Did have a positive hospital birth? How did you ensure your wishes were respected? - Mothering Forums

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#1 of 34 Old 07-05-2005, 08:34 PM - Thread Starter
 
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The chances of my insurance covering my homebirth midwifery care aren't looking good. Its not an impossibility yet, but I need to be planning an alternative. I need to prepare for the fact that I may need to see an OB and deliver in a hospital.

I wish dh and I were comfortable with the idea of an unassisted pregnancy and birth, but neither of us are. I had a very medicated awful delivery with my son. I had pre-eclampsia and an induction AND a 4th degree episiotomy. With my daughter I had a scheduled c/s to prevent another 4th degree episiotomy : Yes, I regret that decision VERY much. My ob scared me into that choice. Threats of a non working sphincter by age 50.

Anywho, *if* I deliver in a hospital I want to be able to labor and deliver as if I were at home without any medical interventions. My hospital would make me sign a form promising not to sue if my vbac goes awry. The ob's themselves are actually very supportive of the choice to vbac, its their malpractice insurance providors that are making this stupid rule.

Can anyone share their experiences and preperations for a natural labor in a hospital? I don't want to be tied to any monitors or IV's. I want to bring my own food and eat when I'm hungry, drink when I'm thirsty etc... Maybe if I threaten to go home and deliver alone they would let me do what I wanted :LOL

Thanks Mamas
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#2 of 34 Old 07-05-2005, 09:03 PM
 
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I think you can. I would REALLY suggest having a doula or someone that can advocate for you at the hospital.

I had a great hospital birth with dd with midwives - the one thing that I would have changed would have been a doula to make sure that the monitoring that they wanted when I got to the hospital wasn't in a bed, but that i could still moving around. i ended up with an epidural, but honestly had the easiest labor.

this time it's a different hospital and different midwives, and we are hiring a doula. esp. since you will have an ob since you are going for a vbac, the doula will be great and provide a good buffer btwn you and the nurses.
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#3 of 34 Old 07-05-2005, 09:05 PM
 
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oh, re the monitoring.....mine want to monitor the baby when I arrive, and will do so as i sit in a rocking chair, stand, use the birthing ball, etc. unless the baby is sleeping, takes 10 min. if the baby is sleeping, the mwives give juice, do whatever they can to wake the baby up and get the monitoring over with.

most hospitals have rooms that have telemetry machines - ie cordless monitors for intermittent checking.

that was what did me in with my dd - they monitored me IN BED for an hr when i arrived, and ctx's were 2 min apart. no one bothered to say that dd was sleepign and suggest ways to wake her up and get her moving.

re the food/drink - i would just bring it and not make a big deal about it.
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#4 of 34 Old 07-05-2005, 09:26 PM
 
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I had two wonderful, natural hospital births at two different large Boston hospitals.

I was polite in expressing my wishes and received nothing but support. I told my OB before my deliveries my wishes and they were in my chart when I arrived at both hospitals. I was encouraged to walk, encouraged to get in the water, change positions, etc. They not only respected my wishes to have natural deliveries, but helped me reach that goal by highly praising me for my choice. (I thought that was impressive!) With my first, I got to a point where I was convinced I couldn't go any further without drugs and the nurse and OB gently reminded me that I wanted a natural birth and that I could do it. Her encouragement was just what I needed.
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#5 of 34 Old 07-05-2005, 10:05 PM
 
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Honestly? Given that you're looking at a vbac I wouldn't set foot in a hospital. I bet you can find a midwife to work with you on payment. I really think homebirth is your best bet.



-Angela
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#6 of 34 Old 07-06-2005, 10:48 AM
 
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I had an AWESOME hospital VBAC that I wouldn't trade for anything. The key to my success was an experienced Doula who had attended several VBACs and my L&D nurse (who was requested by us). The Doula knew which L&D nurse to ask for and picked one who had just completed her Midwife training. They also knew what I should/could refuse to have a succesful VBAC. I was able to eat/drink (although I didn't want anything but ice chips - go figure). I was continuously monitored (but I wanted that). I walked around the room and to the bathroom. I refused some procedures and accepted some interventions (but only if recommended by my nurse/doula). My Doula was worth every penny and more!!!

Feel free to email/pm me with any questions.
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#7 of 34 Old 07-06-2005, 11:00 AM
 
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Maybe you can write down some scenarios that you fear most and think of approbiate answers that your doula/husband could give?

Maybe that would be comforting, in the end they can't force you into anything or can you actually imagine a nurse comming and just taking the food away if someone explicitly said she's not allowed to touch your belongings or whatever ( something smarter and wittier :LOL ) or put their hand up your vagina if you say that they do not have perission to examine you internally unless you request it?
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#8 of 34 Old 07-06-2005, 12:20 PM
 
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I didn't have a VBAC, but did have a fantastic delivery at our local birthing center. It's attached to a women's hospital. We had our doula there, and had written out our birth plan (which the OB had copies of, the doula had copies and we had copies!) Our doula made sure the nurses knew what we did and didn't want. I had a fast labor, so when I arrived I was 7cm with back labor. They checked me first thing, and then I was able to go into the shower. I had the urge to push while in the shower so they asked if I wanted to lay on the bed (I did, on my side) and delivered like that. At one point they did put a blood pressure cuff on me, and it was left on during the delivery (just because it was so quick!) but that was it as far as "interventions". I didn't get any needles, meds etc. And because my birth plan said I wanted to try a natural L&D those weren't even offered. We had a cooler of stuff to eat/drink, but didn't even open it until after the delivery.

This time I'm bringing lollipops and Gatorade and that's about it!

If you have a good hospital/birthing center I think you can get the delivery you want. You need to have a birth plan that you've discussed with your OB/MW; I think a doula is important so you have someone else to go to bat for you if issues arise, and that's about it.

Michelle
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#9 of 34 Old 07-06-2005, 12:27 PM
 
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I really think it was my ob/gyn that made my hospital birth so good. He was *very* responsive, and my needs absolutely came first with him. I set up my birth plan with him months ahead of time, and I felt completely confident that he wouldn't c section me unless there was an absolute extreme need--he's not a huge c-sec doc, doesn't do them routinely. I did have a very small episiotomy, but I had said I was okay with that if he truly thought I was about to tear. If I had told him no way, he just plain wouldn't have done it.

My personal advice...find an ob/gyn or midwife or doula who you feel total confidence in. I was able to not worry about all the hospital crap, because I knew my doc would stick up for me. I would never want to worry about advocating for myself during labor, it would be too stressful!

Mom to Liz (14) and Dillon (3) and Mitchell FINALLY born 7/11/10!
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#10 of 34 Old 07-06-2005, 12:35 PM
 
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I loved my hospital experience. The biggest reason? I didn't go to the hospital until I was 8cm dilated. The less time you're there, the less time they have to push protocol.
I checked my own cervix at home during labor, thought I was about 4/5cm, because I felt the bulging bag of water, but since it was my second child, we went to the hospital. I had already talked to my midwives about my wants for birth, which included refusing antibiotics for GBS+. I got monitored for 15 minutes when I got there, but I was able to move around--during a contraction, I would flip onto my hands & knees, and the nurse would get sort of underneath me. I got in the jacuzzi after that, and they left us alone except for the occasional fetal heart rate check that I did not have to get out of the tub for. My midwife was awesome, stretching tissue during delivery (she knew I was afraid of tearing along my old episiotomy scar...I didn't ) the nurse was fantastic, no "cheerleading" pushing coaching AT ALL, cord was cut 30 minutes after birth, he was on my belly for a half hour until they cut the cord, the nurse took him for 2 minutes (still in my room) to wrap him up, and we were discharged 10 hours later.
It was wonderful!

edited to add: my hospital does not routinely do IVs or hep/saline locks or anything like that, so I did not need to insist on any of that sort of stuff.
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#11 of 34 Old 07-06-2005, 12:37 PM
 
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I haven't had a positive hospital birth yet, but I'm really hoping for one this time around. I'm having a VBA2C whenever I go into labour (could be soon...I'm getting the feeling that things are starting to happen, but I can't pin anything down). I don't have a doula or a midwife, but my dh is fully aware of what issues I'm putting my fist down on, and is totally behind me on them.

My OB is...funny. Actually, he's a funny little guy in the first place. But, when I saw him on Monday, he talked about the baby's size (ultrasound, palpation & my own gut feeling all say "big") and about making my "final decision" - which is made! - next week. But, the last thing he said as I left was "just remember - think labour!". He's behind me, but I think he's hoping the baby will arrive sooner, not later.

Anyway...my previous experiences have clicked all my old stubborness into play. Things are going my way, or I'll walk out and have my baby on the sidewalk! The doctors and nurses are supposed to be "care providers" - that means they're there for me, not the other way around. I'm going to keep that in mind, and they can take "policy" and "procedure" and shove it.

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#12 of 34 Old 07-06-2005, 12:38 PM
 
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Originally Posted by dynamohumm6
I loved my hospital experience. The biggest reason? I didn't go to the hospital until I was 8cm dilated. The less time you're there, the less time they have to push protocol.
I think this is generally true, but it depends on the circumstances. I went in at 10cm dilated with ds...and ended up with a c-section half an hour later. I never consented, and never even really believed it was happening until after I woke up from the anesthetic and the sleeping pill they'd given me.

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#13 of 34 Old 07-06-2005, 02:19 PM
 
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(1) Had a midwife

(2) Had a doula

(3) Brought a birth plan that was succinct (they won't read a 5 pager), direct, and respectful (I wanted to avoid coming off as someone who thought they were out to do me bad). I also went over my birthplan with my midwife and doula so I didn;t bother mentioning things that they didn't regularly do.

(4) Brought cookies for the nurses (enough for 2 shifts). I had 8 bags of peppridge farm mint milanos in my hospital bag.

(5) Labored at home as long as possible. I was 9 cm when I got there. This kind of surprised me---I was hoping to be at least 5 (my doula thought I was maybe 7 based on my behavior).

(6) Had a plan for what I would say/do if they tried to do "routine" procedures (like have me sit on the bed for EFM or have an IV. I had talked to my midwife about not wanting an IV and she was cool with this. So if they tried to put an IV in my arm the minute I walked in the door (and before she arrived) I was going to ask if they could call my midwife since we had discussed avoiding and IV (technically they aren't supposed to do stuff like that without a physician/midwife order anyway). This didn't end up happening though.

They did try to get me to sit in the bed for 20 minutes (!) to do EFM. When I told the nurse I couldn't sit during a contraction (I don't see how anyone can), she was a little snarly, but it ended up working out okay. We asked them to bring a birth ball (which they did. I also asked for a rocking chair-not a glider-and a squatting bar. I ended up leaning against the bed and standing and swaying during contractions. You can stand for EFM. You don't have to be sitting.

My doula also did things like ask if it would be okay for her to hold the EFM sensor in place if need be. I mean, of course this would be okay, but she asked more to let them know she wasn't going to try and do something weird, if that makes sense (my hospital was pretty conservative and doulas weren't common).

(7) If they have you on EFM and you want off say you have to go to the bathroom (you want to be peeing at least once an hour anyway--this can help with pain).

(8) Remember that you can always decline a medical procedure.
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#14 of 34 Old 07-06-2005, 02:33 PM
 
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I think that the most important factor in my birthing choices being respected was having a very close relationship with the care provider. She knew exactly what I wanted, knew me personally, and totally was on board with my plan. While she still suggested some intervention (AROM, etc) she knew I'd refuse, and didn't bat an eye.

My husband was an incredible force to be reckoned with in the hospital, and kept my birthing space quiet and calm.

Also, we asked for a nurse who knew about natural birthing. This way, my pain was not shocking or traumatizing for her, and she could relax knowing that I was *fine* and did not need to be offered meds.

I recommend getting a doula! Definitely! And, getting to the hospital as close to transition as possible is a terrific idea!

Amanda
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#15 of 34 Old 07-06-2005, 02:35 PM - Thread Starter
 
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Thank-you everyone for sharing. Hearing your experiences has helped me with what to keep in mind should I decide on a hospital birth.

I am hoping that things are settled soon. I don't want UC or a hospital birth, but I may have to choose between the two (or go into debt having a HB). None of those choices are terrible attractive.
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#16 of 34 Old 07-06-2005, 02:43 PM
 
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I agree with the pp suggestion to not make a huge deal about this--just do it. It's not like they are in the room with you every second and you're not going to want a 4 course meal. Have your DP say it's his/hers if they walk in. A lot of the nurses don't know that there isn't good evidence to support the prohibition against eating, so in their mind this is something very dangerous. Why get into it with them? You have bigger things to worry about. I was more concerned with getting what I wanted than waging a philosophical battle with them about natural childbrith (though if you're up for this I salute you! Ultimately I think the approach you take with the hospital staff should be one that fits with your personality/state-of-being at the time).

I would find out their policy (and your physician/midwife's view) on food/drink in advance so you can be prepared to work around it.
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#17 of 34 Old 07-07-2005, 03:55 PM
 
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I second the advice to stay at home as long as possible. Also, like zeldamom said they pretty much leave you to you own devices in the hospital, I guess unless you have special circumstances, up until delivery time. And making your wishes politely known before that time will help avoid any problems then.

Good luck!
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#18 of 34 Old 07-08-2005, 02:30 AM
 
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Well, I gave birth at Good Sam...

I don't know if I could have had an intervention-free birth. I was up front about what I wanted, but then let them talk me into things. When you are exhausted and in pain and wanting to get things over with so you can sleep, you will be highly suggestible. They even asked if I wanted a c-section! Of course, I wanted one; I wanted to be knocked out!

The first mistake was to allow the monitoring. They tell you it's just for 20 minutes. Well, 20 minutes is a long time. And you do have to sit or lie down while they do it. I'd recommend you not allow the EFM at all.

The second mistake was to allow AROM. They told me it would speed things up and I figured, what's the harm? It sped things up all right, but made them so much more unbearable.

They say they "allow" women to use different pushing positions but IME they don't really help you do anything but on your back. So bring a doula who knows how to help you push in hands-and-knees or a squatting position.

You could also try to refuse cervical checks, so you will push only when you are ready and not when they tell you to.

Also, I hear the best way to increase your chance of a hospital VBAC is to show up while you are in transition or pushing, and to lie about how long you have been in labor. They probably have some sort of time limit, so lie and say it's only been 2 hours or so.

I ended up delivering on my back in stirrups with forceps. It probably could have been avoided. Basically, I let myself get talked into all the interventions because I was tired, in pain, and everyone there was so nice. I wouldn't call it a bad birth experience, but still...

So again, if you are a strong person who can say no to everything in spite of the measures people will try and take to get you to give in, this might work.

Oh, but I was never once offered an epidural or any other drug, and Linda never left my sight after she was born. Some things can be insisted upon.
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#19 of 34 Old 07-08-2005, 03:01 AM
 
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Originally Posted by Greaseball
The first mistake was to allow the monitoring. They tell you it's just for 20 minutes. Well, 20 minutes is a long time. And you do have to sit or lie down while they do it.
Or at least that's what some nurses try to tell you...

I think 20 seconds sitting or lying down while you are having a contraction is a long time!
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#20 of 34 Old 07-08-2005, 12:41 PM
 
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I had one good hospital birth, and one wonderful hospital birth.

For me, it really helped to have my friend (a bradley teacher) there with me. She could talk to the nurses, reiterate my needs, etc and was very encouraging to me. She's had 2 natural births herself so she had a good idea of what I was feeling. I didn't have to be strong all the time because she was there to do it for me.

My midwife knew my wishes WAY ahead of time, and we'd discussed at length my desire for a drug free, low intervention birth. The nurses did want to place an IV, which is standard operating procedure, but my midwife just said we weren't going to have one. (She did say that I needed to be very well hydrated on my own though, so I had been drinking plenty of water during early labor and the days before hand, and sipped some apple juice throughout the labor process.)

My friend told each nurse that we saw about my birth plans (no meds, low intervention) and really most of them just left me alone. There wasn't much for them to do, and they had other patients that did want the meds and interventions, so fortunately, we were left alone most of the time. I did have to sign various releases, but that's just standard procedure too.

Cervical checks....I asked for one, and then the only other one was near the end of labor. There was a lip of cervix left and I asked her to push it out of the way, lol. There is simply no need for lots of checks, as things can happen slowly or quickly. We weren't even offered checks until the very end.

Since I had no IV, it was easy to move around to find good positions for laboring. When my midwife asked to monitor the hb, she just wanted to do it for a couple of contractions, to make sure the hb came back up after the normal decel during a contraction. I didn't have to lie down though, she just held the monitors on in whatever position I wanted to be in.

There were a few problems right at the end of the birth, and I won't go into those right now, lol. But all was FINE in the end.

I think that consistency and politeness goes a long way in this situation. You don't have to be nasty to the staff, just you (or someone on your behalf) say, "Thank you, but we're not interested in XXXXX." After you say it about 10 times, they might stop offering.

Good luck, and I hope you have a wonderful birth, no matter where it is.

Jennifer
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#21 of 34 Old 07-08-2005, 01:39 PM
 
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My doctor told me on Wednesday that I can move around with the monitoring hooked up, so if I can't, I'm not agreeing to it. As for food, I'll lie if I have to. I didn't want to eat when I was in labour with ds, but I definitely wanted to drink!

And, I do plan to stay at home for as long as I feel comfortable doing so...if it takes me a long time to reach transition, I'll lie to the staff about it. They're really hipped about not "letting" me labour for too long, because it's a VBA2C. Well...they can't really stop me unless they're going to hit me over the head to put in an IV and get me into OR...but I don't need the grief of arguing about it.

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#22 of 34 Old 07-08-2005, 03:21 PM
 
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Originally Posted by Storm Bride
My doctor told me on Wednesday that I can move around with the monitoring hooked up, so if I can't, I'm not agreeing to it.
They try to get you to sit in the bed and be still because when you move around the sensors strapped to your belly can move a bit and quit picking up the baby. The nurses know when this has happened because at the nurse's station they have screens where they keep track of all the laboring mamas at once. So when the monitor stops picking up one of the babies they have to come in to fix it (and maybe fuss at you a little because it's inconvenient for them). This staff convenience issue is not a reason to labor in the bed imo.

The other issue about efm and mobility is most efm machines transmit what the sensors pick up to the machine via cables. So you can stand and move, but you're on a leash so to speak. For me this actually wasn't a big deal. Some places have mobile telemetry units, so they are wireless and you aren't on the leash. You might want to check and see if the place where you're birthing has this.
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#23 of 34 Old 07-08-2005, 03:48 PM
 
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My doctor's looking into telemetry units - she's a substitute, so not quite as familiar with the hospital as my regular doctor is.

I'm not trying to be unfair to the staff, but they're there to help me, not the other way around. There's NO way I'd labour on my back in bed (I don't know how anybody can!) just so they don't have to check on me! And, fussing at me goes poorly for everybody...I've never liked being mothered, which might be why nurses generally get on my nerves.

I don't think being limited to a small area would bother me that much, as long as I can move. If I can't go for long walks around the ward (doesn't sound like that much fun, anyway), then I'll just kind of do the cha cha beside the bed...

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#24 of 34 Old 07-08-2005, 04:11 PM
 
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Originally Posted by Storm Bride
I don't think being limited to a small area would bother me that much, as long as I can move. If I can't go for long walks around the ward (doesn't sound like that much fun, anyway), then I'll just kind of do the cha cha beside the bed...
That's what I did. My prenatal yoga teacher was always having us doing pelvic circles and she would say that bellydancers have the easiest time in labor. So I ended up swaying and circling my hips a lot--the nurses called me the Wiggle Queen. :LOL I also leaned on the bed some too. Some people like to sit on a birth ball for efm.
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#25 of 34 Old 07-08-2005, 06:36 PM
 
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what about the bathing the baby afterwards?? The midwives at my hospital looked at me like I was insane when I said I didn't want my baby scrubbed down (I watched it happening to a baby and the baby screamed the entire time). They didn't give me the impression that it was something anyone had ever refused (or that i could refuse). They did say I could go with the baby when they did it and stay with the baby when it is in its warmer afterwards (they do it in a separate room about an hour after birth).
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#26 of 34 Old 07-08-2005, 07:15 PM
 
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If you're told you can do X, Y, Z, then have that person WRITE it down plus their name. I was told heplock instead of IV was fine - not so to the nurse who tried to put me on an IV. I was told I only needed to be monitored for 15 mins every hour - not so to the nurse who said after 15 mins "you moved, I gotta start again...". I was told after finally consenting to a c/s that they could bring my dd to me in Recovery. Not so, they took her off to an Observation Nursery (even though her Apgars were 8 and 9 and she was fine) for 5 hours.

If I had to have a hospital birth again, I'd try to familiarise myself as much as possible with the hospital policies. And make sure the people who tell you that you can do something are the people who have the power to make it happen. Another issue is that the shifts keep changing in hospitals so just because one doctor said X, doesn't mean the next doctor will agree to it.

I think some of it just comes down to luck. If you get good staff on shift that day and a day where they're not too busy. You can't control those things but having a doula who is familiar with that hospital can be invaluable.
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#27 of 34 Old 07-08-2005, 07:30 PM
 
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Quote:
Originally Posted by wombat
If you're told you can do X, Y, Z, then have that person WRITE it down plus their name. I was told heplock instead of IV was fine - not so to the nurse who tried to put me on an IV. I was told I only needed to be monitored for 15 mins every hour - not so to the nurse who said after 15 mins "you moved, I gotta start again...". I was told after finally consenting to a c/s that they could bring my dd to me in Recovery. Not so, they took her off to an Observation Nursery (even though her Apgars were 8 and 9 and she was fine) for 5 hours.

If I had to have a hospital birth again, I'd try to familiarise myself as much as possible with the hospital policies. And make sure the people who tell you that you can do something are the people who have the power to make it happen. Another issue is that the shifts keep changing in hospitals so just because one doctor said X, doesn't mean the next doctor will agree to it.

I think some of it just comes down to luck. If you get good staff on shift that day and a day where they're not too busy. You can't control those things but having a doula who is familiar with that hospital can be invaluable.
Yeah, don't consent to a medical procedure unless there is a compelling medical reason to do so. Henci Goer's Thinking Woman's Guide is a good book to read to know what is a legitimate medical necessity and what isn't:
www.hencigoer.com

Also, if you have a really horrible nurse, request someone who is a better fit for someone trying to have a natural birth. My midwife told me she had done this in the past.
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#28 of 34 Old 07-08-2005, 10:54 PM
 
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I know I'm jumping in late here and not going to say anything of substance different than pp's, but they DO treat you different when you are attempting a VBAC than a "regular" hospital birth. Fears of lawsuits abound and those fears will come out as hospital/doctor procedures.

My suggestions are:

1) Stay home as long as possible (that is if you can't pull off the homebirth).

2) Get a doula--this was the best $500 I EVER spent in my life.

3) Write out a clear, concise (and brief )birth plan and go over it with anybody pertinent--bring extra copies just in case.

I wish you well and am sending happy VBAC vibes your way!!!!
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#29 of 34 Old 07-09-2005, 12:50 AM
 
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I don't think it's just fear of lawsuits. My family doctor and her sub (who will probably be delivering my baby) both seem really freaked about rupture. The sub has seen at least one, which I have to imagine colours a person's perceptions of these things.

But, they definitely treat VBAC moms differently - you'd think uterine rupture in a VBAC was the only obstetrical emergency in existence!

Lisa, lucky mama of Kelly (3/93) ribboncesarean.gif, Emma (5/03) ribboncesarean.gif, Evan (7/05) ribboncesarean.gif, & Jenna (6/09) ribboncesarean.gif
Loving my amazing dh, James & forever missing ribbonpb.gif Aaron Ambrose ribboncesarean.gif (11/07) ribbonpb.gif

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#30 of 34 Old 07-09-2005, 02:20 AM
 
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Lindsay - if you want a free doula to help you with different positions in labor (I gave birth to Austin at good sam and was in bed on my back too - crappy!), I'm DONA trained and working on my certifying births and would love to help you out, if you want that is.
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