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Wednesday
Mar162011

Guest Post: Molly Remer on Hospital Routines

What to Expect When You Go to the Hospital for a Natural Childbirth

By Molly Remer, MSW, ICCE, CCCE

There is a fairly “normal” course of events for women having a natural birth in a hospital setting. In order to be truly prepared to give birth in the hospital, it is important to be prepared for “what to expect” there and to know how to deal with hospital procedures. All hospital procedures/routines can be refused, but this requires being informed, being strong, and really paying attention to what is happening. I hope this list of “what to expect” with help you talk with your medical care provider in advance about hospital routines and your own personal choices, as well as help prevent unpleasant surprises upon actually showing up in the birthing room. This list is modified from material found in the book Woman-Centered Pregnancy and Birth. I am not saying that is how your specific hospital operates, but that many American hospitals function in this manner.

  • Expect to have at least some separation from the person who brought you to the hospital, whether this separation is due to filling out admission paperwork, parking the car, giving a urine sample, being examined in triage, etc.
  • Expect to remove all your clothing and put on a hospital gown that ties in the back.
  • Expect to have staff talk over you, not to you, and to have many different people walk into your room whenever they want without your permission and without introducing themselves.
  • Expect to have your cervix examined by a nurse upon admission and approximately every hour thereafter. Sometimes you may have multiple vaginal exams per hour by more than one person.
  • Expect to have an IV inserted into your arm, or at minimum a saline lock (sometimes called a Hep lock).
  • Expect to be denied food and drink (at best, expect clear liquids or ice).
  • Expect to give a urine sample and perhaps a blood sample.
  • Expect to have an ID bracelet attached to your arm.
  • Expect to have to sign a consent form for birth and for application of a fetal monitor that states that your doctor will be responsible for making the decisions about your care (not you).
  • Expect to have a fetal heart rate monitor attached around your belly—two round discs on straps that will often stay with you continuously until you give birth (or, at best, for 15 minutes out of each hour of your labor).
  • Expect to have your water manually broken at about 4 centimeters (or at least, strongly suggested that you allow it to be broken). After this point, expect to be encouraged to have an electrode screwed into the baby’s scalp to measure the heartbeat and a tube placed in your uterus to measure your contractions.
  • Expect to be offered pain medications repeatedly.
  • Expect to receive Pitocin at some point during your labor–”to speed things up.”
  • Expect to be encouraged (or even ordered) to remain in your bed through much of labor, especially pushing.
  • Expect to either have your legs put in stirrups or held at a 90 degree angle at the hips.
  • Expect to be told you are not pushing correctly.
  • Expect to hold your baby on your chest for a few minutes, before it is taken away to be dried, warmed, and checked over.
  • Expect the baby to have antibiotic eye ointment put into its eyes (without telling you first).
  • Expect to have your baby suctioned repeatedly.
  • Expect to be given a shot of Pitocin to make your uterus contract and deliver the placenta.
  • Expect not to be shown the placenta.
  • Expect your baby to be given a vitamin K injection.

I think it is important to note that what you can expect is often different than what you deserve and that what you can expect often reduces or eliminates your chances of getting what you deserve. In my classes, I’ve made a conscious decision to present what women deserve in birth and though I also talk about what they can expect and how to work with that, I think sometimes they are left surprised that what they actually experience in the hospital. At minimum, what you deserve are Six Healthy Birth Practices (as articulated by Lamaze):

  1. Let Labor Begin on Its Own
  2. Walk, Move Around, and Change Positions Throughout Labor
  3. Bring a Loved One, Friend, or Doula for Continuous Support
  4. Avoid Interventions That Are Not Medically Necessary
  5. Avoid Giving Birth on the Back and Follow the Body’s Urges to Push
  6. Keep Mother and Baby Together – It’s Best for Mother, Baby, and Breastfeeding

As an example of what I mean about what you can expect clashing with what you deserve, consider the second healthy birth practice “Walk, Move Around, and Change Positions Throughout Labor”—monitoring and IVs directly conflict with the smooth implementation of a practice based on freedom of movement throughout labor.

So, how do you work with or around these routine expectations and your desire for a natural birth?

  • Go through the above list of “what to expect” and make a decision about how to handle each one on a case by case—you may choose to actively refuse something, you may be okay with accepting certain procedures or routines, and you can develop a coping plan for how specifically to work with any particular issue.
  • Take independent childbirth classes and learn a variety of techniques and pain coping practices so that your “toolbox” for working with labor is well stocked.
  • Hire a doula, or bring a knowledgeable, helpful, experienced friend with you. It can help to have a strong advocate with you (this may or may not be a role your husband or partner is willing to take on).
  • Another tactic is to “never ask permission to do what you want, but to go ahead and do it unless the hospital staff actively stops you.” (An example of this is of getting up and walking around during labor)
  • Many people, if they can find no other way to get around a dangerous or unpleasant hospital policy, unobtrusively ignore it—a good example of this is with regard to eating and drinking during labor. Restricting birthing women to ice chips or clear liquids is not evidence-based care. Bring light foods and drinks and quietly partake as you please.
  • Leave the hospital early, rather than remaining the full length of stay post-birth. This can minimize separation from baby and other routines you may wish to avoid.
  • When you get the hospital, ask to have a nurse who likes natural birth couples. My experience is that there are some nurses like this in every hospital—she’ll want you for a patient and you’ll want her, ask who she is! If possible, ask your doctor, hospital staff, or office staff who the nurses are who like natural birth—then you’ll have names to ask for in advance.
  • Put a sign at eye level on the outside of your door saying, “I would like a natural birth. Please do not offer pain medications.” (It is much easier to get on with your birth if you don’t have someone popping in to ask when you’re “ready for your epidural!” every 20 minutes.)
  • Once in labor, stay home for a long time. Do not go to the hospital too early—the more labor you work through at home, the less interference you are likely to run into. When I say “a long time,” I mean that you’ve been having contractions for several hours, that they require your full attention, that you are no longer talking and laughing in between them, that you are using “coping measures” to work with them (like rocking, or swaying, or moaning, or humming), and that you feel like “it’s time” to go in.
  • Use the hospital bed as a tool, not as a place to lie down (see my How to Use a Hospital Bed without Lying Down handout)
  • If you feel like you “need a break” in the hospital, retreat to the bathroom. People tend to leave us alone in the bathroom and if you feel like you need some time to focus and regroup, you may find it there. Also, we know how to relax our muscles when sitting on the toilet, so spending some time there can actually help baby descend.
  • Use the “broken record” technique—if asked to lie down for monitoring, say “I prefer to remain sitting” and continue to reinforce that preference without elaborating or “arguing.”
  • During monitoring DO NOT lie down! Sit on the edge of the bed, sit on a birth ball near the bed, sit in a rocking chair or regular chair near the bed, kneel on the bed and rotate your hip during the monitoring—you can still be monitored while in an upright position (as long as you are located very close to the bed).
  • Bring a birth ball with you and use it—sit near the bed if you need to (can have an IV, be monitored, etc. while still sitting upright on the ball). Birth balls have many great uses for an active, comfortable birth!
  • When any type of routine intervention is suggested (or assumed) during pregnancy or labor, remember to use your “BRAIN”—ask about the Benefits, the Risks, the Alternatives, check in with your Intuition, what would happen if you did Nothing/or Now Decide.
  • Along those same lines, if an intervention is aggressively promoted while in the birth room, but it is not an emergency (let’s say a “long labor” and augmentation with Pitocin is suggested, you and baby are fine and you feel okay with labor proceeding as it is, knowing that use of Pitocin raises your chances of having further interventions, more painful contractions, or a cesarean), you can ask “Can you guarantee that this will not harm my baby? Can I have in writing that this intervention will not hurt my baby? Please show me the evidence behind this recommendation.”

I realize that some of these strategies may seem unnecessarily “defensive” and even possibly antagonistic—I wanted to offer a “buffet” of possibilities. Take what works for you and leave the rest! Great births are definitely possible, in any setting, and there are lots of things you can do to help make a great birth a reality.

Finally, and most importantly, “birth is not a time in a woman’s life when she should have to FIGHT for anything,” so if you find that you feel you are preparing yourself for “hospital self-defense” I encourage you to explore your options in birth places and care providers, rather than preparing for a “battle” and hoping for the best. If you feel like you are going to have to fight for your rights in birth, STRONGLY consider the implications of birthing in that setting. Also, as The Pink Kit says, “hope is not a plan”—so if you find yourself saying “I hope I can get what I want” it is time to take another, serious look at your plans and choices for your baby’s birth.

 Side bar: Here are additional suggestions of actions to take prior to hospital admission….

  • Choose your doctor carefully—don’t wait for “the next birth” to find a compatible caregiver. Don’t dismiss uneasiness with your present care provider. As Pam England says, “ask questions before your chile is roasted.” A key point is to pick a provider whose words and actions match (i.e. You ask, “how often do you do episiotomies?” The response, “only when necessary”—if “necessary” actually means 90% of the time, it is time to find a different doctor!). Also, if you don’t want surgery, don’t go to a surgeon (that perhaps means finding a family physician who attends births, rather than an OB, or, an OB with a low cesarean rate).
  • If there are multiple hospitals in your area, choose the one with the lowest cesarean rate (not the one with the nicest wallpaper or nicest postpartum meal). Hospitals—even those in the same town—vary widely on their policies and the things they “allow” (i.e. amount of separation of mother and baby following birth, guidelines on eating during labor, etc.)
  • Work on clear and assertive communication with your doctor and reinforce your preferences often—don’t just mention something once and assume s/he will remember. If you create a birth plan, have the doctor sign it and put it in your chart (then it is more like “doctor’s orders” than “wishes”). Do be aware that needing to do this indicates a certain lack of trust that may mean you are birthing in the wrong setting for you! Birth is not a time in a woman’s life when she should have to fight for anything! You deserve quality care that is based on your unique needs, your unique birthing, and your unique baby! Do not let a birth plan be a substitute for good communication.
  • Discuss in advance the type of nursing care you would like and request that your doctor put any modifications to the normal routines in your chart as “Doctor’s Orders” (if your doctor is unwilling to do so, seek a new medical care provider!)
  • Cultivate a climate of confidence in your life.
  • Use affirmations to help cultivate a positive, joyful, welcoming attitude.
  • Read good books and cultivate confidence and trust in your body, your baby, your inherent birth wisdom.
  • Take a good independent birth class (not a hospital based class).
  • Have your partner read a book like The Birth Partner, or Fathers at Birth, and practice the things in the book together. I frequently remind couples in my classes that “coping skills work best when they are integrated into your daily lives, not ‘dusted off’ for use during labor.”
  • Practice prenatal yoga—I love the Lamaze “Yoga for Your Pregnancy” DVD—specifically the short, 5-minute, “birthing room yoga” segment. I teach it to all of my birth class participants.
  • Learn relaxation techniques that you can use no matter what. I have a preference for active birth and movement based coping strategies, but relaxation and breath-based strategies cannot be taken away from you no matter what happens. The book Birthing from Within has lots of great breath-awareness strategies. I also have several good relaxation handouts and practice exercises that I am happy to email to people who would like them.
  • Before birth, research and ask questions when things are suggested to you (an example, having an NST [non-stress test] or gestational diabetes testing). A good place to review the evidence behind common forms of care during pregnancy, labor, and birth is at Childbirth Connection, where they have the full text of the book A Guide to Effective Care in Pregnancy and Childbirth available for free download (this contains a summary of all the research behind common forms of care during pregnancy, labor, and birth and whether the evidence supports or does not support those forms of care).
  • Ask for the blanket consent forms in advance and modify/initial them as needed—this way you are truly giving “informed consent,” not hurriedly signing anything and everything that is put in front of you because you are focused on birthing instead of signing.
  • If all your friends have to share is horror stories about how terrible birth was, don’t do what they did.
  • Look at ways in which you might be sabotaging yourself—ask yourself hard and honest questions (i.e. if you greatest fear is having a cesarean, why are you going to a doctor with a 50% cesarean rate? “Can’t switch doctors, etc.” are often excuses or easy ways out if you start to dig below the surface of your own beliefs. A great book to help you explore these kinds of beliefs and questions is Mother’s Intention: How Belief Shapes Birth by Kim Wildner. You might not always want to hear the answers, but it is a good idea to ask yourself difficult questions!
  • Believe you can do it and believe that you and your baby both deserve a beautiful, empowering, positive birth! 

Molly Remer, MSW, ICCE, CCCE is a certified birth educator, writer, and activist. She is a professor of Human Services, an LLL Leader, and editor of the Friends of Missouri Midwives newsletter. She has two wonderful sons, Lann (7) and Zander (4) and Alaina (2 months). She blogs about birth at Talk Birth, midwifery at Citizens for Midwifery, and miscarriage at Footprints on My Heart.

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Reader Comments (17)

I like your list of things to expect in a hospital. I think women need to know that these things will likely happen even if they see midwives and even if their hospital has birthing rooms and even if the hospital's childbirth classes say it won't happen. I think there is a lot of bait and switch going on, and it's hard to convince women that they are being lied to and that all the hard work they went through to choose the right provider and hospital are not going to make them immune to having these things pushed on them when they walk in the door.

I do have some questions though about your list of things to do to get a natural birth in a hospital.

- Hire a doula, or bring a knowledgeable, helpful, experienced friend with you. It can help to have a strong advocate with you (this may or may not be a role your husband or partner is willing to take on). -

I'm unclear how you could call a doula a "strong advocate" when doula certifying organizations forbid doulas from "advocating". Instead, they give us a special definition of the word and say that reminding us of our wishes is "advocating" for us. I think it should be made really clear what kind of "advocating" they do, and, it is not the kind I would personally call "strong". In fact, I find it a little odd that you seem to be discouraging the partner from having the role of advocate, when the partner is not restricted by any organization from actually advocating.

As for much of the rest of the list, I am not sure what kind of hospitals women find themselves in where they have so much choice and time and control over everything that happens to them, but that just is not the case for a large percentage of women. I have seen the BRAIN acronym before in my BFW class and honestly it really kind of offended me. Telling women to "use your BRAIN" implies that they can think their way out of interventions. In reality, many (most?) women will have to fight their way out of interventions. It actually makes me laugh when I think of myself trying to apply this thought in my hospital birth where many procedures were forced on me. Maybe between my screams of "no" and "stop" I should have said, "can you please give me the risks of this unwanted vaginal exam that you are currently performing" or "what are the benefits of breaking the water, which you just did..." When I read things like this I always imagine a nurse walking into a labor room with a fancy menu of "options" asking the laboring woman what she would like to order today. The laboring woman then looks up from her perfectly serene labor and somehow turns it off while she logically goes over each menu item asking for the risks, benefits and alternatives. Then the nurse agrees to leave the room while the woman discusses her "options" with her support people so she can calmly tell her providers which ones she would like to "choose" and which she would like to "refuse". I'm not sure what hospital that ideal situation happens in, but I feel like that is the premise that a lot of childbirth educators are coming from when they hand out these suggestions. What about the manipulation, the coercion and the force that happens to laboring women so often? Then what do you do? What do you do when you don't want to sign the blanket consent form and they threaten to call CPS? What do you do when they put in drugs into your IV to make you complacent, or hold you down and force procedures on you, or tackle you down onto the bed if you won't lay down, or punish you by taking your baby away right after birth and keeping it from you? These things are happening, and they are rarely addressed as risks when the advice is given to go against hospital policy. But bucking the system can truly cause great risk to the woman, because the providers are not going to give up their power without a fight. And a laboring woman who has an "advocate" who can't speak for her, and a partner who was told he wouldn't have to, is no match for a whole staff full of people who are not afraid to fight with a laboring woman by using their entire arsenal of weapons. PTSD can result and often does in these situations.

I think your point about not fighting in labor is a good one. However, many women who end up fighting don't know before hand that they will be required to do so to get the birth they want. They also don't know that there are risks to fighting - even if you do get the natural birth you want, you can still end up traumatized by having to fight for it.

I am sure my opinions are shaped by my own experience and the work I do with other women who have been traumatized. Maybe it is not the majority of women who experience things the way I did, but I feel like it happens enough to at least address it as a possibility and list it as risk factor.

March 17, 2011 | Unregistered CommenterJennifer Z.

I don't totally agree with the "what to expect from your hospital". #1 my cervix is checked like once every 2-3 hours, not MULTIPLE times an hour!?!
And while I have had my water broken at close to 9-10 cm, they have never forced me to have the electrode screwed into my babies head.
I have never had inconsiderate nurses while in the hospital. (with my 3 deliveries) I always have a knock and, "can I come in?" before they enter my room.

Hospitals are not as bad as you make it seem!!

You must have had some crappy experiences?

March 17, 2011 | Unregistered CommenterJ Tillman

J Tillman...

First of all, these are things to "expect" as in "be prepared for." Not all of them will happen.

Secondly, you seem to be ignoring important qualifiers.

"I am not saying that is how your specific hospital operates, but that many American hospitals function in this manner."

I.e., none of this is absolute.

"expect to be encouraged to have an electrode screwed into the baby’s scalp"

Not "expect to have an electrode screwed into the baby's scalp," let alone, "hospitals ALWAYS force an electrode into your baby's scalp."

"Sometimes you may have multiple vaginal exams per hour by more than one person."

Sometimes. Not all of the time.

Finally, it's wonderful that these things didn't happen to you. But why would you assume it's this post and not your experience that is the exception?

Just because Molly is a certified childbirth educator with mountains of experience in this arena doesn't make her every word Gospel, but she is basing her suggestions on a real depth and breadth of experience, and I'd be shocked if you could find me any professional with experience at a number of hospitals that would strongly refute much if anything written here. They may not see it as BAD, but these are essentially facts of hospital life in most cases.

It would be as if someone posted "You have about a 25-40% chance of giving birth by C/S in the US" and a commenter objected "Well I didn't have a C/S, and none of 3 my sisters did! You must have had a really bad experience!!"

??

Just as you'd be hard-pressed to find even the most intervention-happy OB denying that there is a 25-40% C/S rate at the vast majority of US hospitals, it would be hard to get him or her to deny that, for example, it is HIGHLY LIKELY that you will be given Pitocin post-birth, you won't be shown the placenta, your baby will get a Vitamin K shot, etc. As I said-- he or she might not see anything WRONG with the above, and that might be a point of argument. But there's really very little argument to be made that these things aren't very, very common in US hospitals and are something to "expect"/be prepared for.

Especially when most pregnant women really don't expect many of these things to happen.

March 17, 2011 | Unregistered CommenterDreamy

God almighty. I am a hospital midwife. I do NOT practice like this. I cannot fathom any midwife or doctor who would. I'm sorry, but i'm so over all the hospital bashing. We do a good job. We try really hard.

March 18, 2011 | Unregistered CommenterLiz

Either you're in a dreamy hospital or you're a new nurse/nurse-midwife. I've been doing birth for 28 years now (as a doula and midwife) and birth is almost always *exactly* like Molly describes. There are a few differences, but for the most part, this *is* what birth is... maybe not from *your* perspective, but certainly from this side.

Of course, I'd love to believe what you say is true... even if it is only true for you and those you work with.

Hospital bashing? Not in the least. Begging hospitals to get that we're tired of being treated like meat on an assembly line? Absolutely.

March 18, 2011 | Registered CommenterNavelgazing Midwife

I'm nonplussed that anyone with any experience in more than one or two hospitals could object to the idea that these are things to be prepared for and most are likely to occur in most hospital settings.

Really?

There isn't likely in most hospitals for there to be ANY separation between a mom and her support person?

It isn't likely in most hospitals that mom will be given a hospital gown?

It isn't likely in most hospitals that mom will be given at least a hep lock? How many women deliver without IVs or at least hep locks?

It isn't likely that mom will be asked for a urine sample?

It isn't likely that mom will be given an ID bracelet? Maybe I'm wrong, but isn't that REQUIRED?

It isn't likely in most hospitals that mom will have to sign a consent form?

It isn't likely in most hospitals that mom will have continuous monitoring?

It isn't likely in most hospitals to be offered pain medication more than once?

It isn't likely in most hospitals that she will be asked or told to stay in bed?

It isn't likely in most hospitals that mom will have her legs in a bent, elevated position during pushing, and be told by somebody that she needs at least to do it "differently?"

It isn't likely in most hospitals that baby will be separated from mom for a little bit, given eye ointment and vitamin K and/or suctioned?

It isn't likely in most hospitals that mom will be given Pitocin for the afterbirth? Is that not pretty much the standard of care in most cases?

It isn't likely in most hospitals that mom won't automatically be shown the placenta?

Really?

I can see in SOME hospitals and practices-- perhaps a significant minority-- that the following MIGHT not occur in the majority of cases:

-Having staff walk into your room without knocking/asking permission and/or talking over you. But... ever?

-Having your cervix checked hourly or more often. But even in those cases, it's generally going to be checked-- and more than a couple times if the labor is not lightning fast.

-Being denied food and drink outside of ice chips. Some hospitals/practices are better about this than others.

-Strongly suggesting/performing AROM.

-ROUTINELY using pitocin to induce or augment labor-- though what's the percentage in the US? Is it not high enough to "expect" this as a serious possibility?

I feel like these things could MAYBE be argued by a person lucky enough to have only spent much time in a natural-birth friendly hospital or practice. But the other things-- the majority? Can anyone really argue that those things aren't typical?

I guess I just don't get it. It's not like Molly said:

"Expect to have to answer questions already answered on your intake form."

"Expect to be told at some point that baby isn't tolerating labor well."

"Expect to be given a C/S-- or have it strongly suggested-- if you don't give birth within 24 hours."

"Expect to have at least one nurse who is kind of a jerk."

Because those things happen very frequently-- but perhaps not enough to "expect?"

And it's not like she said, for example, "Expect to be given an episiotomy" even though they are still done without good, scientifically supported cause-- because HCPs who do them routinely seem now to be in the minority.

All Molly did was outline the really and almost indisputably common rituals and experiences. Not 100% universal (which she stated!) but very common.

If someone would like to come along with evidence that any single one of Molly's bullet points does NOT occur in the majority of US hospital births-- besides "that didn't happen to me/I don't do that and no one in my practice does that"-- I'm sure we'd be happy to hear them out.

But not only do I find that unlikely-- the idea that anyone could "disprove" more than a small fraction of these bullet points is just incredibly hard to believe.

March 18, 2011 | Unregistered CommenterDreamy

I was so grateful to see this post. I wish all expecting women and their partners could be privy to this prior to giving birth. I feel like often a lot of these things come out in the telling of the birth story, and by then it almost becomes rote. Perhaps our way of of coping and being resilient? I linked to this on my FB page and had some comments from moms that had hospital births that were perfectly natural and they seemed adamant that these expectations were not their realities (totally possible), perhaps even taken aback that I would support something presenting hosp. birth in such a way. I spent a good hour or two feeling a little bit like a lunatic, like that "crazy birth lady who's always angry" (my husband did inform me that he thinks I'm usually angry when talking about birth issues). I have only been present at one hospital birth and even though almost all these things happened, I thought perhaps my metric was off. I came back here to read the comments and feel again that no, I'm not crazy, this is a reality (sadly). But, given my friends' comments, I thought a bit more about the issue of these things happening in hospitals. Do I have a "right" to be angry about what's happening in hospitals if the women that are experiencing their births there don't mind the protocols? What if they "don't mind" only because they don't know it could be different? Is there obligation to inform? And finally - more of a personal reflection than a systemic one - how do I bring awareness to birth issues without conveying that there are "bad" ways to birth and "good" ways to birth, or being that angry lunatic? A bunch of rambling I know, but I am grateful for the thought-provoking post!

March 18, 2011 | Unregistered Commenterkateisfun

Man. All I can say is that I am so thankful that I seem to be in the minority here. The hospital I gave birth in twice was recently certified baby-friendly. The difference between my first birth and my second (when they were very close to baby-friendly status) was noticeable. They offered me food and drink (I refused to eat, but did take juice until I got nauseated), they NEVER offered or asked about pain or meds, they held the monitors on my belly for the entire time I was in labor at the hospital, they didn't take my son away until after I nursed for about an hour, and asked what things I wanted done to my son (ointments, shots, etc) before they did them. I labored in the position I wanted to (mostly sitting on the edge of the bed) and pushed on all fours until my water broke 7 minutes before my son was born. No one ever suggested to AROM. My dilation was checked when I arrived, when my midwife arrived, and about 4 minutes before my son was born (to check dilation and station after SROM). My MW did suggest I push differently, to slow down and give "little pushes" so my son (who was flying out of me) wouldn't tear me (which he didn't). No counting or shouting. I didn't see my placenta, but I was very distracted by my beautiful son! My placenta was born 4 minutes after my son (NO traction, just came out on its own, Barb, we discussed this previously), so I wasn't really interested in seeing it. With my first birth, I was offered, but declined. If I give birth again, I may ask. I did have someone accompany me into the bathroom, but I was about 9 cm (I am guessing given the length of time since my MW checked me) and pushy, so I think they just wanted to make sure I wasn't giving birth in the toilet! My hospital has telemetry monitors, that are totally portable, so I could have moved and walked anywhere I wanted.

Lists like these make me realize just how blessed I am to live and birth where I do!

Perhaps interested women should start a letter writing campaign or petition for their local hospitals to start to become baby-friendly? I think if enough women paper their offices with complaints and requests/demands for baby-friendly treatment, they will probably listen. Also, my hospital calls about a week after discharge to ask you to take a survey about your care in the hospital- which is a perfect opportunity to give voice to comments, suggestions, praises and complaints about the treatment you and your baby received.

Lets hear it for South Jersey Healthcare-Elmer Hospital! When I finally get around to getting my RN, I seriously want to work there!

March 18, 2011 | Unregistered CommenterJen B

In my original version of this post (available here: http://talkbirth.wordpress.com/2009/09/09/what-to-expect-when-you-go-to-the-hospital-for-a-natural-childbirth/) I prefaced it with the following sentence: I’ve been debating about whether to share this post or not. I’m concerned that it may come across as unnecessarily negative, pessimistic, or even “combative” or “anti-hospital.”

That is why I specific within the introduction to the article that this is NOT an indictment of anyone's specific hospital and it does not mean that all hospitals practice in this manner, but it is an outline of many events that are considered "normal" and routine in many places and it makes good sense for women to be prepared to experience some or all of them.

March 19, 2011 | Unregistered CommenterMolly

Molly,
Unfortunately your post is out there for naive people to read and assume all hospitals and care providers are as horrible as you say they are. Your post answers the question as to why some patients and their doulas arrive antagonistic and hostile against the hospital setting and staff. My question...why did they bother coming to the hospital in the first place? Nurses and physicians can not provide care without patient consent. The patient receives information from the nurses and doctors and SHE is the one to decifer that information and make her informed consent. As often happens, the aggressive doula (NOT all doulas, ONLY some) will forcably undermine the patient's care and ability to make her own choices in the course of her care and labor. The goal of the hospital staff is to provide a healthy, safe and pleasant/meaningful experience for the birthing family; the key word is SAFE. I am happy to say that I work at a Baby-Friendly hospital but I also call it a birthing and family friendly hospital since we include the family in the process. My final question; Is your goal to have a "birth experience" or to give birth to a baby with a safe and healthy outcome, a baby you will be able to take home with you? Safe, and caring environment and SAFE care are what you can expect. As health poviders it our goal to give the birthing family exactly that. Being the educated person you say you are, you probably know then that not every pregnant woman is the same, nor are her medical and psychological/emotional needs the same as the next either, thus making the level of care unique and customized for each woman's needs and desires.

March 20, 2011 | Unregistered Commenterguest

I'm so glad there are excellent, Baby Friendly hospitals out there available to women. I also know there are caring, committed nurses and doctors. May I remind you that in the introduction to this piece, it specifically states, *I am not saying that is how your specific hospital operates, but that many American hospitals function in this manner.*

I stand by this sentence--MANY American hospitals employ policies and routines that are NOT evidence-based and do not serve women based on their individual needs. SOME hospitals and care providers do. We do women a disservice if we pretend that these routines won't/don't happen. You say "naive" women may read this post and get the wrong idea, I say "naive" women may not read this post and be in for a very rude awakening. I think we need to respect women' right to make their own decisions--withholding information about typical hospital routines and how they might work with them is not the correct approach. Nor, is scaring women with horror stories of horrible hospitals. I encourage couples who take my classes to think of ways in which they may meet both sets of needs--the hospital's for certain routines and also the family's need for safe, healthy, individualized births.

It is insulting to women to imply that they do not want a safe birth or a healthy baby. NO mother in their right mind does NOT want these things, and to suggest so is degrading and simplistic.

March 21, 2011 | Unregistered CommenterMolly

as horrible as you say they are

*sigh*

Most of the things on Molly's list aren't even "objectively" "horrible!" Many of the HCPs I have encountered would be like, "Yeah, so, what? Of course we give eye ointment. Can't argue with that."

And really, guest, "What's more important, the '''''experience'''' or health of the baby?" Ugh, that might be my most hated rhetorical "question" ever.

Let's look at the fact that "birth experience" and "health of the baby" are being posited as mutually exclusive.

-Most of the time, they are not. Not even by a long shot. In fact, the opposite is USUALLY true-- that the health of the baby is better in the context of a birth "experience" (ugh, so condescending) that is better.

-Putting them in semantic opposition denigrates the "birth experience." It essentially assumes that "birth experience" is only about things that are inconsequential or could be dangerous-- or it paints any desire not to follow standard protocol as being frivolous or potentially dangerous.

-Which is interesting, because if simply inconsequential/frivolous, then why NOT "allow" those things? I have heard the most ridiculous excuses to disallow women from doing things that you'd be hard-pressed to argue are HARMFUL (hypnobabies, for example), simply because they challenge the norm. And in their own way, signal a "slippery slope" to those defending the status quo. But anyway.

-G-d help us all, it's just so incredibly condescending. As if 99.99% of women who are interested in a different "birth experience" wouldn't cut off their own left arms to save their babies if it came to that AND that they would be pursuing an alternative "birth experience" if they didn't have evidence for the idea that it was actually as SAFE or SAFER for their children!

Seriously-- if we're throwing out rhetorical questions-- why is it assumed that when a mother shows a desire not to be cut open UNNECESSARILY or to be subjected to painful procedures UNNECESSARILY or to compromise the safety of her child UNNECESSARILY, that she is putting her hippy-dippy "experience" ahead of her own child's safety?

IF AND WHEN THOSE THINGS ARE UNNECESSARY TO THE HEALTH OF THE CHILD, THEY ARE *NOT NECESSARY* TO THE HEALTH OF THE CHILD.

It's reflexive. It's self-evident.

I have literally said things, with heavy disclaimers, like, "As long as the baby's heart rate looks good, etc., I will continue pushing pretty much as long as it takes."

And gotten responses like, "Clearly you care more about not having a C/S scar than the health of your baby!"

???

But... where's the C/S indication in that scenario? Oh, there isn't one, at that point? And C/S are more dangerous for babies in the absence of complicating factors?

Again-- ???

Say I need a root canal, and the SOP in my country for root canals is general anesthesia, but I've determined that local will work just as well and not expose me to the risks of general, so I ask for that.

And someone says, "Well, what if the local doesn't take?!"

And I say, "Well, then, I might have to get general. But as long as it does take, as it usually does, and everything is going fine, well... I'll have a lower risk of complications, a faster recovery time, and yes, usually a shorter, less stressful and less painful 'experience' with local."

"Why are you prioritizing your 'experience' over your safety?! The MOST important thing is that you come out of a root canal alive and not permanently disabled! So forget about all this local stuff. Or at least don't fight for it too hard."

???

March 21, 2011 | Unregistered CommenterDreamy

Molly & Dreamy... *standing ovation*

Dreamy: Your comment would make a fabulous guest post. Want to make it into a post? ;)

March 21, 2011 | Registered CommenterNavelgazing Midwife

Sure, B, just let me noodle on it a little more-- shoot me an email about when you'll need it. :)

March 21, 2011 | Unregistered CommenterDreamy

"It is insulting to women to imply that they do not want a safe birth or a healthy baby. NO mother in their right mind does NOT want these things, and to suggest so is degrading and simplistic." (Molly)

Your above statement is very true and standing back as a woman and as a care provider listenting to a mother outside the hospital setting or even evaluating my own maternal instincts, yes, this is a mother's response to anythuing that may threaten the well being of her baby. Inside the the hospital setting I HAVE seen that protective instinct disappear and their "birth experience" consume their ability to make a rational decision for the wellbeing of the baby. Many times the doula has encouraged and "advocated" for such poor choices. I could give you so many specific situations (20years worth) but I won't due to patient privacy. Condescending? certainly not intended however, I stand by my previous entry because that is what I have witnessed and experienced. I have also witnessed the bad outcomes from some of these cases that resulted in NICU admissions that would otherwise not have occured. I come from a place that had a 40% midwifery population and the rest were/are a variety of patients that choose completely natural, yes even hypnobirth right on to the more interventional style labors...induction, epidural...you know the kind. I support both. But like I said, I do not speak off the top of my head. This is what is out there and this is how many women interpret your hospital bashing.

March 21, 2011 | Unregistered Commenterguest

I have attended birth in 20 hospitals in my area - in two different states. Although I have worked with clients who have had wonderful experiences with nurses/doctors/midwives, on the whole most do happen the way Molly explains. J. Tillman seems to have been very fortunate to get a hospital where these things do not happen routinely or where women are informed before a procedure takes placed - or better yet - asked. I have also traveled all over the US presenting doula workshops and hear stories like this as well. The list is good - most hospitals I have attended births in no longer use internal monitoring routinely - doesn't mean they are not out there. so yes, be ware and make sure you know what you are getting in to.

March 24, 2011 | Unregistered CommenterCrystal Sada

This is excellent! I will be linking to this post, I want all my clients to read this! Thank you :0)

March 27, 2011 | Unregistered CommenterNaomi

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