Can I violate "hospital policy" on wearing a fetal monitor? - Mothering Forums

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#1 of 71 Old 07-13-2007, 01:05 AM - Thread Starter
 
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Hey there - trying to figure out what my rights are, going into trying to have a vbac in August...

My midwife informed me at my last appointment that it's "hospital policy" that anyone attempting vbac has to be on constant fetal monitoring. I don't feel like this is necessary, especially because my previous cesarean was due to the baby's positioning. I don't object to periodic monitoring, but the midwife says that I won't be permitted to use the whirlpool tub because of the constant fetal monitoring required. I want to have the tub option - with ds it helped immensely with labor (I was fully dilated without meds before I had the cesarean). I suppose if there is no other option and it's the safest thing to do, I'll go along with the monitoring, but am I really required to? And will it really make things much safer than just checking the baby every 30 minutes or so? My midwife for ds had me sit up in the tub every 30 minutes to check the baby, and it didn't seem like a huge problem or anything...

Anyway, opinions?
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#2 of 71 Old 07-13-2007, 01:18 AM
 
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You can refuse anything. It is your body! Just prepare yourself for not so happy staff, or find other ways around it.

Allison wife and mom to four. 

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#3 of 71 Old 07-13-2007, 01:23 AM
 
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You can refuse anything and everything. And they can make your life miserable.

I would find a more friendly birth place.

Have you considered homebirth?

good luck!

-Angela
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#4 of 71 Old 07-13-2007, 09:25 AM
 
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Yes, technically you can refuse it, but they might not be very nice to you. I probably wouldn't let them know ahead of time. I did have a friend who managed to avoid a lot of their monitoring by going to the bathroom a lot, and staying there and laboring on the toilet in the dark. They did get mad at her though. I have heard that one of the hospitals around me (the one that doesn't ban vbacs) has a telemtry monitor that makes it easier to be up and moving around while giving in to their demands of CFM.


I have to second Angela's suggestion on homebirth, but as another mom planning a VBAC for next time, I know how hard it is to find that option when going for a VBAC! If you do have to go to the hospital, stay at home and labor there as long as possible (get a doula to help if you haven't already).
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#5 of 71 Old 07-13-2007, 09:48 AM
 
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I'll probably get strung up by my toes for suggesting this on MDC, but if you're committed to this hospital, and like your care providers other than this issue... I'd probably try to compromise with them. Say, 5-10 minutes of monitoring every hour or 2. Gives them their precious "strip" to stare at, and leaves you free to move most of the time.

But no, you don't HAVE to. You can refuse anything. Like Turtlewomyn's friend, I'd unplug the monitors to go hang out in the bathroom or walk around or whatever. Drove the nurses batty (at my hospital, they can watch the monitors from the nurses' station), but they couldn't do a whole lot about it.

Or you could have a homebirth. Or, if it's possible in your area, find another hospital or care provider with less strict policies. There's very little you have to do. You've almost always got options.
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#6 of 71 Old 07-13-2007, 12:07 PM
 
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You don't HAVE to do anything you don't want to.
When you register at the hospital, go ahead of time and take the forms home to read over and modify. Specify on the forms what you DON'T want i.e. EFM, Episiotomy, epi. etc. then sign, photocopy and return the forms. That way they have to specifically ask your permission at the time to do anything you've specifically denied.

I would strongly suggest labouring at home as long as possible or even trying for a home birth.

DH and I - totally winging life with our four children, DS1 (6.5yrs), DS2 (5yrs), DD (3yrs) and DS3 (1)!

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#7 of 71 Old 07-13-2007, 12:14 PM
 
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Another here for laboring at home as long as possible.

I would also recommend getting a doula.

For my own perssonal story, I was going to do a vbac in a hospital, but with every prenatal I became increasingly aware from the cnm that the vbac was not going to happen so I started looking into doing a homebirth. I found a great midwife who would attend(after interviewing about 15 midwives) and pulled my records for her and got to read them myself and my cnm with the clinic blatantly said in my medical record, patient wants a vbac, but it will not happen due to history(my first baby wasy big at 11#'s). Long story short, I opted for the hbac and it was the best decision I ever made.
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#8 of 71 Old 07-13-2007, 12:31 PM
 
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Yes, technically you can refuse it, but they might not be very nice to you.
This was my experience. At one point with periodic monitoring it was incredibly uncomfortable to be in the position they wanted me to be in. I tried to offer some kind of compromise - I don't even remember what it was - something like - OK, I'll lie down for you, but you have to let me.... (something else).

The nurse went all apeshit authoritarian on me. I guess no one had ever dared suggest a compromise. I think my doula got the nurse out of the room at that point. And pehaps DH stepped in. I thought I was being nice, offering her a way to get her damn strip. I think that nurse went off duty soon after and I got a better nurse.

Really, you don't need crappy people around you when you are laboring.

PS. I didn't have VBAC.

Third generation WOHM. I work by choice.
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#9 of 71 Old 07-13-2007, 04:07 PM - Thread Starter
 
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Well, I'd love to have a hb, but I'm due in a month, but we live an hour from the nearest hospital, so I don't think I'd feel comfortable doing it... I also can't imagine I could find a midwife who would take me with only a month to go. And I really do like my midwife - it's the hospital staff I'm more worried about.

I think my biggest concern is never being sure when an intervention is being proposed because it's necessary, and when it's suggested just because of medicalization of childbirth. And even harder after having a cesarean to know what's safest.
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#10 of 71 Old 07-13-2007, 04:14 PM
 
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Can you write up a birth plan and present it to the staff the second you walk in there so they are fully aware of your wishes?
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#11 of 71 Old 07-13-2007, 04:37 PM
 
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Haven't read all the other post...

I did the intermittent monitoring with my last birth. The nurse I had knew I was knowledgable and prepared for birth. I went to the hospital in advanced labor and was handling it well. I did refuse continous monitoring. I did agree to the intermittent monitoring. As long as they saw everything looked good on a piece of paper.... they were happy. Plus, they knew they had my cooperation if anything out of the normal happened. Once the monitoring showed some signs of distress (after the doctor was verbally abusive and tried to forcefully break my water after I told him not to). But when I calmed down, so did my DD. I was "allowed" off EFM once again. Also, I most uncomfortable when on EFM. But having my doula hold the thing in place while I tried to get in a better position helped.

The reason they want to use continous monitoring is a decrease in the fetal heart rate is the first sign of uterine rupture. In case of an emergency, they can get you to the OR ASAP. But I would venture to say if you are truly in tune with your body, I think you would know when something feels different. But it does give the doctors a sense of them doing their job. (Remember, they think they have to save/ deliever you from birth.) And if something out of the ordinary did happen... they would have that silly strip of paper to prove they were doing what was "necessary".

Position of the baby is very important. Don't wait till labor begins to get baby in a good position. Here is an article about optimal fetal positioning: http://www.homebirth.org.uk/ofp.htm Spinningbabies.com always has great info also.

Have a wonderful birth!
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#12 of 71 Old 07-13-2007, 05:48 PM
 
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Ditto what the others said. "Hospital policy" never trumps your right to autonomy nor your ability to give informed refusal for any intervention as a pregnant and laboring woman. Period.
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#13 of 71 Old 07-14-2007, 07:44 AM
 
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If your last baby was a c-section b/c of fetal positioning, I'd highly recommend chiropractic care between now and delivery so that this baby can get into the best birthing position. Check out www.icpa4kids.org to find a chiropractor near you, and look for one that knows Webster's technique, a technique specific for pregnant women.

Good luck to you. I agree with the pp about trying to see if you can do intermittent monitoring as long as there are no concerns on the strip, but depending on the hospital, it could be a hard sell.
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#14 of 71 Old 07-14-2007, 10:29 AM
 
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Technically you can refuse things but it's not very easy while in labor and there can be a lot of scare tactics used. Can you go to a more supportive place or do HB?
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#15 of 71 Old 07-14-2007, 07:29 PM
 
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I comprimised on 2 things, a forearm insertion heplock and intermitant fetal monitoring done by a nurse not a strappy belt thing. She even monitored me while I was in the tub and it wasnt intrusive at all.

I felt like the hospital staff was ok with the compromise. Ask about water proof monitors, I know they make them since I had intermitent monitoring in the tub at the birth center as well.

You can refuse anything but do it before you are in labor. Your ability to stand up for yourself while in labor land is difficult and hard to stay in a good pattern. I went and talked to the head of labor and delivery nurse and gave loads of copies of my birth plan and signed all waivers well before labor started.

Of course all copies of my birth plan mysteriously disapeared but I brought extras and we did have to ask for anouther nurse once but the second one was a doll!!
Angela
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#16 of 71 Old 07-14-2007, 10:08 PM
 
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That's a tough situation to be in. I would be doing what you are if I were in your situation. WHen I chose a Hbac, one of the biggest factors is that I live in the city so the hospital was only five minutes away.

I would study about birth as much as possible, what all the interventions are etc. Have you checked out http://www.midwiferytoday.com That is a great source of info.

Do you have a doula?
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#17 of 71 Old 07-15-2007, 06:08 PM
 
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It is also my hospital's policy to have CFM during VBAC births. Both times I clearly stated my wishes to my OB to remain mobile throughout the birth. I said I would agree to CFM only if I had a telemtry unit made available. When I went into labor with each of my VBAC's (I have had 2), the Dr.'s on call agreed to intermittent monitoring only despite hospital "policy".

I agree with everything PP's say: consider a homebirth, hire a doula, find out if they have telemtry units at the hospital, labor at home as long as possible and finally, if you end up strapped to the monitor go to the bathroom as much as possible. Good luck! I wish you the best.
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#18 of 71 Old 07-16-2007, 01:05 AM - Thread Starter
 
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That's a tough situation to be in. I would be doing what you are if I were in your situation. WHen I chose a Hbac, one of the biggest factors is that I live in the city so the hospital was only five minutes away.

I would study about birth as much as possible, what all the interventions are etc. Have you checked out http://www.midwiferytoday.com That is a great source of info.

Do you have a doula?
I haven't gotten a doula, because what I really really want - and what I wanted with my ds (the previous cesarean) is to be ALONE in labor. I know this sounds crazy, but I just have no desire to have anyone there at all. So adding another person into the mix just doesn't seem for me. I always wonder if I had just "braved" it and walked off into the field to have the baby last time if he wouldn't have gotten "stuck" at all. I just feel like a really private person, and with both my 13 year old and my son, in labor I felt like I just got really into my own head or something. With ds, I barely made a sound the whole time, and never wanted to talk to anyone or ask anyone for anything. I just wanted to sit in the tub and deal with my feelings myself. And I almost felt like I was "supposed" to be in more pain than I actually was experiencing because I had my husband and a friend and the midwife and the nurse all standing around focusing on me, and I really didn't like it. Does this sound insane? Seems like "most" women really want people there - I don't know...

Anyway, with ds, I was reading all these stories about women who had solitary labor and childbirth, but being an hour away from a hospital just was too scary for me. And still is, because there's really no way for me to be sure if the baby would have been ok if I had just done what I wanted, or to know that there won't be a very real problem with this one, because no one seems to be really clear on why ds got "stuck" - they say it may have been just a fluke, or it may have been a problem with his size - so if I have another baby of similar size, the same thing could happen.

I'm thinking at my next midwife appointment, I'm going to tell her that I'm willing to do the intermittent monitoring - or even do constant monitoring for the first hour I'm there and then take the monitor off and switch to intermittent if everything is normal. I feel like the more medicalized things get, the more it's all going to get into my head and psyche me out of a normal birth. Wish I lived closer to the hospital - I'd just go ahead and stay home!
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#19 of 71 Old 07-16-2007, 01:14 AM
 
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Have you considered a homebirth with a midwife? Many are willing to leave you alone and stay in another room. But you'd still have someone there for your concerns.

good luck!

-Angela
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#20 of 71 Old 07-18-2007, 12:02 PM - Thread Starter
 
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I can't do homebirth because I'm in VA and it's basically been criminalized here - so the midwives who take the risk generally aren't willing to take VBAC's unless you've already done one - because they're already breaking the law, so...

My husband actually just suggested going down to the Farm in TN, because they supposedly will take short-notice folks sometimes, but I'm not sure I want to go so far... I've been reading Ina May's Guide to Childbirth, though, and they have a 98% VBAC rate! Just wish we had options like that where I live.:
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#21 of 71 Old 07-18-2007, 12:31 PM
 
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Research nearby states. I bet a state closer than TN has a birth center that would take you.

-Angela
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#22 of 71 Old 07-18-2007, 05:27 PM
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i have the same concern. i wonder how much i should ask my midwife about what she is willing to do to help me "bend" hospital procedure. at our first visit, when i asked about it, she gave a very short answer which my husband interpreted as saying that she will work with us, but i just can't get a feel for where she stands.
she said that she only knows of one doula who works at this hospital and that it is only with hacidic (i know i've spelled that wrong) jewish women. buttttt- the hospital has one of the highest vbac/lowest c-cection rates in the country. they must be doing something right.

if i ask too many questions that make me seem like a "trouble maker" could she deny my care? i mean, i guess it will all be discussed when i finish my birth plan anyway- i am just worried.

two girls and another on the way in feburary!
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#23 of 71 Old 07-18-2007, 07:03 PM - Thread Starter
 
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I think if your midwife wants to drop you because you ask too many questions, you'd be better off with another midwife anyway! :

I'm going for the birth center tour on Tuesday, and have no idea what I'm going to do if they start listing a bunch of policies I can't live with - I'll flip, for example, if they say "no food or drink." I know I should have looked into this all months ago, but I wanted a midwife so badly, and this was the only one left within 100 miles that takes my insurance. It's all so frustrating! I keep fantasizing about just having an "accidental" unattended homebirth, but feel like I want to be responsible since there was a problem in the last one. But was the problem real, or caused by being at the hospital?!? ARGH!!!
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#24 of 71 Old 07-18-2007, 08:19 PM
 
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I think if your midwife wants to drop you because you ask too many questions, you'd be better off with another midwife anyway! :
Isn't that the truth? I've got a billion questions on my list and the last one always is "do you mind answering so many questions?"



-Angela
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#25 of 71 Old 07-19-2007, 10:13 PM
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yea, i think i am overthinking things. i have had my 2 yr old at each appointment and been erring on the side of brief rather than struggle which has left me feeling pretty doubtful. i think i will just have my dh watch her next time and go in with a loaded list of questions. trouble is that she is the only midwife on staten island! i went to brooklyn last time, but my hospital was awful and the commute a little dumb when a hospital with such a good birthing rep. is right here.

two girls and another on the way in feburary!
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#26 of 71 Old 07-22-2007, 04:19 PM
 
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I can't do homebirth because I'm in VA and it's basically been criminalized here - so the midwives who take the risk generally aren't willing to take VBAC's unless you've already done one - because they're already breaking the law, so...

My husband actually just suggested going down to the Farm in TN, because they supposedly will take short-notice folks sometimes, but I'm not sure I want to go so far... I've been reading Ina May's Guide to Childbirth, though, and they have a 98% VBAC rate! Just wish we had options like that where I live.:
My twin sis had a first vbac at home in Virginia, in November. I don't if the law has recently changed, but she was able to have her HBAC with a midwife at home. She also switched from a hospital really late in the game, around 36 weeks like you I believe. Her name here is americastamps if you want to PM her.

Mama to my spirited J, and L, my homebirth: baby especially DTaP, MMR (family vax injuries)
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#27 of 71 Old 07-22-2007, 04:32 PM
 
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The bottom line like others have said is that you can refuse anything. I would make sure that your midwife knows what you'd like before hand though. It would be really sad to get there in labor and then have a fight between you and staff and not have the back up of your midwife.

When we have patients that want to have something different than the protocol the docs/midwives have to write that order. The EFM strip is the sole responsibility of that nurse (not the doc), so if the doc did not say that you can be monitored intermittently and something goes wrong the nurse is the one that fingers would be pointed at. It's unfortunate but true that the thought of a lawsuit or job loss can make people pretty grumpy when things are done by protocol.

That said, I'd stay home as long as possible, maybe you'll get there and be ready to push and you won't even have to worry about the protocols.

Crystal, wife to John, mama to Jordan 11, Callie 6 and Laney 1.5, expecting baby #4 in Aug 2010
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#28 of 71 Old 07-25-2007, 11:20 AM - Thread Starter
 
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So, after the comments of an earlier poster whose sister had a HBAC in Virginia, I did some more research, called an Ican leader about an hour away, etc. and found out that I have completely been misled, and that not only was the law changed some time back permitting legal homebirths in VA, there are midwives in the area who will do HBAC, no problem. Except NOW the problem is that I'm 36 weeks and am trying to frantically find a midwife willing to take me this late and attend a homebirth... ARGH!

So I'm feeling really angry at the practice I go to, because both a doctor AND my midwife told me that not only would no local midwife do a HBAC, that it was ILLEGAL for them to do it!! And to make matters worse, we went on the hospital tour last night, and they said:

In emergency c-sections (unscheduled), they don't let the father/partner/midwife in the operating room, and no one could tell me how long until either parent gets to hold the baby!

They don't encourage cosleeping with moms and babies "because of the SIDS" - AAAAARRRRRRGGGGGHHHH!

They won't allow a parent to be present during any "routine" procedure such as heel-sticking/eye drops/etc "because of patient confidentiality in the nursery" - though dad can "watch through the nursery window."

I asked how I can refuse hospital routines, and the nurses just stared at me and then looked at each other like morons. They were all like "We don't know how to answer that question." In the end, they told me to ask my midwife. WHAT? I'm the FIRST WOMAN at this hospital to ever want a waiver for certain procedures???

The tour guide for this tour, by the way, simply quit answering our questions at the end, because "we all have other places to be." I AM ON THE VERGE OF FLIPPING OUT. I have to find some other situation before I go into labor. And I am just kicking myself for being stupid enough to assume that having a midwife and a "progressive" medical practice and a hospital that CLAIMS to be VBAC-friendly and "family-centered" would mean getting what I want.
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#29 of 71 Old 07-28-2007, 01:06 AM
 
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The nurse went all apeshit authoritarian on me. I guess no one had ever dared suggest a compromise. I think my doula got the nurse out of the room at that point. And pehaps DH stepped in. I thought I was being nice, offering her a way to get her damn strip. I think that nurse went off duty soon after and I got a better nurse.

Really, you don't need crappy people around you when you are laboring.
Exactly what happened to me! That's when i decided i had to pee....alot

In love with the Hubs (6-03) & : Kookie Pookie Girl (c/s 5-05) & Bouncy Big Boy (vbac 2-07) & : Miss Cheeky Cheeks (hbac 11-08) 100*90* 100lbs = Las Vegas : Almost there!
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#30 of 71 Old 07-28-2007, 01:24 AM
 
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So, after the comments of an earlier poster whose sister had a HBAC in Virginia, I did some more research, called an Ican leader about an hour away, etc. and found out that I have completely been misled, and that not only was the law changed some time back permitting legal homebirths in VA, there are midwives in the area who will do HBAC, no problem. Except NOW the problem is that I'm 36 weeks and am trying to frantically find a midwife willing to take me this late and attend a homebirth... ARGH!

So I'm feeling really angry at the practice I go to, because both a doctor AND my midwife told me that not only would no local midwife do a HBAC, that it was ILLEGAL for them to do it!! And to make matters worse, we went on the hospital tour last night, and they said:

In emergency c-sections (unscheduled), they don't let the father/partner/midwife in the operating room, and no one could tell me how long until either parent gets to hold the baby!

They don't encourage cosleeping with moms and babies "because of the SIDS" - AAAAARRRRRRGGGGGHHHH!

They won't allow a parent to be present during any "routine" procedure such as heel-sticking/eye drops/etc "because of patient confidentiality in the nursery" - though dad can "watch through the nursery window."

I asked how I can refuse hospital routines, and the nurses just stared at me and then looked at each other like morons. They were all like "We don't know how to answer that question." In the end, they told me to ask my midwife. WHAT? I'm the FIRST WOMAN at this hospital to ever want a waiver for certain procedures???

The tour guide for this tour, by the way, simply quit answering our questions at the end, because "we all have other places to be." I AM ON THE VERGE OF FLIPPING OUT. I have to find some other situation before I go into labor. And I am just kicking myself for being stupid enough to assume that having a midwife and a "progressive" medical practice and a hospital that CLAIMS to be VBAC-friendly and "family-centered" would mean getting what I want.
Oh man mama! I am so sorry! THis sounds just like me. Don't worry- I found a blessing of a midwife at 38 weeks! I'll pray and cross my fingers and focus all my energy on you finding a HBAC midwife NOW! That whole practice/hospital sounds incredibly scary and dangerous! :
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