Thursday, August 4, 2011

Another Fork In The Road

Yesterday was my 16 week OB appointment.  For the most part, the appointment was quick and uneventful.  I am doing better than I was last appointment (with the exception of the gestational diabetes) and the baby’s heartbeat is loud and strong.  Dr. B is filling out my Family Medical Leave Act paperwork, so that I will be able to take days off intermittently for pregnancy related symptoms and treatment…without the leave time having any effect on my employment, insurance, benefits, etc. 

The only upsetting thing that occurred at the appointment was my discussion with the nurse practitioner (NP) about which hospital I was going to give birth at.  Dr. B had asked me when I started seeing her which of two hospitals I wanted to use for my labor and delivery.  One of the hospitals is a large teaching hospital with a first class NICU (neonatal intensive care unit) and a guarantee of private postpartum rooms with a bed for a guest (my husband) to sleep right in the room with me and the baby.  The other is a smaller women’s center with a more homey feel and almost no residents or medical students involved in patient care.  There were pro’s and con’s associated with each, but I had decided before I even got pregnant that I wanted to use the smaller women’s center unless there were complications during the pregnancy that warranted starting out in the hospital with the better NICU.  

My reasoning for choosing the women’s center had little to do with the type of care I would receive at either facility.  My problem with the teaching hospital was that, when I worked for a law firm for five years (before moving over to state employment), I represented that teaching hospital and its doctors in their “bad baby” cases (cases where something went horribly wrong during the birth of the baby or during the c section procedure).  Generally, the cases involved death of the child or the mother, although some were shoulder dystocia cases.  Rarely did I feel that the physicians or medical staff were responsible (legally or otherwise) for what happened, but I was concerned that my mere association of that hospital with bad baby cases would be enough to ruin any chance I had at a positive experience at that hospital.

So, when Dr. B asked “Which hospital?”  I replied that I wanted the small women’s center and she expressed that the smaller hospital was her preference as well. 

Then…I got admitted to that small hospital a couple of times.  I waited for medication, was packed in a room with two other women, had to observe water stains on the walls and broken medical equipment lying around the rooms, and had to argue with a nurse about giving me the medicine that the doctor had ordered because she felt she knew better than the doctor.  The rooms are small and my husband would not be able to stay with me and the baby at night.  I learned that when the women's center is crowded, you are only allowed a couple of visitors at a time…knowing that your roomates’ visitors will likely be disturbing you, too.  There were also little things…like the hospital not having ice packs or hot packs or quality beds.   These are things I know are not problems at the teaching hospital.  The teaching hospital is big, state of the art facility, that is surprisingly progressive when it comes to “rooming in” options and supporting family bonding as soon after birth as possible.   

Also, the teaching hospital is 5 minutes away from our house while the women’s center is 35 minutes away…in the summer.  I’ll be giving birth in January…in upstate New York…meaning snow on the ground is almost a guarantee.  For my husband, that fact alone is enough to make him want me to deliver in the teaching hospital. 

When I told the NP, yesterday, that we had changed our mind and wanted to give birth at the teaching hospital, she said “Well, we can certainly transfer your care to another office.”  I explained that I didn’t want another office to care for me, I just wanted to deliver at the other hospital that Dr. B had given me as an option.  The NP said “Well, we can’t guarantee that Dr. B will be the one to deliver your baby if you go to the other hospital and I think you should talk to her about how you feel at your next appointment so that a decision can be made about your care.  Even though you will likely be induced at 39 weeks, there is no guarantee that Dr. B won’t have other patients laboring at [the small women’s center] during your labor.  We can schedule yours, but we can’t schedule everyone’s and she goes to [the women’s center] first.  You might be better off with a different doctor is you really have your heart set on [the teaching hospital].”

So now I apparently have a choice to make over the next four weeks.  Which is more important?  The quality of the care I receive during pregnancy or the quality of the hospital I give birth at?  While Dr. B and I had our differences during my last hospitalization, I love that the dozen medical staff in her office all know my name, my husband’s name, the problems I’ve been having during this pregnancy, and my expressed wishes about testing and prenatal care.  You just don’t get that type of individualized attention at any other high risk OB’s office.  I also love (and I realize I sound totally spoiled and shallow here) the standard 3D ultrasounds, flat screen TV’s in each room to entertain you while you wait, and chilled bottled water in the lobby (for last minute bladder fillings).  I love only waiting a short amount of time in the waiting room.  In other OBGYN offices the wait time frequently exceeds an hour.  But…I really don’t like the small women’s center and I hate the idea of being stuck in a tiny shared room after delivery, with my husband driving back and forth in the snow because he won’t be able to stay with me and the baby.  So, what do I do?  The only possible compromise is to continue treating with my OB, planning to birth at the teaching hospital (assuming Dr. B will let me do that), and taking my chances about whether my baby will be delivered by Dr. B or some “on staff” OB at the teaching hospital.  That thought terrifies me because I won’t be able to reject the “on staff” doctor, even if I know him from a case.   I have no idea what to do and I’m really disappointed that I have to make this decision at all. 

Many of you know me pretty well at this point.  Any thoughts, ladies?


LKL said...

I would stay with your current doctor and make plans to deliver at the bigger hospital. I wouldn't pay too much attention to what the nurse said. I was in a similar situation when I had my dd. The hospital I had my dd at was very close to our home. My dh was able to stay in my room with me, but since our house was only 5 mins away, he was able to go home and get stuff without it being inconvenient. Even though I thought I had packed everything I needed, I still found there were things I needed from home. I wouldn't pick the smaller hospital based on the conditions of it you described. My sister had to share a room when she had her second child and she absolutely hated it. Also, just imagine you choose the smaller hospital and your dr still can't deliver your baby because she's delivering someone else's baby there at the same time. This has happened to several friends of mine. That kind of situation would suck, because you'd be stuck at the smaller hospital with a roommate, dh wouldn't be able to be with you, and you'd be farther from home. I saw one dr during all of my pregnancy and ended up having a different dr in his practice deliver my baby. I had met the other dr before, and even though I had wanted my dr to deliver my baby, the other dr was just as wonderful. Hopefully once you discuss it with your dr, it will make the decision easier. BTW, my dd is from donor egg also.

Michelle D said...

I would also pick the bigger and more high tech hospital without shared rooms. It sounds like it makes more since based on the rooming in and close factor. It's very possible your doctor could still be available. If not is it possible to let them know there could be a conflict due to your connections with the teaching hospital? Maybe there is a little wiggle room if a doctor you know were to be "on call" or such. Good luck...that stinks to have to change it up at this point in the game.

Elaine said...

I say go with the bigger hospital its long term what’s best for you and your little one. I know myself I will be delivering at one of the biggest hospitals in our area and it to is a teaching hospital. If you aren't comfortable with the students you are able to enter that right on your birth plan and then you don't have to worry about that. I also go to their OB office which is the top rated high risk group and they are excellent, big yes but I have always have such great care there, they know what we went through and they respect that and understand why we may react different then some of the other ladies they see. I actually normally see a 4th year resident who I love and he actually has done some shadowing with my fertility doctor too so I feel we are connected with our clinic through him. So that comforting and he wrote in my chart that he wants to be paged no matter if he's on or not when I go into labor. You have to make yourself feel comfortable and after the little one is here it's so important to feel comfortable and be able to focus on your new family and bonding. Follow your heart it will never lead you wrong!

My New Normal said...

I think like the other commenters I would stick with the OB you like and request the bigger hospital. If you think about it, there is always a chance that when you deliver, your OB won't be available for a multitude of reasons. So I wouldn't let that be a deciding factor.

Anonymous said...

I agree, too. The way I see it, you will probably be stuck with a roommate at the smaller hospital, but there's a good chance you can get your doctor for the delivery at the big hospital. Even with your doctor delivering at the small hospital, a roommate would be less than ideal. If you do need another doctor to deliver at the teaching hospital, the doctor is only with you at the very end anyway. It's really the nurses that are more important during delivery. Sorry you have to go through this.