Talk It Out - Part 2
This post is for Kimberly, who requested I write a follow up post to Talk It Out, with examples of positive communication and what to look for when talking with your provider about your wishes.
If you are planning on a hospital birth, a great place to start is first figuring out which hospital will be most encouraging of your birth preferences and beliefs. Not all hospitals are created equal. Case in point, here in Houston the rates for cesarean vary from 13% to 37%, depending on which hospital you choose.
So, let's start with a hospital questionaire. Some good questions to call up and ask the hospital:
Does __________ Hospital have childbirth classes and, if so, what types of natural labor management techniques are taught/where does the instructor have certification through? If they have Lamaze or Bradley classes taught in-hospital, GREAT. If they teach deep breathing, progressive relaxation, mobility, hydrotherapy, massage, and visualization, EVEN BETTER. If they offer a number of childbirth class options, including natural childbirth, hypnobabies/birthing, Bradley, Lamaze, sibling childbirth classes, medicated birth, and cesarean preparation classes - BEST.
Are there any restrictions on the people I have with me during labor and birth? This is a very important one. If you want your partner, your doula, and your mother in the room, you should find out if they restrict visitors to a limit of 2... another thought, if you have older children you would like with you during labor and birth, do they have any age restrictions.
How does _______ Hospital encourage mom to be ambulatory or active during labor and birth?
Some good indicators that they are encourage active labor (which means less discomfort, more holistic means of pain management, and, usually, lower cesarean rates) would include: intermittent fetal monitoring, showers and jacuzzis, TENS machines, telemetry units, birth balls, hot blankets, rocking chairs, squat bars, and the like.
Do the rooms at ___________ Hospital encourage mom to create a mood cohesive to birth?
A hospital birthing room can be more homelike. The closer to homelike a hospital room can feel, the better mom will relax into the atmosphere, make her feel comfortable and secure/safe, and the better chance her labor will progress with no hindrance. Some things to be looking for: jacuzzi/tub (or the ability to bring your own in), access to lots of pillows, temperature/climate controls in your room, private rooms, lighting controls/ability to dim the lights, CD players or the ability to bring your own, the ability to silence the ringer on the phone, drapes or blinds on the windows, rocking chairs, and a nursing station that will restrict un-invited guests from entering the room.
Do the nurses or __________ Hospital have experience with doulas? Points given if the nurses or hospitals know what a doula is and are familiar/happy with a doulas presence. Bonus points if they have a list of local doulas to give to a mom who requests them.
How does __________ Hospital encourage a mom to push her baby out? Hospitals that know where and how to set up their squat bars (or even have them) are more likely to be used to using them. Nurses who are familiar with 'tug of war' for birthing understand that all women birth babies with different methods of 'pushing'. If they encourage mom to push in 'whatever position feels best', or even suggesting things like squatting, side-lying, or on all fours, draped over the back of the bed... these things all point to a nursing staff, and thus, a hospital, that encourages natural, physiological birthing.
Can you tell me what immediate postpartum for me and baby might look like IF we are both healthy and fine? Key words to be looking for are: immediate skin-to-skin, baby on mom's chest, immediate breastfeeding, rooming in, shower, meal and drink, partner cutting cord, PUSHING placenta out, routine newborn exam in the room/in mom's arms, delayed newborn procedures, etc... Bonus points if they can tell you how to get a release to bring your placenta home with you or can tell you, off the top of their heads, who their lactation consultants are and when they make their rounds (even if you don't plan on using/doing either of these things).
How does ___________ Hospital routinely care for an exclusively nursed newborn? They should support complete rooming-in and breastfeeding-on-demand. They should have the choice of either breastfeeding or formula feeding bags for mom to take home. They should have lactation consultants/educators on staff and available AT LEAST every other day, if not every day, or a list of LLL leaders available. They should respect a families choices (even if they are not your choices) to delay or selective vaccinate, refuse eye prophylaxis, vitamin K injections, in-hospital hearing tests, PKU tests, and circumcision. They should also support a parent's right to be with their child during any of these chosen/accepted procedures.
If my doctor is cool with it, can I request early discharge? Even if you don't plan on making use of early discharge, this key point will allow you to know if your hospital supports a woman's autonomy and ability to make her own informed choices. Regardless if they 'allow it' a woman is always able to sign herself out of the hospital; knowing a hospital DOES 'allow it' shows that they are mindful of your rights.
Examples of positive communication with your doctor or midwife is up next....