Monday, March 21, 2011

Why the Closest Hospital May NOT be the Best Place to Have Your Baby

When I was pregnant with my first baby, I was asked a number of times during the pregnancy where I was planning to have my baby.  I thought this was about the dumbest question ever (next to "Are you having the drugs?").  Obviously, I was having my baby at the closest hospital.  I'd seen enough TV shows and movies to know that I would have to get there really fast, so it just made sense to pick the closest one.  It wasn't until I was pregnant with my second baby that I discovered the significance of choosing a hospital wisely -- that maybe distance was not the top priority after all.

When people email me or call me about classes, one of my first questions is "Where are you currently planning to having your baby?"  The word "currently" throws them off, but I want them to know upfront that it's not set in stone.  More than 50% of people that take my class do switch their care provider and/or birth place. 

It seems that most people choose their hospital because that is where their OB delivers.  They've been with him/her for years and just loves him!  They honestly believe that their OB will support their decision to have a natural birth.  This post is not about your OB however, but the hospital.

Fact:  You are more likely to have a c-section in a busy hospital than elsewhere.  Define busy?  Well, the hospital I had Daymon averages 30 babies a day.  I'd call that pretty darn busy.  There's a hospital in the Ft. Worth area that touted more than 5000 babies a year on a billboard.  It is normal to think, Oh good, they do this a lot, so they must be really good at it.  Practice make perfect, right?  If you do the math, that average is almost 14 babies a day.  Doesn't sound so bad after the average of 30 a day I just threw out!  This particular hospital's c-section rate is 35-40% -- straight from the horse's mouth.

But does practice make perfect?  Why would a busy hospital have a higher c-section rate?  Let's face it -- it's like the Olive Garden (I worked there for  4 years and love the OG, so this is not a slam on them!) and you cannot sit at a table all night.  We need your table.  The lobby is filling up and your server needs to make money.  We cannot allow you to take up this table any longer!

And so it is with labor.  They simply will not allow you to occupy a room longer than a day.  At 24 hours, or very close to it, your time is up.  The OB can make up a million reasons why you need a c-section (fetal distress, baby too big, water broken for 24 hours, failure to progress, maternal exhaustion, the list goes on and on), but ultimately, your time is up.  You failed to progress on our time frame.

If you've seen Born In The USA, a PBS documentary, you've witnessed the scene where the residents are sitting around a conference room discussing a particular labor where the woman had a c-section because her time limit was up on pushing (my words, not theirs).  Part of that dialogue includes an OB explaining that it goes against their very nature to not do anything in the hospitals.  She explained that in the hospital, nurses and doctors are constantly monitoring and assessing, monitoring and assessing. They will not just sit around and wait on your labor.  You expect a baby out of this, and darn it, we will be the ones to do that for you!

So, we have imposed time limits.  Next, we simply have hospital policies.  Things such as:  continuous electronic fetal monitoring (EFM), routine vaginal exams (usually every 2-4 hours), no walking after water breaks (which you're not doing anyway if you have EFM), and a routine IV.  I talk about all of these things at length in class, so I don't want to spoil all the fun here.  Suffice to say, none of these things are good for your labor.  You are more likely to have a c-section when these policies are in place.  These are red flags!  Run!  The local hospitals that have these policies have 60% c-section rates.  Ultimately, your baby is left to figure labor and birth out on his own.  You will not be moving around, changing positions, rotating hips, or using gravity to assist the baby on his way down and out.  Labor is harder for mom and baby under these conditions.

Another red flag along the lines of policies are no VBACs (Vaginal Birth After Cesarean).  Over 800 US hospitals banned VBACs in the last decade.  ACOGs recent statement said that women should be given a "trial of labor" -- don't get me started! -- but I haven't seen any change as of yet.  A hospital who does VBACs is hopefully following evidence-based maternity care in other areas as well (allowing women to eat and drink in labor, intermittent fetal monitoring, hep-lock instead of IV, and no routine vaginal exams).

Honestly, I believe you are more likely to find this type of care with a midwife than an OB.  The vast majority of OBs simply are not trained in normality.  They are trained in the management of labor and birth.  And make no mistake -- they will manage your birth.  If your hospital does not even have midwives, this is also another red flag.  Midwives bring a different attitude and philosophy of birth to a hospital.  As long as the staff is open and willing to listen to the evidence, midwives can make a huge impact.  If the doctors won't listen to the midwives and let them be midwives, again, run. 

Birth is very political.  I was speaking with a CNM the other day about this topic.  She's only been out of school for about a year.  She said they didn't talk about how political things are in birth while she was in school and she's been shocked by it since working in the field.  It's like I always say, as long as the baby is still inside, you have options. I've had a handful of women change their plans in the middle of labor!  Don't let your birth be a political battlefield.  Fighting with the staff is not an option.  This also is not good for mom or baby and is not how anyone should remember their labor.

No matter how scary you think it may be, changing care providers or hospitals (or even switching to a home birth!) can be the difference between a c-section and a vaginal birth.  If you have an outcome you are not happy with, you will always wonder what would have happened if you had switched to a better birth place.  Like Tim sings, "There's no such thing as what might have been, That's a waste of time, drive you outta' your mind."  (Had to sneak him in there!)

You might have to drive a titch further, but in the long run, you'll only give birth to this baby one time.  Regret is a yucky thing, especially when you had the red flags laid out before you and you chose to tie your blindfold on and hope for the best.  Don't be a victim of bad hospital policies!


Shannon said...

I deliver at Baylor which is about 40 minutes from my house. I have been worrying about whether I will know when to go in because I want to wait as long as I can obviously. The other night I had a dream that I had an unassisted breach delivery at my friends house, and it turned out to be a boy instead of a girl! I guess that addressed all of my fears! Haha. I wish more hospitals had midwives.

Gloria said...

Your hospital- Restaurant analogy was spot on. Another things that chain restaurants do is design the environment, so the diners won't want to stay. They use things such as loud music and tables set far apart, uncomfy chairs, some of them are even built with bad acoustics, all of which hinders communication and can be physically uncomfortable.

Joy@WhenDoesDaddyComeHome said...

Great post and spot on! This is the kind of stuff I try to educate women around me on BUT sometimes they're too dead set on the "OB my mom had that delivered me and that I just love and trust to pieces"! That's all great for regular gynecological care but do the research on their delivery statistics. The OB you've loved since you left your mother's womb may be great at pap smears but women still need to know what that OB would do in the delivery room.

Veronica said...

My husband and I were set to deliver our son at one of the hospitals relatively near to us when we started our Bradley classes. At 38 weeks we fired our OB, got out of the hospital and decided to deliver at home. It was most definitely the difference between a vaginal delivery and a c-section. I have watched 80% of my friends who chose to deliver with OBs end up with c-sections. I'll never look at any type of healthcare the same. I wish people would educate themselves on their options!

chewymama said...

Great post. And "trial of labor" is SO insulting, I hate that phrase. Like they are doing women a favor letting them "try". Its so condescending (and discouraging!)

plankter said...

I am about to have my last ultrasound right before 20 weeks w my OB than the very next day we are switching all care to our wonderful midwife. I could not be happier w our decision for home birth! That said, my brain can not -not- run through all the possible scenarios and I wonder, if I end up being one of the few who really needs a hospital, how would things work with that transfer in terms of care we would get once we are in OB-land....any word of advice?

Antonio said...

I feel a little silly asking this (and maybe it's one of those things you address in your class), but I've read all your blogs and I haven't seen any advice on the topic yet. How is it that we find out a particular hospital's statistics and policies? I wouldn't have the first idea of who to ask - and besides, it's hard to get really straight answers from some people, who may be either uninformed or biased. Any thoughts? :) ~Michy
(Sorry this says posted by Antonio. My hubby and I share a Google account.)

Donna Ryan said...

Plankter and Michy, those are both excellent questions. I put them both on my list of blog posts to write about. Stay tuned... Oh, and congratulations Plankter for switching to a midwife!

heidelade said...

A hospital near me has some truly fantastic OBs on staff - more midwife than surgeon - but they were outvoted when the hospital changed management and let the OBs decide if CNMs would be allowed to remain on staff. I've seen incredible very hands off births there attended by this group of doctors, but the other docs have very different philosophies on birth. The second hospital in town does have midwives on staff, but as reported by an L&D nurse they also have a 90% epidural rate and have banned VBACs. If I had to choose a hospital birth I would actually go with one of those specific OBs at the first hospital, but I just avoided that issue and birthed out of the hospital. :)

John clinton said...

Those are some cute and useful organizer. I might be needing them after I have my child. Well I am currently using well-proven pregnancy planning.