucky that here in New Zealand hospitals are government funded (though you can chose insurance for private healthcare), and maternity care is 100% government funded, which means that my homebirth won't cost me a cent. It makes me realise I'm pretty fortunate to have this option.

[Erin Pavlina]

Homebirth in America is not covered by health insurance policies, at least I've never heard of one that is. We looked into homebirth for our child, Emily, but the cost was going to be about $4,000 and we didn't have it at the time. Plus the insurance we DID have covered a hospital birth 100% and we decided on that, but we made darn sure the hospital staff complied with all our wishes regarding having a natural birth.

Homebirthing midwives are severely looked down upon by the medical establishment here in America. I think I read in one book that only 5% of births here are homebirths. Pretty sad.

[veganobgyn]

As I was reading through I wanted to respond to a couple of things: One, home birth is often covered by insurance, they just won't tell you that. A home birth midwife around the corner from me writes letters of exception to the insurance companies saying something to the effect that since they have no home birth providers on their panel, to make an exception since that is the service the patient desires. When the insurance company realizes that they do not have to pay lots of money to a hospital, they usually ok it (at least here in New York). Also, my experience with group B strep is that the problems often arise after the baby is born with the pediatricians. I recall one baby who was NEVER sick, but the pediatricians were so hypervigilant, poking and prodding and worrying about whether to do a spinal tap! So if you are GBS +, you also need to communicate well with the pediatricians. One interesting fact is the recent spread of E. coli in nurseries. E. coli is much worse for babies than Group B Strep, and it is thought that the E. coli outbreaks are due to antibiotics used for the GBS creating resistant E. coli strains.

[Erin Pavlina]

Vegan Obgyn,

Boy do I have questions for you! Glad to see you on the boards! We could use someone with your expertise.

I didn't know that about homebirths possibly being accepted by insurance. I definitely want to look into that for my upcoming birth.

Secondly, my OB has told me that I am GBS positive for this pregnancy. She said she'll give me antibiotics during labor. I told her I didn't want them. She gave me a really hard time. She said the pediatricians would give my baby a spinal tap and an MRI and a couple of other really invasive tests to rule out the infection. She also said they would force my baby to stay in the hospital for 4 days to watch for infection. But with my first child, the peds did no such thing. This OB swears it will happen and why don't I just get antibiotics during labor and save the baby all kinds of pain.

Can you arm me with some informatin that I can use to prevent this from happening? What is the liklihood of my baby actually getting a GBS infection if I don't get antibiotics during labor? And if the baby does get GBS infection, what is the liklihood of a good recovery with antibiotics?

[Ginarama]

We're pregnant with outr first, sohaven't had a hospital birth. Of course, everyone and their sister has been happy to share their own stories with us. We have opted for a home birth -- there are actually 4 studies out showing that home births are, statistically, SAFER than hospital births -- lower mother & child complications & mortality.

Of course, that all makes sense, when you consider that hospitals handle more high-risk births than home-birthers. But for low-risk, normal pregnancies (which are most), home births are a perfectly viable option. Per our nurse midwife, age is NOT a risk factor (I'm 33).

Also, for whomever asked about the cost of home births -- make sure you check with your insurance fully. Some may pay for some services, just not the birth itself. Ours is costing around $3k, not covered at all by insurance. Then again, my insurance only covers me for emergency c-section, not for anything routine maternity. The home birth option was MUCH cheaper for us than an OB and hospital birth, though that's not why we opted for itt.

Gina

[Erin Pavlina]

Thanks to all your suggestions, I called my health insurance company and discovered to my utter shock and delight that they cover homebirth 100%!

I'm now looking into finding a midwife who can do a homebirth or a hospital birth, just in case things go awry.

[Ginarama]

There are a few OBs in my area who will do a home birth. There may be some in California as well. We are perfectly happy with a Certified Nurse Midwife (CNM), which is what I would recommend. Contrary to the OB I first saw, the CNM does not treat pregnancy like an illness.

I recommend a CNM over a "direct entry" midwife -- one who's not also an RN. A CNM has more thorough medical training.

As for "if something goes awry," some CNMs have hospital privileges. Ours does not, but she does work with three collaborating OBS -- two of whom have other CNMs on their team. I will see one of these OBs in a few weeks, so I know them just in case. Their hospitals are about 25 miles from our home, so we'll also be touring the birthing center at our closest (3 miles) hospital -- which also, fortunately, has a midwife on staff.

Check around and don't be afraid to interview a few midwives. Bradley instructors are also a good source for referrals -- you may want to check with the AAHCC (Bradley method) in Sherman Oaks, CA.

Good luck -- everyone I know who's had a home birth has raved about the experience. I trust we'll soon be among them!

Gina

[CarlaJ]

Congratulations Erin! That's SO exciting that it's covered by insurance!! My mom had me and my younger brother at home with a midwife and loved it compared to the hospital birth she had with my older brother.

Carla

[kykarraliv]

The midwife I am using is costing my about 1400. That covers all the prenatal appointments and a water birth. She brings the birthing tub and all the supplies. Her prices go all the way down to about 800 for complete prenatal care and birth. She accepts payments. She is a really competent midwife with OBGYN back up. I am happy to have found her. She completely supports me being vegan.
Kim

[Christa]

Both of my daughters were born in a hospital with certified nurse midwives. The first was a very bad experience, the second wonderful. I would say that the main reason my first went so counter to how I had wanted it to, was the midwives. If you are sure that your medical provider will adequately inform you of what is going on & follow your wishes, I would think that that would be the most important thing. Also, with this being your second child, I would also think that you will know more of what to expect & thus have a better shot of it going how you want, as well.

With my older child, the midwives wanted to induce b/c she was nearly 2 wks past due, however there was no indication that she was stressed. If I had known more, I would not have agreed. It took 3 days of the maximum dosage of Pitocin, cytotec (a little pill that they put near your cervix to make it dialate), manually forcing my cervix open & more to get her out. I was not told & did not find out until later that the usage of cytotec & pitocin together significantly increases risk of uterine rupture. I also was not told that it is basically impossible to manually dialate the cervix w/out an epidural b/c it is so excruciating. I started thowing up from the pain when they did the manual dialation & continued to throw up for 24+ hrs until I finally had an epidural - I was only 6 cm dialated at the time. Angelina was finally born on a Sat. morning - the induction began on Wed. morning. I also was given an episiotomy w/out even being told that they were going to do it. My midwives knew that I did not want one unless the baby was in danger. I don't believe that she was, but was more upset that they didn't tell me that they were doing it until they already had. I also wound up hemoraging after the delivery due to my uterus being overstimulated from all of the Pitocin.

Needless to say, I changed midwife practices with the second. She was born at the same hospital, but was a completely different experience. My wishes were honored & supported. When it got truly painful & I wasn't sure that I could do it, the nurse & midwife were very supportive & I delivered Tessa with no pain meds having gone into labor with no induction.

I guess that my main point is that you need someone there who will tell you the truth about the consequences of any interventions and will support your desires for the kind of birth that you want. It can be done at a hospital if you are an informed consumer with a supportive practicioner.

[tina]

I completely understand your fear. My first birth was a planned hospital birth that I expected to be as natural as possible in a hospital. It tuned into a nightmare!!! Ending in an unnecessary ceasarean. (My birth record actually states that things are ok but "will proceed with ceasarean anyway"!) After this experience I decided never again. My second birth was a 10lb VBAC at home.
I too would say be VERY prepared! My favorite book that helped me to understand hospital procedures more and what can be done about them is A Good Birth A Safe Birth by Diana Korte.
Also I wanted to mention that HBs in our area are only $1200. This is a lot less that the copayment after my first birth. Maybe if you check around you can find a cheaper rate. Also it is not covered by insurance in IL. As a matter of fact, some lay-midwives are being "hunted" down to put an end to it in IL!
Another idea would be to hire a doula. It would be her job to know what you want and help you get it. In the heat of the experience, it can be difficult for you or your DH to take care of this. I know some who have stayed strong and alert enough, but I know of many who weren't able to, including me and my husband.
I wish you the best.
Tina