You may have read a recent post about limited options for having a baby in Key West, Florida. If not, you can catch-up here. Long story short, the hospital is big on technology and pretty silent about labor that doesn’t involve constant monitoring. I had hoped that my fears that this hospital was less than accomodating to women aiming for a natural birth were unwarranted, and contacted a couple of doulas to see if they could tell me I was wrong and they just forgot to mention their midwives and birthing tubs. Or maybe there is a birth center there that doesn’t show up on an internet search. Or maybe there is at least one midwife doing home births. Here’s what I learned from them:
- There is no birth center. The closest one is in Miami (three hours away). There is no midwife for a home birth because none of the doctors there will back one up.
- There is a birthing tub. There is one midwife in Key West and she has “rights” to the tub. If you want to use it, you have to be seeing her and the OB she works with and pay $1000 for a liner for the tub. The doctor she currently works with has the highest c-section rate.
- You can labor in the tub but cannot have the baby in it. They will make you get out when you reach transition.
- The midwife practices like a doctor and actually wants women on their back and in stirrups for delivery.
- The only doctor that really worked with women to have their babies without pain medication and in any position is currently not practicing because she had an aneurysm.
- One of the doctors has great bedside manner and patients seem to like him. However, he is notorious for using every reason under the sun to start pushing a c-section around 38 weeks (the baby is too big, you’re too small, fluid looks low, etc.). He promises to be at all of his patients’ births and does not use the on-call doctor on weekends like the other OBs. That sounded good at first until I was told of a story where a mom arrived at the hospital about 7 cm dilated. She was admitted and the doctor was called. He was about 45 minutes away, so he told the nurse to give the mom something in her IV to slow things down. Had mom not asked, the nurse would have injected the drug without consent. Apparently this doctor is better if you have a doula, but still wants you to have the baby in the lithotomy position.
Lithotomy Position - maybe the worst position for avoiding a tear. After having a 4th degree tear with Madeline, avoiding another one and the possible incontinence issues is of the utmost importance to me. Since a water birth is out, position is all I've got.
- There is a doctor considered the “next best thing” now that the one is out with the aneurysm. However, he has been described as “crotchety” and reeks of cigarette smoke. I’ve heard good things from some women I’ve communicated with, but they’ve all had c-sections.
- Two different women that I have talked to were threatened by their doctor and hospital staff with calls to Child Protective Services because they refused to consent to certain interventions. Here is one story I got after asking on a military wife forum if anyone had a baby naturally in Key West:
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Well, I hate to be discouraging, but prepare yourself for a fight. Unless things have drastically improved from six years ago, they will argue with you about every little thing that doesn’t fit their “plan to be bothered as little as possible and get you out of our hair as soon as we can.” I was forced to stay on a monitor and submit to regular checks, which meant that I couldn’t get up and walk normally. I was “required” to have a full IV, even though they acknowledged that I was drinking enough fluids. After a few hours (of normal progression), I was bullied into taking pitocin and it was just downhill from there. They used threats (such as me killing my baby if I didn’t do what they said and how they would call CPS on me for ignoring medical advice.) If I hadn’t been in so much pain from the pitocin, I probably would have been able to stand up for myself. I knew I would have no trouble giving birth (DS1 was born naturally and he was almost 10lbs…this baby was only 7lbs), but the constant pushing and scare tactics made me give in. We won’t even go into the breastfeeding nightmare. Like I said, I don’t like telling horror stories, but I do think people should know what happens there. They have pregnant women at a disadvantage because there is no where else to go to have a baby. And I am, by far, not the only one this has happened to…there are some here on CC that have been through even worse there. |
- Another doctor was described as “the worst of the bunch.” He has the highest c-section rate and usually works with high-risk patients. The impression is that he treats all patients as high-risk. He was the doctor involved in the other CPS story I heard.
We had been thinking about going to Miami to have the baby at a birth center there. Not wanting a three hour drive while in labor (on the one road going in and out, so you’re shit out of luck if there’s an accident or traffic or something) we decided to go there the week of my due date and bank on the baby being born right at 40 weeks like the other two. I was liking this idea because it meant no monitors, no checks, no IV, no epidural being offered, and best of all, a tub for delivery. I wasn’t fully committed because I don’t like the idea of trusting that the baby will be “on-time” and I would really rather be at home the last few days of my pregnancy.
So this morning, after reading about the CPS threat I shared above, I decided that maybe I would rather beat them at their own game. I will do more research that I did during either of my other pregnancies. I will read up on patient rights and seek legal counsel regarding what happens when a patient’s (particularly a pregnant patient) desires are in direct conflict with hospital or doctor policy. I will speak to CPS myself when I arrive to find out if they had ever been called and what their take on this kind of situation would be. I will let them see me in a professional setting rather than risk meeting them for the first time at the hospital and pissed off. I will arrive at the hospital as far into labor as possible, preferably holding the head in as I waddle into the ER. I will arrive with a detailed birth plan and binder full of my research that will include documentation on patient rights, copies of business cards from my lawyer and whoever I speak to at CPS, and a copy of the Hippocratic Oath in case someone forgets it. Just for fun I might write up a legal memorandum summarizing the law as it pertains to informed consent and the right to refuse consent during childbirth. I will be super nice to my doctor at all prenatal appointments so that he has no idea what a true pain in the ass I will be if they don’t work with me to have the birth I want.
I’m also going to make sure Jay is wearing something Special Forces related…maybe one of his t-shirts with a picture of a skull with a knife going through it.
I’m not sure what showing up for a war will do for my psychological preparedness for childbirth, but I’m hoping that being over-prepared for the worst will make me confident that I can win a battle of wills with the hospital should it become necessary.
And it goes without saying (at least it should) that I have no problem consenting to interventions that are medically indicated. I don’t want constant monitoring, but if I need it, fine. I don’t want a c-section, but if there is a real emergency, I’ll sign the paper. I’m not an idiot. I’m an advocate for natural childbirth, not a crazy fanatic about it.
For anyone who thinks that I’m being crazy and no one can force me to do anything, let me leave you with a story I first read about in the book Pushed: The Painful Truth About Childbirth and Modern Maternity Care and read again while researching forced interventions this morning:
Oh my, that is a lot to take in! Hearing tales of doctors like the ones you mentioned make me so angry/terrified/stabby. I just can’t believe these people are DOCTORS. Stay strong mama! I hope you get to have the birth experience you want and deserve:)
I know. The stories I have heard from women down there remind me of stories I’ve read in books about how things “used to be.” I know a lot of hospitals have policies that conflict with a completely intervention-free birth, but most make some accommodations for women who want to do it that way. Or you’re in an area where you have more options when it comes to places to give birth or providers to work with. It’s so isolated down there and shockingly limited. The “hospital” doesn’t even have a NICU, so if something is wrong with the baby he/she has to be flown to Miami. Then you really hope you didn’t have a c-section so you can get out of there faster and be with your baby!
How did your birth turn out?? I am considering a move to Key West to practice as a homebirth midwife ( I currently live in Tampa) but was not sure of the need there…. Clearly it is huge.
I’m not due until July 25, so there’s still time to come help me!!!
We will be moving there May/June. At this point in the story I am planning on going to the Miami Maternity Center (probably renting a place near my due date rather than trying to make the drive in labor).
There is a HUGE need. From my understanding there are some great doulas who would be awesome support for moms and homebirth midwives, but no midwives right now. I think the environment is a little hostile to homebirth (even more so that to the idea of natural hospital birth) and I don’t know what kind of support, if any, you could get from the doctors and the hospital there. At a time when it seems more hospitals are trying to accomodate natural birth, the hospital in Key West has instituted a continuous monitoring policy.
Oh my goodness- well you do have lots of time! I know several homebirth midwives in/around orlando. Any reason you chose Shari’s center instead of just having a ‘homebirth’ in a hotel??
I was only able to find one doula in Keywest- any others I should contact??? Wish I could be of more help for YOU but Tampa is just too far for now
I chose that center because it just seems easiest honestly. With moving so close to the birth and the other logistics I think it will be simplest to be able to just show up there and everything will be taken care of. I thought of a “home” birth in a hotel or rental, but since I won’t really be home it doesn’t have as much appeal. I think I will be more comfortable in a birth center than in a hotel room. Do you know much about that center? There didn’t seem to be a lot of options without having to plan or traveling too far from Key West.
I am a OB nurse that is currently employed in key west and I have worked there for about two years. I am sorry you have heard horror stories from other people. But let me tell you the facts. There is one midwife in key west who is exceptional and does not practice like a dr. I have pushed with patients on the back, on their side, hands and knees, on the toilet, and many other positions. The midwife is always there for her patients, she has stayed at the bedside with a patient for more than six hours straight helping with pain with massage, music, the medicine ball, etc… All the labor nurses are game for what the patient wants. If you want to go all natural that is fine with me and any other labor nurse. I have labored many patients who have decided to take that route. I have sat with them for 12 hours on a medicine ball, walking the halls, changing positions, etc… The doctors are very welcoming and I have never seen them pressure a patient to do something for the reason to get it done. I have stayed after my shift to be with plenty of my patients that are 8 or more cm dilated. We are fully committed to provide the best experience possible. We also encourage all pts to breastfeeding. We have a lactation consultant that comes and helps with breastfeeding. She is available for one on one time even after you go home. She also gives you her cell phone number to call if you have any trouble. We also have a breastfeeding class that is offered…free. Yes I do understand certain things, all drs require you have a IV just in case for emergencies, but if you are adequately hydrated and don’t wants fluids the labor nurses will fight for you to not have fluids running. There is only one doula I recommend in key west and I have done many deliveries with her. She and the nurses work as a team for you can have the best experience possible. I have delivered a baby with the women on her hands and knees with that wonderful midwife. I am done more vaginal deliveries than csections. We do not do VBAC. We encourage are patients to speak their mind and educate/explain everything we are doing…I know this because I am also the charge nurse.
I appreciate your comment and am happy to report that I did have my baby here in Key West on July 26th…maybe you were there
Overall my experience was a positive one. There was more “intervention” than I would have preferred in my ideal scenario (hep lock, continuous monitoring) but I arrived complete at 10 cm and ready to push so I was so into my labor at that point that I wasn’t bothered much by those things. None of what was done interfered with me being comfortable.
I don’t doubt that what I heard from people is also true. When you want a natural, intervention-free birth and you’ve delivered in hospitals that don’t require a hep-lock, will monitor with a doppler for a few minutes at a time (as ACOG states is fine for a woman who is not high-risk), will allow you to labor and birth in a tub and will allow for delayed cord clamping (rather than give you some nonsense about how the blood will flow out of the baby if he/she is held above the placenta) any policies that interfere with your ability to just let things happen seem invasive.
I had an amazing nurse, my doula was worth her weight in gold (it was Arianna – I hope that it the one you like working with), my doctor was fine (other than the cord clamping/placenta nonsense), I was given over an hour of skin-to-skin before my baby was taken to be weighed/measured/etc. and that was awesome, and the nurses I had during my stay were very nice and helpful. The lesson learned from the experience is to do what you are comfortable with and remember that everyone brings something to the experience. What one person went through during her labor will not determine what the next person will go through.
I will be writing the story of this birth in the next week or so and my assessment of the hospital, doctor, and nurses will be an honest one and thankfully it will also be a positive one.