I am going to go to a hospital to give birth. I didn't want to at first, but in my financial state, it is actually cheaper out-of-pocket to use my insurance to go to an OB and hospital than to pay a midwife right now, even if at the end my insurance does reimburse the midwife--and there's a chance they might not.

Anyway, I have very set ideas in how I want my experience to happen. I really don't want to be cut, induced, hooked up to an IV, forced to lie down on my back, etc. etc. The way I see it is this is between my baby and me, and I am not there to be convenient for the doctor, he is there for me. I am so scared that they are going to tell me i have no choice but to do these things, and what if they are really good at finding reasons and convincing me in my vulnerable state that it really is the best? What if it's not? What if I could have avoided an episiotomy just because it might speed up the birth? What if they lie to me? I'm so scared that I won't be able to make the decision and know when I can say no, and when it's really ok to let them do what they have to do.

Am I being irrational? I am so scared of the big doctor/hospital entity and how I am just another person giving birth. At least I have insurance, so I feel like they will treat me a little better than a non-insured person (I know it's horrible, but I believe there is some discrimination in care when they know you have no insurance). The hospital I am going to is a Women's hospital exclusively and encourages you to keep your baby with you in the room. I don't want him or her to go to a nursery if they aren't sick.

First I would just like to say that I think its great that you are this aware...and second...GET A DOULA!!!!! or someone that you trust to help you and your partner face the medical establishment and keep things as much on track as possible. good luck.

first, your insurance may very well cover a certified nurse-midwife and hospital birth. there are more and more CNMs working with OB groups. my insurance said they wouldn't cover a midwife, but the CNM billed through the OB group so she was covered. look into it. it's certainly not a home birth, but it might give you a bit more of the experience you're looking for.

and then write up a birth plan outlining how you'd *like* for the birth to go, and make an appointment to meet with the maternity coordinator/head OB nurse. talk to her (or i suppose it could be a him) about the birth experience you hope to have and that if at all possible, you'd like to be assigned nurses that are supportive of natural childbirth. you may be pleasantly surprised and find out that there several on staff. when i went in with my birth plan to the hospital, the mat.coordinator allayed my fears and said that episotomies were the exception rather than the rule, that while most people want epidurals as soon as they walk in the door, they're happy to help mothers do it naturally if that's what they want, and encourage moving around and different laboring positions, encourage rooming in and breastfeeding immediately, etc. have her sign your birth plan and have her put a copy in your file.

but more importantly, take this birth plan to your OB and talk to him/her. i sense a fear and distrust of doctors that should probaby be addressed with your particular doctor before you give birth so it won't be getting in the way when the time comes to have that baby! not all OBs are in a hurry to cut or give drugs, etc. a good OB will recognize that you may want to do it differently from the norm and will work with you. hell they may just be excited that you want to do it differently from 99% of their patient population and encourage you to birth the way you want to birth. i ended up having an OB for the delivery and he was not interested in finding reasons to speed things up or lying to me. he recognized that i was doing things my way, and he was fine to just hang out and be there to catch the baby and stitch up my small tear when it was all done. go over the birth plan line by line with your doctor or CNM and ask for their input. let them know you are flexible and they'll be more likely to go along with the birth you want, and may have suggestions for things you hadn't even thought of. a lot of it is attitude - if you go into it showing you have an open mind and are somewhat flexible and willing to listen to reason, you should be treated with respect. if you go into it rigid and "it HAS to be this way" and "medical intervention is ALWAYS wrong", sure, they're gonna get their backs up, and probably won't be as willing to work with you to acheive your goals.

make sure your labor support person (spouse/friend/doula/mom/whomever) knows your birth desires and is willing to be a strong advocate for those desires. if you're in the middle of labor and are overwhelmed and in pain and scared, that person can help ask you if this is something you really want if the doctor or nurse is pushing you to do something you don't feel comfortable with. they can ask the doctor to leave the room for a minute so you can discuss it. make sure everyone knows that NOTHING is to happen, no procedures will be done other than in a life-or-death situation, without your informed consent. ask questions (or have your support person do it) about WHY such and such should be done, what are the risks, what are alternative options, and then discuss it and decide what you are comfortable with.

my husband is a doc, though not an OB, and his main concerns with the birth plan were that it be short - 1 page 'cos if it's too long, the staff will likely not read it all and you're less likely to be taken seriously - and cover the points you REALLY don't want to budge on, except in the case of an emergency. and to make sure that you state that you are willing to budge on those points if it truly is necessary for the health of the child, or for you. my first draft was about 4 pages long, but i pared down the verbosity and ended up with a very workable birth plan.

now, things never happen exactly as you plan, no matter how carefully you make those plans, so you have to expect that there will be last minute changes. for example, my plan said, i don't want to lie down on my back. the nurse kept encouraging me to squat and get vertical, and i wasn't having it. i was fine right where i was thank you very much. and i did let them put in a hep lock so they could quickly put in an IV if needed, and hey, it was nice to have it in already when it was all over and they need to give me some fluids and pitocin to help stop the bleeding.

ok i'm done spouting my $.02 on the matter. good luck. just know that there are plenty of people out there who have had very satisfying births in hospitals with OBs. take courage from that!

jjfantastic gave alot of great advice,
it's soo important that whoever you plan to have in the room with you (husband/mother/sister?) be a firm supporter in your plan. tell them *now* that if things start to go in a direction you hadn't planned (for example labor being more painfull then expected and a suggestion of epidural sounds great all of a sudden) that they calmly remind you of your plan and suggest an alternative (different position, massage, whatever) to help you cope. it's their JOB to help you get through this.

on the other hand, just as jj said, things never go as planned. if meds start to sound great and you don't want anyones hands NEAR you to give you a massage then go for it and don't look back. the point of that day is to give birth to a beautiful healthy baby. no awards are givin to the moms whose birthplans were followed to a t or that refused all meds..we all end up happy as long as the babys happy.

i also think its important to stress to your OB that you are realistic and flexible as far as your plan goes, but that you want to feel in control. i think dr.s tend to roll their eyes when we come in as first-timers with plans in hand telling them this is how it's going to be, because none of us knows how it's going to go down.

all you can do is be prepared and go with the flow of labor..

I'm also going to the hospital for mostly financial reasons -- we couldn't even afford the doula, so my husband is doing his best to take on that role for me. He even has a printed list of questions to ask about any proposed intervention to try to ensure that I don't get, say, an episiotomy just because my doctor wants to move it along. I don't trust my healthcare provider (read: baby factory) either. We've seen encouraging pieces of their philosophy -- rooming in, breastfeeding as soon as possible, etc. -- but we'll end up with one of a zillion doctors du jour and have armed ourselves as best we can with a short, firm birth plan and lots of research into various interventions.
Just be sure to have someone informed with you who can help protect your interests, and be flexible. I just tested positive for group B strep and found out I'll need to go in earlier than I had wanted, and be hooked up to an IV for antibiotics, which torpedoes much of my plan (laboring at home, showers, etc.). I thought I was open-minded, but found myself deeply depressed for a day or two. But from what I know of strep there's no way I'd refuse the antibiotics. And since I'm still nesting away, waiting for the baby, I tweaked my birth plan to take the IV into consideration.
I've been downright paranoid about my healthcare providers, but have found that has subsided the closer I get to the due date. I'm a fretter, and I would drive myself insane if I gave too much room to my hospital fears. I want a good birth experience, of course, but I'm more focused on those first days when the baby's on this side of the womb. So I've kind of compartmentalized, for my own sanity, what stuff I'd really fight over (pitocin sounds like the work of the devil to me) vs. what I could grudgingly live with (the IV). Most important to me is to get home as quickly as we can, so we can get the baby in an environment where we feel we have more control -- and where we can focus on loving the baby and each other, rather than bracing for battles with hospital staff.

Just so you know, that 1% or less of women with Group B Strep (which is a common bacteria in the vagina anyway and occurs in approx. half of the population at large) have babies who suffer consequences of contacting the bacteria during birthing. Many hospitals in countries with far better maternal/natal care records than the US (Sweden, Canada and the UK, for example) do not routinely check or give prophylactic antibiotics for Group B Strep.

While I would also err onthe side of caution over the issue and go with antibiotics during labour, you shouldn't feel that getting the IV at the hospital should impact your plans to labour at home. You can safely labour at home until your contractions are measuring 2 mins apart/ 1 min long and THEN go to the hospital and have plenty of time for the IV antibiotics.

I would also recommend getting and taking acidophalus when you go into labour. Take a few tablets every few hours during labour and that will greatly reduce your chance of having thrush, which if the baby gets it, will be a huge pain in the ass after you come home. Antibiotics during labour are the leading cause of thrush post partum.

Good luck! You sound like hubby and you have done all the research and are going into this very smart.

Oh, also, did you realise that most women who labour without epidurals and then suddenly beg for them do so at the beginning of transition? So, if you find yourself suddenly saying "I can't do this, give me drugs, it's too much," it usually means you are a few minutes away from pushing! Keep this in mind and let hubby know, it will make gently helping you to resist that temptation much easier (knowing that the end is definately in sight).

Thanks for the advice, jane bond, especially re acidophalus... I've heard varying numbers re problems associated with group b, from 1% to 5%, and am not worried about it. But I'm OK with going in early (they want me there at least 4 hours before delivery, if it works out) and the IV: I've been among the lucky 1 in 100 and 1 in 50 for various things through this pregnancy, so even super-low odds don't mean much to me any more! I want to labor at home for my own comfort, and to keep meddlesome doctors away -- and frankly I'd be more comfortable with a just-in-case IV than going without and waiting to make sure the kid was OK. But I am refusing penicillin: I've never had it, and don't want to find out now if I'm allergic. And my doc said I was more likely to be able to detach the IV and get in some shower relief with something else. My only real concern is that they'll be more eager to try to dump gunk like pitocin in my veins since they'll already have one open.

As for the temptation of drugs: I've heard the same thing from so many women! My husband has that down on his crib sheet too.

blissed - you might be able to find a doula who will donate her time....or at least charge less. Call your local midwives' office and see if they have any recommendations on that.

You might be able to find a birthing center that your insurance will cover. While not home, they feel more homey and depending on the center, you can have all the medical things available in case things don't go as planned.

When I have kids, I hope to labor in home as long as possible, and then go to the hospital for the actual birth. Once you are admitted, the staff seems to want to rush you through and out, and sometimes the body and baby just won't be rushed.