Where (and how) to bring our baby into the world

Ok, back to the kiwi (Brent's parents felt this was a good metaphor for this week as a kiwi is small, fuzzy, sweet, and "smiles on the inside." Brent however, would like to make clear that it does not refer to any parentage from New Zealand)...

One of the biggest decisions we had to make once we found out that I had a baby in me was how and where to get it out (at the appropriate time of course). This led us on a complicated journey through the unfamiliar (and in my opinion, crazy) US medical system, as well as the gamut of available modern medical options. We had to choose who we wanted to deliver our baby (midwife, OB-GYN, large practice, small practice, individual, team, etc) and where. Did we want a home birth, a private birth center, a hospital (and if so, which hospital), or somewhere in between?

Luckily, Brent's health care plan through IRC (which we pay a small fortune for) allowed us a lot of choice and for the entire birthing experience, we will likely only have to pay one $20 co-payment! So it came down to choosing, not only with whom and where we wanted to have this baby, but we realized we also had to decide how. What was our childbirth "philosophy?" How did we feel about natural childbirth or pain medication or episiotomies or induction or what would happen to the baby in the moments after it was born? (Trust me, the list goes on and on...)

Interestingly, as we learned more some of our opinions solidified while others became more flexible. As any midwife, doctor or mother will tell you, when and how a baby is born seems really to be up to the baby. But within that necessary "wait and see what happens" range, we realised that if possible, we would like a natural birth experience, but that being our first child, we would also like the reassurance of the best medical expertise and equipment should anything from pain medication to a C-section or NICU III (neo-natal infant care unit level 3) be necessary.

We found a close-to-ideal solution in the University of California San Diego's Birth Center. The birth center is located within the UCSD Medical Center, which is the regional hospital for SD county. This means a homey, holistic birth center is on one floor, while state-of-the-art medical equipment and 17 of the US' top 100 doctors are on the next floor. The hospital is also only 2 miles from our house in the center of Hillcrest, perfect for visitors :-)

As long as we have an uncomplicated pregnancy, we will be able to deliver in one of the birth center's four birthing suites: big spacious rooms with tubs and showers and birthing balls, etc. to help with labor. The biggest benefit to the birth center in our eyes is the degree of control it provides for the mother (and father). We toured two other hospitals and they all had a fairly rigid set of policies and procedures regarding what would happen when you arrived at the hospital and throughout the birth, who could visit and when, who could be in the room during labor, what the husband was and wasn't allowed to do, etc. While touring both the regular labor and delivery suites and the birth center at UCSD, the staff made it clear that in the LDR (labor delivery and recover) area, you had to follow the rules. But if you wanted to make your own decisions, go to the birth center (BC).

While that sounds great to us, we do realize that there are a lot of scenarios where we may not have that choice, or where our options direct us away from the birth center. If our pregnancy has complications before the birth we won't be able to deliver at the BC. If our pregnancy has complications during birth, we will be transferred out of the BC, but our midwife will come with us, and assist the OB-GYN. If I decide I want an epidural (they do do injection pain meds in the BC if you want them), they need to move us out of the BC for increased monitoring, though again the midwife will continue to provide our care. And, (the one that worries me the most, as I feel I could rationalize the others) if the birth centre happens to be full we may have to deliver in LDR, though they will ask to move a woman who has already given birth out of a BC room into a special LDR post-recovery room if it will allow someone coming in to deliver in the BC.

The only "downside" to the birth center (besides possibly finding it full) is that we don't get to choose who delivers our baby. Eleven UCSD midwives work at the BC on 12hr shifts. This means that while I've been seeing the same 2-3 midwives for my prenatal care, I could have any of the 11 be there for the birth. Not that that is really that different for an OB-GYN. Your doctor could be away or sick and then you get a stranger. Or, even if he/she is around, they often only show up for the 30min-4hr pushing phase, and the rest of your 12+ hour care is done by nurses you've never met (not hacking nurses Mike, nurses are wonderful!). So, I think it's a compromise we're willing to make.

Most of all I like the midwifery philosophy that birth is a normal, natural process that our bodies know how to do. Sure things can go awry, and maybe they will, but I feel a lot less scared going in to 12-72hrs of unfamiliar discomfort/pain with someone reassuring me that my body can do this. Which reminds me, another bonus of the BC is that it has a volunteer doula program. A doula is a birth coach. She does not get involved with any of the medical side of things, but provides constant moral and logistical support for the mother and her support person/people (e.g. massage, encouragement, or going to get food for the dad so he doesn't have to leave the laboring woman). Equally importantly, she stays with you for the entire duration of the labor, no matter how long it takes (and I thought spending 3-5hrs at a hospital with a sexual assault survivor was an involved volunteer position!). You can hire a professional doula, but this is a great opportunity to have someone in addition to Brent, Mom and my personal masseuse (and wonderful sister) Lindsay on hand if needed, without an additional expense.

Ok, well I'm sure I could go on and on, but this post is getting novel-length! And the kiwi is hungry... a lunch of mac and cheeze (Annie's organic) and chocolate chip pancakes is sounding good!

xoxoxo
J,B &k