Hospital protocol list, etc.....

[Jojo F.]

So I don't look like a total buffoon (& help me if I am right now!!) when I ask this, what are some general questions to ask about hospital protocol?

I do understand that each hospital is a little different but I'm willing to bet they are in some ways pretty much the same.

Edited to add- I have looked at the questions to ask a MW in the HB forum(I'm keeping that handy in case I really do get to have my HB but this is strictly for a hospital birth.

What I have so far...

- addmitting
- list of newborn testing/waivers
- bathing of newborn
- breastfeeding
- rooming in
- use of IV- heplock/saline
- photographer in room for birth?
- hours allowed after water breaks?


Questions for OB-

- C/S rate
- episiotomy rate
- What is your precedure for suctioning baby?
- Do you accept clients with doulas?
- When do you feel an induction is necessary? Techniques?
- What would you reccomend if baby is above average size?
- What would you suggest if I was 42 weks and had no signs of labor?
- What are your thoughts on cord clamping?
- What are your thoughts on eating and drinking? (would this be part of hospital protocol?)
- Can someone else catch the baby?
- What are your thoughts on rupturing/stripping membranes during labor? (If my baby is going to be born en caul I'd like for that to be allowed)


Anything I've missed, misplaced, or have totally wrong?

TIA!!

[lifeguard]

If anything else arises in your pregnancy you may find more specific situations come up (I have GD & so I've had concerns about how they would treat hypoglycemia & jaundice).

I've been breaking up my questions & asking a few at each appointment. I don't want to overwelm him with questions & also wanted to establish a relationship of trust - going both ways & was worried if I bombarded him with a ton of questions that sounded like I was second guessing him it would damage that relationship.

[claras_mom]

Eating and drinking would be part of the hospital protocol, I think. Ask about circ and HepB--at our local hospital, they don't even do the latter at the hospital, preferring to let the peds deal with the issues of informed consent. Hours permitted after water breaking might be more of an OB question.

All of this assumes you have a choice of hospitals. I didn't (unless I wanted to change insurance and then drive a long, long way), so the thing I found most useful on the hospital issues was the hospital-sponsored Childbirth Preparation classes, which covered everything from standard operating procedures to natural pain management techniques.

[MegBoz]

- bathing of newborn
---Ask if it’s possible to have it done in your own room and/or if you can do it yourself

- breastfeeding
--- My hospital had lactation consultants available basically all the time. BUT – they were not good ones!!! If you want good help, you might want to consider interviewing the hospital LCs so you don’t get blind-sided with lousy support, like I did. I have lists of Qs for that too if you’d like.

- rooming in
Will DC EVER have to leave the room (if he’s healthy)?

- photographer in room for birth?
---ACOG official recommendation is to NOT allow filming of birth! So my guess would be most hospitals follow this recommendation (mine did), but ask if you can start filming as soon as baby is born & stable (they let us do so. LOL, my doula is on tape saying, “Oh, do you want me to stop filming while you get your stitches taken care of?” hehe)

Questions for OB-

- C/S rate
He may have lots of CSs due to no-VBAC. Many hospitals “ban” VBAC because they’re simply following the ACOG recommendation not to do it unless they meet a bunch of conditions such as 24-hour anesthesia, etc. To really get an idea of how quickly your OB reaches for the knife, I’d ask about what he considers “failure to progress.”
1. Under what circumstances do you feel CS is necessary for FTP?
2. What other steps do you take first to encourage labor to continue before moving to CS?

- episiotomy rate
Rather than just hearing a percentage rate, I’d want to know under what circumstances do you do episiotomy? If it’s anything other than ‘fetal distress” I’d be worried! If he mentions “shoulder dystocia,” as a cause of episiotomy, ask what OTHER techniques he will try first to fix this scenario (There’s something called the “Gaskin Maneuver” named after famous MW Ina May Gaskin!)

You might also want to ask what steps he takes to PROTECT the perineum (rather than deliberately damaging it! Which is what episiotomy is!) Such as counter pressure.

- Do you accept clients with doulas?
If you really want to know the OBs philosophy of birth, I’d suggest asking “What do you think of doulas?” It’s probably likely most OBs would “permit” them – but do they dread them, or appreciate the many benefits they bring?

- When do you feel an induction is necessary? Techniques?
- What would you reccomend if baby is above average size?
- What would you suggest if I was 42 weks and had no signs of labor?
- What are your thoughts on cord clamping?

Great open-ended Qs here!

- What are your thoughts on eating and drinking? (would this be part of hospital protocol?)
Again, I love how you ask, “What are your thoughts?” as opposed to “will I be permitted.”
As far as hospital protocol is concerned, your OB CAN deviate. Hehe.. I knew my hospital protocol was to allow laboring women to drink clear fluids, but not eat. But I pretended not to know & asked my MW. She said,
<deep sigh> Pause, “Well…. I would say…. Just don’t ask. Just go ahead & eat.” Ha! She didn’t explicitly confirm for me that eating isn’t allowed, but she implied, “I don’t care what hospital policy is – you can eat!”

Things to add:
--Will he be there while you labor, or just monitor over the phone & show up for pushing? (I hear stories of women being told to WAIT to push for the doc to arrive. Oh man, that would tick me off!)

--Fetal monitoring!!
I’d leave this open ended & ask what their policies are. If he says you’ll be hooked up to EFM and then stops talking.. red flag! Continuous EFM for low-risk pregnancies does NOTHING but increase the intervention rate (doesn’t improve outcomes for babies & moms AT ALL). So I’d want to hear, “EFM for 10-15 min every hour.” I’d also ask if you could just have intermittent Doppler monitoring.

If they do have any options for hydrotherapy (bath, shower), under what conditions would you NOT be allowed to use it? The list of things that would stop you from using the bath tub at my hospital was HUGE! So I’d want to see that.

-- How does he manage 2nd stage?
I’d phrase it like that & leave it open-ended, but what I really want to know is, does he encourage you to be on your back or semi-reclined, or encourage you to be in whatever position works for you. (Of course, if he rarely sees un-medicated Moms, the idea of a mom pushing on hands & knees would be really unusual to him.)

Does he do directed-pushing, hold your breath & count? (Again, if 90%+ of his moms are medicated, he may just do this out of habit since I believe it’s necessary if you can’t feel anything! But I’d want to be sure he was at least OPEN To the idea of letting you work with your body without being “bossed around.” Personally, it was really important to me to not feel bossed around!

What else is available in the hospital? – squat bars, ropes to dangle from, birthing stools, balls, etc. But that you could find out on the hospital tour. No need to bug your OB with that Q.
Of course…. You could ask the OB his opinion on each of those tools. I’ll never forget on my hospital tour, the nurse says, “We used to have a birthing stool, but all the docs hated to use it.” (I guess cuz it was hard for them to see, they had to practically lay on the floor. I don’t know for sure, she didn’t say why.)
She continued, “They never liked it, and then it somehow disappeared. Hahaha.”

She thought it was funny that the docs got rid of a tool that would help laboring Moms because THEY didn’t like it.

Sorry, call me crabby, but I find NO humor in that whatsoever.

--How does he manage 3rd stage?
Again, I’d ask that open-ended Q, but I’d want to know if he pulls on the cord to get the placenta out. If he always prophylactically administers Pitocin to get the uterus to clamp down & thus reduce the risk of hemorrhage (as another posters OB does), or does he encourage Moms to BF instead & just wait & see if drugs are necessary?

[ASusan]

My experience on the hospital tour was that I was the only one asking questions. If that made me look like a buffoon, so be it. After several responses on the tour, it became clear to me that anything that went "against" hospital policy was up to my doctor. (like being able to eat/drink during labor, or delay an internal exam). Thus, the necessity of having a specific, doctor-approved-and-signed BIRTH PLAN to give permission became all the more clear. (and I also learned not to call it a birth plan, but a "birth preferences" list. I flat-out refused to call it a "wish list" as advised. Neither the doctor nor the hospital have the power to grant wishes.)

I also agree with PP who suggested doling out questions to the OB in small doses. For the first session, pick the top 3 which give you really important information, yet make you look smart (not too smart as you don't want to threaten, but smarter than the average birthing woman). I always made sure my OB appointments included a sit-down in the doctor's office (me dressed and off the exam table in another room - his office - usually with a notebook or clipboard). Also plan the questions so that you address each issue on your birth plan well in advance of the OB agreeing to it/signinig it. And you do want this document signed and in your chart by...I'd say 34 weeks.

Good luck!

[wrzos]

Not to be a total party pooper - but thought I'd share my experience as well! All questions at the hospital that involved me going 'against' hospital protocol - were referred by hospital staff back to my care provider. My care provider then stated they couldn't go against hospital protocol. Nice big circle they put themselves in - with no way to break out. :

just be prepared to get the run around....

[meganmarie]

All questions at the hospital that involved me going 'against' hospital protocol - were referred by hospital staff back to my care provider. My care provider then stated they couldn't go against hospital protocol. Nice big circle they put themselves in

After several responses on the tour, it became clear to me that anything that went "against" hospital policy was up to my doctor. (like being able to eat/drink during labor, or delay an internal exam). Thus, the necessity of having a specific, doctor-approved-and-signed BIRTH PLAN to give permission became all the more clear.

:

If the doctor agrees to your birth plan ahead of time, the nurses can reference that during those hours before he shows up, when they would otherwise revert to "hospital policy." Routine use of EFM, IVs, pitocin, and limits on eating/drinking are all good examples of things that hospitals would normally do but an OB could "waive" for you. Make sure a copy of your birth plan is signed by your OB and placed in your medical chart.

[TCMoulton]

Something that was important to me but often isn't thought of is if the rooms on the maternity floor are all private rooms or if some have more than one patient in them. When my 1st DD was born the hospital did have a small number of rooms with two beds that they only used if the floor was overcrowded. Having a private room was important to me so we inquired about it and found out that if there was a chance we could get stuck with a roommate we could request a private room and that it would cost us $100 a day above what insurance covered. By the time I had my 2nd DD it was no longer an issue as the floor is all private rooms now after a recent renovation.

[nashvillemidwife]

Originally Posted by meganmarie

Make sure a copy of your birth plan is signed by your OB and placed in your medical chart.

And this needs to be done before the doctor faxes your chart to the hospital, which is usually around 36 weeks.