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Mapping Out Your Birth Plan: Close to Home or Close to Work? #labor #delivery #pregnancy #birthplan #birthingcenter #maternityward

Mapping Out Your Birth Plan: Close to Home or Close to Work?

By Amalah

Hi Amalah!

I’ve just loved reading your blog for years, and enjoyed your weekly pregnancy calendar, Zero to Forty, even when I wasn’t pregnant! Now I am 15 weeks pregnant and really delighted to enjoy all this information all over again for myself!

I have a question you may be able to uniquely understand, because I live in the DMV. I currently live in DC (NW) and am currently seeing midwives that deliver downtown. My plan is to move out to the burbs (to your county, in fact! I swear I don’t stalk you too much, I’ve just seen you mention that you moved in the county I grew up in!) because my wonderful parents have offered to watch my baby, offering me !free! child care. I love living in the city, but it makes the most sense to live near them for pick up and drop offs.

Here’s where my question lies: I work in the city and plan on working up until my due date. Should I switch practices to one in the burbs because that’s where I’ll be living, or should I remain with my practice in the city? For ease of appointments, the city is best. But if I go into labor at home… and you know how DC traffic is. What would you suggest? I don’t feel particularly tied to the practice I’m currently being seen, but the hospital in the city is definitely a higher caliber than the general hospital in the ‘burbs.

Urban Mama

This question is much trickier than it should be! For non-DC-metro-area readers, let’s start with some geography: I live in Howard County, Maryland now, so we’re talking about a move 45 minutes to an hour’s drive from DC under “normal” traffic circumstances. However, DC-metro-area traffic is rarely ever “normal.” It’s batshit insane, frankly, with three-hour rush “hours” morning and night and heavy volume pretty much all the time. We are perfectly used to random stop-and-go gridlock because of bad weather (or like, a drizzle), accidents, breakdowns, rubbernecking, or even because the sun is shining too bright and everybody on the Beltway forgot their sunglasses.

(Actual traffic report I heard on the regular.)

(The good news is that while getting to and from DC at peak times can still be hellish, driving around here in what the locals consider “traffic” is basically adorable.)

Like you, Urban Mama, I lived in in Northwest DC during my first pregnancy. I chose an OB/GYN closer to where I worked (in the Montgomery County burbs) for the ease of appointments, and because I planned to work right up to my due date. But that plan didn’t actually happen, as is very often the case in late pregnancy. I made it to about a week before my due date before the discomfort and swelling and exhaustion (and the lack of any maternity work clothes that could adequately cover my giant belly) won out and I opted to work from home. This meant a lot of extra driving out to the suburbs in those final days for cervix checks, and of course, once I went into labor we needed to be conscious of the time it would take to get to the hospital (about a 20-30 minute drive).

It all worked out just fine, obviously — I went into labor in the evening and by the time the contractions got into head-to-the-hospital territory it was super late at night and we coasted there on an completely empty highway. And the ease of getting to all my regular appointments and being close to my doctor and the hospital while at work was really nice!

As for the cons, well, it wasn’t always ideal for appointments where my husband wanted/needed to be there (he was usually down in the city or even Northern Virginia, aka the seventh circle of commuting hell), or whenever there was a preterm issue that required getting checked out in Labor & Delivery. (Spotting, false labor alarms, etc.) So in retrospect, yeah, maybe it would’ve been nicer to have gone with a practice closer to home, or with one that had admitting privileges to more than one local hospital.

But it was fine! And I think you’ll be fine, with whatever option you go with. Personally, I’d probably stay stick with your current practice, then reassess on a month-to-month basis. Once you make the actual move you may find that you’re working from home more and more and appointments down in the city aren’t as convenient after all. Or you might feel just great and keep working until your due date (or even past it), and can just spend the last couple days of your pregnancy at a hotel downtown to ease any worries about a long drive in active labor. (Also, room service and housekeeping! Yay!)

Or, if something completely unexpected happens (like super-fast labor that requires getting the nearest hospital ASAP, no matter which one it is) you might end up giving birth at a different location and with a different doctor or midwife than you planned on. That can happen, and guess what? It will also be fine! If that possibility feels super distressing (which I do understand), then yeah. I’d probably look for a close-to-home practice once you move — maybe you could even see midwives at two practices for awhile, just to make sure you have someone you’re comfortable with in both geographic areas. (Note that not every insurance or birthing practice will be down with that arrangement, but it might be a compromise worth looking into.)

I also understand — if we’re talking about the same DC hospital vs. local general hospital comparison that I think we’re talking about — your concerns about a possible quality disparity. While the ER doesn’t get the highest marks reputation-wise, I’ve heard almost universal praise for their Labor & Delivery unit, maternity ward and NICU. There are also quite a few private birthing centers up here, if you want to pursue a natural birth/experience. But again, I probably would stick with the current plan/practice until you’ve made the move and reassess your options then. There’s no shortage of great doctors/midwives up here so even a late-in-pregnancy switch won’t be too difficult, if that’s what you end up deciding.

Readers: What did you do, if you had a similar choice between close-to-work or close-to-home decision in regards to OB care and birth location? Or if you moved mid-pregnancy? Chime in with (NON-SCARY TO NEWLY PREGNANT LADIES ONLY PLEASE) stories in the comments, please!

Photo source: Depositphotos/jovannig

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Amalah
About the Author

Amy Corbett Storch

Amalah

Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Ama...

Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Amalah. Also, it’s pronounced AIM-ah-lah.

If there is a question you would like answered on the Advice Smackdown, please submit it to [email protected].

Amy also documented her second pregnancy (with Ezra) in our wildly popular Weekly Pregnancy Calendar, Zero to Forty.

Amy is mother to rising first-grader Noah, preschooler Ezra, and toddler Ike.

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Liz
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Liz

I faced this same dilemma, but in Philly vs. DC. I live in South Jersey, but work in Center City Philadelphia (only 12 miles but a 45-60 minute commute during rush hour, assuming “normal” congestion). I opted to go with a doctor in the city near work and delivered all 3 of our kids in a hospital in the city. It definitely made it harder for my husband, who does not work in the city, to attend appointments, but it made it so much easier for me to get to all those appointments. And when I eventually went into labor,… Read more »

M
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M

I live in the “DMV” and work about an hour commute from home. During my pregnanacy, I chose to go with a doctor/hospital close to home and tried to sign up for the earliest appointments possible so that I went to work afterward, most of the time later in the rush when the traffic wasn’t so bad. Husband worked from home, so any ultrasounds were easy for him to get to. I decided to stop working after my due date passed, which kind of sucked in terms of maternity leave (one week less with the baby, no telework for me),… Read more »

Annie Pinyard
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Annie Pinyard

I had the same issue in the Boston area. We lived 13 miles from where I worked, but it would take an hour and a half if I left even 5 minutes later than planned. I went with the doc/hospital close to work. It was great. I could go and do the sugar tests on a lunch break, or for the few times I had spotting (no issues, just spots) I could run over mid-day and see someone. If I had to go to a doc/hospital near home, I would have had to take time off of work (which I… Read more »

Amy
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Amy

I live in the DFW metroplex. I live in the burbs and commute downtown for work and I too had the issue of choosing a practice close to work or home. In my circumstance, I chose my OB/GYN after we moved to the burbs and chose a practice that was precisely in between my work and home (20-25 minutes from either, under “normal” traffic conditions). As for the hospital, I ended up choosing one that was very far from my work (45-50 minutes in “normal” traffic) and somewhat far from my house (25 minutes again in “normal” traffic). I chose… Read more »

Cass
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Cass

Timing on this is appropriate, I’m 32wks w/my 2nd and my office is 45-60 mins from home so this was a big discussion the first time around. My OB has privileges at multiple hospitals in the area so that wasn’t so much a factor, but the hospital closest to work I wasn’t a big fan of. I ended up going with the hospital close to home (15 mins) and transitioning to working from home the last few weeks before my due date. The down side is that I had to factor in travel time for each dr. appt. but in… Read more »

Rose
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Rose

I live in Denver, but 45 to 60 minutes away from the hospital I worked at while I was pregnant. I still chose to deliver at that hospital. My appointments were super convenient while I was working with my first pregnancy. I ended up scheduled for an induction that changed to emergency c-section when I checked in. Baby’s heart rate was dangerously low, even though he had been fine at the doctors office less than 24 hours prior. With the second pregnancy, I still went with the same hour away hospital because I was most comfortable there. They had a… Read more »

Brenna M
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Brenna M

“random stop-and-go gridlock because of bad weather (or like, a drizzle), accidents, breakdowns, rubbernecking, or even because the sun is shining too bright and everybody on the Beltway forgot their sunglasses.” Firstly, I can confirm ALL OF THAT. Secondly, if this is your first birth, I think it will take a lot longer than you think. Like, maybe if it was your second or third it would pop right out. I live in northern VA but my OB was in DC/Falls Church and had privileges at Sibley, which was ~30 minutes at best. I will say the experience was overall… Read more »

Pheobe
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Pheobe

Ah, we lived in NOVA and had this exact debate with our first. To add to the chaos my office moved while I was pregnant. In the end I went into labor on the weekend and it was super fast so I ended up in an ambulance and at INOVA….instead of with the midwives at the hospital I planned. But it was all fine. So my advice would be go with the practice most convenient most of the time. And tour both L and Ds. That way you and your spouse are familiar if you need to make a quick… Read more »

Pheobe
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Pheobe

Oh! And one other thing consider a doula. That way no matter the hospital you could have some continuity of support (other than your spouse) that was a HUGE support for us. We have worked with Family ways twice (they arE DMV located and great)

Rachael Maltiel Swenson
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Rachael Maltiel Swenson

I had this similar situation for my baby born 6 weeks ago. I work 35 minutes with no traffic (which never happens in the Bay Area!) from home and picked a hospital the opposite direction of work from home. Doctor is 15 minutes from my house but hospital was closer to 25 with no traffic, so nearly an hour from work. I had figured I’d go to the hospital once for delivery so it didn’t really matter. Turns out I ended up with a complication with extra monitoring, meaning weekly hospital visits from 32 weeks and biweekly from 36, plus… Read more »

Natalie
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Natalie

I moved just before the third trimester with my first. So I had to decide – start with my OB, which was about equally a pain from both work and home (I worked in Boston at the time) or pick a different OB and hospital which was closer to home or work. In the end, I opted to study because I honestly hit a point where I was freaking out about it way too much, and for my own sanity it was best. I did switch OBs at 35 weeks pregnant in my second pregnancy, but that was because we… Read more »

Kathryn
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Kathryn

One of the things that really helped me was to do an informational meeting for “just in case” planning. If the alternate hospital L&D is willing to sit down with you and walk through a birth plan, what would happen if you had to show up because you were in the wrong place when it was time, etc, it might really put your mind at ease about the contingency. I was super nervous about a midwife practice where they were on rotation and I couldn’t guarantee I’d know the person I’d be working with for my birth. When the time… Read more »