It irks me that hospitals spend inordinate amounts of money on the aesthetics of Labor and Delivery Suites. Several million dollar renovations create identical rooms around the United States. And, as far as I can see, every single one is geared towards making things easier for the hospital staff, not the laboring woman herself. Women do not have homebirths because the hospital room doesn’t have pastel wallpaper or integrated technology; women have homebirths because they want to have a normal birth without everyone around them expecting tragedy. Autonomy + safety would make a fantastic birth room in a hospital.
If I were to design a Labor, Delivery and Recovery room, I would do things a lot differently than they are done now. And, by design, I mean creating an entire ambiance, not just what furniture and curtains would I pick.
But, before I lay my ideas out, let’s look at what hospitals around the country have done with their million dollar renovations. And while I detail Medical University of South Carolina, I could just have easily used any of the other hospitals mentioned –and dozens more not listed here.
Medical University of South Carolina has several videos that describe their services to women, a pregnant woman walking with the Nurse Manager of the unit, learning about her upcoming birth as we watch and listen in. When “wood” floors are highlighted as making the unit more home-like, I chuckle because how many people really do have wood floors? And who really cares what the floor looks like as long as the darned thing is clean!
Televisions and free Wi-Fi are there for both mom (“When you get your epidural.” Not if; when.) and dad, “So he can watch USC football games.”
The nurse states, “You’re put in a hospital gown when you come in,” and that the “Backs are open so we can put in your epidural.” It’s rather disgusting that an epidural has become the default.
When speaking about the fetal heart monitor, she says, “The straps stay on the entire time.” No intermittent monitoring here.
MUSC allows video and still cameras, but during the actual delivery, the photographer is required to move to the head of the bed and take photos from that position. The nurse says that it’s more discreet. No mention was made that not seeing every detail of the birth removes the possibility of visible proof in a court case of the doctor’s or midwife’s hand movements, say, in a shoulder dystocia, for example. While this limitation is annoying all on its own, it is far more liberal than a growing number of hospitals out and out banning all cameras during the delivery and for the first few minutes afterwards. I haven’t heard a woman say she was birthing at home in order to have total control over the photo documentation of her baby’s birth, but I am sure that, in the future, this aspect will become one of the top unhealth-related reasons to stay home. I find it beyond insulting and disrespectful to control what a family is able to –and not able to- record during their births. I can’t help wondering… if someone refuses to stop filming, what would the staff do? Knock the camera out of their hands? Who pays the staff anyway? That the staff’s fear of proof in lawsuits demands the families become accomplices in their protection is really gross.
MUSC’s really special LDR room includes:
- The typical OB hospital bed that breaks down into the ideal configuration for the doctor. Not the mom, but the doctor or midwife. The woman’s comfort is secondary. Perhaps even tertiary since the nurses have great access to the birthing woman, too.
- The bed’s mattress softens or hardens depending on mom’s wishes. The nurse in the video makes the comment about women lying in bed, hour after hour, needing a variety of firmnesses in a mattress.
- The bed has foot pedals (again, this was highlighted as something unique to MUSC) for the mom to use as she pushes. Foot pedals are often left unused in the births I've seen as, instead, the calf is “supported” in a feet-in-stirrups sort of position.
- The bed also has handles for moms to pull on while pushing. Apparently someone will be shoving her legs back while she yanks on the handles instead of the mom pulling her legs back herself.
- A removable birth bar was shown in the video and the nurse semi-demonstrated, on the floor, how a woman would sit up to squat and then lie back inbetween contractions. It would be great if the birth bars were used a lot, but with an epidural rate over 60% in most hospitals, that’s unlikely.
- A birth ball was mentioned as well as saying women can be mobile until they have “their” epidural. Later, the nurse says even women with “their” epidurals are mobile, being turned side to side every hour or so. Now, that’s mobile!
The videos continue saying that after the birth, the baby is put on mom’s belly and she can “help dry the baby off,” then, the nurse says, “We take the baby from you,” and put “Medications mandated by law” into the baby’s eyes (Erythromycin) and, via injection, into the baby’s thigh (Vitamin K). She also talks about the baby getting circumcised the day after the birth as if that was as normal as talking about the importance of a car seat.
The woman “touring” the L&D floor carries around her Birth Plan and asks questions from her paper. The nurse, more than once, says women who have a “reasonable birth plan” can have a “unique birth experience." I suspect a reasonable birth plan doesn't equal a unique birth, but a birth that taxes the nurses least and causes the fewest amount of waves with Standard Operating Procedures.
Each hospital’s website I visited said they had virtually the same “amenities” as MUSC, so I took to reading what they had to say to try and make their units unique in the eyes of the Consumer.
The University of California, Los Angeles Hospital’s Labor & Delivery description says:
“The young couple visits the spacious and light-filled labor and delivery rooms, which include private bathrooms, sweeping views of Westwood, flat-screen televisions, XM satellite radio, sofa beds for dads and families to sleep over, and warming beds for the new babies.”
Let’s look at that in regular-people-speak. The parents… er… mother-to-be and support person? Who says they are young couple? More than likely, they are not young in today’s world. (Nit-picky, I know, but if they’re trying to be inclusive, they should try and be inclusive!)
Next is the private bathroom. Seriously? This is an amenity? I know some older, unrehab’d hospitals still share bathrooms between two laboring women, but that is not the norm around here anymore.
The sweeping views of Westwood are unique to UCLA Hospital, unless the views are less than stellar.
Flat screen TV’s? Eh, pretty common now.
XM satellite radio is an amenity I haven’t heard of before and I think that would be really great! I like when families have their own Labor mix on their iPods, but if the hospital doesn’t have a docking station and speakers, only the mom hears the music unless the family lugs that stuff in. Of course, she is the important one, but I love hearing what people choose for their births, too.
On to the sofa beds… hrm… I’d love to see what they look like. Most "beds" come from the pull-out chairs. They say the sofa beds are for families to sleep over… does that mean the new baby’s siblings, too? If so, that’s a pretty nifty amenity.
And then there’s the “warming beds for the new babies.” sigh No, no, no! Why would the baby warmer be an amenity? It isn’t some bonus for the parents; it’s specifically for the medical personnel! I think if they said there were no warmers, that would be an amenity.
White Plains Hospital, in White Plains, New York, boasts:
“The new Labor and Delivery suites at WPH feature all the comforts of home while still providing advanced medical care. These spacious, state-of-the-art suites are equipped with the latest technology, including a Central Fetal Monitoring System, tastefully tucked behind built-in maple cabinetry and ceiling panels. There is ample room for visitors (two people maximum at one time) and in-room sleeping accommodations for fathers or labor support persons. Each room also has a private bathroom with a shower.”
“All the comforts of home.” The home-like aspect is a common selling point with all these hospitals, but I don’t see any kitchen stocked with healthy food or a king-sized bed so mom’s lover can cuddle with her comfortably. These are comforts, aren’t they?
WPH brags about their “spacious” rooms and there is “ample room for visitors,” but then caveats with “two people maximum at one time”; that’s a serious red flag to me… the limiting of support people. I don’t have rules in my house limiting the number of visitors; do you?
And one of the most irritating –and common- highlights is the technology “tucked behind built-in maple cabinetry and ceiling panels.” C’mon. The moment a woman is admitted, the “cabinetry” is opened (if it was ever closed in the first place) and never closes again. I honestly believe the only time it’s closed is for a hospital tour. Nurses? Is this so? Have any of you ever had patients and had the cabinetry closed?
St. Luke’s Hospital, Kansas City, Missouri says they have “an improved layout (that) was designed with input from physicians and labor and delivery staff.” Wow! No help from the women themselves? Oh, that’s right, LDR’s are designed with the staff’s comfort in mind; women are ancillary.
Shady Grove Adventist Hospital in Rockville, Maryland says, “We talked with hundreds of moms, dads, doctors and nurses to find out what they wanted from their birth experience. The result: state-of-the-art maternity services and the warm, relaxing atmosphere of home. Our birth suites are designed to cater to your every need.” They then expound on their “Private Mother-Baby Suites”... are the private suites different than the regular birth suites? I read through several times trying to figure out if they were the same or if the private rooms were for women with the bucks to buy them. I think they’re all the same.
The service that especially caught my eye was “a family lounge featuring a kitchenette, a flat screen tv, computers with Internet access and plenty of space for growing families.” At first it seemed each room had that, but as I read more, it really is a central waiting room that has the kitchenette. And I was so excited to share a hospital that came close to a real home-like environment!
Note this new advantage to SGAH: "A new unit floor-plan that allows nurses to be more accessible 24/7 to meet your every need.” Really? I would hate to have been a patient before that had time periods without nurses. And you know what I want to say about “every need,” right? “Please do not ask me the Pain Scale. Please do not offer medications. Please take this monitor off so I can ambulate. Please cap off this IV so I can get in the shower.” These are my needs; what are yours? One final note about SGAH… they have “48 all private Mother-Baby Suites.” FORTY-EIGHT. Criminy, that’s a huge hospital.
I saved the best for last. In the name of worst Mother-Baby services, Brookdale University Hospital and Medical Center in New York City, wins, hands-down. I’m sure you know a worse one still; please share. Be sure to visit this site and look at the pictures of their “suites.” Note the technology “tucked away” behind the faux wood paneling; it isn’t like that in labor. These labor rooms look a hair’s breadth away from operating rooms because they display the beds completely flat. If I were the person-in-charge of choreographing these photos, I would put a lovely pregnant model in the bed, perhaps cross-legged, perhaps with the birthing bar on the bed. While I know most women are choosing epidurals, the fact that they have the beds empty and flat, connotes the helplessness and vulnerability of women in labor. Blech.
This is the blurb BUH has on its site:
“In Labor and Delivery, and later on the maternity floor, you'll find yourself surrounded by warm pastel colors, soft lighting and floral fabrics. Immediately after birth a few important procedures are performed on your baby. The staff will remove the mucus from your baby's nose, warm your baby, and conduct a physical assessment. After these brief steps are taken, you, your support person and your baby are free to spend ample time together in the LDR room immediately after birth. Mothers who choose to breastfeed are encouraged to begin at this point. Once you are ready to be admitted to your room, your baby will be taken to the nursery.”
This video from BabyCenter demonstrates exactly what BUH’s policy is with newborns. It will be at least five minutes before mom gets her own baby. And note that dad is standing behind all the nurses; what’s the woman’s view of her newborn?
With my mouth hanging open in shock, the only positive thing I can say about BUH’s blurb is, “At least they’re honest!” They say you’ll be enveloped in warm, pastel colors, showered with soft lighting and decorated with floral fabrics, but the hell if you get to touch your own baby until they’ve done what they have to do. They’re going to shove rubber into your baby’s mouth and into her nose, hindering that breastfeeding experience you’re so hoping to have. They’ll warm your baby… wayyyy over there in the “special” warming bed amenity so many hospitals brag about. You can watch –if no one’s in the way. They’re going to do their physical assessments on the baby… the one and five minute Apgars… the Dubowitz and/or Ballard, which takes even longer depending on who’s doing the exam… putting Erythromycin in the baby’s eyes and giving the baby the Vitamin K injection. After all that, then you can begin breastfeeding. But, wait! Don’t get too attached. As soon as you’re moved to your postpartum room, the baby goes to the Newborn Nursery. Nothing is mentioned as to the reasoning for this. There is no reason with a normal, healthy baby.
As I poked around, looking at different hospitals around the United States, I found it interesting how each tried to make themselves stand out and how the great majority of them were exactly the same… physically, anyway. It astounds me how hospitals believe it is the accoutrements that will bring clients (patients) in… and might even cause a potential homebirthing woman to change her mind. Really?
In the next post, I’m going to design what I think would be an ideal LDRP room. If forced to, I’ll create an LDR, but then would send moms home 4-6 hours after the birth.
Off to design a great hospital LDRP!