Birth: A Survey of Options in the Bay Area
After birthing three babies and watching a fourth born, I’m in the unusual position of having first-hand experience about four hospitals and six obstetrician/midwife practices in the Bay Area.
El Camino Mountain View: My tour of Bay Area practices started in 2009 at the Altos Oaks Medical Group, located at El Camino Hospital in Mountain View. I learned I was pregnant three days before a trip to SCUBA dive in Antarctica. I made a quick OB appointment to ask whether there was anything I should know about the first trimester on a trip where medical help might be days away. Luck was on my side: My doctor was a certified deep sea diver and thus uniquely qualified to speculate about the risks of diving while pregnant. After advising extra caution on depth and duration, he wished me a great trip. It was the second appointment, after crossing the Drake Passage there and back, that turned me off El Camino. The doctor admitted to a 30% C section rate, double or triple what the World Health Organization (WHO) recommends, and the doctor had no qualms. The hospital tour told me women in labor were allowed only ice chips in labor, no food or drink, regardless of duration. Hospital fliers were accompanied by a sample of formula but no information about breast feeding support. This did not seem like my best option for a maximally natural birth.
UCSF: My next experience was with the midwifery group at UCSF, with appointments in Daly City and delivery at the Parnassus campus. I can’t recommend enough the Centering Pregnancy program in which check-ups are replaced by group prenatal care. After a very brief individual check-up, the midwife meets with a group of women all at a similar stage of pregnancy to discuss relevant topics and answer questions. I was reassured to hear what other women are going through. I felt confident that the UCSF staff was well trained in normal birth and had the skills to encourage a vaginal delivery even in case of complications. UCSF is one of very few hospitals in the US to offer nitrous oxide for pain relief, which I believe really helped me have an easy delivery. I had only two complaints. My first complaint was the frequency of post-partum check-ups in the 36 hours I stayed at the hospital after delivery: a nurse came to check on me every 2 hours, and another to check on the baby every 2 hours, and since they didn’t coordinate I was awoken every hour. Had I known it was an option I would have asked to “decline care” for 8 hours overnight so I could rest. My second complaint bothers me more as time passes, and that is that the staff did not delay cord clamping as requested in my birth plan. My baby emerged purple and not breathing. He needed some rubbing and agitation but nothing that couldn’t have been done by the bed side. As time goes on I see more studies showing that letting the baby get the blood from the placenta by delaying cord clamping has measurable positive effects.
Homebirth: With my second baby I hoped for a home birth. I asked my OB for a recommendation and of the few names he gave me I chose Rosanna Davis. Her Village Prenatal Care was very similar to UCSF’s Centering Pregnancy and, again, I loved the community of other moms going through pregnancy with me. Unfortunately due to a medical complication (placenta previa) I was unable to attempt a vaginal delivery and did not deliver with Rosanna.
Sequoia C-Section: Placenta previa is one of the ways women and babies used to die in child birth before invasive modern medicine. I’m grateful to be alive and thus grateful for the C-section that delivered my second baby. The staff at Sequoia were wonderful (except a rude male NICU nurse). My surgeons, Drs. Rydfors and Bluvas, operated quickly and I lost very little blood. I had scheduled a C section for three weeks before his due date but I started bleeding before the date. Dr Rydfors recommended surgery that same day so my C section was rescheduled for three hours after our conversation. I was amazed to be allowed to sleep all night, a far more restful first night after major surgery than I’d had after an uncomplicated vaginal delivery at UCSF. On his second night, baby Arlo started breathing oddly and was moved from my room to the NICU for observation. At four weeks early though he would latch at my breast he wasn’t strong enough to get enough milk. Every feeding consisted of Arlo nursing, followed by Arlo getting a bottle while I pumped for the next feeding. In between I’d walk, slowly and painfully, from the NICU to my room to get some sleep. The nurses were wonderfully supportive of this complicated process, of the pumping, of the golden yellow milk, of encouraging my rest. I was quite pleased with Sequoia.
Stanford: I was honored to attend my friend E as she birthed her baby at Stanford. E was induced but eventually her body took over and her body did all the work of active labor without medication. In mid-2014 Stanford got two portable nitrous oxide units and E used one. I’m so pleased that their anesthesiology department provides this option, though as of late 2014 when E delivered most of the staff seemed rather clueless about it. The anesthesiologist on call had to get help from a more senior staff member to set up the machine. The nurses didn’t have any advice on how or when to use it. Before having my first baby I’d read the 2002 paper by “Nitrous oxide for relief of labor pain: A systematic review” by Mark A Rosen which notes: “There is a time lag of approximately 50 seconds after the onset of administration before the full analgesic effect can be expected.” And indeed, in my first labor I quickly realized that starting to breathe the nitrous oxide about a minute before a contraction was most effective, ensuring I was fully under the influence when the pain peaked and also allowing me to set aside the mask and breathe more freely then. I guided E to do the same and she later agreed this was a good technique. E was happy with her experience.
Stanford, Take 2: My third baby was due March 2015. Though I’d planned for an unmedicated vaginal delivery at Sequoia, towards the end of my pregnancy I hesitated. It had been a rough pregnancy and I was generally tired. I wasn’t sure in my tired state I could handle the pain; an attempt at getting nitrous at Sequoia fell through; and since I’m sensitive to pain killers I was afraid of an epidural. I switched practices from Dr Bluvas to a Stanford doctor, call him Dr S. Several medical professionals recommended Dr S as absolutely wonderful so I went to my first appointment very hopeful of a wonderful relationship, a VBAC, and nitrous. I assumed Dr S would protect me from Stanford’s reputation for overly interventionist practices. Instead, I learned that Dr S intended to monitor me more invasively than Dr Bluvas, than UCSF, than ACOG recommendations for VBACs. Dr S would break my water to put an electrode into my baby’s scalp upon my arrival; all those other experts resort to internal monitoring only if external monitoring fails to give reliable results. I fled back to Dr Bluvas.
Sequoia, Take 2: I had a wonderful (if you can call something so painful “wonderful”) VBAC (Vaginal Birth After C-Section) with Dr Bluvas at Sequoia. The nurses were diligent at continuous external monitoring, as is standard for VBACs, but otherwise let me birth as was most comfortable for me. The birth was straightforward, a bit of luck for which I’m grateful. The pediatric nurse waited to clamp the cord as we’d requested. He placed the baby on my chest and attended to her there for the first 10 or 15 minutes, and only after a while took the baby for a few minutes to suction her nose and weigh her. The nurses were kind and competent. I was ready to check-out of the hospital in the morning, some 9 hours after the birth, but they talked me into staying for some tests that are best done at least 24 hours after the birth. We walked out the hospital door 25 hours after little Sonoma’s emergence, pleased to have stuck with my experienced and not overly interventionist doctor, pleased with the Sequoia staff.