The Ideal Hospital

[eilonwy]

I know, I know. In an ideal world, people wouldn't give birth in hospitals most of the time because those are places for sick people, and pregnant women aren't sick. But suspend that for a moment:

Ideally, what would a hospital birthing setting be like?

[mamallama]

To me, it's not about the amenities, it's about the staff and the protocols.

Evidence based protocols, true informed consent, and of course, Baby Friendly designation (as per WHO guidelines) would go a heck of a long way, as would ending mandatory overtime for the nursing staff and hiring more nurses.

[eilonwy]

Yes, but what protocols are you referring to?

I ask because I delivered in a hospital and I don't remember experiencing most of the negative things I keep hearing about hospitals. For example, an automatic c-section if the ultrasound indicates the baby is more than 8 lbs. I had an ultrasound (to check my amniotic fluid levels just before I was admitted to the hospital. It estimated the baby's weight at 9lbs, 4 oz. I was told that the ultrasound is often as much as a pound off, that the baby would probably be around 8 lbs. That's it, no one ever suggested a cesearian even though I'd already been in labor long enough to lose all of my amniotic fluid.

Someone mentioned that doctors/nurses in hospitals always check your cervix even after your water has broken and that it's a bad thing because it can introduce infection. I *begged* for someone to check me, and they told me flat out that they would not check me more often than once every 6 hours because it was likely to risk infection.

The "hold still during labor" protocol; I was encouraged to move the entire time. "Do you want a birth ball? Do you want to get in the tub? Would you like a different kind of chair to lean against?" There was a poster on the wall full of laboring and pushing positions, and I was encouraged to take up any position I felt comfortable in. That only stopped after I begged for pain relief.

About lying flat on your back with your legs in the air to push; I didn't. They tilted the bed up, removed the bottom of it, and got my feet into stirrups. I was in a squatting, upright position with people holding my knees I remember feeling like I was going to fall out of the bed, because there was nothing really below me.

Most of the things I've heard about "universal hospital protocols" didn't happen to me, except for a few things which even the crunchiest seem to agree on (for example, antibiotics for GBS+ mothers whose membranes have been ruptured for more than 12 hours or who run a fever during labor). I'm wondering if the hospital I delivered in was exceptional or if the horror stories are just that-- horror stories taken from a few really crappy hospitals/doctors.

[oceanbaby]

I too had a good hospital experience, but it was because I was educated and knew exactly what I wanted - they could tell this right away and pretty much left me alone.

But all you have to do is watch a couple of Birth Day episodes to get that most hospitals are very much into medical birth.

For me the ideal hospital would be one that was midwife transfer friendly and located next door to my house!

[anothermama]

Originally posted by eilonwy
I'm wondering if the hospital I delivered in was exceptional or if the horror stories are just that-- horror stories taken from a few really crappy hospitals/doctors.

I think you delivered in an exeptional hosptial. I've been with about 150 women delivering babies in 8 different hospitals and in general they were very assembly line, generally did what you hear about a "typical" hospital doing, etc etc. Also, I (stupidly) watch A Baby Story...I've seen about a dozen different hospitals and they are pretty typical. I think your experience was a typcial. Not that thats not AWESOME...I just think it was.

The ideal hospital would encourage women who can to birth at home.

[mamallama]

Your hospital experience sounds lovely. I'm glad that you were supported and respected. Believe me when I say that the reality is very different for other women in other hospitals. I'm not saying that hospital birth has to be a "horror story," I'm just saying that there is a ton of room for improvement in 5 of the 6 hospitals I have worked in.

If you are sincerely looking for specific examples, I will be happy to come back later, but I have several things I need to do today.

[oceanbaby]

I wanted to add that although I had a good hospital experience, it really was because I took control of the situation. If they had had their way, I would have been laying in the bed, hooked up to the fetal monitor, gotten pitocin, an epidural, let them break my bag of waters, and pushed laying flat on my back. They weren't overly pushy about it - I made it clear that I had my own ideas about what I was going to do, and a doctor that backed me up on it. But if I had just walked in there with no idea about how I wanted things to go, I would have ended up with a very medicalized birth, and given my prolonged pushing session (3+ hours), probably a c-section. And I live in a very progressive, liberal area.

I really think that exceptional hospitals are just that - the exception. Like the other poster mentioned, I don't think that they are all horror stories, but I have watched too many episodes of those damn birthing shows watching women show up with a normal healthy labor, be given pitocin, an epidural, an iv, catheter, oxygen mask, and then end up with a c-section because they aren't progressing. And I watch them cry as the doctor gives them the news. It breaks my heart every time. They are being robbed. My dh argues that it is their responsiblity to take control of their bodies and be educated and in control of what happens to them, which I can agree with, but on the other hand, I believe the medical communicty has a responsibility to live up to their own code of ethics: First do no harm. They have a responsibility to educate themselves about the area of medicine in which the practice. They have an ethical responsibility to not let insurance companies dictate the care given to their patients.

Anyway, I guess my ideal hospital would be one with an attached birthing center that supports midwife deliveries, and supports a natural birthing experience, but with the medical options nearby if they are needed.

[Greaseball]

You could check out the guidelines for hospitals that are considered woman-friendly. That designation has only been awarded to one hospital, who may be losing it because they will no longer do VBACs.

Here are my ideas:
- CNMs, rather than OBs, are used for all normal births.
- Mothers are encouraged to bring any number of chosen attendants - father, children, other family and friends, doulas - and these attendants should be allowed to stay as long as the mother wishes.
- Food and drink in labor is encouraged, even provided by the hospital if the mother did not bring her own.
- No routine fetal monitoring, IV hydration or cervical checks.
- The hospital discourages the use of the lithotomy position for birth, and allows any others, including underwater.
- The hospital discourages drugs as pain relief for normal births.
- No time limits are placed on the mother. Stalled labors are seen as an opportunity for the mother to rest, rather than for pitocin to be administered.
- The baby's possible weight is not seen as a concern.
- No routine inductions or augmentations are practiced.
- The hospital discourages non-religious, non-medical circumcision.
- Full rooming-in is not even something the mother should have to ask about. Her baby should never be out of her sight. Each NICU baby should have its own room where the parents are free to stay. (This is not some wild fantasy; some places actually do this!)
- Hospital does not give out formula coupons or samples; gives breast pumps instead.
- Twins (or more) and breeches are seen as variations of normal birth and are delivered vaginally with the lowest possible amounts of intervention.
- 10% cesarean rate or less.
- All c-sec mothers are encouraged to have VBACs; hospital should have a VBAC success rate of at least 90%. VBAC mothers should be treated the same as anyone else, with no special requirements. Induction should be avoided.
- Medical staff are familiar with natural ways to treat shoulder dystocia that do not include instrument delivery.
- Mother and attendants are allowed to stay after delivery as long or as little as they wish.
- Routine eye ointment, vitamins, blood tests and vaccines are not given. Mothers with HIV can refuse AZT and can be treated the same as everyone else.
- All staff affiliated with the hospital are supportive of home birth and will refer to midwives who can deliver at home.

[applejuice]

The most ideal hospital would not have a maternity ward.

Becoming a mother is not a disease that only a surgical team can cure.

Honest to G-d, it is not!

[USAmma]

The ideal hospital birth setting, as a pp said, would have more to do with the staff than the props. (First of all I think the ideal place is probably at home as long as the woman wants a natural childbirth, but I know that for medical reasons some women have to deliver at the hosp. at their midwife's request).

I had a hospital birth recently where the staff was very respectful of my wishes, even though I had to sign a waiver at one point. However I attended a friend's birth a year ago at the same hosp. and the nurse was awful! Kept saying my friend would have to have a c-section, and they also had her hooked up to every imagineable kind of monitor or medical device (epidural, catheter, irrigated uterus with saline, an IFM, and an internal cx monitor).

If I hadn't had a birth plan I would have recieved the standard procedural care. For example right before I started pushing the nurse prepared a syringe. I asked what that was and she said pitocin, and they would inject it after the baby was delivered, and that it was standard procedure. I asked that they hold off on the pitocin injection unless I started having heavy bleeding or something. Turned out I didn't need it at all and had all kinds of comments about how little I bled. Also had them delay the cord cutting and other non-standard requests like that. They were great about reading my birth plan and knowing what I wanted, although I did remind them just to be sure.

I think it all depends on your birth plan and how firm you want to be about it, and also your freedom to ask for a different nurse or doctor if they are not respectful of your birth plan. My nurse, in accordance with my birth plan, stayed out of the room and monitored me from outside. She only came in every hour or so and then popped back out again.

The hospital where I delivered had very large and beautiful rooms for labor and delivery, plus about an hour afterwards for bonding. The lights could be dimmed, the bed could be made into a birthing chair-type thing. The decor was faux wood floors and soft colors. The bathrooms were also huge with a comfortable seat and hot spray wherever you wanted it. Upon request the woman could have a rocking chair, birth ball, squat bar, mirror, and I'm sure I'm leaving some stuff out. The rooms also had a recliner, a sofa, and a TV for the comfort of the support people. I had four people at my birth and no one said anything about that being too many people.

The hospital nursery only cared for babies upon request, like if mom was recovering from csection or something. The rest of the women and babies had "couplet care" which meant one nurse for mom and baby, and baby roomed in the whole time. An LC popped her head in later that day after I had the baby and wanted to know if I needed any help.

One other nice bonus: I'm vegetarian and when they didn't have a veg. menu selection they asked me what I wanted instead! I had them custom make mac and cheese and an egg sandwhich for me. For dinner they actually went out and bought a Boca burger for me instead of the standard beef patty served for dinner! :-)

One thing I would change about the atmosphere was to hide or remove the medical equipment. The bed was set up next to a cabinet with a computer monitor and the cx and doppler stuff in it. In one corner was the cart with all the forceps and scissors and stuff draped with a blue cloth. The warming table was across the room, and the oxygen mask was also in plain view. If they had taken those things away it would have been a lot less hospital-like. Also, they only had one labor tub for the whole ward (about 12 beds) and waterbirth was not permitted.

Lastly, they required women to be monitored in triage in bed for 60 minutes unless they were in obvious labor or close to giving birth. The triage area had very uncomfortable beds and only curtains btwn. patients. If someone was closer to giving birth than you, they got priority over getting a room. Luckily for my second birth someone had major vomit in triage and they sent me directly into a labor/delivery/recovery room so I got to skip that stage.

Darshani

[Greaseball]

In an ideal hospital, mother and baby would call the shots.

Oh yeah, and sliding scale fees!

[HeidiJ]

We, also had a really good hospital experience. I had a birth plan ready, and was going through the birth center that is affiliated with the hospital. The BC is only about a block away, and you can choose to give birth at either place. The midwife made herself fimilure with my birth plan and stayed with me the whole time except to take a couple calls when things were slow. The labor/dilivery room was very comfortable, with a couch, rocking chair, birthing bed, and I had a birthing ball available. When I got there, my MW wasn't there yet and the nurse asked if I wanted pain meds. I said no and that was the last it was ever mentioned. I was incouraged to move, offered the tub (they do only have one, but they have future plans of putting one in every room), and all my nurses were aware of my birth plan and respected it. They did all the baby procedures right in the room and respected my wishes as far as eye ointment, bathing, etc. was concerned. They also have "mini NICU's" set up between each labor room so that if NICU is maybe needed a team will come, set up in there and then if they are truely needed they just open a door and it's like the baby is still in the same room and they can hopefully get the baby stabalized and back to the mom without haveing to take baby far. we were able to relax afterwards for about 4 hours before they had me shower and moved me to recovery. As a hospital policy they try to warm babies on mom's chest well before they consider an incubator. during recovery, there is no option of sending a baby to a nusery because they have none. You can have a nurse watch the baby if you really need her to, for whatever reason. You have signs to put on the door if you don't want them to come in and do procedures right then (hearing test & weight tests) and they encourage all moms to BF, even if they have said they want to FF. Plus they have LC on the floor at all times. And, all my nurses were really nice and helpful. Oh, and they charge on a sliding scale (side note: a few years back I had to go in to the emergency room at this hospital and I didn't have insurance. When I went in to talk about a payment plan, the lady looked at my income and my bill and just wrote the whole thing off, which was very helpful at the time.)

[hotmamacita]

When I was pregnant with the twins, I thought for a very brief moment, of a plan for transfer in the event of an emergency. I chose the hospital with the most amenities because IF I needed to have surgery, I wanted to be pampered afterwards. I know sounds odd but that is what I wanted. I mean if we were going to transefer, we knew we'd end up with a C-section.

So, the ideal place to birth babies is at home or homes geared towards it. And the ideal hospital is one with excellent medical care while providing the comforts of home.

(I went on to birth my breech, 8 pounder twins in my living room and promptly crawled into my bed to nurse & sleep afterwards.)


I do like others well thought out responses, though.

[DreamsInDigital]

I hate hospitals and will be as far away from one as possible when I give birth.
The only good a hospital can do is for sick people. Pregnancy, labour and birth are not illnesses.

[eilonwy]

I hate hospitals and will be as far away from one as possible when I give birth.
The only good a hospital can do is for sick people. Pregnancy, labour and birth are not illnesses.

Twice this has been mentioned. I ask only that you please read my original post (which addresses this) before you respond.

[TurboClaudia]

The ideal hospital birthing setting would be prohibitively expensive for the average, normal-risk pregnancy and birth.

[Greaseball]

It would also encourage breastfeeding among everyone - even people who are most likely to be discouraged, such as teenage mothers, mothers of twins or more, and mothers of very sick babies.

Wetnurses would be provided for mothers who truly could not breastfeed.

Disabled women would have the same chance as anyone else for a vaginal, unhindered birth. (Open Season goes into the high rates of cesareans among women who are deaf, blind, extremely obese, in wheelchairs or otherwise disabled.)

Unassisted birth, with the nurse just lurking outside the door in case she is needed, would happen there at the mother's request.

Mothers would be encouraged to have sex or masturbate during labor if that helped, and be given the privacy to do so.

Burning of candles and herbs would be allowed. Pets would be encouraged to attend. The hospital would offer a wide variety of food choices to meet all diets, including various ethnic diets and vegan/vegetarian.

Fathers and other guests would be allowed in for all cesareans, even emergency ones done under general anesthesia. Videotaping of sugery or normal birth would be encouraged.