Hospital birth - who is calling the shots?

[2sw33t]

I'm just trying to figure out with whom I need to communicate my birth plans, because during my first pg, I had assumed (stupid to assume anything, I know) that my OB would be calling the shots.

However, at the hospital, there were a variety of doctors running around - I wasn't really able to keep track of who was who - and my OB only came for the last few minutes of the delivery. (Also, since it was a group practice, it turned out that it was an OB I had never met before.)

I was pressured into receiving pitocin because my water had "broken" (really, "leaked" is a better term) - it was probably only a few hours afterward but I couldn't give them a firm time because I didn't even know it had happened. Anyway, I'm wondering if the doctor(s) in the hospital communicate with the OB during the labor process, or just call them in when it looks like delivery is imminent. If my OB is more involved, maybe I can stress that I really don't want pitocin or any sort of induction. If not, then I'll need to be better prepared for a fight or else (probably the best option anyway) wait as long as possible before heading to the hospital.

Always,
Jill

[Kirsten]

If you want a cheeseburger, what are you doing at the pizza place? You CAN have a decent natural birth at the hospital with an OB, but you are fighting an uphill battle. Why not just go with a midwife who at least wants the same model of birth as you have?

If that isn't possible, I'd:

*take Bradley classes (not hospital classes)
*stay at home until you are feeling birth is pretty immenent (I stayed home for the first 14 hours with my dd1)
*no induction (my dd3 was 11 days late)
*no IV
*make sure your dp is educated about birth and will stand up for you
*write a ONE PAGE (no longer) birth plan that is positive ("Thank you for helping us have a natural birth. I would like to use relaxation techniques, massage, changing position as pain-relief during labor. Please do not offer me any pain meds - thank you! I would like to hold the baby during the apgar and any other exams." instead of a list of NO this and NO that.
*understand that the hospital and the OBs can't MAKE you do anything. You can politely (or not so politely if it comes to that) decline anything. They can threaten and scare you but they can't FORCE you. It is still YOUR decision. I more than once nicely said "I'm not comfortable with that but am happy to sign an AMA (against medical advice) for you." They only had me actually sign for one thing though I offered for quite a few. Once THEY know that YOU know your rights, it goes easier. But be nice if possible - catch more flies with honey and all that.

But honestly, I'd just get a midwife!

[cileag]

It all really depends on the hospital.

One thing to keep in mind is that most hospitals have protocols that they are following. So the OBs can override them, but rarely do. Also, the OBs often have residents who are in charge of the "busy work" which for them includes most things like starting pitocin, arom, etc. The other thing to take into consideration is how busy the unit is, which on our unit directly correlates to how much 'control' the nurses vs. ob/residents have. If I have a patient desiring a low interventive birth, who is an OB patient, it's much easier to deflect a lot of the routine management if they are off doing other deliveries.

I agree that you should just get a midwife too. They usually have their own, more liberal protocol and at my hospital, the residents do not round or see midwife patients. Your best bet is to figure out how things work where you will be giving birth---is your OB the actual one that will come in and manage your labor and birth? Or is it just who is on call? You should ask and talk to your provider to figure out if IVs are mandatory etc.

good luck!

[DeChRi]

Due to insurance coverage, I had one OB practice options and one hospital option. I had my anti-intervention birth plan which I presented to my OB at 35 weeks. I had her sign 4 copies, as did we, saying she approved it. One she put in their file. We had one put in our file in the L&D unit when we did our pre-admit. We brought two with us, just in case.

THe first nurse that came in told me to toss my tea I brought in as they dont allow drinking. I said, check my file, and here is another copy. She was Very compliant after that. With shift change we handed over another and really it went very smooth.

I found that 1) having Dr agree with a signature and 2) having enough copies to give to ANYONE that comes in...went very far with us.

[Beccadoula]

I would like to suggest that you consider hiring a doula. We are trained to help moms with this kind of situation and to help with writing a birth plan, talking to nurses...etc. Usually the nurses are the ones who really impact how the birth goes - they are the power houses of the hospital. You will need to be bold enough to say no to some things - and so will your hubby. It takes a lot of guts some times. I will PM you with some other info.

[someguy79]

Yeah a doula. Or a family member that will hell or high water enforce your wishes. I am the husband that does that.

Also prep an advanced medical directive set poss. for both you and the child. We do a birthing plan for my wife. But we have in hosp. midwifes a 25 YO prog. they are excellent. On the kid we do a you shall nots. With a paragraph saying anyone that can't follow this is prohibitted from care and anyone who violates we reserve the right to file medical battery charges among other things. We refuse the HUGS RFID tracking thing. I personally hate the idea of tracking my kid and more kids have been kidnapped becuase of it rather than prevented. This sort of thing in bulletpoints straight to the point. Sign and notarize.

I learned after a nurse ignored our no shots w/o parent and was very agressive with our son. I prepare the you shall nots in writing and they do it. Remember a lot of medicine is fearful of lawsuits use that to your advantage. Now I don't advise threatening a lawsuit every little thing in fact I haven't on the 2nd and 3rd kid other than don't do this or I may file civil and criminal suit in writing. The 1st one told me they could what the wanted with my kid. But definitely get a doula that will enforce your wishes.

[changingseasons]

Originally Posted by Kirsten

If you want a cheeseburger, what are you doing at the pizza place? You CAN have a decent natural birth at the hospital with an OB, but you are fighting an uphill battle. Why not just go with a midwife who at least wants the same model of birth as you have?

I have to argue that this is not always the case. I chose a practice of midwives for my hospital birth thinking this exact thing- that they would want the same model of birth as I did. NOT the case.

OP- I had the exact situation- my water had leaked a tiny bit, they said it was broken (it ended up actually breaking during an exam about 15 hours later) and that I had to stay at the hospital. I was then on the hospital's clock and list of rules. I got the one midwife in the practice on call that day that I didn't particularly care for, and she was pressuring me for interventions as soon as she walked in the door (cytotec- I refused.) After I reached my "24 hour deadline" it didn't matter what the midwives wanted (even though they also were pressuring me with pitocin, etc.) The authority went straight to the ob on call. The midwife no longer had any say in my care.

I ended up with a c/s, because my labor hit 36 hours. They "let" me push for 2 hours, even though my body wasn't ready to push yet, and then said time's up.

[Kidzaplenty]

[etsdtm99]

in my area there are no midwives in hospitals.. the authority is kind of fuzzy too - at the hospital, they told me that the OB has the final say and that their policies are just there so teh OB doesn't have to be the bad guy - for example, the hospital said i couldn't get out of bed after my water broke .. the OB said i could. i had to wait 30 mins while the nurse paged the OB and asked her if i could get out of bed.. during that time the nurse sat in my room to make sure i didn't get out of bed .. so, i don't know if even knowing who is in charge helps.. i had everything worked out with my OB and she was on call and i STILL had to fight the nurses every step of the way.. they just couldn't believe that the OB had actually agreed to everything i wanted.. that was my 2nd try at the hospital, next time i am having a homebirth.. i just don't want to fight anymore..

[prancie]

i agree with the previous suggestions but i want to emphasize that you should stay out of the hospital for as long as possible. Go in pushing if you can. The shorter time you are there the less opportunity they have to do stuff to you!

If you feel uncomfortable staying at home that long you can labor in your car or the parking lot (depending on the weather) or a nearby hotel room.

[seashells]

I think the cheeseburger-pizza analogy is spot on. The only thing is that if you want a cheeseburger, you have to make sure you're in a cheeseburger joint. Not all midwives offer cheeseburgers. IMHO, hospital-based midwives are usually serving pizza. Birth center midwives might serve either. Home birth midwives are usually serving cheeseburgers. The task is not to find "a midwife" but "a care provider that is offering the model of care you are seeking." There are certain places to look (like homebirth midwives or birth center midwives) that increase your chances, but you still must, um, read the menu .

[MyLittleWarrior]

Although I agree with the cheeseburger/pizza analogy in theory, it's not always that easy of a choice. There are states where cheeseburgers are all but illegal. There are financial situations where a pizza is basically free, and a cheeseburger would bankrupt the family. In some cases no amount of bartering/or payment plans will make money appear that isn't there. Without knowing the OP's specific reasons for birthing at a hospital, I think we do her the most service by answering her question as it was stated.

OP, in your case I would agree with DeChRi, and get what ever OB your seeing prenatally to sign off on several copies of your birth plan, and then hand them out to anyone who enters your room. A doula would also be a terrific help, as well as making sure your DP is on the same page with your wishes and ready to put the smack down if he needs to.

[DeChRi]

Originally Posted by MyLittleWarrior

Although I agree with the cheeseburger/pizza analogy in theory, it's not always that easy of a choice. There are states where cheeseburgers are all but illegal. There are financial situations where a pizza is basically free, and a cheeseburger would bankrupt the family. In some cases no amount of bartering/or payment plans will make money appear that isn't there. Without knowing the OP's specific reasons for birthing at a hospital, I think we do her the most service by answering her question as it was stated.

OP, in your case I would agree with DeChRi, and get what ever OB your seeing prenatally to sign off on several copies of your birth plan, and then hand them out to anyone who enters your room. A doula would also be a terrific help, as well as making sure your DP is on the same page with your wishes and ready to put the smack down if he needs to.

[Peace+Hope]

2sw33t, if i were you, and assuming you aren't making changes as big as your care provider, i'd do these things to address your original question:

- talk to my OB about how things will go, blow-by-blow with different possible scenarios.

- tour L&D and if that does not automatically include some kind of personal interview time, ask for it so you can become familiar with the protocols and style/feel of the ward.

- be positive and reach out, giving the impression of thankfulness and working WITH said ob/l&d nurses

- definitely have a birth plan that is as short and concise as possible, and take the advice of PP and have the OB sign off on it and take it signed to your L&D visit to be filed for you, and have multiple copies with you.

- have someone with you at all times who knows your plan AND is able to interface and advocate for you, whether that is your partner, sister, mother, doula, whoever.

OBs may call the shots, but if they buck hospital protocols, they can lose their privileges, and they are working under pressures with other OBs who may not be into your plan. this is not a black-and-white issue with any hospital, my understanding, and best carefully researched and planned for ahead of time.

good luck!

[petrovska]

I had a doula who made sure my birth plan was respected. I told my OB right away what I wanted, and what I did not want. I wrote it out on a birth plan and gave her a few copies, i also made lots of copies to take with me to the hospital, to give to any-one that came into my room. It went well, I kept reminding them I did not want X and they they just nodded.

[terrabella]

You call the shots. Period.
And the nurses are your friends. IME anyway.

[Banana731]

Originally Posted by terrabella

You call the shots. Period.

That.

[meganmarie]

Agree with: you call the shots. that is basic patient rights. you can refuse any procedure. offer to sign waivers, with a smile.

BUT, your real question is: when you are trying to call the shots, who are you up against? Unfortunately the answer is often, "hospital policy". The nurses, residents, hospital-based attending OBs - they are all trained to follow hospital policy first. They are checking off boxes on forms they are required to fill out, and when you try to refuse standard of care they are in a scary position where they could get in trouble if they allow it.

OB permission trumps hospital policy, but that requires YOUR OB either to be there or to be reachable by phone. Getting a short, polite, specific birth plan SIGNED by OBs is the right advice. Have it placed in your medical chart and bring copies to hand out as many PPs have said. This worked well for us.

I would also suggest that if you are in a big practice, you spend your last 6 appts meeting each doctor in turn and asking each to read to your birth plan. As you learned the hard way, any one of them could be at your birth. You only need one sig, but you're better off if all of them at least have seen it.

Also agree if you have a doula, that can be a great a buffer between you and the pressure to conform to hospital routine. Doulas can't and shouldn't "fight for you" but they can say things like "would you like some time to discuss that option with DH?" or "do you have any questions for the doctor about that?" or "would you like to wait a little before trying that?" which nudges and supports you in standing up for yourself.

Good luck, hope it goes better this time around

[luv-my-boys]

I think the key here to getting your *cheeseburger* is to make sure you have a HCP that supports your *cheeseburger* choice. Whether that be a md, midwife, or who ever it might be. With my last birth the midwife (in his office) was WAY more intervention oriented than my MD. I was able to have a wonderful natural hospital birth with no interventions, but trust me it took a lot of legwork to find a HCP that supported that.

Remember a lot also depends on the hospital and providers. If you are in a teaching hospital or your HCP has residents/students you may have to deal with them for the majority of your care. They may only be there to *catch* the baby at the end. In our case I made sure that my provider would be there thru the whole thing so I knew he was on board and knew what birth we wanted and we were in a non teaching hospital. However I understand its difficult if that is not available to you.

[BetsyS]

And, as another kink in things, OBs can only over-ride so much.

Say that hospital policy is that all VBACs/women with ruptured mebranes have to be continually monitored. You have discussed this with the OB, and he/she says that you don't have to be on continuous monitors. You're thinking, woohoo! I'm free!

But, really, when you get to the hospital, you get a nurse that *totally agrees* with the hospital's policy and thinks that your OB is dead wrong. If that nurse has the right personality (and depending on her relationship with your OB), she can and often will fight that decision right up the chain of management, and management can often pressure your OB to change his/her mind.

Now, as a patient, you can of course refuse treatment. "I don't want to be monitored. No, I do not consent." And that's perfectly within your rights.

But, if you have a nurse that is willing to fight up the chain to the hospital attorney, well, then, it might be a losing battle, you know? And, regardless, it can make your hospitalization/labor pretty miserable.