Quix, or anyone else, can you give me advice from am medical standpoint?

[mrsturbo]

If you remember any of my posts I am currently in the satge of "suspected ms" without an official diagnosis.  I am also pregnant, and even though alot of my symptoms have gone away, a few are reappearing and new ones are showing up.  My question is about labor and delivery.  My last child was delivered at a birthing center by midwife.  The closest hospital was 10 minutes away.  At that point I had not had any symptoms.  Well now that I am experiencing MS symptoms, and the docs have ruled out most of the major mimics, is it still wise to deliver at a birthing center or should I be at a hospital just in case problems arise.  Most of my online research about pregnancy and MS sais that normally labor is okay, but some other sites have said that basically until labor begins I won't know if there is any nerve or muscle damage to the area which could cause problems with delivery.  So basically I would like some one else's opinion other than my midwife who seems to think it should be fine, but also wanted to know what exactly MS is (not exactly comforting from a medical professional).  Thanks for your time in advance.

[mrsturbo]

Thank you so much.  My last delivery was horribly painful and pain was presenting in weird locations.  At the time my midwife thought I was nuts, bur now I know it could have been from nerve damage.  I think my heart, and the Lord, is telling me that this time I need to be in a hospital setting.  Usually I am under the opinion that pregnancy is not an illness and should not be in a hospital, but if you have an underlying illness then my opinion changes.  Thanks for your time, and I have an appt. with an OB that has had a pt. with MS before, so I will take her opinion highly as well as yours.  Thanks.

[Quixotic1]

Hmm...I'm not really well-qualified to discuss this, as I have never read anything about it.

My first thought was that a birthing center delivery should be fine - with one very strong personal bias.  But, when you mentioned that MS "could" show up with some problems that had not surfaced before - that "rang true" in my medical mind also.  I think I would ask your neuro to ask a high risk OB for an opinion.

The statistics are very good from good birthing centers and actually very good from home deliveries with highly qualified midwives.

As a pediatrician I have attended thousands of births.  When a problems present, it can be in a life-threatening (to the baby) way.  I was and remain adamant that access to a hospital for an emergency CS be "very close" and have always preferred birthing centers attached to a hospital for that reason.   10 minutes away means 10 minutes to get to you (unless they keep an ambulance at the center) and 10 minutes to the hospital -presuming normal traffic.  Then there is the possible delay of an OR and 2 to 3 minutes to get the baby out.  So, 10 minutes away means a "minimum" of a 30 minute delay once they determine that a C-Section is necessary.  If a baby is having a low heart rate, 30 minutes is a long, long time.  If it is just Failure to Progress 30 minutes isn't important.

When I was a solo pediatrician in rural Nevada I was the one they called for problems in the home deliveries.  I had to pick up the pieces.   I am probably too scarred (not scared) from so many rescusitations of nearly dead infants, that I am too biased and too cautious.

So, I am a poor one to ask.  I guess I would want to know that my midwife would opt for a CS earlier than later if something neurological appeared to be happening with the labor.  My gut feeling (which is not a scientific enough reson to follow it) is that the effect MS would have (if it had any effect at all) would be something like failure of the labor to progress normally.  This is something that usually does not present as a major emergency.  

I would want to know the opinion of a doc from a large MS Clinic, like at a major hospital or university.  

Quix

[jensequitur]

What MS is, huh?  Tough question to answer, because nobody really knows.  Tell your midwife that essentially MS is like having an intermittent fault in your car's electrical system.  Sometimes your lights come on, sometimes they don't.  Sometimes your wipers work, sometimes they don't.  Sometimes it'll start, sometimes it won't start at all.

Quix has had lots of experience as a pediatric nurse, (I think!) so she's the best person to answer whether you should have your child at a birthing center or in a hospital.