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I've been thinking about a birthing center since finding out I was pregnant. I would kind of like to be in a hospital just in case something is wrong with the baby, so help is there as quickly as possible. But was just reading over my insurance info and it said that they do cover licensed birthing centers. I'm just really torn about it. Just asked DH his opinion on it and he is supportive either way since he knows I have been doing my research. So I guess my questions are, any books or videos you can recommend so DH can become a little more educated? Also, if I do go with a birthing center, will insurance generally cover both those visits and regular OB checkups? I am on medication that I do need and I like my OB. And from what I was reading online the hospital he delivers at has some rooms with tubs! And he seems pretty laid back and not apt to order a bunch of tests or put me on medication if it is not safe for the baby (from a couple of problems I have had), and is open to alternative medicine. Oh, and can a midwife order ultrasounds? I will probably also talk to him at my next visit about my birth plan and see what his response is. I do have time, I'm not due until March, but if I do go the midwife route I should get in quite some time before the due date, right?
Sorry to be so long and rambling. Just trying to explore all my options and find what's best for me. Any thoughts, opinions?
First though - I will preface this by saying most of the answers will vary greatly depending on the MWs at the birthing center, your state laws, etc.
Typically, this is how it works:
In some states MWs must work under or have a "connection" in some way with an OB - most states also regulate which patients a MW can and cannot accept as patients. So, first things first - youll want to contact the local birthing centers & the MWs there, and find out if you are a candidate for a birthing center birth. If you have a medical problem which necessitates OB care, then chances are the MW care and birthing center may not accept you.
Now, in places where MWs do work with OBs (such as my state), then basically you will go to their partnering OB (theymay not be in the same practice - the one here at our local birhting center just has a rapore, and will transfer you to his care unless you choose otherwise). Some MWs can order U/s's - but typically this is only done if there is an indication of a problem, and so in that case you may get referred to the OB & the OB order or perform the U/S. If youre just wanting an U/S for gender, thats possible, but they wont typically order the U/S for those - youll go to an U/S place or OBs office and pay for an U/S out of pocket for gender prediction only ($50 - $100 depending on your area).
As for your insurance - some insurances may cover both - but youll need to ask them. Chances are though - if you are seeing a MW, youwont need OB care since OB care is reserved for high risk women. If you stray from the path of "normal" your MW will likely transfer your care to an OB at least until you are able to get whatever it is managed & get back into her care. A good example is high BP. If you start out with a MW and a birthing center, and your BP exceeds the range she can accept, you will transfer to an OB for your care. IF you can get your BP under control then typically you will transfer back to the MWs care so long as you stay low risk. Basically Obstetrics is a specialty, and is intended for high risk women. Only in the US do obstetricians see and treat low risk women.
And yes - if you decide to go the route of a MW and a birthing center, you would want to get in early. You will notice immediately that OBs typically do not do much in the way of preventative care - they are trained to treat not prevent. For example, they are not trained at all in diet & nutrition for pg women - they are only trained to identify & treat problems that may result from these things. A MW will guide you so that you can be and remain low risk. Which is one of the great benefits of choosing that type of care.
As for your DH - I was in a similar situation - what worked for us was touring the birthing center & meeting the MW. We had a great OB, but really wanted a more personal low risk low intervention option - so after much convincing he agreed to just LOOK at the birthing center & meet the MW in charge.
It went great. What youll find is that the MW and birthing center will have on hand almost everything that a hospital has on hand - the difference is its used ONLY as necessary. Hospitals use most interventions as a precautionary method before it is actually necessary - and unfortunately often times increasing your risks and limiting your options. A MW will focus on keeping you low risk making these things unnecessary to begin with. But - should your baby need oxygen - its on hand. Should resuscitation be necessary - its available (even in a free standing birthing center). Should you hemorrhage, she will have the medication necessary to administer. what WONT happen is she WONT administer things like pitocin unless they ARE necessary - not as a precaution or to fit a managed labor model such as a hospital where youll be limited in time to deliver. What she MAY do - is if you have TRUE failure to progress, adn all reasonable options have been exhausted, you would be transported BEFORE There is a true emergency so that you are in a hospital.
So - check it out. My DH was very surprised to see that the birthing center had all the technology that our local hospital had at their disposal, short of an OR to do a cesarean. If something were tragically wrong then it was something our local hospital wouldnt have been capable of handling b/c they didnt have a NICU & Id be transported anyways, even at our hospital.
They will give you information on their transport rate for first time moms, subsequent moms, and overall. They will probably tell you what equipment they have there, and what they are able to handle in house. They will also have strict guidelines that specify what they transport for (ruptured bag of waters > 24 hours, prolonged labor of > 24 hours, etc).
And - theyll likely tell you wehre they transport to. For me, our birthing center had a transport rate of 8%, with a 4% cesarean rate. The hospital was 8 miles away, with a typical transport time of 12 minutes. The local hospital wouldnt even be able to get me into a stat cesarean within 12 minutes - it was standard about 40 minute wait for a cesarean b/c they had to wait on OR availability, Anesthesiologist, prep time, etc. Whereas the birthing center could call ahead, they knew with them it was a TRUE emergency in the making, and would have the OR available & ready and no wait time.
So, just check into it with DH, thats my best advice. If you are interested in a video - a great one is "Born in the USA" where it looks at & compares various birthing locations including hospital, birthing center, and home.
That was great! So thorough. I think what I will do is talk to my OB about a tentative birth plan and see what kind of reaction I get. Also I can tour the L&D area of the hospital he works at, and make an appointment at a couple local birthing centers for consults.
A great book to read is the thinking woman's guide to childbirth from Henci Goer there is also a great one from INa AMy Gaskin but I always forget the title.... It isn't spirtual midwifery...something pregnancy.... Darn hopefully someone else knows it.