Having the best possible hospital birth

[Hannah32]

So hey, I'm halfway along now. Eek. Time to start thinking about the actual birth process. Hospital registration forms came yesterday as well.

I'm interested in hearing from those who gave birth in the hospital and what they did to minimize excessive interventions and to avoid c-sections.

My goals for this birth are to have a healthy baby boy and a healthy me, avoiding pitocin and a c-section if at all possible. I'm doing my kegels and wall squats daily, along with exercising moderately and eating.....well somewhat healthy.

I'm not posting this for debate. While I think homebirth is great for those who want one, that's not what my body and my mind are telling me is "right." Neither my husband or I are comfortable with that scenario.

[blessedwithboys]

are you comfortable with having a midwife attend you in the hospital? each woman shoudl birth where she feels personally comfy, but a hospital is a place for sick people, and it can be very hard to avoid interventions when the "experts" are holding your baby's life over your head. this i say from firsthand experience...

you might also want to investigate hiring a doula. GL

[woodchick]

I have had two completely unmedicated births in a hospital. It was absolutely the best choice for me.

I think the best way to have the kind of birth that you want is to make sure that you have open communication with the staff that is attending you. I did that by meeting and talking with all the midwives in my practice (any one of 6 could have attended the birth) as well as having a clear, concise birth plan to give to and discuss with the Labor and Delivery nurse(s).

Even having taken these steps I still found it necessary to advocate for myself and to refuse many things that were "offered" to me- IV, pain meds, etc. Having a trusted birth coach/partner/doula with you is definitely advised. My DH was more knowledgable about natural birth than the nurse in our second delivery!

[MiaMama]

When I birthed in the hospital, I noticed that a lot of things were not presented as a choice, but I actually had more say than I would have otherwise realized.

For example:
Nurses: "We are going to put an internal monitor in now."
Me: "Don't you have to break my water to do that?"
Nurses: "Oh, its not already broken? I guess we don't HAVE to put the monitor in right now."

Nurses: "Ok, time to turn the pitocin up."
Me: "Can you turn it OFF instead? it is making me feel sick."
Nurses: "Well, I guess we could TRY, but your labor will probably stall." (it didn't)

Nurses: "Your baby has low blood sugar, she needs formula."
Me: "Can I try nursing her instead?"
Nurses: "Well, as a first time mom, you probably aren't making enough milk, but I guess you could TRY." (I made plenty )

So the moral of the story, they never ASKED, they just TOLD. But, when I asked, I got my way (on some things, not all). I never had the internal monitor, my water broke on its own, they did turn the pit off and let me finish on my own, my daughter never got formula. Just because they say "Its time for...." or "we need to..." does not mean that is the end of the story. SPEAK UP! If you think you might not be able to, have someone there to advocate on your behalf. Your mother, your sister, a doula, a friend , your husband.. but make sure they know what you want. I was alone except for my deer-in-the-headlights husband, but we brought a childbirth book with us to make sure that we were well informed, and could doublecheck anything we weren't sure of.

[lunita1]

I've had 3 hospital births and I'm 5 weeks away from my due date with #4. I think the single biggest factor in my *good* hospital births has been my choice of hospital. If I didn't have this hospital as an option, I would probably chose a home birth or birth center.

Factors to consider:

-the hospital's c/s rate
-your caregiver's c/s rate (can be very different from the facility's rates)
-policy on things like water biths, hep locks, food/drink in labor, episiotomies, nursery care, etc.


I see a team of midwives who share call with another team of midwives. I don't know ahead of time who will attend my birth, but all low-risk births at this hospital are attended by CNM's. They do water births, they monitor with a handheld doppler if mom is up and about/in the tub/whatever, they offer juices to laboring moms, they don't routinely do Iv's or heplocks, they routinely let the cord pulsate before cutting it, pride themselves in their low episiotomy rate, think skin-to-skin is the best method of warming baby, they have a FREE volunteer doula program available (which I've never used), are baby-friendly certified (which means breastmilk substitutes aren't offered/pushed and breastfeeding is fully supported)... etc. Some checking stats 5 years ago actually verified that more births that start at the local birth center end in C/S than births at this hospital (probably because the birth center transfers to a hospital with very high intervention rates). I travel about 40 minutes to get there (bypassing several closer hospitals) but it is worth it.

I had my first at a more typical local hospital. It was unmedicated, but not great. I had to fight to not get a heplock or IV, I had to turn down an offer of drugs, I spent a lot of my labor in the shower trying to avoid more monitoring (which was with the typical belt at the bed), baby was taken to the nursery for a bath and then "warming" in a warmer which took forfreakingever! DH went with her, and I was stuck in the bed, alone in the dark(attached a postpartum iv, because I ended up dehydrated during labor... lots of vomiting) wondering when the were going to bring my baby back. The nurses were all fascinated by my wide awake, alert baby. She was like nothing they ever saw. I guess they didn't see many unmedicated births! I wouldn't willingly birth there again. If I was forced to, I'd definitely want a very experienced doula on my side.

[buckeye_bebe]

I had an unmedicated vaginal birth in a hospital. I waited until the last minute to go. I think that was a key factor in having a "good" birth. The other factor was trusting my body to do the right thing, independent of what I thought or what I wanted. I was at the hospital just long enough to get my pants off. If only I kept my pants on this time...I'd not be pregnant... :^)

Good luck. There are a hundred or more things you can do, hope you get what you want!

[notjustmamie]

Make sure when you arrive at the hospital, you tell them you would like to be assigned a nurse who likes to support natural, unmedicated births. If you are likely to be there through a shift change, you may need to ask twice.

Having a MW or OB who is on board with a natural birth is vital, but your life will be so much easier if you have a nurse who is rooting for you as well, rather than one who doesn't understand.

[scottishmommy]

Stay at home as long as possible. The hospital I used had a very high epidural rate (over 90%), but I got there at 8 centimeters so they discouraged pain meds. In general don't head to the hospital until you can't stand, or talk during contractions. It makes for an uncomfortable car ride, but it doesn't leave the staff a lot if time to mess with you. They'll whisk you right through triage. Also follow your own urge to push. If they coach your pushing remind them that you can feel the contractions. Don't push through the pain. Push when you feel like it. If you can, find a midwife or natural birth friendly ob. When I was pregnant, I was reluctant to change providers. BIG mistake. My ob hadn't seen a natural delivery in years.

[lifeguard]

I had done up a pretty detailed birth plan - probably more detailed than is recommended but I was giving birth in a hospital where most of the staff were spanish speaking (so I had it translated), but the process of doing that birth plan really helped clarify for dh & I exactly what we were wanting & ensure we were both on the same page, so even if you write a detailed one & then a simplified one to actually give your care provider you would accomplish the same thing. I made many copies so everyone had access to it.

I LOVED my ob. My experience would have been totally different without him. He advocated for his patients (eg. his patients didn't have to move to a delivery room as was hospital policy but could remain in the regular room, etc.). He was also present for the majority of my labour & delivery.

We brought stuff to make the room more homey, my own pillows, blanket, pj's, food, etc.

[Sileree]

I second the suggestions for finding a CNM if possible and hiring a doula.

Healthy birth practices:
http://injoyvideos.com/mothersadvocate/videos.html

[gcgirl]

1. Hire a doula.
2. Know your stuff, and your rights. Like a PP said, they will usually TELL you what they plan to do, and you need to be able to counteract that. Or they just won't even mention certain choices, like turning the pitocin down. A really good doula can help you navigate that kind of stuff too.
3. Did I mention hiring a doula?

I had a reasonable hospital birth with DS. It was a pitocin induction, but I went in knowledgeable, asking them to test for evidence of amniotic fluid because I wasn't sure if my water had broken, and casually but calmly letting the staff know what kind of birth I planned. I was really lucky in that all the staff on that night were supportive of natural birth, but having my doula by my side gave me an extra boost of confidence.

[ElliesMomma]

if you haven't already, watch the business of being born.
read books on natural birth.
hire a doula.
if possible use a midwife instead of an OB.
write a simple birth plan... stating that you want a vaginal birth, freedom to choose pushing position, and "do not offer me pain medication; i know it is available and i will ask for it if i need it.
definitely labor at home as long as possible. my first unmedicated hospital birth, i got there at 10 cm, and it was "too late" for an epidural, baby was born 2 hours later. my second unmedicated hospital birth, i got there at 7 cm, with birth plan in hand, doula arrived, midwife arrived, and i had the baby three hours later.
research the best hospitals, and doctors/midwife in your area. go to the "finding your tribe" area to ask for help in this regard.
good luck!!

[MegBoz]

It's absolutely possible, just find the best hospital in your area. Generally, it's discussed often in your tribal area. If you only have 1 or 2 that are in a reasonable driving distance & they're both awful, I'd urge you to reconsider, but hopefully you do have options. (For example, in Baltimore,I've often joked that I'd squat alone in the woods before giving birth at GBMC! But Mercy & Upper Chesapeake are quite good.)

1. Doula
2. birth plan - have the health care provider (HCP) SIGN OFF ON IT (maybe even write it on a perscription pad!) That way you don't have to argue with the nurses if it differs from "policy" (specifically, continuous EFM & having an IV with fluids, and "nothing by mouth" are likely to differ from policy.)
3. Show up late in labor
4. be educated - I recommend Bradley training
5. make sure DH is on board & advocates for you too & knows your birth plan to the letter, in case they try to do something like break your water without even telling you
6. doula
7. never let your DC out of your sight, or your DH's if you must be separated (so they can't give formula & the like without your permission)
8. get educated - KNOW alternatives like how to help move labor along, natural pain relief options, and how to resolve shoulder dystocia (many hospital-based HCPs won't even know of the Gaskin Maneauver since most mamas have epidurals - they just cut an episiotomy.)
9. Get educated (Bradley training!) to KNOW what REALLY is a problem - do you need a CS if you've had PROM for 24+ hours? Do you need pit in that case? Do you need a CS for "Failure to progress"? How about CS or vacuum for extended pushing? Do you need cord traction & pit to "manage" the 3rd stage? Does the cord need to be clamped & cut immediately?
   --- in other words, I'd try to take a lot of the care into my own hands - knowing that hospitals tend towards agressive "active management" that is more harmful than good.
10. Doula!

[Thalia]

1. Choose a good hospital. By good I mean one that makes you feel comfortable. We chose a small community hospital over the big fancy teaching hospital down the road because it was very mellow, had happy, supportive staff, had natural light in the maternity rooms, and had a great lactation consultant . We knew that if we had a surprise complication the fancy hospital was only a five minute ambulance ride away.

2. Use a midwife instead of an OB. My sister is an OB, and no matter how supportive they are, they usually have different pressures and less experience in supporting women through LABOR than a midwife does. If you are giving birth in a hospital, remember that they have OBs on staff if some situation should arise in which they are really needed.

3. Arrange for a much labor support as you can. Hire a doula that you really like and feel comfortable with. A doula you don't like is worse than nothing. Friends can also lend a hand, if you trust them.

4. If possible, attend a friend's birth. This prepared me like nothing else for labor. It was very empowering. Obviously, you have to be fortunate enough to have a friend who is willing to let you do this!

5. Have a birth plan and discuss it very thoroughly with everyone on your team. Be ready to be flexible if necessary.

6. Take natural child birth classes with plenty of time for additional practice of comfort measures before your due date.

7. Don't be afraid to tell anyone you DON'T want there to stay home. My in-laws wanted to wait at the hospital, but it would have been too stressful for DH; he would have felt obliged to go visit them when what he really wanted to do was support me. We asked them to stay at home and I am so glad we did!

8. Give yourself as many choices of support measures as you can (people, techniques, equipment, motivational stuff like signs or pictures or symbols), and be ready to chuck anything that isn't working. You just never know what you will really want in labor.

[kltroy]

You've gotten some great advice. I had a very nice unmedicated intervention-free hospital VBAC 19 months ago. Key things for me were:
1. good labor support. Can be your mom, a doula, etc.
2. you and HCP need to be on the same page about what your wishes are. Go through your birth plan ahead of time (35+ weeks?) and get her to document it in your chart electronically, so that in case she isn't there for the birth, whoever IS there knows what the plan is. (This actually happened to me and wow, was I glad my doc had taken good notes! I also brought copies to the hospital just in case).

I prefaced my birth plan by saying

"I am planning an intervention-free and natural birth. Residents/students are welcome to come in but please be respectful of my privacy by knocking and not turning on lights or making unnecessary noise. Assuming there are no medical complications, I request the following:

1ST STAGE OF LABOR
•In general, please leave me alone as much as possible. My body knows what to do. "

I thought this first bullet point, and the intro bit, were good for setting up expectations.

3. Have someone remind HCP and everyone (you too) of key parts of your birth plan as they become relevant. So if you want to delay cord clamping, remind someone right before the baby is born. There's no point in reminding way ahead of time.
4. Keep your birth plan short and sweet - 1 page or less. Check w/ hospital and don't bother requesting things that you will already get (like rooming in). Also I did not bother with much in the way of postpartum requests (like vaccinations, circumcision etc) because you'll be able to ask for that stuff yourself easily. If you want to make YOURSELF a version that has that stuff as a reminder, fine. But don't clutter up the birth plan with it.

ETA: You can always buy yourself time if an intervention is suggested, unless it is a true emergency. How will you know the difference? If one person comes in and says, "we need to do XX", or "I think we should do XX", you can ask questions. what are the risks of XX? what if we do nothing? How about if we do nothing for 1 hour and see how things go? What are the concerns if we don't do XX? etc.

If 10 people come running into the room and say, "We need to get your baby out NOW!" - well, I would believe them!!

[Honey693]

For me the magic words were "But my doctor said I didn't have to" My doctor was out on maternity leave and no one had sent my birth plan over so they had no idea what I wanted and what I had talked about with my doctor. But if I said "But my doctor said I didn't have to" they usually left me alone.

[Anna Phor]

Hannah, your goals are very similar to mine--my son was born 12 weeks ago. I don't know what your feelings on pain meds are, but mine were very open before the birth; I didn't know how much pain I would experience or how I would react to it, so my attitude was very much "they are there if I need them and if I don't, that's fine."

I was much more worried about pit & other interventions that lead to unnecessary c/s; the hospital that I gave birth at has a high (40%) rate of c-sections.

What worked for me:
educating myself about the normal process of labor; the various stages, what I could expect in terms of contractions, frequency etc, and what would happen with my body.
talking to my doctor about *when* it made sense to come to the hospital given my preference (and I had to be forward about this. She didn't ever ask me about what sorts of preferences I had, and she wasn't the doctor who delivered me.)
Waiting until my contractions were 5 min apart before going to the hospital. My water had broken about 7 or 8 hours before that and I was positive for group B strep so the doc wasn't pleased (but given that she didn't have a time machine, what was she going to do?)
This meant that I spent early labor at home, we took a walk, I bounced on the ball, I ate & drank what I wanted.

I labored for about 4 hours at the hospital before I decided that I wanted pain relief, and gave birth about 3 hours later. In retrospect, I might not have needed it if they were not so insistent on the fetal monitor--I refused the internal monitor, and I also refused a catheter (I forget why they wanted to do either of those). But I was also not committed to giving birth without pain meds, so if that's your goal, ymmv.

[Addie]

You've gotten some really great advice here. I just wanted to chime in to add that I had an unmedicated, intervention-free birth in a hospital, and it was absolutely the right choice for us. I definitely agree with the suggestion to choose a midwife as your provider, if possible - they just have a lot more experience with natural births. And if you're comfortable doing so, hire a doula and make it clear that you want her to serve as your advocate during the process.

One thing I didn't realize before birth (I'd never been hospitalized before) was what an important role your nurses play. Even though we used a midwife group that afforded us a lot more face time during labor than an OB would have, it was still the nurses that were our primary contact. We totally lucked out and had great nurses - aside from the flurry of nurses when we first got to the L&D room, I was never offered meds or interventions, and they were totally supportive of my birth plan. In fact, the nurse who was there during delivery was a doula in her spare time. That was mostly luck - but be aware that you can ask for a new nurse if you feel like you're not getting along with yours or she's not supportive of your birth plan. This happens fairly regularly, and I really don't think there are any hurt feelings.

[gcgirl]

Originally Posted by Addie

One thing I didn't realize before birth (I'd never been hospitalized before) was what an important role your nurses play. Even though we used a midwife group that afforded us a lot more face time during labor than an OB would have, it was still the nurses that were our primary contact. We totally lucked out and had great nurses - aside from the flurry of nurses when we first got to the L&D room, I was never offered meds or interventions, and they were totally supportive of my birth plan. In fact, the nurse who was there during delivery was a doula in her spare time. That was mostly luck - but be aware that you can ask for a new nurse if you feel like you're not getting along with yours or she's not supportive of your birth plan. This happens fairly regularly, and I really don't think there are any hurt feelings.

Yes...I was going to mention that if you get a hostile nurse, order him/her out and request another, but I didn't know how well that would go over at various hospitals. I didn't have to do this myself because all the staff on duty were supportive of natural birth, but I would NOT HESITATE to tell someone to get the hell out if necessary.

[kltroy]

More about nurses: I would actually designate your husband to make it known when you get there that you are planning an unmedicated birth. Nurses get to choose their patients (to an extent) and some nurses really like attending moms like us. Others have no clue what to do. I had both kinds during my birth - the first nurse I had was GREAT. Second one literally had no idea what to do - I don't think she'd ever seen a mom without an epidural. You can always ask for a different nurse, even if the one you have isn't openly hostile - you can see about getting one assigned who is more "into" supporting moms through natural births.

More on expectations: My mom, a CNM who acted as my doula, said afterwards that I was a "good laborer". By that she meant that I allowed my contractions to be productive, didn't fight it, had realistic expectations about how long and how intense labor would be. I think having realistic expectations that labor is WORK and will require some amount of concentration to deal with helps. Never once did I think to myself, or say, "I can't do this anymore" -- though I did ask, a couple times, "how much longer do I have to do this".