Birth policies

[Laura575]

I had my 24 Wk appointment on Friday.  I was given a binder with all kinds of info regarding giving birth in the hospital.  The binder is pretty comprehensive - addresses women in basically every situation.  There were 4 things that really stood out. 

Of course - the circumcision decision - which they would do on day 1 if you want it...i know this is a majorly controversial issue - but I have to agree with the Jews here for waiting - I told my DH that if he really decides our son should have one - it will not be the day our child is born.

2 - it is NY state law that our newborn gets a shot of Vit K and antibiotic eye gook within 1 hour of being born....Really??? Law?  There were some old posts on this buried on this site and it looks like we really have NO choice.  I so wish I was having a home birth.  At least we can refuse the Hep B vaccine until some future date.

3 - they don't want a women in labor to eat solids.  I want to go 100% natural.  I know I can't possibly fathom how it will feel to be in labor or give birth - but I have no interest in having a needle in my spine - so no one better take food away from me because I plan on eating.

4. - the way they describe the amount of fetal monitoring bothered me.  I want the freedom to move around.  I don't want continuous fetal heart rate monitoring.  I'll have to talk to my doula and midwives about this.

I needed to vent.

[Beckily]

Originally Posted by Laura575 

I had my 24 Wk appointment on Friday.  I was given a binder with all kinds of info regarding giving birth in the hospital.  The binder is pretty comprehensive - addresses women in basically every situation.  There were 4 things that really stood out. 

Of course - the circumcision decision - which they would do on day 1 if you want it...i know this is a majorly controversial issue - but I have to agree with the Jews here for waiting - I told my DH that if he really decides our son should have one - it will not be the day our child is born.

2 - it is NY state law that our newborn gets a shot of Vit K and antibiotic eye gook within 1 hour of being born....Really??? Law?  There were some old posts on this buried on this site and it looks like we really have NO choice.  I so wish I was having a home birth.  At least we can refuse the Hep B vaccine until some future date.

3 - they don't want a women in labor to eat solids.  I want to go 100% natural.  I know I can't possibly fathom how it will feel to be in labor or give birth - but I have no interest in having a needle in my spine - so no one better take food away from me because I plan on eating.

4. - the way they describe the amount of fetal monitoring bothered me.  I want the freedom to move around.  I don't want continuous fetal heart rate monitoring.  I'll have to talk to my doula and midwives about this.

I needed to vent.

I bet you did! I'm frowning for you!

If they have testing showing you don't have the STDs, I very much disagree with mandatory eye-gook. Or vitamin K which is great for the, what, 5/100000 kids who need it, but silly for the rest.

And surely they can't require continuous fetal monitoring? Fight that one hard because sitting around is the opposite of helpful!

[Baby_Cakes]

Yikes, I'd be freaking a little too!

I say, talk over those few issues with your mw.  Especially the continuous monitoring.  They require that b/c most women get epi's and it *is* required for someone who can't feel contractions and move around.  I would see about intermittent.  I'm sure it's possible!

Sneak food in with you.  In little baggies.  And bring like gatorade or something in your bag.  Try to drink and eat when the nurses aren't there or just do it and don't worry about them.  You probably won't want a full meal or anything too crazy anyway, but having things to keep your energy up is smart.

I'm also thinking though it may be recommended by law or something you can ALWAYS decline anything.  You might have to sign something.  That's fine. Sign it and move on!

You will be ok and so will your baby.  Good luck and try not to stress.  Talk these things over with your MW so you're on the same page.  If she's been to this hospital before, she'll know how the rules bend.

[kristandthekids]

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Edited by kristandthekids - 1/16/13 at 7:03pm

[Baby_Cakes]

Question about eye goop/drops - isn't it antibiotic?  It's not just for STDs, but for infection right?  What if you just delay the eye goop until after the first nursing/after bonding?  That could be at least a middle ground.  I didn't realize it made their eyes swell shut for days!  Is that normal?  My best friend just gave birth and there was meconium, so after they bonded and she nursed, she said ok to the ointment so that they wouldn't have any issues with infection.

[jennyfah]

Originally Posted by Baby_Cakes 

Question about eye goop/drops - isn't it antibiotic?  It's not just for STDs, but for infection right?  What if you just delay the eye goop until after the first nursing/after bonding?  That could be at least a middle ground.  I didn't realize it made their eyes swell shut for days!  Is that normal?  My best friend just gave birth and there was meconium, so after they bonded and she nursed, she said ok to the ointment so that they wouldn't have any issues with infection.

My two cents on it:

The thought with the eye goop is that it will prevent blindness from gonorrhea (and less so, chlamidya?), which is (as I understand it) very hard to treat and has been the cause of blindness in people for a long time.  Other eye infections (that we all sometimes get) are eminiently treatable.  However, a lot of times, healthcare professionals try to sell it as "Well, it prevents infections from other bacteria, too."  That may be so, but eye infections from non-STIs are much more treatable and probably don't need to be addressed within hours of birth.

The tricky part about the eye goop that I've gathered from my discussions with healthcare providers as a doula is this:  A mom may want to refuse them for the appearance of not having an STI, when in fact she may have one---or her partner may have given her one without her knowledge during the pregnancy.  This happens a lot, sadly.  It's a tough place for a healthcare provider to be, because when you're asking if they want to give the baby the eye drops, there may be a lot of unknowns going on in the relationship that would compel people to answer one way when they really *should* perhaps answer in another way. 

Does that make any sense? 

Do I think that everyone should have the right to refuse them?  Absolutely!  Do I refuse them for my own children with full confidence?  Absolutely!  Do I think it's a potentially difficult issue that is hard to address in a tactful way that gets an honest answer?  Absolutely. 

From what I've heard, it's impossible to refuse in NY state.  They will call CPS if you refuse. 

[jennyfah]

Originally Posted by Baby_Cakes 
 

Sneak food in with you.  In little baggies.  And bring like gatorade or something in your bag.  Try to drink and eat when the nurses aren't there or just do it and don't worry about them.  You probably won't want a full meal or anything too crazy anyway, but having things to keep your energy up is smart.

 

Yes, this.  If you are compelled to eat during labor, EAT!  You are an adult and you do not sign away your right to bodily integrity or informed consent when you are in labor.  Restriction of fluids and food in labor is not evidence-based medicine. 

[cat13]

I am so sorry that you and so many women have to worry about these things!  It sounds like you are already doing the right things.... starting to research early, and starting to differentiate between state law (you don't want CPS to get involved) vs. hospital policy ("but that's how we always do things").  If it's hospital policy, you have the right to decline. Just make your decisions ahead of time, get your partner and/or birth team on board with them, consider having a doula to help you advocate for yourself, and be confident in yourself! Also, here's an inspiring blog where she talks about a friend who followed a "don't ask, just do" style.  

[Laura575]

It totally makes sense.  I know my husband would tell me if he slept with someone else so I am really not concerned about STDs.  We both have been tested repeatedly and are clean - so I am confident the eye goop would not be necessary.  I also know I cannot refuse and I don't want CPS called.  I will be asking for the delay.  I want my baby on my chest as soon as it is born - they can clean it and give it the vit k/eye goop within the first hour - just not within the first few minutes.  If I knew what I know now 6 months ago - I would have looked very hard for a homebirth midwife.

As for food - they say you should pack food to keep your helpers hunger in check - so I'll just make sure there is enough for me.  I'm guessing when I am close to the end, I won't want to eat. 

I have no idea what to expect - labor will be an adventure - I just hope I don't end up at the hospital too soon.
 

Originally Posted by jennyfah 

My two cents on it:

The thought with the eye goop is that it will prevent blindness from gonorrhea (and less so, chlamidya?), which is (as I understand it) very hard to treat and has been the cause of blindness in people for a long time.  Other eye infections (that we all sometimes get) are eminiently treatable.  However, a lot of times, healthcare professionals try to sell it as "Well, it prevents infections from other bacteria, too."  That may be so, but eye infections from non-STIs are much more treatable and probably don't need to be addressed within hours of birth.

The tricky part about the eye goop that I've gathered from my discussions with healthcare providers as a doula is this:  A mom may want to refuse them for the appearance of not having an STI, when in fact she may have one---or her partner may have given her one without her knowledge during the pregnancy.  This happens a lot, sadly.  It's a tough place for a healthcare provider to be, because when you're asking if they want to give the baby the eye drops, there may be a lot of unknowns going on in the relationship that would compel people to answer one way when they really *should* perhaps answer in another way. 

Does that make any sense? 

Do I think that everyone should have the right to refuse them?  Absolutely!  Do I refuse them for my own children with full confidence?  Absolutely!  Do I think it's a potentially difficult issue that is hard to address in a tactful way that gets an honest answer?  Absolutely. 

From what I've heard, it's impossible to refuse in NY state.  They will call CPS if you refuse. 

[RubyLu]

Originally Posted by Laura575 

labor will be an adventure - I just hope I don't end up at the hospital too soon.

This is how I feel too! My hospital doesn't sound as militant as your (I had no idea NY had laws like that!) but I'm still not looking forward to fighting for my way or having to fend off the fetal monitoring or post-birth routines. I'm going to labor as long as possible at home. I'm hoping I show up pushing! (Well, really, I hope I end up birthing at home quickly/safely, but I am not planning on an unassisted birth, so I just hope I get there no more than an hour before that baby arrives. Fingers crossed.)

[jennyfah]

Hi there-

If you have concerns about knowing when to go to the birthplace, I have a few tips that I can offer about guessing where you are in labor.  

Ways to estimate cervical dilation w/o a vaginal exam:

During a contraction and with mom on her back, determine how many fingerbreadths of space are between the fundus [top of the uterus] and xiphoid process [the triangular tip of the breastbone] at the height of a contraction.

5 fb = no dilation
4 fb = 2 cm
3 fb = 4 cm
2 fb = 6 cm
1 fb = 8 cm
0 fb = complete

Scroll to the bottom of this page http://www.natural-pregnancy-mentor.com/vaginal-exams.html  to see a better illustration of the xiphoid process measurement.  

Other measures:  There is typically a red line that rises from the anus to the dimple in the small of a laboring woman's back that rises like a thermometer during dilation.  When she's 10 cm dilated, the line extends all the way to the top of the buttocks.  (It's amazing; I've seen it!)  

Emotional signposts are usually a very accurate measure of where a woman is in labor.  The Bradley Method teaches extensively about emotional signposts---Susan McCutcheon's book about the Bradley Method is good for this!  

This blog has good ways to guess cervical dilation w/o exams (i.e., at home before going to the birthplace):  

http://www.sarahvine.wordpress.com/2010/03/07/how-dilated-am-i-assessing-dilation-without-an-internal-exam/

I always tell my clients that if they can smile between contractions, it's too early to go to the hospital!

Note:  None of these are foolproof, of course, and cervical dilation is no real measure of how soon you'll be holding your baby.  You can be 3 cm and entering transition, or you can be 7 cm and still have a very long second-stage to go.  That's why it's important to not let a pre-labor cervical exam (or even an exam in labor!) cause you to feel despair.   Your cervix could be 2 cm dilated for weeks, or you could be firm, posterior, closed, and thick and go into labor in a matter of hours.  An old doula adage goes:  "High and tight, baby tonight!"    

Also, don't underestimate the power that changing locations can have on your labor.  Some women find that going to the birthplace causes their labor to stall (or even their cervix to reverse dilate) and some women find that it really increases the power of the surges.  Environment can play a big role in how you labor, depending on how safe the space feels. 

Happy birthing!

Edited by jennyfah - 4/17/11 at 3:10pm

[Beckily]

Originally Posted by jennyfah 

Hi there-

If you have concerns about knowing when to go to the birthplace, I have a few tips that I can offer about guessing where you are in labor.  

Ways to estimate cervical dilation w/o a vaginal exam:

During a contraction and with mom on her back, determine how many fingerbreadths of space are between the fundus [top of the uterus] and xiphoid process [the triangular tip of the breastbone] at the height of a contraction.

5 fb = no dilation
4 fb = 2 cm
3 fb = 4 cm
2 fb = 6 cm
1 fb = 8 cm
0 fb = complete

Scroll to the bottom of this page http://www.natural-pregnancy-mentor.com/vaginal-exams.html  to see a better illustration of the xiphoid process measurement.  

Other measures:  There is typically a red line that rises from the anus to the dimple in the small of a laboring woman's back that rises like a thermometer during dilation.  When she's 10 cm dilated, the line extends all the way to the top of the buttocks.  (It's amazing; I've seen it!)  

Emotional signposts are usually a very accurate measure of where a woman is in labor.  The Bradley Method teaches extensively about emotional signposts---Susan McCutcheon's book about the Bradley Method is good for this!  

This blog has good ways to guess cervical dilation w/o exams (i.e., at home before going to the birthplace):  

http://www.sarahvine.wordpress.com/2010/03/07/how-dilated-am-i-assessing-dilation-without-an-internal-exam/

I always tell my clients that if they can smile between contractions, it's too early to go to the hospital!

Note:  Of course, none of these are foolproof, of course, and cervical dilation is no real measure of how soon you'll be holding your baby.  You can be 3 cm and entering transition, or you can be 7 cm and still have a very long second-stage to go.  That's why it's important to not let a pre-labor cervical exam (or even an exam in labor!) cause you to feel despair.   Your cervix could be 2 cm dilated for weeks, or you could be firm, posterior, closed, and thick and go into labor in a matter of hours.  An old doula adage goes:  "High and tight, baby tonight!"    

Also, don't underestimate the power that changing locations can have on your labor.  Some women find that going to the birthplace causes their labor to stall (or even their cervix to reverse dilate) and some women find that it really increases the power of the surges.  Environment can play a big role in how you labor, depending on how safe the space feels. 

Happy birthing!

Extremely helpful, thank you so much!!

[mama2soren]

Originally Posted by Laura575 

Of course - the circumcision decision - which they would do on day 1 if you want it...i know this is a majorly controversial issue - but I have to agree with the Jews here for waiting - I told my DH that if he really decides our son should have one - it will not be the day our child is born.

Not flaming... just offering a different perspective: why not wait even longer and let your son be the one to decide whether or not to keep his foreskin?  That will eliminate one major source of worry and stress in the days after your birth.  If you circumcise, it might not be a wise idea to skip the vitamin K.  Hemorrhage is a real risk of circumcision, even in healthy babies who received vit. K.  If the baby did have a vit. K deficiency or blood clotting disorder and was circ'd without the vit. K shot, the risk would be multiplied.  If you keep him as-is, you can avoid a painful shot and an excruciatingly painful surgery and recovery for him.  Breastfeeding will go more smoothly, too!

If you or DH are concerned about the health and cleanliness of an intact penis, there are lots of great resources on the MDC "Case Against Circumcision" board.  As a mama of an intact boy, I can tell you it's actually super easy to keep things clean down there.  It's actually easier to clean an intact penis than a circumcised one!  An intact one, you just wipe the outside off and go (the idea that parents should retract and clean underneath has long been known to be needless and actually quite harmful).  With a circumcised penis, one has to worry about pulling back adhesions and cleaning out bits of poo from under the remaining foreskin, not to mention the days/weeks of wound care needed for the circumcised newborn.  The average age of full retraction in an intact boy is around 10 years.  After they can retract on their own, intact boys just need to know to pull back to rinse things off in the shower, then put the foreskin back down.  Before that, no retraction of any sort is necessary.  Just "clean what is seen."  Way easier than teaching a little girl about feminine hygiene, I think!

We haven't had a day of trouble related to my son's foreskin.  And when he grows up and, um, "discovers" how things work down there, I think he'll be pretty glad that he has all those tens of thousands of nerve endings present in his foreskin.  

[Italiamom]

One thing you might want to check on are the vitamin K drops, rather than the shot.  I know it's frustrating, but the drops are more gentle.  Since it's mandatory in NY state (unless you want to deal with CPS, eeeep!), I wouldn't put a whole lot of fret into them.  But the drops could very well be an option that would allow you to follow the law without having to give in to an actual shot.

I agree with everyone else to just sneak food and drinks in.  I know a couple of obstetric nurses who've both said something along the lines of "do whatever you want, just don't do it right in front of me."  I'd just make sure to brief your partner, doula, or whoever will be with you in labor that you'd like them to offer you food and drink often, but to NOT do it in front of the nurses.  If it makes you feel any better, too, I didn't want to eat a darn thing from early on in my labor, even before I knew that those were actually contractions.  It's a good idea to have it available, but you might not want it at all...

You mentioned wishing you had looked harder for a midwife...  (homebirth pony pulling up)  I just have to say, it's really never too late to switch to a midwife if that's something you're thinking about.  I know quite a lot of mamas here who have switched at 35+ weeks, and went on to have lovely homebirths.  So if you don't have any pressing risks that make hospital birth a necessity, there's still time!

[Beckily]

Originally Posted by Italiamom 

One thing you might want to check on are the vitamin K drops, rather than the shot.  I know it's frustrating, but the drops are more gentle.  Since it's mandatory in NY state (unless you want to deal with CPS, eeeep!), I wouldn't put a whole lot of fret into them.  But the drops could very well be an option that would allow you to follow the law without having to give in to an actual shot.

I agree with everyone else to just sneak food and drinks in.  I know a couple of obstetric nurses who've both said something along the lines of "do whatever you want, just don't do it right in front of me."  I'd just make sure to brief your partner, doula, or whoever will be with you in labor that you'd like them to offer you food and drink often, but to NOT do it in front of the nurses.  If it makes you feel any better, too, I didn't want to eat a darn thing from early on in my labor, even before I knew that those were actually contractions.  It's a good idea to have it available, but you might not want it at all...

You mentioned wishing you had looked harder for a midwife...  (homebirth pony pulling up)  I just have to say, it's really never too late to switch to a midwife if that's something you're thinking about.  I know quite a lot of mamas here who have switched at 35+ weeks, and went on to have lovely homebirths.  So if you don't have any pressing risks that make hospital birth a necessity, there's still time!

I agree! Some might be full, but they're also going to be losing a few mamas who have health risks, so it's always worth asking!

[nemrac917]

I see you're in Ithaca.  Are you delivering at CMC?  I can give a little bit of info from the perspective of a nursing student who has spent time on the L&D floor at CMC for school.

Babies did go straight to mamma's chest in the deliveries I saw.  They do have a wireless monitoring system if they want continuous monitoring that can be used while walking or spending time in the shower (in room) or tub (in it's own room).  And yes to sneaking food.  The nurses I worked with were pretty strict about the "no eating" rule while they were present, but they were pretty aware that the moms were most likely snacking when they weren't in the room. ;)

[Beckily]

http://www.childbirthconnection.org/article.asp?ck=10218

A Guide to Effective Care in Pregnancy and Childbirth is an overview of results of the best available research about effects of specific maternity practices. The full text of the current edition (Oxford University Press, 2000) is available on this website courtesy of the authors: Murray Enkin, Marc J.N.C. Keirse, James Neilson, Caroline Crowther, Lelia Duley, Ellen Hodnett and Justus Hofmeyr

Very informative, worth a read :)

[Laura575]

Yes and yes.  When I met with my Doula - she made me feel pretty comfortable about having a baby at CMC. 

I'm hoping no one will think there is a need for continuous monitoring - I would prefer intermittent.  The binder said a good thing to pack is snacks for your support people - so I am sure I can eat that food if/when I am hungry. 

And Italiamom: I wish I could switch - but financially, it really would be tough - if one of the 2 home birth midwives did become available.  A homebirth midwife is out-of-network and so almost the whole thing would pretty much be out of pocket because of my high deductible plan - out-of-network deductible is 2x the in-network amount.  I've known quite a few women who have had good birth experiences with the group I go to at the same hospital.  Each midwife I have asked has been okay with my DH being a part of the birth by catching the baby - so that is a plus.
 

Originally Posted by nemrac917 

I see you're in Ithaca.  Are you delivering at CMC?  I can give a little bit of info from the perspective of a nursing student who has spent time on the L&D floor at CMC for school.

Babies did go straight to mamma's chest in the deliveries I saw.  They do have a wireless monitoring system if they want continuous monitoring that can be used while walking or spending time in the shower (in room) or tub (in it's own room).  And yes to sneaking food.  The nurses I worked with were pretty strict about the "no eating" rule while they were present, but they were pretty aware that the moms were most likely snacking when they weren't in the room. ;)

[Italiamom]

Originally Posted by Laura575 

And Italiamom: I wish I could switch - but financially, it really would be tough - if one of the 2 home birth midwives did become available.  A homebirth midwife is out-of-network and so almost the whole thing would pretty much be out of pocket because of my high deductible plan - out-of-network deductible is 2x the in-network amount.  I've known quite a few women who have had good birth experiences with the group I go to at the same hospital.  Each midwife I have asked has been okay with my DH being a part of the birth by catching the baby - so that is a plus.

This sounds great!  I had to ask of course , but the fact that you've got a doula, and that she feels really positively about the midwives and the hospital you're working with are both excellent signs that even if policy seems kind of backwards, reality probably won't be that way.  And it's great that you're taking the steps now to cross all your t's, so to speak.  My SIL had two natural, unmedicated, fantastic hospital births, and she credits both of them to her doula's presence!

[IBAMAMAX4]

i was able to opt out with my second and last hossy birth because both me and my son are allergic to petroleum jelly and it is the base for the eye goop. i recently had pink eye and the normal treatment is the same goop they use for new borns at birth. and also both of my daughters turned out to be too. just a thought.