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What can I decline in the hospital?

post #1 of 32
Thread Starter 

I am currently set up with a CNM and birth center, but am not letting myself get too attached to the idea, because I know a lot can happen in the next 7 months.  DH and I want to make sure if we end up in the hospital, things go our way and not "the way things are".

 

So I'm wondering what I can decline without getting kicked out?  IV?  Hospital gown?  Eye ointment?  Wheelchair to leave?  Continuous monitoring?  Delayed cord clamping?  Baby on stomach immediately after?  I have really strong feelings on weird stuff and do not live in a very progressive town (they still move you room to room during labor) so I don't have high hopes of getting what I feel is best for us.

 

Obviously in an emergency situation, it would just be about us both surviving, I'm thinking more in a case where I risk out of the birth center and can still have a natural hospital birth.

post #2 of 32

Welcome meow2013!

 

I think it may depend on your care provider and hospital procedures but I doubt anyone will kick you out in the midst of birthing. They may have you sign something to exclude them from responsibility.

 

Anyone have any experience to share?

post #3 of 32
Legally, you have the right to decline absolutely anything in the hospital without being kicked out (assuming you are in active labor and the hospital falls until EMTLA, which almost all do). By law, they are not allowed to *not* treat you and they cannot force you to do anything unless they have a court order.

However, you may be setting yourself up for an adversarial atmosphere if you are declining everything or specific things that that hospital really pushes for. It might be helpful to speak with the midwives or a couple local doulas about what the culture of the hospital is when it comes to that. Some of it will have to do with your care provider, some with hospital policy. For example, I have two hospitals about 45 minutes apart here. One just has you sign a form with very little hassle to decline eye ointment, vit K and hep B. The other will throw an absolute crazy fit and give you such a hard time. It's really useful to know those things in advance so you can sort out what is worth fighting about *for you* and what might not be.
post #4 of 32

There are a bunch of considerations here.  This gets super technical.  I am not a doctor.  I've had two babies, one totally normal, one crazy high-risk emergency.  In between those, I had one miscarriage.  I wound up seeing doctors at three different hospitals (as well as midwives at one of those hospitals) over the course of these pregnancies, but because of where I live, all of these hospitals were teaching hospitals of Harvard, which means they all had certain policies in common.  Things may vary for you.

 

I think it's worth discussing with your midwives what conditions would risk you out of the birth center, and how that would be handled.  I have heard of women being referred out because of changes in midwives insurance coverage, for example, and if you're dealing with a basically bureaucratic change, you probably want to go ahead and agitate to keep things as close to your birth center plan as possible.  If they risk you out because you're showing signs of pre-eclampsia, because you're GBS+, or because you have gestational diabetes... you get into a place where some of the procedures you're concerned about become solid practice. 

 

You also want to know where they'd send you if you risked out, and what standard policies and procedures are there.  You want to know how they staff L&D.  Is there an anesthesiologist on the floor?  Will you be seen by the attending physician on shift when you're in labor, or will they page your doctor?  Your odds of having a natural delivery are actually higher when there's staff on the floor, because you can take a wait and see approach if monitoring is revealing variations that might indicate trouble later.  If they have to page a doctor in, they'll pick up that phone the very moment they think things might be diverging from normal, and you can wind up with an OB who doesn't want to have wasted a trip.  Whereas if the doctor is there, they can wait to start the emergency moves until there's an actual emergency.  The problem is, having staff on the floor all the time is more expensive then paging doctors in on an as-needed basis.

 

You also want to know what the hospital's insurance allows them to do.  Can they do vaginal breech?  VBAC?  How often do these things happen?

 

And then you just have to pick your hill, and decide whether it's worth dying on.

 

Hospitals tend to kick up a hell of a fuss about monitoring issues.  They want you on the monitor.  The paperwork you are going to have to sign to not be on the monitor is the scary "your baby might die" paperwork.  If anything goes wrong, the monitor strip is going to come up as a discussion point, first in the hospital's morbidity and mortality review (where the staff on your case are going to be grilled up down and sideways), and then in depositions and in court (if you or your baby are injured, you're going to need money, so you'll sue).  Mothers hate it, though.  It's annoying to have on, and it can mean that everyone's frowning at the monitor strip while you're screaming through contractions.  If you've been risked out for a basically bureaucratic issue, there aren't special concerns about placental function, and you are not getting an epidural, you can probably convince them to go intermittent on the monitors (although it's my experience that "intermittent" means "fifteen minutes out of every hour", which can be more annoying then just leaving it).  Some hospitals have wireless units, which make it easier to walk around and do what you want, even with monitors.  No hospital is going to leave a nurse in the room all the time, and they don't padlock those babies - you can just take it off ("I needed to use the bathroom," or whatever).

 

The IV is another one they're going to fight for.  You want to be able to use your hand and walk around; they have nightmares about trying to get venous access while you hemorrhage.  The standard compromise is a hep lock (not a ton better, in terms of using your hand, but at least you're not tied to a pole).  I hemorrhaged after my son was born, so I'm kind of with them on the hep lock. 

 

The hospital gown - dude, so long as they can get to the things they need to get to, you should be able to wear whatever the heck you want.  Anyone who says otherwise at the hospital is powertripping.  BUT.  They might quite reasonably offer you a johnny so that you don't ruin your own stuff (or after your water breaks all over your own things).  Labor is messy, and afterwards, the staff  just sweep everything up and bundle it off to be dealt with by their linen service, which means that if your stuff gets caught in that sweep, you're never going to see it again.  All of the hospitals I've been in have been perfectly happy for me to wear my own clothes as long as they weren't doing surgery, as long as there wasn't blood or feces on them.  Once you have blood or feces, their prejudices kick in in favor of "clean", and they want it gone.  I strongly recommend laboring in their stuff.  Save your things for after the baby is born.  (But if it's a situation where, say, you have a history of childhood cancer, and you throw up as soon as you put a hospital johnny on - no joke, some people do - no johnny for you, but stock up on cheap pajamas so you have extra sets of things you won't be sorry to lose.)

 

The wheelchair to the door - on the one hand, what are they going to do, kick you out?  Great, because you're trying to leave!  On the other, it's two minutes in a wheelchair, is it going to kill you?  Do whatever gets you home fastest, with the fewest insurance hassles.

 

Eye ointment, and delayed clamping are issues where you're going to have to feel out the culture.  Baby on the stomach is partly a culture thing, partly a thing where it depends on the situation.  I hemorrhaged after my son was born, and couldn't safely hold him, plus, they were using that space for uterine massage.  Have a backup plan on this.  The classic alternative is to have your partner cuddle the baby skin to skin.

 

Congratulations on your pregnancy.  I hope all these concerns remain theoretical.

post #5 of 32
I think it is safe to not worry about these things until you visit the hospital you would transfer to and ask about them. Hospitals can get a bad rap and while some deserve, many do not. Ask about these concerns and you may find that the hospital is progressive and you have no reason to get fired up. Most hospital staff want what's best for you and want you to be safe and happy. If you have your baby in the hospital because you are risked out of the birth center you will have to give on somethings you want because that is what is best for you and baby. If you transfer during labor, which for most first time moms is for exhaustion, you may need an iv for hydration or monitoring because you needed pitocin to get things moving.

Birth is so incredible and so unpredictable. Your best bet on being happy with how it happens is being flexible. Being knowledgeable, being part of the decision making process, knowing when to stick to your guns and when to let it go and knowing that whatever decision you make, you made it to the best of your ability in the moment will serve you. I hope that all of this is hypothetical and you have your lovely birth in the center you chose. Good luck!
post #6 of 32
A doula who knows your wishes would be really key. She can notice/remind yu bc soooo much is done quickly and before you even realize it, especially when you are distracted. As a pp said, when you are in active labor by law they cannot kick you out. They threatened to transfer me, but i knew they were bluffing. You really can say no to anything. The best strategy is to just do it...ie dont say 'i want to move around/eat/birth upright', just go ahead and move around/eat/birth upright! Make your way the default. I had to repeat no, calmly and firmly, so many times over and over but eventually was heard. Just like you would with a child. Of course the best advice is to arrive as late as possible in labor! Good luck, i would really encourage you to stick up for yourself as it took me a few births to gain that confidence, but once i did i wished i had from the beginning.
Edited by myra1 - 6/8/13 at 1:41pm
post #7 of 32

You have the right to decline any procedure but staff may not be very happy with you so it is important to do your research, find a doctor/midwife that will match your needs or at least work with them, and have support by either doula or partner, better yet, both. 

post #8 of 32

Your CNM should be able to tell you what you can refuse etc. We had a homebirth but told the CNM what we didnt want in advance so there would be no issue. Plus knowing what we wanted helped her decide what hospital would be best for us to deliver at if we ended up going.  If that makes sense. We didnt end up going but she said we didnt need to vacc, circ, do the hep lock , we could leave 2 hrs after the birth , no eye ointment etc etc. Also good to use a doula and have a birth plan :)

post #9 of 32

I would make a list of the most important things to you and decided which things you absolutely will not budge on and which things you are okay with and in what circumstances.

 

With my last birth, which was my first planned hospital birth, I had a two page birth plan and I went over the whole thing with my OB and then again with the nurses when I arrived at the hospital. The things which I would absolutely not budge on were circumcision if our dd had turned out to be a boy, the use of cytotec/misoprostle, and Heb B or any other vaccinations. I typed these in bold, highlighted them, and wrote that I DO NOT CONSENT to them.

 

Other things which were important to me I briefly described how I would like things to proceed if we needed a change of plans.

 

We ended up needing a pit induction, which meant IV fluids. I agreed to those things, even though I would have prefered to avoid them. It also meant limited use to the tub and food. Not fun, but it went well overall. All my other choices were respected and kept in place as much as possible.

post #10 of 32
Thread Starter 

Sorry I posted and ran, was on vacation without internet.

 

Obviously if something critical happens, things may go a little out the window, but I am still adamant about some things (like the eye ointment).  I guess I'm thinking if I risk out early for something like GD requiring insulin - I find it hard to believe that would require much of anything special at the hospital, except maybe an IV (although if you're a nurse and can't get one started quickly in an emergency, I don't want you anywhere near me or my baby).  I'm already REALLY ticked off the state won't let me decline HIV testing - in my mind I can already tell the general culture around here is that women can't be trusted to make their own decisions.

 

So yeah, lots of my feelings just have to do with refusing to be treated like a patient - hence the no hospital gown or wheelchair ride for me.  I think things like that set women up for a submissive attitude towards their doctors and that's just not my thing, you know?  I live in a very non-progressive area and while I count myself lucky I can afford to not have the baby in the military hospital, the civilian ones don't appear to be much better.

post #11 of 32

You can wear your own clothes but it gets messy.

Instead of IV you can ask for heplock. I  would really not decline that. IF you are risked out of the birth center, it mean something can go wrong. It is not easy to start an IV on someone who is bleeding etc.

 

No one will force an epidural on you.

 

I never had issues with a baby being on my chest right away.

 

Yes, you can decline the oitnment etc

post #12 of 32
 I'm already REALLY ticked off the state won't let me decline HIV testing -
[/quote]

HIV testing is required???? For you or baby? I cant imagine that can be done without consent anywhere. Maybe you could just not give a blood sample? I never had blood drawn on myself or baby at the hospital, despite being told it was required. Its so ridiculous to subject a woman in full on labor to sitting still for a blood draw, especially when its usually been done prenatally.
post #13 of 32
I also declined the baby being taken for a bath and nursery observation/warmer, (and if there were health problems i had other support so that my husband could go with the baby and be able to make decisions)......i found its much easier to control what happens if he/she never leaves your view, and all exams can be done in your presence. We also left within a few hours, i think the longer you hang out the more you will feel like a patient. With my first the ob kept coming up with specific reasons to stay, like jaundice and bleeding but they all 'resolved' exactly at the 48hr insurance pay mark. After that birth I questioned more and was able to go home right away.
Edited by myra1 - 6/8/13 at 1:45pm
post #14 of 32
Now that im thinking about it, i even declined the baby being footprinted, filling out the birth cert questionaire, meals, the hat/diaper/swaddle, just about everything lol. You may not make any friends that way, but honestly you can say no to anything, even if they say you cant. We never even had i.d. bracelets. (Not because i refused them. Just because I arrived pushing, kept baby with me, and left too quickly to bother.)

It was so funny because after the birth there was almost a page of charges on my hospital bill for things I refused, which goes to show how common they are and what moneymakers. I did get them all removed with the exception of 2000 in nursery charges ( they said it was for the nurses' bedside observation).

I think its much, MUCH more likely that you will be lied to or talked into procedures or that things will be done without your *knowledge* or realization than actually without your consent. I know a lot of people will say pick your battles, and i understand that, but for me i think being consistsnt won me some credibility with the staff. After a bit they just started assuming I didnt want things instead of assuming I did. Of course, i was also well informed about issues with my pregnancy and very familiar with the pros and cons of interventions. Without that knowledge, it would have been foolish to blindly decline advice from the pros.
Edited by myra1 - 6/8/13 at 1:49pm
post #15 of 32

Meow, I totally understand not wanting to feel like a patient, but I don't think that turning down the hospital johnny or refusing to sit in a wheelchair is going to make you either be or feel more empowered.  It's a waste of energy that sets up a power struggle with the nurse, where you refuse the hospital johnny, and then it looks like a surrender when you get poop on what you're wearing and need a hospital johnny.  Don't cling to your dignity when your dignity is likely to abandon you. 

 

If your discharge is anything but standard, your two-minute victory over hospital policy is likely to turn into hours of phone time with the insurance company.  But for what it's worth, I walked out of the hospital when discharged, both times.  (By contrast, I know one couple whose hospital insisted on wheeling a parent and baby to the door after a two-month NICU stay.  They made the hospital wheel dad, just to make the point.)

 

If you want control, you need to understand what's going on in the hospital from an obstetrical point of view.  You talk about getting risked out of the birth center for gestational diabetes, for example.  GD is related to fetal macrosomia and shoulder dystocia, and insulin-dependent GD can also be related to placental insufficiency.  These are situations in which you really might need an IV in a hurry, and while sure, a nurse *should* be able to get that in no matter what's going on, I promise you that it is better to have it set up while everything is calm and your blood pressure is normal (not while you're hemorrhaging and your veins are collapsing).  If you want to convince these people that you know what's best for you, you have to actually know it, and be able to say it to them in the language that they use.  This is more then possible - but you won't get it just from a childbirth prep class, or by reading about midwife-centered care for normal birth.

post #16 of 32
Quote:
Originally Posted by MeepyCat View Post

Meow, I totally understand not wanting to feel like a patient, but I don't think that turning down the hospital johnny or refusing to sit in a wheelchair is going to make you either be or feel more empowered.  It's a waste of energy that sets up a power struggle with the nurse, where you refuse the hospital johnny, and then it looks like a surrender when you get poop on what you're wearing and need a hospital johnny.  Don't cling to your dignity when your dignity is likely to abandon you. 

 

If your discharge is anything but standard, your two-minute victory over hospital policy is likely to turn into hours of phone time with the insurance company.  But for what it's worth, I walked out of the hospital when discharged, both times.  (By contrast, I know one couple whose hospital insisted on wheeling a parent and baby to the door after a two-month NICU stay.  They made the hospital wheel dad, just to make the point.)

 

If you want control, you need to understand what's going on in the hospital from an obstetrical point of view.  You talk about getting risked out of the birth center for gestational diabetes, for example.  GD is related to fetal macrosomia and shoulder dystocia, and insulin-dependent GD can also be related to placental insufficiency.  These are situations in which you really might need an IV in a hurry, and while sure, a nurse *should* be able to get that in no matter what's going on, I promise you that it is better to have it set up while everything is calm and your blood pressure is normal (not while you're hemorrhaging and your veins are collapsing).  If you want to convince these people that you know what's best for you, you have to actually know it, and be able to say it to them in the language that they use.  This is more then possible - but you won't get it just from a childbirth prep class, or by reading about midwife-centered care for normal birth.

 

Quote:
Originally Posted by eabbmom View Post

I think it is safe to not worry about these things until you visit the hospital you would transfer to and ask about them. Hospitals can get a bad rap and while some deserve, many do not. Ask about these concerns and you may find that the hospital is progressive and you have no reason to get fired up. Most hospital staff want what's best for you and want you to be safe and happy. If you have your baby in the hospital because you are risked out of the birth center you will have to give on somethings you want because that is what is best for you and baby. If you transfer during labor, which for most first time moms is for exhaustion, you may need an iv for hydration or monitoring because you needed pitocin to get things moving.

Birth is so incredible and so unpredictable. Your best bet on being happy with how it happens is being flexible. Being knowledgeable, being part of the decision making process, knowing when to stick to your guns and when to let it go and knowing that whatever decision you make, you made it to the best of your ability in the moment will serve you. I hope that all of this is hypothetical and you have your lovely birth in the center you chose. Good luck!

 

I totally agree with both of these comments. Find out about the hospital in advance, but don't go in expecting to fight. Don't waste your energy stressing out about little stuff like this. Have an idea of what you'd like, but if it goes differently, decide what you can roll with and what's a deal-breaker. I think a lot can be accomplished by remembering that you are still a free agent and don't have to ask permission for anything (don't ask to wear your own clothes, just do), but also remember that the goal of the hospital staff is not really to knock you flat on your back and do interventions on you. I think I wasted a lot of time during pregnancy worrying about having to fight the hospital staff and it just wasn't an issue. 

 

I think it's funny that the wheelchair to leave is a thing for people. In my case, I didn't want my daughter taken out of my sight after delivery and that meant tramping around with her when they wanted to take her to the nursery or whatever. I wish they'd offered me a wheelchair for that! And I did accept it to leave because I figured hey, sure I could walk, but let's conserve energy. I didn't have a ton of energy. I could have done the walk to the car but it would have wiped me out. That's what the wheelchair is for. 

post #17 of 32
Thread Starter 

Yes, no one can accept me as a patient/client if I decline the HIV test (for me).  I have to consent to be tested at least once - ridiculous!  Personally, I think it borders on insurance fraud, because it's a completely unnecessary test.

 

As for the wheelchair, why are they discharging me if I can't even walk out to the front door?  It's just a reinforcement of your status, nothing more.

 

I'm really just worried because of where we are.  I've talked to a few people who've had babies at the local hospital and a lot of the garbage is standard.  Heck, they still move you from labor to delivery to recovery to postpartum rooms around here!  And you do have to deliver one your back, no exceptions. I didn't even know hospitals still did things like that!  I feel like I'm living in 1950 or something.

post #18 of 32

So what if you are in another position than on your back? Is your care provider going to push you over? Can't you just refuse to get on your back? I would fight that one. If your care provider is sympathetic, you may have better odds there. 

 

The wheelchair may be a reinforcement of patient status, but also it saves you some energy at a time when you need it, so I'm in favor of that. I wouldn't have wanted to walk 500 feet carrying my daughter on post-partum day 2 if I could avoid it. 

post #19 of 32

First of all, I hope you can birth in the birth center like you're planning. 

 

What is the specific hospital like?  Do you have a specific midwife or doctor you would be working with if you risk out?  Can you hire a doula?  Even for birth with a midwife I think they are so valuable.

 

I think what would work for me, in the location I'm in, is to go in expecting... shall I say... resistance.  But don't act as if I were expecting resistance.  A lot of getting people to not mess with you in general is just your attitude.  Like, an 'Of course you will listen to me I am very reasonable' vibe.  Lots of No thank yous, and I decline that at this time, No thank you I don't consent to that but thank you for asking. And lots of compliments for what they do right.

 

I saw your disclaimer about just being interested in survival if it were an emergency, but wanting to plan for a "normal" but risked out delivery.  So it seems like you're the kind of person who wants to think out things ahead of time and think out responses ahead of time.  So that's what I'm talking about too.  Just planning things so you feel that you can be confident in all situations.  In reality, who knows what kind of frame of mind you'd be in when you got to the hospital.  Would you remember all these details?  For me, the basics are: Be firm, be as polite and appreciative as possible, don't ask permission, don't compromise on important things, and finally- If you don't like the nurse assigned to you Request A New One!

 

I would plan ahead, but then go with the flow.  For me- No circumcision, No shots or ointment, Keep baby with me (or husband if there's an emergency) at all times, and this is also completely not negotiable for me- No restriction of my movement. I believe the safest way for me to birth is to get into whatever position I want. So I would just do that.  The wheelchair thing?  I see both sides here too.  It's meant to reenforce your status as a patient.  But...if I know that, is it really hurting me at the end of a hospital stay on the way to the parking lot?  (And I gave birth at home but if I had to walk that amount I sure would have been happy to have a wheel chair, a piggyback ride, or whatever.  Even with an easy birth.)  The gown?  Yeah, that's one you put on right at first and sets the tone.  I guess if I were offered a wheelchair at the beginning I would look at them like they were jacked up and would laugh at them. 

 

It makes sense to find out as much as you can about what you could possibly be facing.  Then you can think about responses to the scenarios that are actually likely.

post #20 of 32
Quote:
Originally Posted by meow2013 View Post

I'm really just worried because of where we are.  I've talked to a few people who've had babies at the local hospital and a lot of the garbage is standard.  Heck, they still move you from labor to delivery to recovery to postpartum rooms around here!  And you do have to deliver one your back, no exceptions. I didn't even know hospitals still did things like that!  I feel like I'm living in 1950 or something.

 

Talk to the hospital directly.  I'm not saying that the people you've talked to are dishonest, but I know that what I experienced as "hospital policy" was sometimes wildly inaccurate - labor does not make for perfect reporting.  So talk to the hospitals, visit the hospitals, take the L&D tour/info night thing, and see what they say.

 

There is a modern trend towards keeping laboring patients in the same room from labor through delivery and recovery and then moving to post-partum rooms, and that's great - far easier on families - but this requires that hospital rooms be built for it.  If the hospital just hasn't been able to afford the renovation (or the downtime for the renovation) it may be that they'd love to keep you in one room, but they can't.  They have the facilities they have.

 

On this one:

 

 

Quote:
As for the wheelchair, why are they discharging me if I can't even walk out to the front door?  It's just a reinforcement of your status, nothing more.

 

I'm not saying that the wheelchair is absolutely necessary to your health, or that it isn't stupid or annoying (although I'm kind of with Erigeron here).  I'm saying you might not want to fight for that particular hill.  It might cost you more, long run, then it's worth, to not feel like a patient for two minutes.  You have almost certainly already spent more time thinking about this wheelchair then you might spend in the wheelchair.  There's probably some kind of zen comment that could be made about that.

 

Also, you might be a patient.  You might have that status, as much as you would prefer not to.  Birth is not always easy.


Edited by MeepyCat - 6/5/13 at 12:29pm
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