Help me prepare for a hospital birth, please. - Mothering Forums

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#1 of 60 Old 08-18-2005, 03:17 PM - Thread Starter
 
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I'm having a hospital birth. I wasn't able to choose my OB, my insurance does not cover anything else. I've looked into it all. I cannot afford a midwife to even be there. My first labor was in a hospital, as well. I had an epidural and could not feel a thing throughout and even a long time after the delivery. The whole experience was not good, and I ended up having an epidural headache for 2 weeks afterwards, disallowing me from even holding my baby.

I need to prepare myself this time. I'm not going to get an epidural. I've just ordered some books about natural birth (don't remember the names, all have been mentioned here) but what I need to know is what the doctors/nurses might try to do to me that I need to watch out for. I don't want pitocin, and I wonder if an IV is necessary or can I refuse one? I vaguely remember them saying they were putting something in my IV last time, but I don't know what it was.

I guess what I'm asking is... can I legally refuse *everything*? I don't want to be hooked up to a bunch of machines, I want to be able to move around, drink something (last time they told me not to??), that sort of thing. Any thoughts, suggestions, experiences, etc., would be great.

Thanks for listening.
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#2 of 60 Old 08-18-2005, 03:30 PM
 
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You can legally refuse EVERYTHING. For you and your child. If I had no choice but to birth in a hospital (fwiw I would go uc in a heartbeat first) I would:

1. labor at home as long as possible
2. bring at least 2 support people who feel okay standing up to drs.
3. wear my own clothes or nothing
4. refuse everything
5. refuse everything LOUDLY
6. no one could touch me without asking and telling me what they're doing
(support people would enforce this- do not touch her without explaining what you're doing first)
7. NOTHING would break my skin (every skin break is a chance for infection, esp. at the hospital)
8. Nothing would break my baby's skin (see above)
9. baby would NEVER leave my sight
10. baby would never leave the arms of myself or one of my support people
11. check out immediately, even if ama

good luck!

-Angela
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#3 of 60 Old 08-18-2005, 03:50 PM
 
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Angela is right, you are probably best off if you can minimize your time in the hospital both before and after the birth, and are absolutely allowed to refuse everything. Once you get into labor it is pretty hard to keep refusing though so the support people are crucial. If you don't have anyone who will be comfortable in that role, perhaps you can find a doula who would be willing to work with you for reduced fee, a trade of services, a long payment plan, or something like that. I'm sorry you don't have any choices, I've been there and that feels really crappy. I hate that money/insurance is often the reason that people cannot birth where they want to. Big mama!
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#4 of 60 Old 08-18-2005, 03:54 PM
 
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I would strongly suggest you look into a homebirth midwife. At least talk to a few of them, tell them about your insurance situation, and see if they might have an option you hadn't considered yet. My insurance would pay for midwives, but as out-of-network providers, and we do not have a very good policy. The first person I spoke with on the phone didn't know anything about the company they work for (at least when it came to maternity stuff, since we have no specific maternity benefits on our policy), it took several phone calls and long nights reading our policy booklet and their website before I figured it all out. But before that, I had already decided that I was not going to let money interfere with my plans to have the vbac I wanted, even if that meant paying for it for the next five years. You only get one chance to give birth to this baby, and you will live with the memories of it forever.

If that is totally not an option, hire a doula and take Bradley Childbirth Classes. The only women I know IRL who have had natural births in the hospital had experienced doulas there with them.

You can do it! But it will take major planning and preparation, along with a good healthy dose of determination and positive thinking, to make it happen.
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#5 of 60 Old 08-18-2005, 03:57 PM
 
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I think support people are crucial. Make sure you have someone(s) there you are sure is one the page as you. I had a dear friend of mine as a doula, along with my husband at my hospital birth, and it was great. Good luck and happy birthing.
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#6 of 60 Old 08-18-2005, 04:04 PM
 
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Good idea to call around and try. There was a little clause in my insurance that worked out great for me- all surgery was covered at 100%. My midwife managed to put global midwifery care under a code listed under surgery. They covered it at 100% even though it was out of network.

-Angela
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#7 of 60 Old 08-18-2005, 04:14 PM
 
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I also think it would really help to have a doula if you have a hopsital birth. This spring I met a women who was going to go without one for her VBAC in a hospital, even though she wanted one, because of the $$$ issue. She said she didn't feel comfortable telling prospective doulas she couldn't afford their fees. I was a little more blunt than usual and told her I thought she needed to get over that. She did and got a really good doula for free and had a natural VBAC in a hospital with an OB attending.

I think every woman who wants a doula should have one, and I think most doulas feel this way too. Of course they have financial constraints too, so I am sure some can't reduce or waive their fees, but it doesn't hurt to ask imo.

California doulas certified though Doulas of North America:
http://www.dona.org/search/results.p...irth&x=15&y=15

I believe if you conact DONA they will also give you the names of doulas in your area who aren't certified yet. These are typically women who are new who are working toward getting certification. It is common for them to have low/no fees:
http://www.dona.org/contact.php
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#8 of 60 Old 08-18-2005, 04:45 PM
 
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My dd was a hospital birth and honestly I didn't feel like they harassed me at all. You're OB's opinion about those kinds of issues really matters -- mine wanted to check baby's heartbeat once an hour. I was never offerred any drugs, I was allowed to wander the floor just fine (I'm sure I could have gone out of the birthing center, but I never tried). They were cool with people eating (though didn't provide meals). Water and juice and soup were provided if I asked for anything. I also had tons of hotwater for water bottles for my back labor and a nice private shower. One of us was with babe at all times, and they were ok with us refusing any thing we didn't think necessary.

Ultimately I had a csection, but honestly it was a good decision and not one of these deals where I had all sorts of crazy interventions and then the baby had trouble. It was me, laboring for a whole day there in the hospital, with serious back issue and pushing my babe in every imagineable position and deciding baby just wasn't coming. So i think had I done a homebirth I would have been a transfer...

Anyhow, I wanted to write to suggest that if you DO decide an insured hospital birth is what should happen for you it is possible to take some control over your care. The bradley childbirth series of classes in general does a nice job of teaching you how to question what's going on and become a consumer of health care, rather than just a receiver.


Our doula for the current birth told us when we asked "how much?" -- she said "I charge from zero to 400 dollars, whatever you and your husband think you can afford."

And I was also surprised to learn that in this area a homebirth runs about $2000, much much less than many friends have had to pay as copay for a normal vaginal, unmedicated birth.

Kristin -- mom of Erin (11/5/02) and Leah (9/29/05)
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#9 of 60 Old 08-18-2005, 04:49 PM
 
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one more thing....
I was never really antagonistic about refusing anything or asking questions. When I went back to have baby weighed a week later, one of the nurses pulled me aside and thanked me for being calm and polite in refusing services. She said they'd all been talking about how my "team" (dh, me and my doula) had all been really rational and polite. Apparently i had been immediately pegged as a problem patient because I didn't want EFM continuously.

Dunno if my politeness helped my experience, but thought I'd share.

Kristin -- mom of Erin (11/5/02) and Leah (9/29/05)
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#10 of 60 Old 08-18-2005, 05:12 PM
 
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Really good suggestions here. I agree that a doula would be so so helpful.

Good support people are a must.

I also think you should make sure to talk to your doctor. You need your doctor to at least KNOW your wishes, even if they are not particularly supportive. I would also recommend a written birth plan, which clearly states your wishes regarding IVs, pitocin, etc. You cannot be too clear in a birth plan!!! In one place mine said "I would rather suffer a severe tear than have an episiotomy." It doesn't mean that everything will work perfectly but the clearer you are the better.

You can absolutely refuse anything.

Good luck! I had two wonderful hospital births, with very little pressure or problems from the hospital staff. I'm planning a homebirth for the next one (what next one DH will say) but I have no complaints so far.

Also after the baby is born Do Not Let Your Child Out of Your Sight (or DH or DP or trusted supporter).
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#11 of 60 Old 08-18-2005, 05:38 PM
 
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My insurance said they didn't cover homebirths, but they would cover my midwife in a hospital or a birth center. I asked my midwife about it, and she said that she just bills homebirths in a way that is acceptable to the insurance company regardless of where it happened. If you've only spoken to your insurance co, you might want to call a couple midwives-- they may better understand how to navigate the insurance co. Their livlihoods depend on it.

As for preparing for a hospital birth-- I can hear how nervous you are about repeating your previous experience. My friend had an epidural headache for 2 weeks, too, and it sounds terrible! I wouldn't want to repeat it, either! But I also know how hard it is to decline drugs when you're actually in pain! I was yelling for drugs, and I was at home! I know that if I'd been at a hospital, I'd have taken the epidural in a heartbeat. But I also know if I'd been in a hospital, I would have had a c-section. I digress.

1. Find an OB that knows how you feel about the epidural (etc) and is willing to work with you on that.
2. Find the most hands-off hospital in your area. Call midwives and ask them if they had to deliver in a hospital, which hospital they would go to. They'll know.
3. ITA the support people. The only way I can imagine feeling safe in a hospital is with a whole crew of people who know my wishes who are prepared to fend off the staff. You don't want to have to be the one who is doing the fending. You have other things you'll need to be concentrating on. I imagine my dad and FIL sitting outside the door like bouncers. My friend the L & D nurse being my staff liason. My dh and doula tending to me. I imagine four rings of interference between me and the staff-- If the staff decides to take an issue it'll get bumped from my L&D nurse friend to my FIL, who is also a hospital nurse and knows how to navigate the system in a polite fashion, to my dad who is perfectly willing to be the bad cop-- to my husband who has the legal right to speak for me. I don't imagine having to advocate for myself at all. It's a pretty antogonistic picture, but it makes me feel better about the idea of perhaps having to be in a hospital.

Sorry so long! Good-luck! It'll be fine I'm sure!
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#12 of 60 Old 08-18-2005, 09:39 PM
 
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I would agree with the PP who said to discuss it all with your OB now, and really get their take on everything, so you can go away, research and come back with really good reasons why you want to be left alone as much as possible.

eg: say your doc is for continuous foetal monitoring, you could come away, get lots of thorough scientific papers from really good journals to say there is no benefit, and possibly harm in the practice - you're in a much stronger bargaining place when you're fully clothed, calm, with a sheaf of papers in your hand and not in pain than when you're in labour, naked and vulnerable.

I would suggest, like a PP, being very polite, friendly and nice to the staff rather than antagonistic. You'll get a lot further in life by calmly explaining why you'd like something rather than shouting and screaming about it. This is where a doula could help, too. I bet they're experienced in how to deal with recalcitrant staff.
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#13 of 60 Old 08-18-2005, 11:59 PM
 
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Write a birth plan, discuss it with your doctor, get it signed, and have copies. If possible, get a copy placed at the hospital beforehand and also in your doctor's chart for you. *And* have copies with you when you go to the hospital.

You absolutely can refuse anything you're not comfortable with, but, if I were you, I'd pick your battles. Decide which things you're willing to put up with and which you aren't. I'm not saying to give in on things that are important to you, but compromise will probably help your doctor and the hospital staff to be happier with you. Many would say that it's not your job to make them happy, and it isn't, but there is a reality that you want a good relationship with your medical staff.

Expect nevertheless to have to say no alot, repeatedly and firmly. And politely, for that matter. But don't let them push you around on the day. Any compromising, do *beforehand*, on your birth plan. If the nurses insist on arguing with something, refer them politely to your signed birth plan which your doctor endorses. And as much as is possible decide ahead of time what you'll do if circumstances make it necessary for you to change your mind.

I'm in a pretty similar situation to you, actually. And the hospital I'm giving birth in is like a relic from 10-15 years ago, as far as certain things go. So, I offer these things on the basis of my experience with my mother's last two natural hospital births (13 and 15 yrs ago), and on my preparation for this upcoming birth (I'm 36 wks now). Good luck!

Julia

ETA: About IV's- this is one of the things my hospital gets real shirty about, but I won't let them hook me up to one- partly because I don't want to be tied to a stupid stand, but also so they can't just slip some drug in there. They wouldn't let me refuse one without getting nasty, but we compromised on a saline lock (basically an unconnected IV port in your arm). Might work for you too, if they get intrasigent.
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#14 of 60 Old 08-19-2005, 01:04 AM
 
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ITA with all PPs and would add: wait to go to the hospital til the ctx are about 2-3 min apart and lasting 60-90 seconds. You would generally be about 7 cm by then or so, and so when you get to the hospital, it would be just about time to push. I have only had 2 clients who had thier babies in the car, all the others(including my first daughter) had thier babies within a halfhour of getting to the hospital, and no time to interfere , so all had natural births, and the staff was impressed with the clients...most stayed only 24 hrs or less, then went home....and all had some sort of home support, especially for breastfeeding....
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#15 of 60 Old 08-19-2005, 08:36 AM
 
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You have been giving some great suggestions and I am looking into them too as I am planning a hospital birth. You might want to pick your fights so to say, like a PP mentioned if they are being pushy about an IV opt for a hep lock, or sometimes called a saline lock. One thing that always helped me is to know where I am going. Talking to others who have birthed there, espically if they have simialr parenting styles, and going to see the place yourself. Every maternity floor offers tours. Go there with a ton of questions about everything, from epidural rates to pushing positions (is a squat bar easily avaible-some places have them but they are so rarely used that they can't be found) typical baby care, can you follow the baby to the nursery for heel sticks, exams or whatever, where do they weigh, measure and bathe the baby after delivery, and whatever else you can think of. Also talk in depth to your OB about typical procedures, like when do they use pitocen, epsiotomies and all. there are a lot of visits at the end so have something to talk about at every visit.
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#16 of 60 Old 08-19-2005, 11:13 AM
 
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Can I suggest finding out what is legally required and what is not?

For instance, the eye ointment is a legal requirement in Massachusetts. That way, if someone tells you that something is a requirment, you'll know yourself what is a real legal requirment and what is just hospital protocol.
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#17 of 60 Old 08-19-2005, 11:25 AM - Thread Starter
 
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Thank you all for your great insight and suggestions!! I will definitely work on a birth plan and speak more thoroughly to my OB. I've also looked into doulas in my area and there don't seem to be many, but they are definitely a more affordable option. I've discussed this all with my DH but I think when it really came down to it, he cannot stand to see me in pain and would forget all the things I told him.

I would *love* a homebirth, but I'm currently living with my MIL and it's like walking on eggshells lately, plus my DH, despite talking about it several times, is just freaked out about it. And while obviously my daughter's birth is very important to me, I choose my battles and a homebirth would be a VERY big battle.

Anyway, thank you all for your suggestions, this thread itself has made me feel more prepared and confident that I can do this and that it can be a good experience for us.
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#18 of 60 Old 08-19-2005, 11:28 AM
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I think you need to discuss with your OB, and also do a tour of the hospital and ask a ton of questions. Some hospitals are very hands off - when I registered at my hospital, they had me complete a 'fill in the blanks' birth plan, where I was able to indicate that I did not want to be offered medication, who my support people would be, positions I wanted to try labouring and delivering in, that sort of thing. They don't do IVs as routine, and although hospital gown was available to me, I laboured and delivered in my own clothes. They had a fridge full of ginger ale and juice and popsicles available (although I kept throwing up, so wasn't particularly interested in anything other than ice chips).

Once you have more info about the hospital and the OB, you'll have a better idea how aggressive you'll need to be, and how aggressive your support people will need to be.
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#19 of 60 Old 08-19-2005, 11:55 AM
 
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Okay, aside from my inclination to suggest UC and my personal feelings towards Ob's- I wanted to chime in about your situation.

All these suggestions are terrific, and doing your research about your options, the hospital's statistics regarding interventions and c-section rates is important, too.

I hadn't noticed this mentioned but I feel the need to tell you.
Getting a doula or a very very supportive STRONG person to come with you is crutial. Here is why (i think)

Mama, you'll be in labor and frankly, medical staff use this "vunerable" moment to convince you to do things you may not want to do.
You might here something like"Oh, dear, please take the epidural, you've worked so hard and long laboring and your body needs a rest."
or,
"We feel your bp is a bit elevated and need to adminster an IV to help control it, for your sake and the baby's "
or
"For the good of the baby, its best to have a fetal monitor. We really want to hear the baby's heartbeat, don't you?"
or
"Just let us do what is best for you, and episiotomy is an easy cut to heal."
Know what I mean?


maybe I am being a bit paranoid or causing you to be, and if so, I am sorry. Not my intention- just want you to be aware.
I just think it good to know that most cases, laboring can be a very emotional experience and having emotional directives fired at you may cause you to fold and surrender.
(It did for me anyhow)
If you do write a birth plan- have someone there specifically to keep everyone in line with your wishes.
all my best.

I wish you all the best.

Mama to 5 babies. UCer, too!
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#20 of 60 Old 08-19-2005, 11:59 AM
 
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Quote:
Originally Posted by MrsSmall
Can I suggest finding out what is legally required and what is not?

For instance, the eye ointment is a legal requirement in Massachusetts. That way, if someone tells you that something is a requirment, you'll know yourself what is a real legal requirment and what is just hospital protocol.
Remember that you can refuse EVERYTHING. Even those things "legally required"

-Angela
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#21 of 60 Old 08-19-2005, 12:59 PM
 
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I want to emphasize what AmyJean said. They used even stronger tactics to get me to comply with what the hospital staff wanted, up to and including telling me my baby would die if I didn't do whatever it was they wanted me to do, telling me that "IF your baby survives, we'll have to call CPS and you will not be allowed to see your child, much less nurse her, until their investigation is over and you are determined to be a fit mother" They played on my worst fears. It was really awful. How wonderful for some women that do have positive hospital birth experiences, but the only ones I've ever heard of had doulas present at the time. It's that important to have someone there to help you advocate in a calm, clear-headed manner.
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#22 of 60 Old 08-19-2005, 01:23 PM
 
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Quote:
Originally Posted by alegna
Remember that you can refuse EVERYTHING. Even those things "legally required"

-Angela
ITA. It's state law in WI that newborns get the eye treatment and we are declining this. I have heard of instances of hospitals calling CPS when a parent declines a legally mandated procedure and the baby being taken away for a few days. I think this happened in New York. I don't know if this kind of thing still happens anymore. Where I live declining the eye ointment is not a big deal. We are planning a homebirth, but people who give birth in the local hospitals can generally decline this procedure w/o huge hassels. I think how much hassel you get depends to some degree on which nurse you get. I don't think some L&D nurses know why the eye ointment is given (to prevent blindness when mom has gonorrhea or chlamydia), they just know it's the law. In that scenerio I think it might be more difficult to explain how you are making an informed choice based on careful weighing of the risks and benefits of the procedure. Even so, my strategy with declining procedures is to let them know I am making an informed choice (and it's not just that I am refusing because I'm an oppositional person or something).

I do think it is wise to get the skinny as much as you can about common procedures for your doctor, your hospital, and the laws in your state (and strategies others have used to get around them if they're something you don't want). This is one way in which I think doulas can be really helpful.
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#23 of 60 Old 08-19-2005, 01:43 PM - Thread Starter
 
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Amyjean, I was paranoid to begin with, don't worry!! The situation was scaring the wits out of me, I just feel I have more to go with now than I did when I first posted. At least I feel very confident there is NO WAY I would get another epidural, even if I thought I was dying. Those 2 weeks after my first delivery I was unable to hold my baby and had to stay in a reclining position or I'd have HORRIBLE back, neck, and head pain, to the point of vomiting, is something I will *NOT* go through ever again. But at least it taught me to nurse lying down very quickly. :LOL

I'll be calling some doulas over the next few days in my area. I didn't even consider a doula before this, I figured they were as unaffordable as a midwife, and am so relieved that I may be able to find one to attend my birth.

Thank you again, ladies. I have an appointment with my OB next Thursday and will definitely be going in prepared. I'm determined to go to this hospital feeling confident my experience will be a good one, even if, in reality, it isn't perfect.
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#24 of 60 Old 08-19-2005, 04:10 PM
 
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You might want to check with the hospital to find out if they offer a doula service. Some work with the March of Dimes and provide free doulas to those who might qualify (whatever that means) or a doula in training for free...someone who needs the hours to complete their certification.
All my best!

Mama to 5 babies. UCer, too!
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#25 of 60 Old 08-19-2005, 04:55 PM
 
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I agree about getting a doula. I had a hospital birth by choice and it was really OK. (Not great, not fantastic, but OK. Not horrible either.)

The hospital I birthed at supplied doula's if the mother requested. So I had a hospital supplied doula at no charge. She was fantastic.

I had talked a LOT to my OB about low intervention and she was righ on board with that. Unfortunately, she wasn't there for the first 17 out of 18 hours of my labor! So just remember that the doctor probably won't be there. It's those L&D nurses who "decide" when you need fetal monitoring, what you can eat, etc. I really tried to work WITH my nurses instead of opposing them. It worked out well for the most part, but I think one pushy one went off-duty or was reassigned.

I talked with both my mom and my DH about not wanting an epidural. I acknowledged to both of them that I knew they loved me and would never want to see me in pain. But that childbirth might look painful but I really wanted to trust my body and not have the epi. I told them it might be hard for them, but that I needed their support. They were both fantastic!

Also, if you are really at odds with your L&D nurse, you can ask to be assigned another one. Don't hesitate to do have your DH or doula do that if you see you have inadvertently come to have some antagonistic relationship.

You might also ask your OB if she knows any doulas or has worked with any good ones.

Third generation WOHM. I work by choice.
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#26 of 60 Old 08-19-2005, 05:19 PM
 
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Originally Posted by Keja
I'm determined to go to this hospital feeling confident my experience will be a good one, even if, in reality, it isn't perfect.
Good for you. That's the way to be.

Julia
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#27 of 60 Old 08-19-2005, 05:39 PM
 
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We thought my husband would be a great avdocate my first birth which was in the hospital. Well, we were wrong. He was not prepared for how much politicing and coersion goes on and so failed in helping me navigate that. He was also a bit overwhelmed by the intensity of the labor and birth, it put him in a mode that was incapable of fighting with staff people. And at one point he feared for the life of me and the baby (after the nurce told a big honkin lie implying our lives were at danger) so he started to side with them, do whatever they say honey, he didn't want to lose his wife and child, YK?

So I strongly advise brininging a second support person who has been in the hospital L&D enviornment before and who know what to expect and how to help ypu navigate the BS. It's really hard to be rational and in fightin mode during laborland.
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#28 of 60 Old 08-19-2005, 05:42 PM
 
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I had talked a LOT to my OB about low intervention and she was righ on board with that. Unfortunately, she wasn't there for the first 17 out of 18 hours of my labor!
yep, my natural birth and even leboyer supporter OB wasn't there at all during my labor. By the time he showed up my nurses had bullied me into an epidural and had yelled me through over 2 hours of purple count to ten pushing. I don't think it matters what your doctor supports (in most cases) the nurses run the show. Getting a good nurse is 90% of the game.
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#29 of 60 Old 08-20-2005, 08:02 AM
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I refused stuff and they did it anyways. I was forced to lay down flat on my back, forced to wear monitors... told I was getting pitocin, told I was getting an episiotomy... and I was so out of it with pain that I would fight it but not for long.

If you truly want to stop them from performing things on you without consent - you need to have somebody there willing to take a stand for you. Otherwise odds are very high they will just bulldoze right over you.

One nurse I had was very very nasty. Finally I told her to get the hll out of my room and htat she was fired. She never came back. I agree with previous posters - you are really subjected to the hospital nurse assigned to you.
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#30 of 60 Old 08-20-2005, 10:12 AM
 
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Something you should be aware of also, though, is that they won't necessarily listen to anyone who isn't you. Legally, they don't have to. Neither your husband nor a doula has the right to speak for your medical decisions unless you're incapacitated or they have a medical power of attorney.

But a support person *can* support you in continuing to say no, and in *noticing* if they start to sneak something by you. Very, very valuable.

And me, I take great comfort in the fact that they can't actually do alot of things if I don't let them. I mean, they could bully me until I lie down and let them do whatever, but unless I consent in *some* way, they ain't getting the IV in, YKWIM? It makes me feel a bit more empowered, anyway.

Julia
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