Thursday, April 3, 2008

Childbirth in the hospital - Navigational Tips

There are many reasons why a woman chooses to birth in the hospital. Women have the right to choose where and with whom she will birth regardless of what another would choose.

Women need the tools to navigate the hospital setting. She and her baby ARE unique. They are human beings. Laboring women are often placed under one-size-fits-all standing orders and protocols. Because of this, pregnant women need to be very careful regarding the books read, the types of birthing shows viewed, the care provider chosen and the childbirth class taken prior to entering the hospital to birth.

Here are some tips for a truly healthier and safer experience:
  • Take the hospital tour - ask lots of questions - induction rate, induction medications and/or procedures routinely used, average cesarean rate for first time moms, VBAC rate, pitocin use rate, epidural rate, use of non-medical pain relief, natural childbirth rate, IV use versus heplock, percentage of moms who utilize doulas, is pain management highly suggested to every laboring mom, monitoring norms, availability of tub or shower for labor, standard protocol on eating and drinking in labor, use of non-supine pushing positions, mobility in labor, are the labor and delivery nurses open to anything goes in labor, what is protocol on immediate postpartum baby care, is there a lactation staff available....
  • Read the pre-admit paperwork. If you are not sure what it says, ask a paralegal or lawyer to look at it. Be certain that you agree with what you are signing. Do not sign epidural consent form or cesarean consent form at pre-registration. You want to be fully consented during true decision making time. Be sure though to be familiar with benefits, risks and consequences of everything ahead of time.
  • Take a non-hospital childbirth class.
  • Only agree to induction for a true medical reason - (suspected big baby, pre-pre-eclampsia, being tired of pregnancy, care provider going on vacation, relative will be in town, being past your "due date", just because you can - are not medical reasons)
  • When induction is necessary - choose a foley catheter to ripen the cervix over misoprostol (cytotec, miso, or the little pill) and if labor establishes upon cervical ripening - decline pitocin or ask to keep it very low over a longer period of time.
  • Keep your "water" (amniotic sac) intact until it breaks on its own. This can keep infection probability much lower, lessen risk of cord prolapse, and lessen the discomfort of contractions among many other things.
  • As long as a mom and baby are low-risk - wait until well into active labor to arrive at the hospital - contractions 3 minutes apart and lasting a minute or more. Shortening the time in the labor and delivery room usually keeps interventions and medications to a minimum.
  • Any birth and immediate postpartum preferences need to be discussed PRIOR to labor with your care provider. A concise birth preference plan can be given to the nurse upon arrival.
  • In the event a cesarean is necessary (hopefully not created by interventions and medications in labor), discuss with your care provider prior to labor what you would like to have occur (partner in OR, no separation of baby from mom, pictures taken, etc. - for a complete list, please email me).
  • Make postpartum baby care decisions prior to arriving at the hospital. You do not need to have a pediatrician or family practitioner picked out ahead, as the floor doctor will oversee your baby's care. If you are unsure of what you want, it is always acceptable to delay any immunization, vitamin K injection, eye ointment, etc. until you have the opprtunity to investigate further. As a parent you have the right to say yes or no to anything.

The key thing to remember is that as a consumer, you are paying your care provider for a service, for the hospital staff to attend you respectfully, and for the use of the room you are renting. You do have rights. Protocols and practices are not laws. You can say yes or no to anything or everything.

As a woman you are making parenting decisions throughout labor, delivery and early postpartum that should be respected, honored and can have lasting consequences. There is no do-over.

Remember to be a driver - not a passenger!

6 comments:

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