Yesterday, I went on a tour of what has been argued for years by homebirth midwives to be the best hospital in San Francisco to have a natural birth. Not having had occasion to transfer there myself, I was curious to learn about their facility and policies. This is what I learned...
One of the nurses guided myself and 3 pregnant couples on our 45 minute tour at 5pm on a Tuesday evening. She started by explaining that in labor, patients should come in through the main entrance, unless it is the weekend or after 8pm, in which case patients should enter through the emergency department off of San Jose Ave. There is a cafeteria on the 2nd floor that is open Monday through Friday from 6:30am to 6:30pm where guests can get hot food and snacks.
Labor and delivery is on the 3rd floor. There are 3 delivery rooms and 3 triage rooms. The delivery rooms are smaller than the rooms at some of the newer hospitals like UCSF Mission Bay. The triage rooms are very small, and are used for patients who are not yet in active labor. Both the labor and the delivery rooms have attached bathrooms - although none of them have bathtubs, and only the delivery rooms have showers.
All rooms, according to our guide, have telemetry units, also known as wireless fetal monitoring. This allows for monitoring of the baby without requiring that you be hooked up to a static machine at the bed. The monitor hangs around your neck so you can move about.
The nurse estimated that St. Luke's does about 80 deliveries a month. On the evening of our visit, all 3 delivery rooms were occupied, and 2 out of 3 of the triage rooms were occupied. For that reason, we were not able to see an actual delivery room, just one of the smaller triage rooms. Our tour guide assured us, however, that it is very rare for them to be so full as to have to deliver patients in the triage rooms or reroute patients to another CPMC campus.
Next, we went up to level 5 to the postpartum unit. The postpartum rooms are also small and uninspired. There is a hospital bed, a television, a fold out chair for partners, and a small sink area. They also have a connected bathroom with toilet and shower. The typical stay for a vaginal delivery is 2 days, and for a Cesarean section, 4 days.
- Midwives are the primary providers at all low-risk deliveries. There is a midwife and a physician in the labor and delivery unit 24 hours a day, 365 days a year. The physician attends deliveries only when it is deemed medically necessary.
- Intermittent fetal monitoring is an option and wireless monitors are available in all rooms.
- Group prenatal appointments are available in cohorts of 10 families per group. The program is modeled after the Centering Pregnancy model, but was developed by CPMC. In this model, prenatal appointments and pregnancy/childbirth education are blended into bimonthly group appointments. Afternoon and evening meeting times are available. The groups fill up months in advance, so sign up early.
- The hospital started allowing VBACs in October of 2017. I do not have any more information on the requirements for a VBAC, policies, or rates of successful VBAC at St. Luke's.
- Laboring patients are allowed to move freely during labor and to push in positions other than flat on their back in bed. In fact, our guide assured me that babies at St. Luke's do not have to be born in the hospital bed - that babies are born on the birth stool, in a squat, on hands and knees, and in a variety of positions. This is a BIG DEAL. I don't know of any other hospital in the Bay Area that will let you deliver your baby anywhere other than in the hospital bed.
- Baby rooms in with mom.
- A lactation consultant and social worker are available on the postpartum floor Monday through Friday.
- There is no restriction on the number of visitors you can have in labor and delivery or postpartum.
- The facility is old and the rooms are small.
- There are no bathtubs in any of the rooms, and only the delivery rooms have showers.
Unfortunately, our guide didn't have a very good grasp of the actual hospital policies or practices around things like GBS, VBAC, induction, eating in labor, C-section, or pain management options.
I was able to glean some information about St. Luke's C-section rate from online. According to the California Hospital Assessment and Reporting Taskforce, CPMC St. Luke's had a NTSV C-section rate of 21.7% in 2014. For reference, the statewide rate for that year was 26%. The NTSV C-section rate includes only first-time mothers giving birth around their due date, having a single baby that’s positioned head down.
Without knowing much more about key procedures or policies, all of the obvious cons are related to the facility. And guess what - there's good news here. CPMC is currently in the process of building a new campus for St. Luke's. The new campus will be right next door to the current one, and is on track to open towards the end of August 2018. That's in 8 months, folks! So many of you reading this will benefit from the new facility, which is certain to be leaps and bounds better than this one. I'm told there will be bathtubs :-)
If you are healthy and are having a healthy pregnancy, then having your baby at home or in a freestanding birth center is the best option if you want to avoid a C-section or other restrictive or invasive procedures. That being said, if you are absolutely set on a hospital delivery, you should seriously consider St. Luke's for your care if you are desiring a natural birth. Having a midwife as primary provider and being able to deliver in the position of choice makes St. Luke's much closer to a mother-baby friendly model of care than most other hospitals in the Bay Area. I wouldn't be surprised if many of their other protocols are similarly progressive.
In my opinion, once St. Luke's is in the new facility, it'll be a slam dunk for Best Hospital in the Bay Area for a Natural Delivery.
Addendum: Shortly after I published this post, the lead midwife at St. Luke's reached out to me by email to clarify some aspects of the facility that my tour guide hadn't been completely accurate about. Those updates have already been made in the body of this post. She also emphasized that along with the move to the new facility, St. Luke's was working to implement changes to make the midwifery-centered approach even stronger. This is really fantastic to hear. While a nice facility can certainly make your experience more pleasant, there is nothing more important than the values of the team that is providing your care.