By Michelle Crouch
Web Exclusive - February 13, 2009
When I was expecting my first baby, the nurses who gave the hospital tour stressed how comfortable the hospital was with natural childbirth. Instead of asking specific questions about what that meant, I believed them.
I should have known better. Though my labor was normal, the nurses would not unhook me from the fetal monitor to let me walk around the room to ease my contractions. They didn't have birthing balls or a squat bar available. At one point, they even tried to keep my doula out of the room.
Despite those circumstances, I was able to have a medication-free childbirth and delivered a beautiful baby girl. During my next pregnancy, however, I asked better questions—and that helped me choose a hospital more friendly to natural childbirth. More important, there were no surprises once I got there.
A hospital is not the ideal place to give birth if you want a natural childbirth, but it is possible. Even if you can't choose your hospital, knowing what to expect once you get there will help you prepare so you can have the type of labor you want. Here are ten key questions to ask your maternity center before the big day:
- Are there any restrictions on who is allowed in the room? Some hospitals limit the number of people who can be in the room during the birth; others have an age restriction. If you want the baby's siblings present or other relatives in the room, make sure you ask the hospital what its policies are. Also check to see who is allowed in the operating room, should you need a C-section.
- Can I eat and drink during labor? Most US hospitals restrict women to sips of fluid or ice chips during childbirth, though nurses acknowledge they can't control what you do when they're out of the room. The restriction dates back to the 1940s to prevent the aspiration of stomach contents in women who need general anesthesia for a C-section. But a recent report from the American College of Nurse-Midwives found that drinking and eating during labor had no adverse effects on mothers or babies; in fact, it actually improved hydration and helped relieve stress by giving women a sense of control. The report reviewed studies from the United Kingdom and the Netherlands, where women eat and drink freely during labor.
- Can I walk and move around during labor? The medical community agrees that moving around makes labor less painful and more efficient. But the big question for a hospital is whether they are willing to do "intermittent fetal monitoring," in which the baby's heartbeat is checked occasionally, rather than continuous monitoring, which makes it difficult for laboring moms to change positions and cope with contractions. Studies have shown that continuous monitoring of low-risk labors does not improve fetal or maternal outcomes and tends to increase cesarean rates. Some hospitals now have devices that work by telemetry so you can walk around while you're being monitored.
- What are the rooms like? Ideally, you want a private, comfortable room decorated with relaxing colors and soft lighting, at least one big comfortable chair, a window, a TV, a CD player, access to the Internet, a mini refrigerator, and a deep tub, preferably with Jacuzzi jets. Some hospitals hide medical equipment behind panels until needed—a nice touch. Find out if birthing balls are available.
- Will I have to change rooms during my stay? Traditionally, hospitals forced women to labor in one room and recover in another. This can be a difficult transition for an exhausted new mom. But a growing number of hospitals today are creating comfortable birthing suites where you stay for the duration of your time in the hospital. Make sure you ask if you are guaranteed a private room, and where you'll be put in the unlikely event that the labor and delivery rooms fill up. (It does happen!)
- Are there rules about what I can wear and what I can bring? Can you labor in a T-shirt, or do you have to wear a hospital gown? Many women are more comfortable in regular clothes. If you want to record this special time, ask about any rules regarding still and video cameras. Lawsuits have prompted some hospitals to ban recording devices during some parts of labor and delivery.
- Do I have to deliver lying flat on my back? Squatting during delivery increases the pelvic opening by approximately 28 percent, reduces the need for forceps and speeds up the birthing process. But many hospitals and doctors still want a woman flat on her back with her legs up in stirrups for the birth. Find out now what your doctor and the hospital are comfortable with. Does the hospital have squat bars (to support the mother's weight), squat stools (U-shaped stool) or other tools to help a mother who wants to squat during delivery?
- Can I nurse my baby immediately? Studies show that infants who nurse soon after birth have a longer duration of breastfeeding than infants who are first put to breast three to six hours after birth. Yet many hospitals still whisk the baby away immediately after birth to be washed, weighed, and checked. Ask whether you can nurse your baby immediately, perhaps even while he is still attached via your umbilical cord. Find out if the nurses are willing to do the baby's routine checks bedside, in the room with you. If you object to any routine procedures, such as the vitamin K shot or the eye ointment, make sure the hospital allows for such exceptions beforehand.
- Can my partner stay with me after the baby is born? What accommodations are available? A growing number of hospitals are providing recliners that lay flat or cots that fold down out of the wall to accommodate fathers and other family members who want to spend the night during labor or in the days after baby's birth.
- How does the hospital support breastfeeding? Many nursing mothers have been frustrated over the years by hospital staff members who offer their babies formula, sugar water, or pacifiers. While maternity centers are growing more supportive, it's still a good idea to ask about the hospital's policy on those items. Do the nurses support rooming-in and breastfeeding-on-demand, rather than on a three-hour schedule? Finally, find out if there is a lactation consultant on staff and how often she is available.