UCSF v Alta Bates/Sutter v John Muir for childbirth

I delivered my first at Alta Bates. The L&D nurses were overall fantastic, but the facilities were not (nor were the nurses’ jobs as we heard over and over). My OB was at Sutter and I want to get out of the Sutter system for a variety of reasons - always late, practicing cookie cutter medicine, wrong diagnosis from the MFM team causing serious trauma in the third trimester, etc. 

We are considering John Muir but have heard they are overall more interventive than Alta Bates. I’m over 40 and it’s an IVF pregnancy and MDs tend to like to intervene in such “geriatric” pregnancies despite that my first was no issues (other than the misdiagnosis). 

UCSF seems to get the highest marks from folks who would probably tend to lean towards pure midwife care (like me) but can’t bc of age+IVF - great OBs, a Midwife practice, good facilities, Centering program, etc.

My question to the community who have gone to UCSF - in your experience, is it worth the commute from Richmond not for L&D but for the weekly (maybe daily) appointments at the end? 

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I live in Oakland and had an incredibly high risk pregnancy. I ended up transferring from Alta Bates to UCSF and it was the best decision, would make it again in a heartbeat.  The facilities are wonderful, the nurses and physicians seem to have a lot of respect for one another, I felt I was treated with dignity, care and compassion. I transferred in my third trimester, but I understand UCSF will do as many appointments as possible virtually, which helps with the visit trekking. Maybe it is changing, but a year ago UCSF seemed to be very selective about which patients they would take on, and required a referral. 

Was pregnant last year (also an IVF pregnancy and had our son in March 2022) and moved from SF to the East Bay in January 2022.  We had started at UCSF, loved our greater OB team and as one of the best rated maternal fetal programs we decided that it wasn't worth it to change practitioners or where I planned to give birth.  Yes, took some planning to get to early appointments on time and wasn't always my favorite to drive to SF for what would end up being a quick check-in, but was 100% worth it to me.  And while my son's birth didn't quite go as I had hoped, I felt so supported by my team who made sure that whatever could be accomplished in my birth plan and keep me and baby safe they made every possibility to do and always asked my permission before doing anything (which I know should be standard practice, but from the stories I've heard from so many  always the case at other practices/hospitals).  If we are lucky enough to have more children and are still in the Bay Area I will still have my pre-natal and L&D care be through UCSF.

I will say though, if having a consistent care team throughout pregnancy is important to you, UCSF is likely not the place to be.  As they are a large academic hospital, I very rarely saw the same doctor/midwife/NP/etc. for any appts.  I never had a bad experience so for me it was fine, but I know the consistency in who is at each check-up, ultrasound, etc. is important to some people.

I didn't love UCSF.  My pregnancy overlapped with the start of the pandemic, which probably contributed to a general sense of disorganization and seeing a different provider almost every time (I tried to see a midwife but this wasn't always possible).  When they told me I would need to be induced at 39 weeks due to the baby measuring small, it was basically impossible to get a straight answer on how this would work -- some people at USCF told me I could go in to get the Foley and go home until labor started, but I ultimately learned that due to the reason for my induction, I would be hospitalized and monitored from the start of the Foley insertion.  For delivery itself, I specifically requested a midwife but my mom (a former Labor & Delivery nurse) was chagrined when just five hours after the Foley insertion, when I was already on Pitocin and ~5 cm dilated, the midwife pressured me to break my waters to speed up labor (which in my mom's opinion was already going pretty fast for a first-time mom).  I ultimately needed a C-section due to potential fetal distress and while the surgery went fine (baby and I both did well), I did see the downsides of a teaching hospital, as I had a resident straight out med school (July birth, which is when the new resident classes start) doing much of my operation and I could hear the attending chastise the resident for things she was doing during the surgery (e.g., "Don't press on that muscle -- you aren't listening to me!!") which was a bit unnerving!  (This same resident told me that I was fully dilated after examining me a few hours earlier, which was nowhere close to true...)

That said, I also had a *terrible* experience at the Alta Bates ER where they misdiagnosed me when I had appendicitis and then I didn't get surgery until more than 72 hours after my initial ER visit, which led to all sorts of complications due to a ruptured appendix and an unpleasant hospital stay in a small room with a challenging roommate.  So I'm really negative about Alta Bates too.  If I ever had another baby, I just don't know where I'd want to go in the Bay Area.  I had another hospital stay in the Chicago area that was amazingly better than either of my California experiences and also less expensive...