Choosing between birth centers

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Choosing between birth centers

Postby Puddle of Cuddles » Sat Nov 28, 2015 7:43 pm

Hey yall.
DH and I are still TTC, but in trying to do some homework we've been on some tours of local places to give birth. We are SUPER lucky to be in reasonable distance to two midwife based birth centers, which has always been my strong preference and wish for where I'd like to give birth if possible.
I'm not trying to put the cart before the horse, but after touring both facilities, I'm really torn between the two...And would love some insights from some folks that may have made a similar choice or are making a choice like this soon, or better yet, have some personal insights after making a choice like this and then having a baby!

Birth Center #1
Pros
-Literally less than an 8 minute drive (15 minutes in traffic)
-Brand new facility, that is absolutely beautiful (the birth rooms are large, well equipped, and look more like they belong in a spa than a birth center)
-All basic prenatal care done on sight (blood tests, ultrasounds, etc)
-Seperated by only a parking lot to an excellent hospital (birth center to OR table transfer can be under 10 minutes if necessary)

Cons
-I've had 3 appointments at the facility (a well woman exam, an exam when I had a miscarriage, and a follow up to the miscarriage) and I recieved wonderful care at the miscarriage appointment (it was very early, and didn't require any special attention) but at the other two appointments felt like I was being brushed off (or maybe less important because I wasn't pregnant?) and felt like I left with a less-than-satisfied feeling.
-At all three appointments there were some basic errors in my chart...which could have been honest mistakes, OR could have resulted in real problems!
-It's a brand new facility...so there isn't a ton of reputation, or statistics to go by (although they have a sister clinic in another state with excellent stats and reviews)
-They have one full time midwife (who seems awesome), and it seems like they are interviewing lots more for full time positions...but it feels like there's a bit of a revolving door of practitioners until they find the ones that "fit" (which leaves me feeling unsure of who I can rely on for providing my care, and getting comfortable with those practitioners)
-They may not allow me to be a maternity patient because I take Cymbalta for (very well managed) anxiety and depression (I would have to meet with the centers supervising physician and get the final ok from them in order to be a maternity patient)
-practitioners seem to be younger on average (and I'm sure they're great at what they do...but if I had a choice I'd rather have my first baby with a midwife who seems like she's caught thousands of babys and has seen it all)
-The center is a franchise...which I can't tell if that business model bothers me or not in regards to a birth center?

Birth Center #2
Pros
-Extremely well established practice that is well loved in the community.
-I've heard wonderful things from several moms I know who have delivered here
-great safety and birth statistics
-Lots of very well established midwives, nurses and lactation consultants on staff

Cons
-40 minute drive (could be double or triple in traffic...having never had a baby, valid or not, this is a big concern to me)
-5-10 minute drive from the closest hospital (est. 25-30 minutes from birth center to OR table if needed)
-facility is workman-like. It is equipped with all the standard equipment, but the facility is a little outdated (completely willing to overlook aesthetics for stellar care)
-Basic prenatal care is done at the facility, but anything more than bloodwork is referred to other practices (ultra-sounds, nonstress tests, any additional screening is outsourced...and most of which would also be a 30-45 minute drive to get to)


Acknowledging that I'm super lucky to have TWO of these centers in my area, I almost feel silly debating between the two, because if either one didn't exist, I'm sure I wouldn't give the remaining practice a second thought, and would be excited to be a patient there. They are very different facilities...Each with their own pros and cons.
Any insights?
Puddle of Cuddles
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Re: Choosing between birth centers

Postby FrostedFuji » Sat Nov 28, 2015 8:32 pm

I will say, I notice significantly fewer cons for birth center 2. I would personally choose the one that has excellent word-of-mouth reviews, AS LONG AS you are very comfortable with the midwives there. Am I correct in thinking that is where you'd get your prenatal care as well? Another thing I would recommend is asking each birth center if they have a handout of their labor & delivery policies for you. If one looks perfect from the outside, but their policies for mothers during labor are completely against what you would like, you might want to rethink your decision.

A long drive can be problematic when you're in labor, but assuming you have someone to drive you and there aren't any serious concerns, it's totally doable. At my own birth classes a couple of weeks ago, two of the couples expressed concern because they're 30-45 minutes away without traffic, and the hospital we're all going to is actually the closest hospital to them. The doula leading the classes assured them that under normal circumstances (e.g. 99.9% of births) you will have experienced early labor for long enough to know when you should go to the hospital. The "rule of thumb" we were taught was 5-1-1; that's contractions 5 minutes apart, lasting 1 minute each, for at least 1 hour. She recommended to couples living further away that they consider leaving the house when contractions seem consistently 6 or 7 minutes apart, rather than 5.

My final piece of advice is that you can always switch! If you pick one and then find out their policies are totally against what you want, or you decide that the drive is definitely way too long, or you're not comfortable with the midwives - change practices. You would absolutely not be the first person to change care centers during pregnancy. Some women are unfortunate to experience a bait-and-switch where a practice may promise one thing, and then impose serious restrictions once it's actually on the horizon (such as in the case of a VBAC). Other women do their best to carry out due diligence before pregnancy, only to learn so much more while pregnant that they inquire further and decide the practice is no longer right for them. I can tell you, I still believe I knew more than the average person going into pregnancy, and I have still learned a ton that I never would have considered before. I'm fortunate enough to have midwives who are extremely flexible and already geared toward the way my philosophies and preferences changed, but if they weren't I absolutely would have started looking around for another practice to work with.

You definitely have a tough choice ahead of you, but rest assured it's not permanent until you're there and in labor! :) Good luck!
Fuji: 28; H: 29

Our first baby!
Willow Del, born at 37,5 on 12/8/15
5 lb, 7.5 oz; 18.25" long
Former code name Little Jedi

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Re: Choosing between birth centers

Postby Puddle of Cuddles » Sun Nov 29, 2015 10:28 am

What a great reply...Thanks so much Fuji!

I never even considered the option of switching if I didn't like the one I choose! I suppose I just assumed you pick one for the duration of your care!
And there is always a chance the closer practice wouldn't allow me to stay based on the low dose of Cymbalta I take.

Both practices provide all prenatal care for the entirety of pregnancy through birth and newborn care, and both subscribe to the care practices that are important to me in provedure and policy, so they're on level ground there.

I guess, what it really boils down to is the practice that is further away is also further from the closest hospital if something goes wrong, but it has lots of midwives with decades of experience...the one that is closer, is steps away from the hospital in case of emergency, but I'm slightly less confident in their care.
I know being less confident in their care should seem like a big deal...but it's birth, not neurosurgery...If everything about my pregnancy is going well enough that I can deliver at a low-risk birth center, I feel like it may be just as important to have an atmosphere that is comforting and calm (and there's a chance that the anxiety over the drives/hospital distance may outweigh the know-how?) But I've never had a baby so I don't know what would be more comforting in the moment!
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Re: Choosing between birth centers

Postby Puddle of Cuddles » Sun Nov 29, 2015 10:32 am

*I also wonder if hiring an experienced doula may bring the maternal comfort to the table that the new facility feels like it's lacking. That may be a wonderful way to balance the scale!
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Re: Choosing between birth centers

Postby FrostedFuji » Sun Nov 29, 2015 11:11 am

Realistically, true emergencies in labor are extremely rare. If there is a complication, there is generally enough time to get you prepped and ready, regardless. I'll be giving birth at a hospital birth center, and the doula who gave us the tour explained that typically if you reach the point of a c-section, the prep will take about 45 minutes or so, then your husband comes in and 10 minutes later your baby is born. Obviously in the event of a really critical emergency it would go a lot faster, but the vast majority of the time there is no extreme urgency to get baby out NOW.

In addition, any signs of concern leading up to delivery should be discussed with you so there is even less of a chance for a surprise complication. You can certainly ask what precautions they take, both leading up to labor and when you arrive. Another hospital in our area does a routine ultrasound on every woman who shows up in labor to ensure there's no cord wrapped around baby's neck and to be absolutely positive the baby is not breech. Either scenario leads to a transfer from the birth center to the medical center.

So another question I'd ask of both birth centers is how often they have experienced a true immediate emergency, what their protocol is, and what precautions they take to avoid them :)

And finally, if you really are worried about the maternal comfort factor, a doula could be a wonderful choice for you! Definitely a great idea, and something to look into - some will help you advocate for yourself, some will advocate on your behalf, and others will just be there as your support person. It all depends on what you're looking for, but you also have plenty of time to "shop around," so to speak, once you do find yourself expecting :)
Fuji: 28; H: 29

Our first baby!
Willow Del, born at 37,5 on 12/8/15
5 lb, 7.5 oz; 18.25" long
Former code name Little Jedi

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FrostedFuji
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Joined: Sat Apr 18, 2015 5:52 pm


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