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BoobyJuice 06-09-2004 02:11 AM

I'm pregnant with my third, but I've never had a hospital birth before. My first was born in a birth center and my second at home. We've since moved and there aren't any midwives for about 75 miles (even if there were we don't have the money to pay out of pocket like last time). Since I have precipitous labors (really, really fast : ), that's out of the question. Even if I was up for an unassisted hb, we're living with my parents and I can't see them to excited about it. Sooooo, I'm seeing a dr for the first time and I guess having this little one at the hospital.

I like the dr. He's pretty casual and knows I've had hb - his wife's had one too (and one at a birth center in a tub)! Now I'm worried about hospital rules and regs. I know a lot depends on the doc, but hospital also have their own legal requirements. What kind of stuff do I need to ask about? What can I legally refuse? I can't imagine having this baby in the hospital, and although I have lots of time left, it's making me nervous. Advice? ideas? Questions to ask? Stuff I need to know?

Aura_Kitten 06-09-2004 02:41 AM

here was my list, from when i was still considering a hospital birth ~

* can I remain in the same room during the entire labor and delivery process? or will I have to be transferred to a different room to deliver? Will I have a private room?

* will I be allowed to move around at will throughout labor and choose the position in which I want to deliver?

* What alternative pain coping things to they have (tubs, showers, etc) and how and when do they let me use them?

* What is their policy on how long I have to stay? How long the baby has to stay?

* What is their policy regarding babies in the room? Do they MAKE the baby sleep in the nursery? How about babies sleeping with their mothers? Bedsharing: Are there consent forms that need to be formed / waivers to state that I won’t sue?

* Who can visit you? – siblings allowed during labor/delivery? will we be asked before anyone can enter the room and visit?

* Do they have a lactation consultant on staff?

* What are their hospital "rules" about eating/moving/drinking during labor?

* Is there a hospital policy in place that after a certain amount of dilation, the laboring woman must remain on her back and monitored? (( when i was in the hospital w/ my son, at 8 cm the nurse came and said, "oh, it's hospital policy for all women to stay on their backs after 8 cm and have continuous monitoring" regardless of the fact that i -- and my son -- were perfectly healthy. ))

* What are the hospital "rules" about how long a woman can labor/when they MUST do a C/sec, etc etc.

* What are their rules regarding the pediatician visit before the baby leaves?

* Are there nurse-midwives on staff?

* What are the hospital policies regarding how often cervical exams / checks for dilation are done?

* Are the babies bathed involuntarily or may the parents choose to bathe the child or postpone the bath until they return home?

* Will the doctor attending the birth do perineal massage? If so, may the father (or partner) perform the massage instead?

* I’m planning to bring cloth postpartum pads and cloth diapers/wipes. Can they be laundered at the hospital or should I plan to bring extra and wash them when we go home?

* are extra pillows provided for the mother if requested?

* what are the hospital policies on who can catch the baby?

* we are considering a partial Lotus birth (where the umbilical cord is left on for a while after the baby’s born, at least until the placenta is delivered). Is this supported? What are the hospital policies regarding when (or by whom) the cord must be cut?

watermamma 06-09-2004 04:49 AM

I would call the l&d floor and ask to speak to a head nurse. The nurses are the ones really "there" during your labor, and they would know more about alot of the interventions (monitoring, etc.) than the Dr. I ahve heard of Dr.'s telling patients not to worry about EFM, etc. and when mom shows up, nurses are insisting upon everything the Dr. said was not needed. Typically, Dr. shows up at crowing anyway. Of course from the sound of your labors, that might be when you are arriving as well

And I am a firm believer in your absolute right to refuse anything. Period. They do not own you or your baby and it's your body. Just be ready to sign your life away for refusals.

Happy birthing and I hope you have the wonderful birth you deserve!

kofduke 06-09-2004 10:24 AM

Is there any chance you could afford a doula? I had one for my hospital birth and I really believe it made the difference between a vaginal birth (albeit highly managed) and a c-section.

Piglet68 06-09-2004 01:35 PM

yes, a doula would be a good idea.

but I highly recommend getting a tour of the L&D ward of your hospital, and speaking ahead of time to the head nurse, etc...can't think of anything to add to klothos' list of questions...

oh, except...just in case, find out what their policies are towards mothers who deliver by Cesarian. IN my hospital, barring any emergencies I was allowed all the same bonding time, rooming-in, etc. privileges with my baby. But there are hospitals where the rules are different. Find out ahead of time what those are (hopefully you won't need a C/S but you never know).

Eman'smom 06-09-2004 05:18 PM

I'm a big believer in refusing anything you don't want, just make sure your dh and doula know what you want and don't want.

I'm going to duck for a minute here but I had an ok hospital birth and an awsome hospital birth. Dh even said once "I know we are going to have number 3 at home but Riley's birth was so great maybe we should do the hospital again". She was an intervention free water birth in which dh caught her, the only exam I had I asked for. It was great.

Anyway check on policies, and another thing if you get a nurse that is hell bent on policy ask for a different nurse.

I too have fast labors, remeber fast labors mean less time for them to mess with you.

Good luck

Piglet68 06-09-2004 05:22 PM

Eman's mom: I had a great hospital birth too, but then I had a great hospital! Certified "breastfeeding friendly" they were all pro-BF, pro-rooming was a wonderful experience. I hear some of the hospital policies for other mamas and my heart just aches for them: I'd feel like a prisoner!!

BoobyJuice 06-09-2004 06:59 PM

Thanks everyone. Yikes Klothos I hadn't even thought about some of those. I didn't know there even were still hospitals where you couldn't eat or drink in labor. Guess I've spent too much time around midwives

I'm not sure you can refuse everything, but I'll ask. That was a lot of the reason for my last hb. The midwife I'd used at the birthcenter with my first moved to a hospital. The hospital required you to be on a monitor at least 5 minutes every half hour no matter what the dr or midwife said. Insurance regulations, blah, blah, blah. So now I'm kind of worried this one will have similar silliness.

We are really rural. The town I'm in doesn't even have a post office. The hospital is 25 miles away and still really rural; it's actually called the regional hospital - as in, the only one in the region. So no midwives on staff at the hospital, no dulas for probably 100 miles. There is only one OB in town; I'm using the only other person who delivers - a family practitioner.

Since I was fully dialated when I got to the birth center with my first and the midwife didn't even make it for my second, I'm pretty much worried about the after stuff. I'll have to ask about rooming in, bathing babies, etc. I guess I'll need to see if they put you on the monitor to make "sure" you are in labor - although if I'm crowning that's usually a good clue Anyone know how soon you can check yourself out ama? Anything not on Klothos (you're good) extremely thorough list?

Thanks all!

BoobyJuice 06-11-2004 06:43 PM

So I just called. Forgot to print klothos' list so I didn't get answers to nearly as many questions as I have. Didn't like the answers I did get though. The nursery stuff was good. Babies get to stay in the room unless they are sick. Oh and if it's a boy, they take them to the nursery to circ them - not if, just do.

But you do have to be monitor, have to have internal exams and have to have an iv hep lock - but they don't start an iv until you need it. They won't even check you in to the hospital until they do an internal and monitor you. She finally - very huffily - said it sounds like you want one of those birth you do at home. I said I do, that's what I've always had, but there is no one here who does them. "Well, we are a medical facility. We have to make sure we are prepared for anything that might go wrong . . . . ." She actually said they won't force me to take med or get an epidural force me? Yikes - I may be standing in the parking lot until I crown. Oh and with the hep lock, she actually said, how have you been given pictocin after birth to deliver the placenta? Ummm, actually lady (Head of Nursing who should know something) they kind of come out . . . have for tens of thousands of year.

So there are no hb midwives around here - actually no mw period. I'm not up for an unassisted. This is the only hospital for 100 miles. Any ideas? Please?

Aura_Kitten 06-11-2004 06:50 PM

i'm so sorry to hear that. s

i honestly have no ideas beyond UC.

pinky 06-11-2004 11:41 PM

I'm sorry you had such a bad conversation with the nurse.

If you definitely are going to birth in that hospital, I would really really urge you to find an experienced doula. It sounds like you will really need someone to run interference with the docs and nurses.

As for the hep-lock, it may be policy, but you can still refuse. I was asking my OB about this before my first birth (I posted this elsewhere on another post) and she said, "Of course you can decline the hep-lock. If they do it without your consent, it's ASSAULT." This is not to say that they won't give you a hard time, but you can say no.

I'm so sorry that you're in such a difficult situation.

obnurse 06-11-2004 11:56 PM

Im sorry you got such crappy answers!!! We have a lovely hospital, more like a birth center. we are major pro bfing, encourage rooming in, etc, etc. You can refuse just about anything here, except montoring. We don't make anybody go on their backs at any stage of labor against their wishes, but fetal monitoring is a must here. Hospitals would never be able to protect themselves in court if they didnt (not advocating just stating) We have a pretty decent monitoring policy though. Moms are not strapped to the bed or anything! We have telemetry, so mom can be up and about, even shower or jacuzzi. Early labor only needs 20 minutes on the mon. every 4 hours. active and pushing can be intermittant (more frequently than early), if all is well.
Pts can refuse all treatments for the baby such as erythromycin in the eyes, vitamin K and hep b vaccine. I've never had anybody refuse the bath, though, but there is a first for everything. I am shocked that they routinely circ babies! That is only at parents request here, and the OB's hate doing them. (good!) Pts can refuse IV's for themselves, pitocin etc.
Honestly you are in a bad position. My standard answer for anyone not wanting intervention is to not go to the hospital. If you don't want the services they are offering, then don't go there. There are usually things that they will 'give' on, but things that legally their backs are too the wall on. I wish you luck, I don't know what to tell you. I understand your hesitancy at an unassisted hb. With any luck, you will just show up at the hospital and have the baby in 2 minutes. The 'after' stuff is honestly what hospitals will 'give' on. You will be fully aware of what is going on and will be able to assert yourself. Hospital is not a PRISON where you have no rights!

Victorian 06-12-2004 03:24 AM

I am so sorry that you are in this position. I would say to have a good friend who is a mom be your doula. She can read books and since she loves you she will be fine. You will need to be an advocate for yourself.

here are some ideas:

Make a sign for the door that says "natural birth in progress - please knock" and make sure that the nurse knows that it includes her.

You can refuse the heplock.

Eat and drink when they are out of the room.

Tell them that you will "allow" THEM 5 minutes of monitoring an hour. After that take it off for yourself. Their legal crap is not your problem. Did they take an oath to "first do no harm" or an oath "first do no harm unless it upsets your lawyers". And for the record, I do think that fetal monitoring is harmful - it increases the chance of c-section and assisted deliveries and has NOT improved the statistics re: birth outcome. The WHO lists it under "forms of care likely to be ineffective".

Print out a copy of the WHO birth practice booklet and highlight the stuff that is relavant to you. Read to them out of the book "i.e. the WHO organization says that there is no need for _________".

Organize for an early discharge (i.e. within 6 hours after birth).

Tell them not to offer you drugs, or to ask what you would rate your pain on a scale of 1-10.

Tell them to be quiet if they talk to you during a contraction.

When I had my dd in the hospital, I allowed the nurse one exam, on check in. I refused all others unless it was done by my CNM (who of course was never around). I only had 2 the entire labor.

Bring pillows and a nice blanket. Take the clock off the wall. spray lavender into the air. Bring a meditation fountain with you. Arrange for pizza after the birth. Refuse the formula that they will give you. Tell them not to touch your baby (you might want to hire an official "penis protector").

And since you are going to piss off the entire OB/nursing staff - bring cookies!

The only other thing that I can think of is if you have something that you could sell (2nd car or something) and then you could go stay with a friend (or sister?) that lives by a midwife for a month. Do you or your husband have any barterable skills? You should see the lovely tattoo on my midwife's back! Are you sure that there are no midwives around? Have you asked at LLL and the local IBCLC (if there is one?) What about at the natural foods store? Naturpathic clinic? Massage? Sometimes they are around, but only do a few births a year, and are hard to find unless you know someone. Any Amish or Mennonites communities around? A lot of midwives will barter. Now of course, if you have good prenatal care, and IF you have a quick labor and just don't make it to the hospital, your In-laws can't be too upset, after all, it will be an interesting story to tell the friends!

Sending you lots of good vibes!


CryPixie83 06-12-2004 03:36 AM

Originally Posted by BoobyJuice

I like the dr. He's pretty casual and knows I've had hb - his wife's had one too (and one at a birth center in a tub)! Now I'm worried about hospital rules and regs.
I'm curious, who attended your Dr's wife's homebirth? Have you asked your doc about the possibility of HIM attending the birth outseide of the hospital? I know it's a long shot, but with his background you might be able to swing it...

nikirj 06-12-2004 02:25 PM

I really suggest you bring someone with you who basically is just there to protect you from the medical staff. For me, it was my mother. She knew exactly what I wanted and did not let them do any differently. Hey, it is tough to know that they are about to inject you with pitocin "to help with the placenta" when you and DH are busy staring at the new baby. My mom was with the medical staff most of the time and headed off all of that. During my first birth, I actually heard her scream "NO EPISIOTOMY" and I was sooo frightened by how close it may have been, since DH was busy with me and really not paying much attention 'down there' at the moment, and it really just takes a moment... She also sent away the anesthesiologist for the night, told the nurses (basically) to shove it when they started worrying about DD looking 'yellowish', all the stuff I was too tired to be really stubborn about. She wasn't like a doula at all, because she didn't do much to support me emotionally, she just really protected me so that I could have the births I wanted.

Mama J Rock 06-13-2004 07:25 PM

Now that you have talked to someone on the phone, I would call and schedule a tour. Take that opportunity to be as nice and sweet to the nurse giving the tour and as her "friend" find out how they do things and ask a few more questions. You can kind of chit-chat about how they have things set up and you can actually see what kind of machines they have, i.e. is the monitoring machine bedside or is it a portable thingy, you can ask where you could take a shower if you want to, etc. There's no need to assume it will be awful, especially if you're educated about your options and feel confident in asserting yourself if necessary. Be prepared for it to be bad but don't expect it to be. Does that make any sense? If you go into it as someone with a list of demands who is going to make them defend all of their policies then they're probably not going to be as nice back.

Also, ask to be introduced to the OB nurses. Like a pp mentioned, they're the ones that you will deal with the most. Since it's a smaller rural hospital, maybe going to their childbirth prep class would be a good idea, even though you don't need the information, but just to get a feel for approach that is taught by the nurses.

Having a doula would be a great idea, even if it's a friend or someone else you know, because if you do have to deal with a bully nurse you don't want to have to do it all by yourself when you're in labor.

BoobyJuice 06-13-2004 10:21 PM

Sorry, sorry, sorry, this got to be a book. I guess I'm thinking things through by typing. It's kind of like talking out loud only more annoying for other people.

Sorry everyone, I've been meaning to respond to all of your post but every time I tried I just wrote such negative drivel I would end up deleting them. I don't want it to seem like I'm just dismissing your good ideas. Let me give it a go now.

The biggest problem is where we are now. Having had a birth at a birth center and home, I'm used to much, much more control of my own birth.
There's no need to assume it will be awful
Probably for a hospital this place is typical; I'm just not used to the constraints. So I really am assuming what they consider "normal" will be awful for me. It's also difficult becasue we are physically so far from everything else. The town with the hospital is the only thing around, after that you're looking at about 100 miles.

Doulas - great idea. The small town doesn't have any that I can find - and I have looked. It would be impossible to get anyone here from further away. As I mention, I have really fast labors (Before I hear 'lucky you', I have contractions for about a month before going into labor!) my first was 5 hours - 3 of which were pushing - and my second was 45 minutes. So unless I have a very different labor this time, odds are good no one would be able to get here. As for having a friend for a doula, I hadn't thought of that. We moved here abot 6 or 7 months ago, though, and I really don't know anyone well enough to have them at my birth. It is a great idea though. I never would have thought of it.

As for someone else to be at the labor it has always been my husband and my mother. This time she'll have to watch the kids though since they aren't allowed, which totally bums me out. My oldest didn't watch my 2nd being born, but at least he had the option. Wow, I just thought of this while typing, I don't know what we'll do if my mom is working. Yikes, new thought!

Birth class/tour of the hospital - don't think they have a birth class. My dr hasn't mentioned it, the few women I know with kids haven't mentioned it, and the nurse on the phone didn't either. Plus my mother actually works at the hospital - totally different department - but she's never heard of one. I'm sure I could arrange a tour but they don't give them automatically. Since this is the only place to give birth for 100 miles it's just assumed you'll go here. There is no thought to alternatives.

Meet the ob nurses - on my phone call with the head of nursing I found out who the head ob nurse is. I went to school with her - ran into her when we first moved here (I grew up around here but hadn't been back in about 10 years) and she answered my hello and walked off while I was still speaking - and yes she knew who I was. So when the head said I could submit a proposal and they would have a meeting between head ob nurse, head of nursing, my dr, head of hospital and me, it didn't thrill me.

My dr's other births - he lived out of state when his wife had the birth at the birth center and the one at home was because they didn't make it to the car - so I guess he attended his wife's homebirth. They then proceeded to have 4 more in the hospital. He lives 30 minutes south of the hospital and I live 30 minutes north of the hospital so even if he was willing, which I doubt with all the crazy liability and malpractice insurance, I don't think he'd make it.

My standard answer for anyone not wanting intervention is to not go to the hospital. If you don't want the services they are offering, then don't go there.
I really don't won't to, but can't, yet, find an alternative. We live with my parents, who do not support hb and would never let me have an unassited birth in their house. I'm not really into the idea of a planned ua hb since the hospital is so far. If anything went wrong it would be 30 minutes for the ambulance to get here and 30 minutes to the hospital.

Part of my dread at going to the hospital is the 30 minute car ride in hard, active labor. I did a 45 minute one with my first and it really is unpleasant. I highly recommend not going through transition stuck in a car. I also don't want to hit the hospital in crazy, hard labor and have them be difficult -that's the thought I keep having. The nuse said THEY WILL NOT admit me until I have a cervical check and am on a monitor. I understand some people think they're in hard labor at 2 cm so they feel they have to check but the thought of being put on my back then is just horrifing. Of course I'm honestly wondering if this one comes as fast as the last if I'm even going to be able to leave the house. (Ever tried walking at 8, 9 , 10 cms?) May end up being an ua hb after all or maybe born in the car . . .

bethwl 06-14-2004 01:42 AM

I think you should have an unassisted car birth in the parking lot of the hospital. I'm kind of joking, but really, then you would be there if anything happened, but you wouldn't have to submit to the internal and the monitor.

georgia 06-14-2004 02:13 AM

One of the most important things that I had pointed out to me after my first birth (hosp) was a patient's right to "informed refusal." Just wished I known about it sooner. It's the flipside to informed consent. I don't have my link right now, but if you google it, you should be able to come up with some great info about patients' rights.

Sending you positive thoughts,

anythingelse 06-14-2004 02:26 AM

have you had a heart to heart talk with the dr? and ask his staff, if one of them works in the hospital as a nurse (odds are high in small town) you can offer to pay them to be your 'birth nurse' to be there when you do in

my mil is an nicu nurse and she has gone in on her days off to run interference to see family/patients that are having hard time getting other hospital staff to respect their wishes re care

Mama J Rock 06-14-2004 12:40 PM

I'm sorry you're having to go through all of this to try to ensure you get a decent birth out of the deal. I live in a very rural area too, however the closest hospital just so happens to be in our town and is only a couple of blocks away from our house. The doctor here who delivers was trained in his advanced ob training (he's a GP not an OB) by midwives and although he can perform c-sections it's not his nature to do them unless absolutely necessary. The other thing I love about our hospital is that they don't even offer epidurals. They don't have an anesthesiologist on staff full time (they only call one in for emergencies and for regular scheduled surgeries) so they don't even offer them as labor pain management. Also, before they'll give any drugs for pain they make the mother change positions several times, try the shower and other natural remedies first. The ob nurses that teach the prenatal classes really try to get the mothers ready for birth, not for a medical procedure. In reality, it's called a hospital, but it's more like a birth center as far as their "standards and procedures".

So, I wish that your local hospital was more like ours but since it's not I think you're doing the best to get yourself prepared and eliminate some of your battles by doing some planning upfront. Also, if you page your doctor so he can be there when you get there since you both have about a 30 min drive and you're anticipating a quick labor, you may be able to insist to see him before they admit you or check you. Since he has no problems with your requests maybe he can let the nurses know that it's okay to go "against policy" on those items and you won't have to fight them on them.

I really hope that you are able to get things figured out. It definitely helps that you've been through it before and know what to expect as far as the actual birthing process goes. Also, I would talk to your doctor about your concerns after visiting with the head nurse and even about the interaction with the friend who is an ob nurse as well. Don't worry about it seeming petty to him, because obviously it's a concern for you and leads you to believe that you will be treated harshly (especially since they know about your previous homebirths and may be defensive anyway).

Okay, so that got long, but I hope it offers another option. Ask your doctor what his plan is for getting there on time since you're probably going to be a fast labor. Hopefully he will want you to call him so he can get going instead of waiting for the hospital to page him after you've been admitted. If that is his plan then demand to see him before the nurses do any procedures.

Good luck!

tinyshoes 06-14-2004 02:31 PM

originally posted by Victorian
Tell them to be quiet if they talk to you during a contraction.
This task is for your doula--after all, you'll be having the contraction at the time!

Your hospital sitation sounds very discouraging. "Stay away from the hospital as long as possible during labor" is sage advuce--but--your hospital is far away, and your labors are quick. Those elements suggest a UC is definitly an option worth concidering.

I hear you have no doulas in the area--but there's got to be SOMEONE who you can hire to DO YOUR BIDDING. Doulas are great because they've BTDT with regards to birth, hospitals, offering boirth advice, etc. You need a person to run interference and ensure you don't get messed with...all that person has to do is read your birth plan and help the staff execute it (I would freak if some tart from my high school were to be my L&D nurse, esp. with the attitude you've described, BoobyJuice.)

Does this hospital have a patient's ombudsman ? When my grandpop was hospitalized, he sure had plenty to complain about, and he did so to the hospital's patient ombudsman. Later on, when he was living out his days at the Old Folks' Home, he had a Nurse Advocate--a former RN who is now a private "brains-for-hire" person who basically acted as a doula for him...she was a valuable second-opinion for various mundane procedures (like IVs!) and her knowledge and support was precious (like a doula's.) Maybe you could hire one of these, if your area is devoid of doulas?

Could you hire a high school student to do your bidding? We hire them as babysitters--heck, you could describe birth attendence as glorified babysitting, right?

Why do you want to go to the hospital? What can they really offer you? Is it really worth avoiding a rift with the in-laws? Maybe it is. Maybe it's not. Maybe you could have your baby in a hotel room, or as bethwl suggested, in the car. SERIOUSLY. Why not in the car?

I wish you luck as you continue evaluating your options, your resources, and what exactly you want to choose. Ultimately, you'll arrive at the decision that is best for you and your family.

BoobyJuice 06-23-2004 09:29 PM

Well, guess what I just found out? The horrible head ob nurse I talked to is gone. She got fired last week. I did talk to my dr today - we spent 30 minutes going over my birth wishes. He agreed to almost everything.

*No IV or hep lock
*Minimal vaginal exams.
*Maintain mobility
*No fluid or food restrictions during labor
*No pitocin, no amniotomy
*Siblings present for labor and delivery.
*Choice of positions, including squat/birth bar
*No episiotomy, prefer to tear
*Mother or father “catch” baby
*Delayed cord cutting, father cuts cord
*No separation from baby
*All non-emergency treatment to be done in arms of parent
*No suctioning

I do have to have intermitent monitoring. And it has to be by machine because they don't have a fetoscope or doppler. He's OK with early release for me but like to keep babies for a day to observe. All the things like "Do not offer pain relief medication", "No directed pushing", "Dim lights and quiet during labor" he said I'll have to talk to the nurses about. Not too bad actually - much, much better than the feelings I got from the head nurse. Now I have to go talk to the nurses and hospital. Unfortunatly he said only one of them is very good with birth plans (small hospital, it only has 4 ob nurses) the rest just do what they always do by habit. I am feeling much better about the whole thing though. Now if I can just get there in time

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