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Wednesday, June 9, 2010

A bold new direction (part 2)

Continued from yesterday's post...

So because I'd had some negative experiences during my hospital stay while birthing Mira, I've been thinking about how I can avoid those pitfalls again, now that #2 is on the way.

My first thought was to hire a doula to assist me in another hospital delivery. A doula would know my preferences and help me express them to the hospital staff. She would be my advocate so that I wouldn't need to fight for my desires and could just focus on my labor. A doula would also have a lot of experience in assisting labor and delivery, so would know tips and tricks that would help me avoid getting to the point of needing an epidural again. A good doula might also be able to measure my blood pressure manually and monitor the fetal heartbeat with a stethoscope so that, presumably, I would not need to be hooked up to a bunch of machines during my labor.

Because Brian's current employer is not offering him a group health plan, we have our own private health coverage. It's a very good plan, but it doesn't have maternity coverage (coverage only kicks in if there is an emergency situation that arises during the pregnancy or during childbirth). So that means that, assuming we have another healthy uncomplicated birth, we will be paying out of pocket, no matter where we deliver or with whom. There is a possibility that our health care policy could change before the baby is due, but we don't really want to *count* on that. When we had Mira, the total bill for the hospital birth was around $16,000. At that time, we had group insurance through Brian's previous employer, which included maternity coverage, so our out of pocket expenses were somewhere between $2,000-3,000.

So the price of doing a hospital birth with a doula would be something around probably $18,000 (hospital fees plus doula fees). This would be a stretch for us, financially. We could do it, but it'd be tough.

But that number got me thinking... Do I really need a hospital this time? Certainly, I feel like it was the right call for my first pregnancy, for me, personally. Like I said, I needed to be there to feel safe. And that was very important to me the first time around. But this time, I'm more confident. I know my body responds well to labor. I know that the contractions are painful but manageable. And statistically speaking, if your first labor is uncomplicated, your risks of having issues during your second labor plummet. So while I do still want quick and easy access to a hospital just in case, do I feel like I really need to be delivering in a hospital? Well, no. And honestly, it'd be nice to avoid the intervention-based mentality of a hospital.

And if you want quick access to a hospital without actually being in a hospital, that basically means a birthing center. So I researched the birthing centers here in Austin, and between recommendations from other moms I know and online resources, a clear front-runner quickly stood out. It's called Austin Area Birthing Center, and we are pleased to have chosen to birth there.

Brian and I toured the facilities earlier this week. The location is great for us: only 15-20 minutes from our house, 2 minutes from my mom's house (where we will hopefully take Mira during the labor), and within 5 minutes of not one, but two major hospitals. The facility has a clinic for prenatal visits and a separated more private birthing center. The birthing center has 3 birthing rooms that all look like very comfortable hotel suites. (Only 3 rooms, but they say they have never not had a room for someone who needed one.) The birthing rooms have deep water tubs with jets for hydrotherapy during labor or even for water delivery. There is a full kitchen and separate waiting area in the birthing center. It's all very quiet and relaxed, opposed to a hospital setting. The staff that we met was all very friendly. The midwives are all certified nurse midwives. During your prenatal visits, you rotate through the 4 midwives, getting to know each of them so that you will not be unfamiliar with the person who delivers your baby. The mindset is very much to allow the mother whatever she needs to be able to birth her own baby naturally. A very different mentality than that at a hospital where the mindset is more "let's deliver this baby for the mother using whatever means and interventions are necessary". There is a doctor associated with the center who oversees any unexpected events, and should transport to a hospital become necessary, there is a very organized, quick, and precise plan for that. But because the center only takes low-risk women, and because the midwives are skilled at anticipating issues and avoiding them, transport to the hospital is only necessary for a very small percentage (8%) of their clients. Additionally, they are trained to be able to handle certain issues on-site. For example, they can give stitches if vaginal tearing occurs, they can administer antibiotics and certain narcotics, and they can even resuscitate a newborn. BUT (and this is a bonus in my book) they do NOT offer epidurals, nor are they allowed to speed up/ slow down the labor process through any medical means (so no pitocin to induce labor etc). Families are usually discharged 6-8 hours after delivery, which is great for us: we'll be able to get back home to Mira quickly. And the cost is a fraction of what we would pay at the hospital: their out-of-pocket patients pay $3,500. Very doable for us.

I'm confident and happy with this decision. I'm certain that I will have a much better* birth experience at this birthing center than I would in a hospital. I feel very lucky that I'm able to consider this as an option, since I know that, were I a high-risk pregnancy, they would turn me away at the door. And for many women, that is their reality.

*By "better", I mean an experience that is closer to my own personal goals and desires. I certainly understand the desire some people may have for a hospital surrounding, it's just not one that I feel anymore.

So barring any unforeseen complications, this is where I'll be birthing #2. I have an appointment with them in a couple weeks; I'll keep you posted on how it goes.


Marcy said...

"A good doula might also be able to measure my blood pressure manually and monitor the fetal heartbeat with a stethoscope so that, presumably, I would not need to be hooked up to a bunch of machines during my labor."

That's not technically accurate. Doulas are not trained medical assistants. They provide information about different medical options, as well as emotional and physical support to the mother and her partner. But unless you chose a doula who also happened to be acting as a nurse or midwife for you, she should not be performing any medical tasks (like checking blood pressure or heart rates) or making any sorts of medical decisions or judgments on your part.

That birthing center looks lovely, btw. =)

Criss L. Cox said...

I know you've already decided on the birthing center, but for anyone else reading this who will give birth in a hospital: talk to your provider ahead of time about continuous v. intermittent fetal heart monitoring. I doubt they can do it with a stethoscope, but doctors/hospitals have doppler machines they can use to check the fetus's heart rate, and you don't have to be hooked up to anything (at least not during the first two stages of labor, which are when you want to move around).

Laura said...

I had done as Criss suggested and asked my doctor before-hand about intermittent monitoring. I was told it would be fine. The problem was that my doctor was not present for the labor (or the delivery, but even if your doctor is present, they usually only show up to deliver the baby and leave the labor to the nurses). Sure, I had it written into my birth plan and several times I asked my nurse when I could go to intermittent monitoring, but she just didn't seem to care. It was easier for her if she could go sit at her nurses station and monitor all of her patients' stats from there.

Now what I didn't know that would have helped me is that you can request a different nurse. I wish we had thought to do that because then we might have been able to find one who was on the same page with me. But I guess hindsight is 20/20.

Oh well, I know for sure that I won't have to deal with anything like that at the birthing center.