Me again - Need hospital advice...

So with my current OB, I have a choice to deliver at one of two hospitals. I am pretty happy with the choice that I initially made (hospital A), and later found out that the c-section rate at the one I DIDN'T choose (hospital B) is the highest in the state (though still in line with the national average). So I was completely on board with my choice, especially after our tour of my chosen hospital - I had a good feeling. But after talking with my new prenatal chiropractor who gave me some resources to check out, I've found some interesting info that's making me wonder if I shouldn't consider the other hospital (B) instead.

The hospital that I chose (A) is NCB friendly - has tubs in most of the L&D rooms (I can request one when I admit and as long as one is free, I can have it), and has waterproof remote monitors, but they do not allow you to have a water birth, which didn't seem like a big deal.

But the other hospital (B), besides having the highest c/s rate in the state, has on-staff CNMs. There are no tubs in the labor rooms, but they have a portable labor tub and actually allow water births. I'm not clear on how many they have, though, and I run the risk of not getting one. In addition, they don't have waterproof remote monitors, so I'd have to get out of the tub (if I had it) once an hour to be monitored. But what got me most excited was what I learned last night from my birth class instructor. That hospital has now begun to offer acupuncture for pain management during labor!! How awesome is that??

The funny thing is that I'm not even sure that I am really all that interested in an actual water birth - I know that I would like to labor in the tub, or at least try it, though, and I think my chances of getting a room with a tub at hospital A are better than my chance of getting a portable tub at hospital B... so that seems like a no-brainer. Though it would really be nice to have the option of a water birth if I were to decide that's what I felt like that day. And the acupuncture option doesn't necessarily feel like it overrides the good things about my chosen hospital (A), especially knowing that B has a higher c/s rate.

I'm familiar with hospital B because I had my other three kids there, but so much has changed in 8 years - I didn't have the knowledge to even desire anything natural back then, nor did they have all that stuff there 8 years ago. And DH really wants hospital A, rather than B, so there is that to consider, too.

Anyway, this has really turned into more of a ramble than anything else... I guess I just need to sort it all out and decide what's more important to me... but any insight from you all might be helpful.

Is there a reason that hospital B has a higher c-section rate? I am thinking something along the lines of 'they have a nicu and hospital A doesnt'. Because if it is something like that, it may just be that more women are choosing it for a c-section, and not that the hospital is not NCB friendly.

Taking that into account, I think I would go tour hospital B, and ask those questions, about the pool, etc. The more info you have, the more confident you will be in your decision, whichever way you go.

I'd stay with Hospital A. First, because I don't trust CNMs to be any more "home-like" than an OB; we call them "med-wives" around here. They are probably employed by the hospital so are going to be obligated to follow hospital policy over your requests or needs. At least with an OB, you're the employer and they just have priviliges to practice at the hospital. So why switch to a hospital-based med-wife when you have an OB that you like & trust & have built a relationship with? Second, offering a labor tub and/or water birth but requiring the mom to get out for monitoring is absolutely ridiculous. There are so many ways that they *could* monitor you in the tub (even just putting a Doppler in a plastic baggie works!) that this fact tells me that they don't really fully support this. Third, there's about as much evidence disputing acupuncture as a labor technique as there is evidence supporting it (the thought of needles in my body during labor just eeks me out!) but more importantly, I just find it highly unlikely that a hospital is going to have trained acupuncturists available 24/7 like they do an anesthesiologist. If you like the idea of acupuncture, then maybe you & DH (and your doula, if you have one) should become familiar with the pressure points & do acupressure yourself during labor at Hospital A. Here's a good article about acupressure in labor: http://blog.gaiam.com/blog/acupressure-for-labor-pain/

That's my two cents. :p

I think I'd probably stick with A, but if you are curious it might be worth just visiting and asking some questions. You should be able to tell right away if things have changed in terms of becoming more NCB friendly in the last 8 years. Which hospital is bigger? I find the bigger ones tend to be less NCB friendly, and the point about the NICU is a good one...maybe moms that already know they have to have c-sections or are at a higher risk of c-section due to complications choose that hospital because it is the safer option for a high risk birth? Anyway, you could always visit, and if they have stuff like birth balls, birth stools, squatting bars, etc. AND they answer your questions about NCB in a reassuring way (not just, "oh, yes, we let moms deliver naturally" but can be specific about how they support NCB). You might go visit hospital B and feel like "meh" afterward, or you might LOVE it and your decision will be clear.

One more thing about the c-section rate is that the official data is generally 2 or 3 years old, because it has to be verified independently. So if Hospital B has been making recent improvements in how they support NCB, it might not show yet in the "official" statistics. On a tour, they should be able to tell you their "raw" c-section rate from very recently, i.e. total number of births, and total number of c-sections. The number of c-sections will include multiples, which are generally removed from the official stats, but unless it's a high-risk center there shouldn't be enough of them to skew things too much.

Hmmmm, you're all making very good points. Hospital B IS a very large hospital that is literally right across the street from the largest Children's Hospital in the state which has an incredible Level III NICU, which is why I chose to deliver there for my first delivery 10 years ago when I had my twins. So yes, that could very well impact the c/s rate. Hospital A is part of a different system, so is affiliated with a totally different children's hospital which is further away (15 minutes), but is brand spanking new and state of the art.

And really, no matter which hospital I deliver at, I will have the same doctor/practice that I have now, so would hope that my probability of a c/s would be no different at either hospital. In addition, hospital A is directly across the street from my OBs practice, so my chances of actually being able to see my OB, rather than the on-call OB is greater (my doc likes to try to make it over there when his patients go into labor, even if he's not on call, if he possibly can).

The more that I am thinking about it, and the more I am researching, I am thinking I may just stick with my original decision.

Personally, having used a hot tub, and a birthing pool, I found the birthing pool useless and the tub great in terms of labouring. The birthing pool was just too small and not enough water in it, didn't support me to squatting, etc...

So, it sounds like hospital A has tubs but won't let you birth in one, and hospital B has a pool (that IMO is useless) that you potentially could birth in. I wouldn't base my decision on that.

What does your team look like? How supportive are they of NCB and your ideas? That will be your biggest asset. Work on those issues and you should cover the most important bases for your birth.

Gosh, I'm post-happy today, but I'm wondering what they can really do if you just don't get out of the tub? It's probably an insurance thing that they tell you you have to get out, but I can't see how they could really enforce it. I mean, are they going to drag a woman who is pushing a baby out, out of the tub? That would seem to be a huge liability on their part.

I'm going to agree with the others that having a portable tub, CNMs, and acupuncture wouldn't be enough for me to switch. And I totally agree with Spacers that the thought of someone poking needles in me during labor is just unnerving. But, I'm also not a believer in acupuncture at all. It seems to me that hospital B is feeling the pressure to at least appear more NCB friendly and has implemented some cosmetic changes. Having a portable tub and actually having patients use it are two different things. They say they allow water births but the fact that they offer no monitoring in the water makes me think they've never seen an actual water birth. Being as attached to water birth as I am, I would still go with hospital A given their tubs despite their stupid policy of only allowing water laboring. Do they allow you to labor in the water once your water has broken? My transfer hospital wouldn't have but I would have fought tooth and nail and signed any form they put in my face to get into that tub and there would've been no getting me outta there once I was in.

I also agree with Sarah that its your support team that matters most. You can most certainly have a wonderful birth experience without water but its going to be much much harder if you don't have true NCB supporters on your side. Ask your OB which he/she would recommend for your NCB. He should have a clearer picture that isn't clouded by old facts or new cosmetic changes.

I wouldn't switch, but I would ask around or google to see if anybody had a natural child birth at hospital B and how it went (though I'd do that same for A too). I've made my choice for my hospital, but I've still been asking around and talking to other moms about their experiences. The c/s rate is about the same at the hospital I'm going to (A) vs. the hospital that's closest to me (B), but A has a NICU and is where they send all the high risk moms from a few hour radius. B has nothing special at all. I've been asking similar questions to moms I've ran across who have birthed at A or B and B scares me more and more! It's hard choosing what's right, but at least you're informing yourself so that you can make the right decision for you.