Can we have a hospital birthing support thread?

[staryla]

Hi ladies,

I'd really like to hear your suggestions, questions, and get ideas from others.  I could write a book about my previous hospital birth (natural and drug-free but with a few unexpected interventions) but I'll try to keep this initial post short.

I'd love to birth at home, but thanks to American insurance companies that is not a financially viable option.  I'm using a group of hospital based midwives who I generally really like, and I've birthed with them before.  However, they are a bit more medicalized than I prefer.

Our goal is to birth naturally with as few interventions as possible.  I still have to talk with my midwife to remind myself of the hospital policies, but I know they routinely do certain things that I don't neccesarily want.  My current internal conflict is how I can strike a balance between having things the way I want vs potentially alienating my birth team.  My husband and I are both very accomodating people and it goes against our nature to stand up to authority figures.  We will stand up for things when it's important (and we did refuse a lot during my last labor), but its emotionally difficult and draining to do so.  During my son's birth I literally felt like I was preparing to go into battle as we headed to the hospital.  I do NOT want to try to give birth in battle mode again, I want to be able to relax and create the space I need.

Is anybody else experiencing some of these thoughts?  Whose planning a hospital birth and how are you planning it to go?

[mad4mady]

I am going to be having a hospital birth and I have been having the same feelings as you. I really want it to be a positive experience not a battle! I am hiring a Doula to help. I am not sure if this is an option for you? Maybe you could also share with your nurses at the hospital that you have previously had successful drug-free births at hospitals and so you would like this to be the same. Maybe if they know you have done it before they will be more likely to believe that you really don't want the drugs.

[Bald_Bull's_Mama]

I'm doing a hospital birth again, after a drug free birth with a few more interventions that I would've liked. I switched from an OB to a midwife that a lot of my friends have had good experiences with. We are on the same page about what birth should be. I'll have a birth plan. I'll go over it with my midwife beforehand to triple check that we are on the same page about everything. I'll have a doula (possibly 2 doulas), both of whom will remind me (or DH) to advocate for what we want. They can remember the facts that support our decisions and remind us of them should that need arise.

For me to feel comfortable in this birth, I really needed to know that my care provider was on the same page. Even the OB in the office is supposed to be pretty great. He backs up the HB midwives in town.

[SGVaughn]

I suggest picking your battles and not feeling the need to justify any decision you make..just say "no" or "no thank you" if you're feeling charitable

birth is so individual that what I may do is not what you may do

I tend to request certain things rather than refuse them if that makes sense..up front and ahead of time that is

for instance "can I have a hep-lock"  (because this doesnt bother me) vs "no iv" (fluids do actually bother me)

or

"i'd like a squat bar" vs "no lithotomy position"

this works better and doesn't set things up for an argument...and if it does...refer back to "no" and "no thank you"

and make sure your coach/partner/doula is on te same page and won't yield

[staryla]

We are getting a doula so hopefully that will help.

I like the idea of requesting rather than refusing things. 

The hep lock is one of the things that I've been debating.  It actually does bother me (though an IV would be far worse!).  It makes my arm uncomfortable and you have to be careful not to hit it.  Not too big a deal--but something I'd like to not deal with.  But I know that would be a big fight--probably not worth it?

[SGVaughn]

yeah see...I think the hep-lock is uncomfortable but I have a different perspective about it...with everything else going on I don't notice it and ...I've tried to start a "line" on very dehydrated or unconscious patients..both are very unfun and I've generally had to go much high than I would have if it had been a more controlled setting..

but yeah, the requesting certain things rather than refusing certain things I learned from the other side of things ..getting patients to do stuff..lol and from trying to coerce nurses or doctors into seeing it my way on behalf of patients..

it changes the dynamic so you're not fighting..you're asking them to do their job..just your way :)

[jshannyn519]

I had a saline lock (they don't use heparin anymore) with my first baby, and nothing at all with my second. I just said "no thank you" to everything they wanted to do or try. I negotiated the EFM to have it on for 10 minutes every hour instead of continuously. And I told the nurses (after the 4th time they offered pain meds) that I would be sure to let them know if I wanted pain meds, but I would prefer they not ask me again. When they would come in to check my dilation I would just say "not right now, thank you" because I really didn't want a bunch of hands up there all the time.

I think that if you're going to do a birth plan, make is super short and include the really important basics. Like the top 5 things that you want. All that stuff about lighting and how you want to listen to music and everything is good to know for your own purposes, but the nurses just really want to know a few things: will you want pain meds, will you want to move around, and who is going to be in the room with you. If you want to give birth in a non-lithotomy position I would be sure to specify that as well. If you're going to eat and drink, bring snacks and beverages with you. If you want to wear your own clothes, just keep them on.

You could do a separate section for after the birth and include the basics like: baby on chest immediately so do all procedures there or wait at least 2 hours, no baths by nurses you'll handle it, breastfeeding so NO formula at all, baby will room-in.

The nurses do have to check on you every so often so they can chart assessments and updates, but you can sure let them know that you'll call them if you need anything so they don't need to check on you frequently.

[Buddhamom]

No needles here unless an extreme emergency.  I never had IV or anything even back 20 years ago when my older girls were born.  I am delivering at a different birthing center with a different midwife and the first thing I told her when deciding was NO IV or anything of the sort "just because" and she said they don't do that.  I have been working on my birth plan and I am getting down to the nitty gritty so there is no confusion.  However I am planning on this birth hopefully being like my last where I do all laboring at home and slide in just in time for babe to fall out and be caught *LOL* There is a good chance of that since my labor pains tend to just feel like bad cramps and the only reason I showed up was because the contractions were 2 min. apart and I was feeling pressure down below. I did put in the plan about dim lights and such just because I need to be centered and the last thing I need is some moron walking in and flipping on the lights and pulling me out of my zone.  I also put no residents/students and no doctors.  She was fine with that when we talked about it however, I will go back over all this again soon just for clarification.  I also have the no vit. K or eye junk, no separation from us and if tests are needed one of us will be with her.  I have been reading too much about babes stolen from hospitals lately as you can tell. Hmm, let's see, cord will stop pulsing and DH will cut it, she will be placed on my chest right away, nursed ASAP, we will give her the first bath, my own clothes, squatting bar, freedom to walk around, no induction but open to nipple stimulation, no formula or pacifier, want to get the hell home ASAP afterward, and definitely NO PAIN MEDS.  There is more but you get the picture.  I am doing it in bullet form so it is short and sweet.  She asked me to submit it by 32 weeks so they can go over it and be familiar with my desires.  When I am done I will post the actual birth plan.  Maybe we could all do that just to get an idea.

[MamaBanana]

Thank you Staryla for starting this thread and to everybody else for the great comments.  I have been in the same frame of mind...I am doing a hospital birth, with midwives (hopefully no need for the OB), and having some anxiety about it going the way I want.  I will also be hiring a doula to help us out as this is our first and I really need to know there is someone in the room with me who will be representing my wishes/needs (and not the hospital's).  The practice where we receive our prenatal care has a rotating on call schedule so we don't actually know which midwife (or which OB) will be on call the day I deliver  - and there's about a dozen between two locations to choose from - and that's a bummer to me - and another reason to have the doula.  I haven't been thrilled with the midwives I've met with so far either...definitely nothing like my fantasy of a mothering, nurturing, pro-woman, type of relationship and approach to birth.  They're just more like other modern medicine/western medicine oriented nurses.  But I have a few medical conditions which put me at risk for earning the designation "high risk" so we're sticking with hospital, at least for this first go around.  Sigh.

I really like the advice SGVaughn of suggesting rather than refusing and keeping a positive collaborative approach.  And feeling certain and confident of your birth plan going in will help with that. You can also do some research about your hospital and doctors and their rates of interventions to help educate yourself.  I am delivering at one of the biggest, oldest and best hospitals in Boston and thought that would be a downfall for the pro-woman approach, but it turns out for example, that their C-Section rate is lower than the state average.  And I have a friend who delivered with this same practice and they let her labor for a long time  - didin't force interventions on her.  So those are good signs. 

Couple questions:  how is a hep-lock different from an iv?  i didn't know they gave women hep-locks in delivery?  and is lithotomy position the lying down position?

Thanks ladies!

[Bald_Bull's_Mama]

Hep lock means the needle is in your arm, but it is closed off. Nothing is attached to it, but they have easy access in case they need to give you something quickly. I had one with DS and will have one again because I had a lot of bleeding with him. Lithomy is the position you see in the movies, where you're like a turtle with your legs in the air. It's really easy for medical folk because they can see and have easy access, but it goes completely against gravity and is not very comfortable.

[Bald_Bull's_Mama]

Oh, I'd love to share birth plans when we have them!

[BarefootinBrooklyn]

Good idea for a thread--I had my daughter in a hospital and had a wonderful experience, but it was learning that others aren't as lucky that really inspired me to start working as a doula. We'll be birthing at a free standing birth center this time around but I'd love to lend my support to those planning hospital births. I'll write more later when I can, but just wanted to give a "you can do it!" :)

[motherbirthlove]

I am a doula and planning a HB. But I want to lend my support. You can have an absolutely beautiful and empowering birth in the hospital with an OB, a medwife, or a midwife. It does take gusto though and good planning. Know what you are heading into. Call the nurses station and ask to speak to the charge nurse. Find out their statistics on use of pitocin, epidural, cesarean and of course their policies on eating and movement. This way you will know where you fall on their continuum of patients. The hospital staff is who you will be dealing with most of the time. If you are assigned a nurse who is unsupportive, request a new one. This is your right and saves you from fighting throughout the whole labor. Go in with a open heart and understand that the staff really does care and wants you to have a good experience. They may just have a different idea of what that is. You don't need to be combative unless they get combative with you. Politely requesting things is a great idea. So is spending a lot of time in the bathroom. If you want privacy and they are poking around more than you like, they will tend to leave you alone if you are in the bathroom. If you need to eat and they don't allow food, bring your own and eat when they aren't in the room. etc.

[msmiranda]

Great thread!  I am also doing hospital for financial reasons this time, and have been spending a lot of time on preparation.  There are so many things I'll be doing differently from the "average" patient, it's a lot to keep track of.  I can't decide how to handle the birth plan part.  On the one hand, I have heard way too much about women with birth plans being made fun of at the nurses' station, so part of me wants just my doula and husband to have the paper document and we can just refuse things as they are offered.  But then I think there are some things that it would be helpful for the nurses to know in advance, particularly things that happen quickly during and right after the birth that we are refusing (eye goop, routine pitocin during third stage).  I am hoping to nail down what the nurses would like to know when I take the hospital tour, and what the doctors need to have in my chart with my OB.

I have never had to do this before, "this" being going in knowing I am the squeaky wheel (a feeling that I generally hate) and knowing that I will potentially get into an argument with someone before it's all over, but this being my third time I am so much more confident than I was the first two times that I can do this successfully, with the help of my husband and doula of course.  The hospital I will be at is well known in this area as being natural birth friendly, so that is somewhat reassuring, and they are by all reports very supportive of breastfeeding.  The only major bummer is that there is a pretty big call schedule (11 doctors) and I can't meet all of them in advance, so it is a little bit of russian roulette on who will catch.  The doc I have been seeing assures me that they are used to accommodating women who want a natural birth and that they are very much about informed consent for everything.  I will never have complete trust, but that's the purpose of having two other people with me who will be watching for shenanigans and prepared to speak up/knock scissors out of hands/etc. 

If you don't mind me asking, what interventions did you all have that you didn't want before?  (I think the OP and one other poster said they had a natural birth with a few things they would have preferred not to have).  My concern is with things like episiotomy and third stage management because those things happen so quickly at a time when the mama is really out of it.  Third stage in particular I think many women desiring a natural birth don't even know could be a sticking point -- I definitely didn't know it before my first birth in a hospital and was just lucky that my midwives at the time practiced expectant management. 

[BarefootinBrooklyn]

The things I felt good about during my hospital birth, and things I would do differently If I were birthing in a hospital again (and will also incorporate into this out-of-hospital experience)...

I had a few days of prodromal labor and timed them all day long--my poor husband. This time I will wait until they REALLY get my attention.

I went to the hospital as soon as my water broke, even though my contractions were still manageable. I was so excited that something was "happening" that I thought I'd just go to the hospital and push a baby out. I had 12 hours ahead of me, and the first few of them were so mellow I should have stayed home.

I skipped breakfast and went straight to the hospital because I was so excited. DO NOT SKIP A MEAL! This time I will not only make sure I've eaten "real" food before labor gets active, I'll have snacks and drinks for myself during labor and a solid awesome meal for afterward. In the hospital make sure your care providers will allow you to eat/drink so you can stay off the IV fluids and if they won't, make sure you are keeping yourself hydrated and nourished in whatever way you find yourself able to.

I was incredibly lucky to have a labor nurse who acted as a doula (she had been a midwife prior to moving to the U.S.), having me squat and teaching my husband & mother to do counterpressure on my back during a very intense labor with a posterior baby. For me an epidural was never an option, and her keeping me up and out of bed was essential to my daughter's descent. Even with monitors on, I squatted on the side of the bed or leaned over and rocked. Stay up and mobile as much as you can. Hire a doula. Watch Penny Simkin's "Comfort Measures" video with whoever will be supporting you during labor. Read "The Birth Partner," and have your birth partners do the same.

My final half hour of pushing was "coached" and I did end up with an episiotomy (which sucks, seriously) but my daughter's shoulder was stuck and I'd been pushing for over two hours so at the point where the episiotomy was offered I said "just do it, get her out..." which I now know I should have waited a little longer to see what nature could have done, but the poor thing fractured her collar bone on the way out so I tell myself, to make peace with my scarred perineum, that she needed a little extra help out or might have damaged her shoulder further. I have a friend who suffered a birth injury had had years of physical therapy for an arm with nerve damage. 

Also a small detail but that could make a big difference...I brought music on my iPod but during labor wanted nothing to do with wires around my body so I ripped the earphones out and had no music. This time around I'm using a docking station or laptop/speakers instead so we can have good tunes during the birth.

After my daughter's birth I was famished, and the hospital food was horrible. Have a plan for something to be ordered in or bring something delicious to heat up...

We were able to refuse the newborn procedures that we weren't interested in, but I attribute that to being in a smaller community hospital in California. At the births I attend as a doula in NYC, people have a harder time with hospital staff.

I would have gone home earlier. The hospital was SO uncomfortable. The rollaway bed my husband slept on was better than mine!

Hope some of that helps! If you have a doula and a partner on your side, you can totally have the experience you want. I think one of the most important things you can do to have a natural birth in a hospital is to tell yourself that is the only option for you, unless your baby's health requires otherwise. If you're okay, if baby is okay, you don't need anything else.

I'm getting so excited to do this again!

[BarefootinBrooklyn]

Oh and if it's your wish to not use medication, let every nurse who comes into the room know this before she offers it to you, because most of them will. If there's a shift change while your labor is very intense, let your partner/doula take the nurse aside and say "this is what she really wants, and it would really help us out if you don't offer any medication. she'll ask for it if she needs it." 

[caityjane]

Thank you so much for this post! We're moving internationally back to Australia at 34weeks (not the way we planned it but visa's mean thats what has to happen!) so I'm really going to be relying on faith that my local hospital has a good midwife waiting for me, a lot of preparation to handle whatever is thrown at us and my wonderful DH. I'm sure it will all work out but what a wonderful thread!!

Thank you from a very excited FTM

[Bald_Bull's_Mama]

Things that I had before that I don't want again:

continuous monitoring

AROM

pushing in the lithomy position

coached pushing, this led me to a huge tear

Really, I should've switched care providers. My OB told me things like, "Oh, you don't need a birth plan". He professed to be comfortable with any delivery position, but my nurse knew they would be putting away the squat bar when he came in. There were a lot of things like that. Even though I was taking a Bradley class, educating myself, I guess I didn't want to rock boats too much, to be a squeaky wheel. Now, I know that while I can do things differently this time, I can never do that birth over. The birth was really amazing pretty much until the doctor came in. Then it got scary with laying down, people shouting counts, oxygen masks, me hyperventilating, I thought the baby was going to die. It was really scary. I think I have some birth trauma to work through, really.

[jshannyn519]

Originally Posted by Bald_Bull's_Mama 

Things that I had before that I don't want again:

continuous monitoring

AROM

pushing in the lithomy position

coached pushing

Yep, these. I narrowly escaped an episiotomy with my son because the OB didn't have time to get the scissors in me before my son's head came out. My baby saved me! I did end up with some tearing, but it was upward and shallow in the tissues instead of through muscles. That was mostly due to the fact that I was pushing really hard and fast.

I was totally starving about the second after both my kids were born so I had my mom order pizza while the OB was stitching me up after my son was born. After my daughter was born, it was breakfast time, so I told the nurse I needed pancakes, scrambled eggs, and bacon STAT.

Although I'm not planning on a hospital birth, and I making my hospital birth plan as plan B, and bringing snacks is on my list for sure.
 

[SGVaughn]

coached pushing is a huge pet peeve of mine.....its one of the few things I'm really confrontational and nasty about...up to and including WHILE I'm pushing