9.21.2008

When a Woman Chooses a Hospital

I know that some of my posts sound extremely anti-doctor, anti-hospital. That is not the case, I am simply anti-proactive and anti-bully... that, and you will rarely (not never) see a midwife, in general, bully a mom, or a home birth planned without proactiveness. So, unfortunately, and by default, many of my rant posts sound anti-doctor and anti-hospital.

I, myself, had three OB-attended labors (4 births) and one midwife-attended birth. I loved my choices and never regretted them. I support women in whatever choice they make, and, for many women, this means a hospital birth.

Women choose hospital births for a number of reasons: finances, comfort level, and relationship with their care provider to name a few.

But, whatever their reason, women who choose a hospital birth should have some practice tools to navigate the hospital setting, especially if she desires something other than the standard of American hospital care during childbirth (ie, spontaneous onset of labor, low-intervention labor, no medication, etc..).

Unfortunately, medical students are taught with medical textbooks which teach through medical texts and tables, giving average-as-rule, and expounding on the travails of malpractice and standard of care. These medical students will grow up to be your medical doctors. As a result, many women are expected to labor under the one-size-fits-all policies and procedures as outlined in the medical texts and hospital protocols.
To be ourselves causes us to be exiled by many others, and yet to comply with what others want causes us to be exiled from ourselves. - Unknown
Because of this, a woman choosing a hospital birth should be very very prudent, educated, selective, and careful of what shows she watches, books she reads, caregivers she chooses, other support people she surrounds herself with, and classes she takes before ever entering through the hospital doors for her birthing time.

Here are some ways she can better prepare for a healthier, safer birthing time:
  • Take an independent childbirth class - this means a non-hospital affiliated childbirth class. Most of these will be taught in someone's home or a free-standing center like a women's center or yoga studio. Very few of these occur within hospital walls. This ensures that the information you are getting is unbiased and medical-fact - not hospital policy or routine procedure for your place of birth. These classes encompass educators certified through CBI, ICEA, AAHCC, Lamaze, Hypnobabies, and more... Many Lamaze-hospital classes are only loosely based on Dr. Ferdinand Lamaze's teachings and are hospital preparation classes, not childbirth education classes.
  • Take the hospital tour - ask TONS of questions. Gird yourself to know that most of the mom's taking the tour will most likely have taken the hospital-preparation class and be looking to know what 'she should expect' from the hospital's policies. You, on the other hand, should go with a list of questions, such as: episiotomy rates, if they have birthing balls, TENS machines, telemetry units, squat bars, tubs and shower in the labor and birth rooms and for use during labor and birth. Ask if there is someone you can talk to yet that day who can answer questions about induction rates, cesarean rates for first time moms, how common are VBACs, what the augmentation rate, IV rate for unmedicated births, postpartum care for mom, immediate and long-term newborn procedures and standards, and if there is a 24/7 lactation consultant available.
  • Request pre-admittance paperwork - then read it. If you don't understand it, ask someone knowledgeable to interpret for you. Be sure that you agree with what you are signing. Do your research on terms and procedures that you are unfamiliar with. If you don't see the epidural consent and cesarean consent forms in your paperwork, request those as well (they are often not). Look over them, read them, but don't sign the epidural or cesarean consent forms before labor. Only have read them so that, if either procedure becomes necessary during labor, you have already read it with a clear mind before labor began and understand the information within.
  • Choose support people who not only will support your birth philosophy and choices, but will advocate for you and agree with you. If your mother or mother-in-law cannot do this, don't invite them to be there. Don't be afraid of offending people by not inviting them or uninviting them to the birth. This is not a spectator event, it is an intimate and highly vulnerable event. Make sure everyone in your room is on-board and completely supportive of your needs and desires. If you are worried about people simply showing up to your room during labor and birth consider: not telling anyone when you go into labor except those who will be in the room, telling the hospital staff the only people allowed in your room, beyond medical personnel, are so-and-so, unplugging your hospital room phone,and consider not signing the pre-admittance form agreeing to release your room number and name to people who call inquiring about you.
  • Talk to your care provider about all labor, birth, and postpartum preferences before labor commences. Discuss your desires, his/her policies and routine/standing orders, and consider writing a birth plan to help outline both of your preferences before hand. If they are grossly in opposition to any of your choices, refuse to support you and your choices, or seem less than supportive of your beliefs and choices (i.e. vague answers, 'we'll see', well, I 'don't like to see', etc..), consider finding another, more supportive, doctor. You have the right to refuse ANY procedure for your body and birth.
  • Establish your newborn and baby preferences and discuss them with your doctor/pediatrician before birth and make sure that they are in agreement with, or at least supportive of, all of your choices. If they aren't, consider changing doctors. If you are unsure of any procedure (circumcision, vaccinations, etc...) consider refusing it until you have time to research it further and make an educated decision based on your families needs and beliefs. You have the right to refuse ANY procedure for your child.
  • Only agree to induction when medically necessary. This is a sticky one in a hospital setting. Some examples of unnecessary inductions are: suspected big baby, slightly higher bp and/or swelling from late pregnancy, being ready to 'be done', a major holiday is around the corner, passing your estimated due date, your careprovider's vacation is coming up, a relative or support person is coming into town, etc...
  • If an induction is necessary, move from the least medically invasive and 'point of no return' as possible and move up from there. Consider things such as Evening Primrose Oil for cervical riping rather than Cytotec, stripping your membranes rather than outright breaking your water, low-drip pitocin rather than scheduled pitocin incremental induction, etc...
  • Keep your water unbroken until it breaks on it's own. As soon as you allow a caregiver to break it for you at any time before or during labor, you are sigining yourself up for the whole hospital experience, you are on the clock and given a deadline for birthing your baby (within 12-48 hours - depending on your doctor's shift change, your hospital's policies, and your water's appearance).
  • When you do go into labor, and as long as your pregnancy is low-risk, stay home until you are well into active labor before moving to the hospital environment. This usually means contractions between 3-5 minutes apart and lasting about 1 minute or more. Mom should be having to work with her body during contractions and show a serious attention to her labor. Less time at the hospital means less time for them to offer or press unnecessary interventions and medications.
Remember, you are a consumer of your health care. You are paying for the hospital and your doctor/midwife's services. You can say yes or no to anything that you want to. You have the right to have your choice respected and not to be bullied or feel coerced or pressured into giving consent.

Hospital births can be a thoroughly enjoyable, beautiful, safe, and wonderful experience; when a woman takes the time to educate herself to her options and make personal exploration of her desires and comfort levels with different aspects of hospital birth policies, procedures, and expectations.

Here is to educated and informed consent...

4 comments:

Anonymous said...

As a practicing doula of 10+ years, former independant educator and now hospital based non-nurse childbirth educator, I take offense at your complete dismissal of ALL hospital based classes. I work HARD to make my classes be very consumer driven. I teach every single thing on your list - from how to ask the hard questions of your care provider to involving your care provider in your birth planning to reading the paperwork ahead of time. In fact, as a hospital based class, I have access to things like actual hospital protocols to show to my students that I would not have otherwise. I have worked long and hard to be able to do this within the system and have not had to alter my independant curriculum much at all. The only changes I made were adding the tour (which again, I can only do as a hospital based educator. Few students did it on their own when I taught independantly) and discussing billing issues, which takes about 5 minutes.
As a hospital based educator, I also have input on things like emplyee surveys, where I can speak up and tell the administration exactly what consumers are complaining about. When I started, I targeted three policies I want changed. 6 years later, one is changed to be much more mom-friendly, one has come halfway, and the third I'm still working on. I know I simply could not have done this from the outside.
When I taught independantly, I felt as though I was preaching to the choir. In the hospital, I get couples who thinking maybe they want to have a natural birth, and I KNOW I really make a difference.
My classes are quite popular and I get referrals coming from other area hospitals, a local birth center, and even home birth midwives.
So please don't lump me into the category of "bad classes" simply because I am hospital based.

Nicole D said...

I apologize that it offends you - but I cannot take time to make concession for the few hospital-based educators that teach solid, true-informed consent because, typically, hospital-based childbirth classes teach what the hospital will/won't 'let' a woman do - what they can expect their health care provider to order for their 'care' and often leave out true necessity of these practices or evidence that this is truly a healthy and labor-favorable choice.

If you are able to give women true and evidence based information in the context of a hospital-based childbirth education class, then kudos to you. By and large that is not the case. In fact, of over 20 hospital-based classes I have screened/audited in my areas of residence, only one, ONE was a true childbirth education class and not a hospital-preparation course.

I know that there is one in this area very similar to Bradley classes taught through a midwifery practice for hospital births - it is very comprehensive... but this is not the norm - and, in writing a blog, I cannot make concession for every exception to the rule.

If you ARE the exception, then that is wonderful and I applaud your ability to work from 'the inside', and again apologize for offending.

DoulaMomma said...

wow - you're on a roll this week - great posts!

slh35661 said...

This is great information. Just as the hospital based classes may not all be this bad, so too is the hospital experience. I feel a lot of times like we hospital based midwives get a bad wrap. But when I look at the practices I have been in as a midwife, I know those women had many more choices and say so then they ever would have had with the physician providers in any of the hospital settings I have been in (and that would be quite a number both as a midwife, a student, and as a nurse).
I think what you are after here is empowerment for women. That women and families have a choice and their voice, if raised up enough to question, can get change to come about. You are saying, "Don't be a slave to fashion. Venture out and question authority." And this information is very well said. I too have not found many childbirth education classes all that different from what you have described in the post. I am sure there are numerous good independent ones as the annonymous post above describes, but I have never had the pleasure of finding them.
Keep on empowering women!

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