I implore you to seek some help. Post in your tribal area - I'm sure some doula (or doula in training) would be willing to help you out free. Please don't go in with no support! Heck, I'd be tempted to help you out if you were in my area & I'm not really interested in being a doula - I just hate to think of someone all alone & worried like that.
You sound really uncomfortable & anxious with this hospital. If you aren't going to switch to another care provider (whether home birth, free-standing birth center, hospital-based MWs,) Then I think you really need to find out what you're in for here. Is it really that bad? I had a hospital birth & it was great! They didn't take DS out of my room, didn't bat an eyelash at my requests like no vax, no eye goop, delay cord clamping, etc. etc. The nurses were awesome, my MWs were awesome. Yeah, I say that modern American maternity care is an "atrocity" - but that is on the whole.
There are a lot of great HCPs out there
If you really believe you're going to have to fight this much, then do you really believe they are "good" HCPs? Because it doesn't sound like that's how you sincerely feel.
Have you taken the tour of the hospital? That was reassuring for me. There were at least 3 or 4 other mamas on my tour & few of us asked Qs - so I know the nurse wasn't trying to "tell us what we wanted to hear." She was telling us HOW THEY NORMALLY PRACTICE - and it was consistent with what the MWs had told me & what my 2 friends who had birthed there had said. (i.e. she said they encourage rooming in, she showed us how to work the beds but said, "We don't you in bed though! We want you up & moving." etc.)
As for screening visitors, they had an option at my hospital where you could be "unlisted." So if someone came in & said, "I'd like to visit MegBoz." They'd reply, "Sorry, nobody here by that name."
Hospital L&D wards are big on security because of the paranoia of baby-napping. While I'm not gonna say it's "fort knox" secure, it ISN'T easy to just wander in. It's not like the rest of a hospital. (Again, not saying it's not worth reminding them, just that they are likely accustomed to helping screen visitors - since many people don't want visitors during the labor process.)
Again, go take the tour & it may help ease some of your anxiety.
So try to find out if you really will need to fight. You may not! & If you don't have to fight, don't expect to. In other words, relax a bit. Put some degree of trust in the HCPs. Sure, speak up if they start to wheel your DC out of the room, but don't feel that you must constantly be on guard. Feeling so upset & anxious is not conducive to labor. (Have you read any Ina May?)
I'm not a trusting person & I wasn't comfortable with the idea of a hospital birth so I totally & completely understand this anxiety, but try to do the best you can to make your birth experience a positive one - and I think at this point the most important thing to do, after getting a labor support person, is to work towards greatly reducing this anxiety somehow.
Originally Posted by laohaire
Some good reasons to have one might be:
- If forceps or vacuum extraction are NEEDED for some reason, they are going to want to make more room for the tools
- To reach in to deal with shoulder dystocia
- If mom really has been pushing a long time (and a long time is not, like, 10 minutes... I pushed for 6 hours, myself) with baby's head engaged but no SD, I dunno, maybe it could help. I had such a situation but ultimately I chose to tear on purpose, and it was done. I don't think anyone could know if the tear would have been better or worse if I had an episiotomy (I didn't). It probably could go either way, sometimes it's better and sometimes it's worse.
Actually there's no need for epis to accompany vacuum - the vacuum doesn't increase the circumference of the 'presenting part' - in other words, there is absolutely no need to make 'extra space'. (Although, yeah, can be needed with forceps, but I believe forceps are relatively rare in the US these days anyway.)
Most hospitals won't "let" mom push more than like 2 hours anyway before moving to CS, so I'd find out what the policy is there.
Yes, if the doc needed to reach in to make adjustments
in the case of SD, it can be necessary.
& I believe tearing is always preferable to epis. Period. Epis just leads to even WORSE tears than without epis. Like the cloth analogy as someone already posted.
As others have said, almost no OBs do them "Routinely" anymore - i.e. with every single solitary birth. It's just not that way anymore. HOWEVER - the rate nationwide, I believe is 20% & evidence-based is nearly like 5%! So I'd ask the docs rate of epis - then I'd ask under what circumstances he does them. If he says anything other than "baby in distress" I'd worry. I.e. if he says, "If I see a mama about to tear upward, I'll do one to prevent that." Then I'd worry - that's not evidence based either.
But, again, if you hear "only if medically necessary b/c baby is in distress" and "5% rate" then try to relax & trust that these really are good HCPs.