Sunday, January 11, 2009

Some Hints to Avoid the "Drama" in the Hospital

AnonymousThe last post I wrote about dealt with choosing a home birth over a hospital birth. I got some great comments, but this one brought up a great question.

Anonymous said...
I check your blog a lot, and I have a question. I have one baby and much of the 'drama' happened to me. After reading your posts, it kind of "clicks" as to why certain things may have happened. I didn't have a C-section but almost had to. I am not one who loves drama, but I just didn't know. question. I plan on having more kids, and honestly, most likely in a hospital again. (don't hate me) What all can I do away with as far as normal procedure at the hospital. You mentioned vaginal exams in this post. Is that mandatory if birthing at a hospital? What are some things you would suggest that I request (or demand) at the hospital next time.
This was my response:

""Anonymous," I loved your comment/question. First of all, let me just tell you how pleased I am that you have picked up some of the reasons for the "drama" in your previous birth through my blog and will do things differently next time around. Been there, done that!

Second, I don't hate you (!!) for wanting to have your next baby in a hospital! If you are not comfortable birthing outside of a hospital, your labor and birth will be harder, not better or easier. Being comfortable with your birth place and attendants play into your "emotional relaxation." You need to do what feels right to you.

Based on what you said in your comment, I assume that you will most likely switch your birth attendant and/or hospital and will not be having medication with the next baby. I assume you had meds the first time around.

With those assumptions in place, I do have some suggestions. First off, in order to avoid as many routines in the hospital as possible, you really need to labor at home as much as possible. Think of birthing at the hospital, not laboring there. No induction, as that automatically puts you on that road of intervention and possible C-section.

You are choosing to birth in the hospital, so there are some routines that will be unavoidable. These include: initial vaginal exam, initial monitoring strip (usually 20 min.), blood pressure check, etc. Some of these are not such a big deal, but others are. If you are chained to a fetal monitor (EFM) the entire labor, you will not be able to help your baby out with the use of gravity and movement. These are essential to labor. Intermittent monitoring is worth fighting for.

I don't know where you live, and all hospitals have different policies, so it's important that you find out their monitoring policy. This is a legal issue, not a medical one. In fact, medically, you are better off to have intermittent monitoring, usually once an hour through a couple of contractions and between them as well. A baby who is truly in distress will be picked up. (The fact that you will not be induced or have drugs in your system has greatly improved your chances that your baby will not be in distress.) EFM has a high false-positive rate and has contributed heavily to our outrageous C-section rate in this country. You will find that hospitals that do not require continuous monitoring have a lower C-section rate. This is often a hospital policy, but it's possible that your doctor or midwife will sign that off in your chart that intermittent monitoring will be fine for you because you have no drugs in your system. If you have drugs, of course, you actually do need to be monitored because of the dangers to the baby.

Another policy to avoid is the routine vaginal exam. The number two reason (followed only by a repeat C-section as #1 reason) for a C-section in this country is "failure to progress." I like to call it, "failed to progress on our time schedule." If a woman is left alone, without the pressure of performing, feeling comfortable with the people attending her birth, supporting her, she will give birth in her own time. The hospital is very unlikely to let you hang out laboring for longer than 24 hours. A lot of the time, we think of this as an issue of the time limits enforced for a broken bag of waters (another topic for another day), but I see this all the time. Insurance is also an issue here. They don't want you laboring, taking up space, for 40 hours. If you are not having vaginal exams (which really don't mean a darn thing), they can't tell you that you are not dilating. Again, you need to know the hospital's policy and also your doctor's. If you both come to an agreement that is acceptable to you, make sure it's in your chart. Better yet, labor at home and be dilated to a 7 by the time you get to the hospital! This will solve a lot of problems.

"Middle Aged Mama" had recommended a doula. I would tend to agree. Recently, I had a student who was at a hospital that had some crazy policies; no walking after your water has broken, continuous monitoring, and vaginal exams every 2 hours. What labor can progress under those circumstances?! No wonder North Texas has a 50% C-section rate! Their doula got them to agree to intermittent monitoring, being out of bed walking the halls even though her water had broken, and vaginal exams every 4 hours (still too excessive in my book), but great improvement. It was a long labor and without their doula advocating for them, I am almost certain this woman would have had a C-section.

As far as "demanding" your wishes, I feel like that is never a good idea. It is crucial that you do the footwork early in the pregnancy, interviewing and touring the hospitals in your area. I liked the advice to talk with other women who have birthed there recently. A piece of advice, however, be sure that they had the kind of birth that you want. If they loved their doctor and hospital but had an induction, epidural, and possibly a c-section, I'd suggest looking elsewhere!

Be prepared (I'd love to see you in my class -- DFW area -- or take my class online!). Be polite. No one wants to be accommodating to a rude, bossy woman, or father, for that matter! Kindness and knowledge will get you closer to the birth you desire.

Know your options. Change providers or hospitals if you have to. You will only give birth to this next baby one time. You can do it. It's YOUR birth."


Sarah said...

So great, Donna! I send my prego friends to your blog for a little teaser on why it really is a good idea to prepare more than taking a 4-hour hospital class on "what we do here" and perusing "What to Expect. . ." (Won't even dignify it with the entire title, I can't stand that book! Such a disservice to pregnant women!)

I would hope, as I imagine you do, that the information you share on your blog has the effect of opening a mom-to-be's eyes to the fact that assuming "they'll tell us what we need to do/know at the hospital," (a direct quote from my hubby before we took your class!) is a very bad way to "prepare" for birthing your baby!

I've said it so many times, but I just *love* these posts! You capture the passion I feel, but am too lazy (or perhaps something else) to express myself!

Kristina said...

I love your blog! The title really captures it and makes me chuckle because I imagine that I could be banned from baby showers. I nominated you for an award on my blog if you are interested.

Kristina said...

I'm going to leave your message here so you can see it. :) You've already won, there is no real nomination moving on to winning. And now you get to put the little picture on an awards section in your blog.

Yes, I've read you before, but I can't for the life of me remember how I came upon your blog the very first time!

Kristina said...

My fault for the misunderstanding about the award. I didn't realize I wasn't clear and went back and edited what I said. You didn't read it too quickly, the info wasn't there! My bad.

To answer your question, I am in FL, happy midwife country. :)