Never had a hospital birth before...

[tiqa]

I am at the end of my third pregnancy (well, third term preganncy) and am just now in the home stretch considering I might have to be in the hospital instead of at home.  It's a long story, let's just leave it at that.  I'm meeting with the OB provider this week (not like I have a huge choice in the matter, there's one practice in town) and I put the following concerns on my list to address with her.  Anyone have any feedback on it? 

Is there continuous or intermittent monitoring?

Is water therapy available?  (I don't think it is, it's a tiny little hospital with no tubs, but maybe there's a shower...)

What's the deal with IV's and such - what is mandatory?

Can I refuse cervical checks?  I don't mean I want them infrequently, I don't want them at all, period.  Not to check "if I'm 10 cm yet", I don't want to see "if I can be admitted yet", etc.  (If I show up in hard labor, I'll assume they can tell without sticking their fingers inside??)

Will I get to labor, and more importantly, deliver in the position I want to? (Last birth was a UC and I was on my knees when she came out.)

Pushing that's not directed - not only do I not want anyone to count down for me, I also don't want anyone to tell me when to push, when not to push, when to pant, etc.

Catching - is it automatic in all hospitals that the doctor MUST catch the baby? I caught DD with DH's help and I really preferred that to a stranger doing it... but I'm assuming that's not a hill to die on, right? They'll just refuse, I'm assuming.

Newborn procedures?  I don't want to be separated unless there's a huge emergency - not just them taking the baby out of the room, but also not taking them to the other side of the room, cleaning them up, wrapping them, etc.  NY state calls CPS automatically if you refuse the vitamin K shop or eye goop but can they be delayed a bit?  I also don't want suctioning, etc, either while the baby is inside or outside.  Once the baby is out, assuming he/she is breathing and such, can they do their checks while I hold him/her?

Placenta procedures (fourth stage) - short of hemmorhaging, can we wait for the placenta to separate naturally?  I had one manual removal by a midwife and one natural removal and omg the difference is crazy.  I also would rather nurse if possible, and not deal with Pitocin, etc.

What if I test GBS positive and my labor is too short for the standard course of IV's during labor?  (What's that, like four hours?)  Are they going to keep the baby for however long for "observation"?  I can't refuse the test because they already did one on me without really asking for consent or not when I was in the hospital already for some PTL stuff.  I don't know the results of the test yet, but with my luck, it'll be positive.

Anyway.   I don't want to go in there with a whole looooong list and present as the problem NCB patient. Is there something I should just take off the list completely?

[fayebond]

I bet that the cervical checks, iv "heplock", and ob catch, would require an informed refusal form at best,  maybe ama, and probably not worth fighting over, I found thse to be the biggest sticking points when I had a hospital birth, no one wanted to budge on them.  Mostly for liability/charting issues, according to the peolp I asked. I'd cut those and just work out a strategy with DH to minimze the checking.

DH and I had ostly post-birth cocerns, so our plan was for him to stick to baby like glue and have a list of things to ask at the moment (its unlikely tht you will meet the shot nurse in advance, for example(.

scuze the typin!

[rnra]

I think it's great for you to discuss these questions with your provider ahead of time.  However, I also think it would be very beneficial for you to go to the hospital and speak with them regarding their policies too.  Hospitals sometimes have policies that are very different than what your provider is comfortable with.  I think you'd be most successful in the hospital visit if you call ahead of time and ask to speak with the manager of labor and delivery.  Set up a time to meet with him/her.  If that person is not available, ask for the L&D charge nurse. Those are the people who can give you the most authoritative replies regarding hospital policies.

FWIW, in the hospital system that I am most familiar with it is not unusual for someone besides the OB/CNM to catch the baby if all is going well.  Many fathers and a few mothers have done so.  Also, in this particular hospital system, newborn assessments/checks are always done while baby is skin-to-skin unless there are issues such as respiratory distress.

Good luck!

[fruitfulmomma]

Faye, by ob catch do you mean dr catching the baby? I've had 2 hospital inductions and both times my care provider was totally cool with letting my midwife/doula (no admitting privileges) catch the baby. Two different hospitals with two different hcp. Tiqa, I had my first planned hospital birth and had a two pg. birth plan that my ob was fine with, although I ended up with a necessary induction so not everything went as planned but everyone was really respectful and my nurses were great. If you want I can send a copy of the plan. I was in a certified baby friendly hospital too and immediate pp was great with me having the baby and skin to skin and all that.

[philomom]

I had amazing natural births in the hospital with my CNM as the main care provider. I was able to refuse everything except a little doptone intermittently to check the baby's heartbeat. I had no drugs, no interventions of any kind and was able to have all the baby checks performed while the baby was on my chest. I had my babes in the late 90's .. I was able to refuse vitamin K, eye goo and newborn shots. Things may be different now. I was home each time just 12 hours after my births and nursing beautifully in my own bed.

[tiqa]

Thanks, everyone.  Unfortunately, I don't think this is an especially baby friendly or modern hospital.  The staff all say they're really happy with low intervention births, but I do know that it's a small, country-ish hospital that only has rare births.  They also don't have an advanced NICU etc.  There's no other place I could birth, but it's not the "high end spa" hospitals I've seen in other places I've lived.  No jacuzzis, hardwood floors, flat-screen TV's, or prime rib recovery dinners. ;)  (Yes... that actually was one hospital I've visited before when living in another city.)  This is a small, efficient type of place but it doesn't strike me as progressive.  I will try to set up something with them, though, to see if I can come in or talk to them as well as the general doctor.  (They have one doctor on call per 24 hour period, and there's like four doctors and a midwife who practice there... so it's kind of a guess to see who I can get at that particular day.  I know some of the doctors there are more lenient than others.)

[penguintattoo]

Ive delivered both kids in NY and no one was in a hurry to do eye goop or Vit K for either, I don't think delaying should be a huge issue. Hopefully you get an understanding ob!

[phathui5]

I would really recommend having a doula if you're wanting to have a relaxed birth in a hospital. I worked as a doula in Syracuse, NY before starting midwifery school. Much of what I did was helping parents navigate the hospital system and support them getting what they wanted. 

Try www.doulamatch.net or ask in your local tribal forum.

[tiqa]

I'm actually a doula as well (though not practicing), so I definitely know they can be a huge help for some families, but for various reasons we're not going to go with one right now.  (Not financial ones, either.  I know a lot of them barter, etc., but that's not why we're not doing it.)

[Budgerigar]

Tiqa said "NY state calls CPS automatically if you refuse the vitamin K shop or eye goop but can they be delayed a bit?" 

Wow!  They really call CPS automatically for this?  I wonder if they do that here in Michigan.  That is just outrageous to me.  What does CPS do in these situations?  They seriously can't keep themselves busy in other, more productive ways?  Perhaps helping children that are actually unwanted? In a crack house maybe?  
 

[allisonrose]

tiqa - We planned a homebirth with my second son but needed to transfer to the local hospital. It is a small hospital with one delivery room and I believe a second room which could be used for a delivery in a pinch. They averaged 30 births a month but then one of the local OBs stopped delivering babies and when my son was delivered they were delivering significantly fewer. The younger nurses were very nice. The older nurse was a bit cooler towards us. My husband feels that he preferred that hospital over the one we had our first son in which is in a very progressive area. (That hospital did have a celebratory steak dinner but the steak was lousy.)

[Oliver'sMom]

I've never had a hospital birth either, and I'm sure you've already thought of this, but just thought that since most of your concerns on your list are during labor, could you delay going to the hospital until you are in the last stages of labor?  There are only so many interventions they can do if you give them a small window of time to do them in.
 

[amlikam]

Originally Posted by tiqa 

Thanks, everyone.  Unfortunately, I don't think this is an especially baby friendly or modern hospital.  The staff all say they're really happy with low intervention births, but I do know that it's a small, country-ish hospital that only has rare births.  They also don't have an advanced NICU etc.  There's no other place I could birth, but it's not the "high end spa" hospitals I've seen in other places I've lived.  No jacuzzis, hardwood floors, flat-screen TV's, or prime rib recovery dinners. ;)  (Yes... that actually was one hospital I've visited before when living in another city.)  This is a small, efficient type of place but it doesn't strike me as progressive.  I will try to set up something with them, though, to see if I can come in or talk to them as well as the general doctor.  (They have one doctor on call per 24 hour period, and there's like four doctors and a midwife who practice there... so it's kind of a guess to see who I can get at that particular day.  I know some of the doctors there are more lenient than others.)

Originally Posted by allisonrose 

tiqa - We planned a homebirth with my second son but needed to transfer to the local hospital. It is a small hospital with one delivery room and I believe a second room which could be used for a delivery in a pinch. They averaged 30 births a month but then one of the local OBs stopped delivering babies and when my son was delivered they were delivering significantly fewer. The younger nurses were very nice. The older nurse was a bit cooler towards us. My husband feels that he preferred that hospital over the one we had our first son in which is in a very progressive area. (That hospital did have a celebratory steak dinner but the steak was lousy.)

From my experience the less technology a hospital has the less they are inclined to want to use. The hardest part of my experience was postnatal care of my newborn. I would make sure you have a great peditrician with hospital rights. AND to room in (which it seems is in your plan). As a doula you can say no to things, it is just hard so make sure your partner knows how to advocate for you here.

Best of luck.

[Quinalla]

My experience at my hospital birth and my advice for what it's worth...

Is there continuous or intermittent monitoring?
Most hospitals really want to do continuous monitoring, but you can limit it by taking the monitor off frequently to go use the toilet. The monitor didn't bother me personally, but I know many women in labor who detest the thing, so if it isn't too bad for you I'd let this one slide and go to the bathroom often.

Is water therapy available?  (I don't think it is, it's a tiny little hospital with no tubs, but maybe there's a shower...)
You should be able to tell this by going on the hospital tour (I recommend this so you can see what it will be like and know what door to go in and all that ahead of time) and seeing if the rooms have showers and tubs. Pretty much all hospitals in my areas have private rooms with a private toilet/shower and most have a few delivery rooms with tubs but they are all first come-first serve.

What's the deal with IV's and such - what is mandatory?
Most hospitals will want to give you an IV, if it is ok with you maybe negotiate for a heplock? I got the IV last time for all of 30 minutes or so until I delivered. Since I'm having twins this time I may not push it, but I had planned to tell them I wanted to wait on the IV since my births are so fast.

Can I refuse cervical checks?  I don't mean I want them infrequently, I don't want them at all, period.  Not to check "if I'm 10 cm yet", I don't want to see "if I can be admitted yet", etc.  (If I show up in hard labor, I'll assume they can tell without sticking their fingers inside??)
I think if you show up in hard labor especially since you are not a first-time mom, they probably won't need to check you, but will probably still want to. They also usually want to at least check you to see if you are complete before pushing. I think the rest of the checks will be pretty easy to avoid, but it does depend on the hospital. If this is important, definitely get your doctor to sign off on this as they won't be there when you first show up.

Will I get to labor, and more importantly, deliver in the position I want to? (Last birth was a UC and I was on my knees when she came out.)
Labor in any position should not be a problem unless it is interfering with their monitoring/IV if you end up getting those. Deliver in any position you should talk to your OB about for sure. Some OBs are very chill about it, others can be talked into it, others not so much.

Pushing that's not directed - not only do I not want anyone to count down for me, I also don't want anyone to tell me when to push, when not to push, when to pant, etc.
I was just coached a bit after each push "That was a good one." or "Try to push a little longer/harder on the next one." but no one counted or told me when to push or how to breath or anything except my OB did ask me not to close my eyes, no clue why, but I ignored him involuntarily! And I told them I was feeling pushy/complete and asked them to check me, so mostly they were telling me not to push until my OB over the phone yelled at them that I could push if I wanted to.

Catching - is it automatic in all hospitals that the doctor MUST catch the baby? I caught DD with DH's help and I really preferred that to a stranger doing it... but I'm assuming that's not a hill to die on, right? They'll just refuse, I'm assuming.
I didn't ask about this, but my OB had me put my hands down so we could catch the baby together and together lift her onto my chest. I was so glad he did as this was a very memorable part of the birth for me! That might go over better if the policy for the hospital is that the OB must catch the baby that you, DH and the OB all catch together, but I'd ask if DH can catch instead first.

Newborn procedures?  I don't want to be separated unless there's a huge emergency - not just them taking the baby out of the room, but also not taking them to the other side of the room, cleaning them up, wrapping them, etc.  NY state calls CPS automatically if you refuse the vitamin K shop or eye goop but can they be delayed a bit?  I also don't want suctioning, etc, either while the baby is inside or outside.  Once the baby is out, assuming he/she is breathing and such, can they do their checks while I hold him/her?
Most hospitals are much more on board with giving Mom & Baby time right after birth with baby on Mom's chest for 30 minutes at least, assumed baby is breathing fine. So just making it clear that you want everything delayed while you and baby bond with baby on your chest and a blanket over both of you should hopefully not be a problem and may actually be encouraged by the hospital. As far as no separation at all, that will be tougher in the hospital, but at least demanding that DH be present at all times and limit separation should be pretty easy. And a lot of hospitals at least official encourage rooming-in, so that will help too.

Placenta procedures (fourth stage) - short of hemmorhaging, can we wait for the placenta to separate naturally?  I had one manual removal by a midwife and one natural removal and omg the difference is crazy.  I also would rather nurse if possible, and not deal with Pitocin, etc.
Talk to the OB about that for sure and have DH on watch to make sure they remember. Too many OBs and even midwives are too eager to pull out the placenta for no reason IMO. And let them know about wanting to avoid pitocin if necessary as it may be standard procedure to give to everyone regardless of bleeding.

What if I test GBS positive and my labor is too short for the standard course of IV's during labor?  (What's that, like four hours?)  Are they going to keep the baby for however long for "observation"?  I can't refuse the test because they already did one on me without really asking for consent or not when I was in the hospital already for some PTL stuff.  I don't know the results of the test yet, but with my luck, it'll be positive.
Not sure, but I'd talk to the OB and try to find out the hospital policy as well. Hopefully you don't test positive, but if you do, make sure to get retested closer to birth so you have a chance to be negative.

And I'd probably start off asking them how a typical natural birth goes, that may cross off a lot of what you don't want without having to ask and make it their idea instead of yours which always goes over better. And try to ask your questions in a non-leading manner so they at least don't know what answer you want. Like "What kind of monitoring do you recommend?" instead of "Do you do continuous monitoring only?"

[its_betty]

Is there continuous or intermittent monitoring?
 

Either way, ask if they have a telemetry or wireless unit. When I was in about to have my son (almost 14 years ago, yikes!), the telemetry monitor unit was attached to a rolling IV stand, so I could roll it along as I walked the halls waiting for labor to start. (My water broke about 36 hours before labor actually started.) I also had it on while I labored in many positions: on the floor, in the bed, etc. Much better than being attached to one place for hours.

[fayebond]

Originally Posted by fruitfulmomma 

Faye, by ob catch do you mean dr catching the baby? I've had 2 hospital inductions and both times my care provider was totally cool with letting my midwife/doula (no admitting privileges) catch the baby. 

My hospital nurse said that the ob has to be the one catching the baby, or everyone in the room has to do alot more paperwork for insurance/malpracice.  But obiously that varies, seems like alot of people have hospitals with differet rules (maybe the ob just needs o be in the room, etc).

Small can be an advantage.  In our big hospital, we got salmon for dinner but postponed various things until shift change (when everyone assumed we were repeating what we'd been told to do, instead of, in reality, expressing what we wanted :)).  You won't be likely to ge lost i the system like that, but, it will likely be easier to work with staff once you have a good relationship going.  I bet that the skin to skin part is going to go over well, but do come back and tell us how it goes!

[berrymama]

Originally Posted by tiqa 

I am an OB nurse at a large baby-friendly hospital (350-400 births per month), and can answer based on our own hospital policies (which apparently vary widely, looking at some of the previously posted answers).

Is there continuous or intermittent monitoring? Not everyone gets continuous monitoring. All patients get a 20 minute strip upon arrival and if everything looks good, they can be doptoned every 30 minutes (every 5 minutes while pushing). Reasons for continuous monitoring include: preterm (before 37 weeks) or post-term (after 41 completed weeks), meconium in fluid, non-reactive or reassuring tracing upon arrival, epidural, pitocin.

Is water therapy available?  (I don't think it is, it's a tiny little hospital with no tubs, but maybe there's a shower...)

What's the deal with IV's and such - what is mandatory? Not mandatory. Reasons to have one vary widely depending on hospital. Where I work you need one for: VBAC, history of PPH, and obvious reasons ie pitocin, epidural

Can I refuse cervical checks?  I don't mean I want them infrequently, I don't want them at all, period.  Not to check "if I'm 10 cm yet", I don't want to see "if I can be admitted yet", etc.  (If I show up in hard labor, I'll assume they can tell without sticking their fingers inside??) I don't see how they could force you, though I am sure you would be asked again and again until you cave. This would definately be a good thing to discuss ahead of time.

Will I get to labor, and more importantly, deliver in the position I want to? (Last birth was a UC and I was on my knees when she came out.) Again, they may have strong suggestions, but if your baby is doing well, you should be free to move however you want.

Pushing that's not directed - not only do I not want anyone to count down for me, I also don't want anyone to tell me when to push, when not to push, when to pant, etc. Good to include on a birth plan, because it will be the RN with you most often, not the OB (until catching time).

Catching - is it automatic in all hospitals that the doctor MUST catch the baby? I caught DD with DH's help and I really preferred that to a stranger doing it... but I'm assuming that's not a hill to die on, right? They'll just refuse, I'm assuming. Good thing to discuss ahead of time. It is really hard for some docs to just keep their hands off! Docs think perineal support will help prevent a tear. (Though the amount of multips I see with 2nd degree tears (most!) disproves this theory to me) They may want to "help" you deliver your baby and then let you bring him/her to your chest. Do you want delayed cord clamping? I would remind them about that as well ahead of time and at the time of delivery.

We have had patients birth (purposefully) unassisted at the hospital, as in....RN is out of room (not uncommun...if you ask for privacy and are intermittently monitored), mom is in tub (or wherever), doesn't call the RN when she feels pushy, delivers, and then calls the RN. Ooops! I just had my baby :)

Newborn procedures?  I don't want to be separated unless there's a huge emergency - not just them taking the baby out of the room, but also not taking them to the other side of the room, cleaning them up, wrapping them, etc.  NY state calls CPS automatically if you refuse the vitamin K shop or eye goop but can they be delayed a bit?  I also don't want suctioning, etc, either while the baby is inside or outside.  Once the baby is out, assuming he/she is breathing and such, can they do their checks while I hold him/her? All procedures should be able to be done on you (unless resusitation is needed). They will want to weight /measure the baby at some point (hopefully in the same room), but this can be delayed.

Placenta procedures (fourth stage) - short of hemmorhaging, can we wait for the placenta to separate naturally?  I had one manual removal by a midwife and one natural removal and omg the difference is crazy.  I also would rather nurse if possible, and not deal with Pitocin, etc. Another time docs have a hard time keeping their hands off. A shot of pitocin with the delivery of the anterior shoulder (or as soon as possible after birth) is standard policy pretty much everywhere. Very important to discuss ahead if you want to refuse. It may be better to phrase it as "I prefer to wait to see if I need it or not, instead of giving it automatically."

What if I test GBS positive and my labor is too short for the standard course of IV's during labor?  (What's that, like four hours?)  Are they going to keep the baby for however long for "observation"?  I can't refuse the test because they already did one on me without really asking for consent or not when I was in the hospital already for some PTL stuff.  I don't know the results of the test yet, but with my luck, it'll be positive. They would probably want to watch baby for 48 hrs if you didn't get 4 hours of coverage. The discharge of the baby is up to the pediatrician, not the OB.

Anyway.   I don't want to go in there with a whole looooong list and present as the problem NCB patient. Is there something I should just take off the list completely?

[JamieCatheryn]

My husband caught our first in the hospital, it wasn't a request or plan, he was just there and I guess automatically reached to do so and the OB on call sort of just let him.

Intermittent monitoring is a must, if they don't normally do it but have someone who can operate a handheld doppler you can insist on it. There is no way I could hold still for that belt to stay in place long during an unmedicated birth, those hardly will even work laying on your side let alone sitting up, rocking, on hands and knees, etc. The belt is for moms and their backs with an epidural or heavy narcotics.

With GBS but under 4 hours from abx to birth they'll want to draw baby's blood from the top of his or her head and observe for 2 days, often trying to insist baby stays in the nursery.