Monday, October 10, 2011

Hospital Policies that Encourage these Outrageous C-Section Rates

Over the years, I have narrowed down the hospital policies that are the biggest problem for moms who want to have an unmedicated birth.  Short and sweet!  Here are your red flags:

1)  The use of continuous Electronic Fetal Monitoring (EFM).  I wrote about this one last week.  This chains mom to the bed.  She's not moving around, helping her baby figure his/her way out.  This policy is applied in nearly all hospital births.  It's very convenient for the nurses, but not for the mom.  Evidence indicates that it is not safer for the baby and the c-section rates rise when EFM is used.  Check with your hospital and your care provider.  If your care provider "approves" intermittent monitoring, make sure that gets written in your chart.  (Just a heads up -- while this improves your chances of not having EFM, it is not a guarantee.)

2)  If your water breaks, you are in bed for the duration of your labor.  They claim this is for your benefit, saving you from a c-section, as the umbilical cord could suddenly slip out, endangering the baby, making a c-section necessary.  The chances of this actually occurring are about .3% of all births.  How can you prevent this from occurring?  Don't let anyone break your water!  This is more likely to happen if the baby is high in the pelvis.  If your baby is low, this is not really a risk.  Also, if this is going to occur, it usually happens when the water breaks. 

A couple other things worth noting that may or may not seem obvious:  You will be on a time clock once your water breaks (find out what that means at your place of birth - usually 12-24 hours), so you really want to do things that encourage the baby to come.  Laying in bed on a monitor doesn't really do that!  Pitocin is usually started after water breaks.  Evidence just doesn't make a lot of sense with this policy.  They say that they are trying to prevent you from having a c-section, but by keeping you in bed, that is exactly where you are headed!

3)  Vaginal Exams every two hours.  The reason women are given vaginal exams are because they have epidurals and can't feel when they are ready to push.  A woman who isn't numb doesn't need to be told how dilated she is or when to push.  Failure to Progress is the 2nd most common reason women have c-sections (2nd to already having had a previous c-section).  So let's add this up:  She's in bed, on a fetal monitor, having vaginal exams every two hours.  She's not moving or using gravity. I know of a hospital midwifery group that hardly ever does vaginal exams, unless there is a medical reason to do so.  This is how it should be.  Many women will stay at a certain number of dilation for many hours and then suddenly dilate in a short amount of time.  Labor is not all about the dilation of the cervix!  Vaginal exams are directly related to the dreaded time clock. 

4)  Does your hospital employ midwives?  This is a big deal.  If there are not midwives at your hospital, only the medical model of care is practiced.  This is the only model the OBs use and the only model the nurses see.  The midwifery model of care views labor and birth as a normal process.  The medical model views childbirth as a medical emergency waiting to happen. They believe that medicine and technology improve the safety and process of birth.  

5)  Does your hospital have a no-VBAC policy?  Then they don't trust birth and they don't read the evidence.

Finally, don't ignore the red flags.   I could go on and on about policies that the majority of hospitals have that are problems for a natural birth mama.  Follow your gut.  There are great places to have your baby.  Seek them out.  Hopefully this list will be helpful on your journey.  Don't be a victim!  Like I always say, as long as your baby is still inside, you have options.  This is your birth.  Choose a birth place that respects your wishes and shows reverence towards your special day.


Meg said...

These are horrific practices, yes. But there are many hospitals that do not use them, and it is very regional. There are hospitals where you can have CEFM on telemetry, where the nurse will Doppler your baby in the tub, where you can not only get out of bed but be in the tub after your water breaks, where vaginal exams are done when indicated. I worked at one. Nurse staffing and unit norms are CRITICAL to how women labor. If you're staffed one nurse for two labors, you're not going to get high-touch nursing. If your unit norms are that your nurse is in your room and walking you around the halls and encouraging massage and position changes, that's much more likely to happen. Nursing care is critical because your provider is not there. Your nurse is. Your doc shows up to catch at the end. For many midwifery practices, multiple labors may be going on, or the midwife may also have clinic, or be first-assisting in a section. Your nurse is the crucial team member, because she is the one who drives care in many hospitals.

Hospital birth isn't monolithic. Humane hospital birth is possible. I promise, because I've seen hundreds, and I've had two.

Plus Size Mommy Memoirs said...

Great post and by reading this I can see why I was able to have an unmediated birth in a hospital. I went with a hospital that had a midwifery program and didn’t make me follow any of those regulations listed above! Thankfully my doula led me away from a medical model of care and towards the midwifery model of care!

amber said...

Good information for those that are unaware how these interventions work against the birthing process.

I am not anti-hospital birth, but it is important for women who choose to birth in a hospital (or for whom that is the only choice) to know what to expect.

As a sidenote: hospitals/ob practices that employ midwives will not automatically support natural choices. Be sure to ask lots of questions ahead of time if that is your wish (we found out 35 weeks in that despite the having an OB who employed Nurse Midwives, they did NOT agree with us on many important matters, and as a result, we switched to a midwife and home birth).

BabyMama said...

Using a midwife can help, but if its a "hospital midwife" I think she may be a lot closer to the MD model of birth than you think. My midwife was big on natural talk & agreeing to my birthplan in her office, but on the big day I felt very surprised at how medical things became very quickly. In the end I was very glad to be in the hospital, I truly believe I needed the pitocin & oxygen to succeed, but i definitely felt like I was thrown into keytone tests, IVs, excessive temperature & fetal monitoring, & positions convenient to the staff more than my comfort as soon as I stepped through the doors.

Ginger said...

I'm so grateful I've been able to have all homebirths. Two months away from my 5th homebirth; 3rd waterbirth. So very grateful.

Jessie Roberts said...

What a wonderful post. Many women go into hospital birth wanting as natural of an experience as possible, but are unaware of how these seemingly harmless practices lead them toward a more medicalized birth.

EFM is a practice that is not supported by evidence, but practiced by nearly every hospital. (Sure, not EVERY hospital, but at least 90%) In order to ensure the best outcomes, hospitals and OBs need to be practicing evidenced-based medicine, and EFM (and routine AROM and Pitocin) are NOT evidence-based.

Janie said...

love this post, but yet didn't create a link - hmmmm have no idea how that happened LOL

Ritsumei said...

This is a very useful post! I'm very fortunate - the hospital and OB I've used for my 1st 2 births is awesome. Intermittent monoitoring - often in the tub, even after my water broke, even with an IV because I was GBS+. I've had 2 completely unmedicated births. My husband likes to tease me about how I was bouncing around the room before I finally settled down to push the 2nd one - on my hands and knees on the bed. My doctor and his team are awesome! The nurses weren't so sure about doing it on hands & knees, but the Dr was great!

BUT we're trying to move, and I'm trying to get pregnant again. And my husband is completely uncomfortable with homebirth, so I'll likely have more hospital births, or a birthing center if we can find one. A list like this is sooo useful to me in trying to find another awesome doctor/midwife with a friendly facility to work with. Thank you.

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