Birth at Alta Bates: What you need to know

Although Alta Bates’ long term future is uncertain, it’s still a hub for East Bay maternity care and sees over 600 births a month. That’s down from 700, perhaps due to Kaiser being such a (relatively) attractive plan through Covered California.

IMG_1936 - Edited.jpg

I recently took a tour of Alta Bates Labor and Delivery. I’ve been there dozens of times as a support person, but I was curious to see it through the eyes of an expectant family.

About 12 couples gathered on the first floor in a big room where the tour guide answered questions and walked us through what to do when labor starts. Always call your doctor or midwife first!

Every provider may make a different plan with an individual patient, but as a general rule of thumb, Alta Bates encourages first timers to come in when contractions are coming every four to five minutes, lasting a minute, and that pattern has been in place for two hours. This is colloquially known as 4-1-2, and is a change from the old 4-1-1, with the pattern only lasting for one hour.

As the tour guide explained, “you are better of staying at home for as long as you can” because “birth is not a medical event” and it’s more comfortable to labor at home.

For a second baby (or more), they want to see you when you have been having contractions four minutes apart, lasting one minute, for half an hour. (I am often set up and waiting at the house of a second baby earlier in labor than that - second babies can come quickly!)

Our guide recommended parking in the garage and walking to labor and delivery (third floor) if labor isn’t too advanced. Once you are through triage and admitted, someone can go back out and exchange the parking slip for a $20 flat rate ticket with which the car can come go for 72 hours.

Although our tour guide said that she has “never heard of it being full in 29 years”, I have twice been told when calling to bring in a home or birth center transport that they were too full and we really should go elsewhere.  They can’t refuse to see someone in labor but I have seen patients have to wait in triage for a very long time to get a room.

When we moved up to the third floor to check out the labor and postpartum rooms, a loud moan from triage sent a thrill through the group of mostly first-timers. Later on we heard a newborn’s cry, equally exciting.

(Once, when I was working at a birth center, a woman was birthing down the hall from a full prenatal class. She screamed many times, at high volume, “Pull it the *@$# out of me! Just pull it out of me!” She did a great job birthing her own baby and did not need anyone to pull it out of her, but the shocked faces filing out at the end of class were a sight!)

They have three telemetry units (portable monitoring so that you can have more freedom to move away from the bed), which doesn’t sound like very many, but most people are on continuous monitoring due to pitocin or epidurals. I’ve never seen anyone not be able to get a telemetry unit who wanted one. They will do intermittent monitoring for low risk pregnancies, which to them means 20 minutes out of every hour on the monitors. I will add that sometimes getting what they consider an adequate strip takes more than 20 minutes.

 Not so appetizing... but luckily there are many close food options nearby! 

Not so appetizing... but luckily there are many close food options nearby! 

There are some archaic policies in place. Once admitted, you are not allowed to have solid foods, only liquids. The guide did say that every doctor feels differently and perhaps yours would be willing to override hospital policy, so that is a good question to ask prenatally (keep in mind the whole group of doctors or midwives has to be on board, because you don’t know who you will get in labor). You could be admitted for all sorts of reasons long before active labor (rupture of your membranes, induction) and have to go literally days without eating.

You are only allowed to have four support people in the labor room (including a partner) and one support person in triage. I have seen this be a problem many times during home birth transports, when support people can add up fast. The person in labor usually wants their partner with them in addition to the midwife and maybe a student midwife, a doula, and other family members or friends. It’s especially problematic in triage, when a laboring person may have a partner and a doula or midwife, and important decisions and conversations are happening about the management plan and whether to stay in the hospital.

In comparison, John Muir allows five support people in the delivery room and two in triage and allows eating in labor. I don’t know what the official Kaiser Oakland, San Leandro, and Walnut Creek policies are but at those facilities I’ve seen at least four support people allowed in triage (where the rooms are private) and at least five in delivery rooms.

After about two hours, everyone is moved to a postpartum room, which all have pullout couches for the partner. Alta Bates practices routine rooming-in (meaning your baby doesn’t leave the room except for medical procedures). Most people stay two days after a vaginal birth and three days after a c-section. There is the potential to go home after 24 hours if you ask.

Lactation consultants are available every day from 8am-6pm but they can get busy so you may have to ask to be seen. I recommend that all parents breastfeeding for the first time ask for a lactation consultant to come to their room before they go home from the hospital.

With the exception of four larger rooms in the middle, all the rooms have windows and are small relative to the labor rooms at John Muir or Kaiser Oakland. Ultimately, room size and shininess has a lot less impact on patient satisfaction and outcomes than the nursing care and provider management of labor and delivery. Unfortunately, those are harder to judge from a one hour tour.

 It never hurts to give feedback to any hospital or care provider

It never hurts to give feedback to any hospital or care provider

Personally, I have had many great experiences at Alta Bates and some that left the family and myself wishing for better care.

To some degree, the hospital and provider are the biggest determinants of your mode of birth. No matter how educated or prepared or motivated you are to have a vaginal or natural birth, you are constrained by the policies and approaches of your providers.

For hard data on outcomes by hospital we can turn to Calhospitalcompare.org, which offers statistics on four key indicators of quality in maternity care, most importantly, the c-section rate for a population that should be largely low risk: first babies, at term, singletons, and head down. They also look at breastfeeding, episiotomy, and VBAC (vaginal birth after cesarean) rates.

In a comparison between Alta Bates, Highland, and John Muir, Highland clearly comes in ahead. If you strongly desire a vaginal birth, and given that Alta Bates has a 19.4 % c-section rate, John Muir’s is 23% and Highland’s is 13.3%, I would choose Highland any day. Likewise on the episiotomies, which Highland reports at less than half the rate (1.3%) of Alta Bates (2.8%) and John Muir (7.2%).

Alta Bates and Highland have almost identical VBAC success rates at 33.2 and 33.8%, respectively. John Muir is much lower at 20.8%. Interestingly, Highland’s breastfeeding rate is the worst. There isn’t any information given on the website about how that outcome is measured. Any initiation of breastfeeding? Exclusive breastfeeding at discharge or at six weeks?

Unfortunately, in our byzantine insurance system, you may not have much of a choice. I recommend calling your insurance company to find out which hospitals are in-network. If Alta Bates is your only option, rest assured that you are still likely to receive quality care.