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Fighting hospital policies

793 Views 17 Replies 14 Participants Last post by  Noodlesmom4
I need some info about fighting hospital policies while in labor. I really want a homebirth, but my mom decided last weekend that she wasn't comfortable with the idea of me having a baby an hour away from a hospital and said that she would not watch our kids while I am in labor. We could probably find childcare for our dd's, but our ds has special needs and doesn't do well with people outside of the family. On top of that, dh travels for work, and we have recently moved, so I really do need her to watch the kids.

My doctor wants to induce me at 39 wks, and I will probably do that so that dh can be there with me. With my last two I heard all about hospital policies, had a nurse threaten to call CPS if I removed my baby from the hospital prior to 24 hrs after birth, was forced to labor flat on my back even though I was having (unmedicated) back labor and fussed at every time I moved the slightest bit because "59 minutes out of every hour must be monitored." My carefully thought out and discussed birth plan was essentially thrown out by the nurses and my then ob's reaction was "it is hospital policy" even though he was familiar with my wishes.

What can I do to keep this from happening again? What department or person would know what this hospital's policies are, and how do I find out what they can and can't force me to do legally? I know that induction is a little different from natural labor, but I know that somewhere there is a mama who has successfully fought a hospital!
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Wow, this is tough. I'm going to assume that re-approaching your mom about this is out of the question. Have you considered a doula? Someone who is familiar with policies and has figured out how to gently (or not gently, whatever is called for) steer the staff into realizing that they don't have to do all sorts of interventions. Perhaps you can consult your geographic tribal area on MDC to get some recommendations.
I am in a similar position myself. I am considered high risk, and a hospital birth is my only option (since I'm not up for an unassisted birth). Are there any birth centers around you? If so, that might work great. Or could you see a midwife instead of an OB? That would be my next choice. Here are a few of the things I'm doing to try to make the best of my hospital birth...

I am spending a considerable amount of time doing research on common interventions (so that when someone says "you need this because" I will not be frightened into an intervention I don't need.) LOVED Ina May's Guide to Childbirth, and the chapter on labor and birth in Christiane Northrup's Mother Daughter Wisdom.

I wrote a birth plan and revise it as I learn more, and to make it as personal as possible (e.g., originally, I said I wanted perineal massage instead of an episiotomy. Now I realize I don't want either.) I showed it to my OB to judge her reaction. At this point, I am mostly convinced that I need to switch to another OB and another hospital.

I found out who in my area understands and supports natural birth (mamas, Bradley instructors, doulas, CPM) to get their advice and suggestions for midwives, OBs, hospitals, etc.

I had a hospital tour and asked a lot of questions about their routine interventions (not all of which were answered truthfully.)

I made arrangements for a meeting with the head of NICU to find out their protocol for taking babies from mamas after birth. I'll show him my birth plan, too.

I hired a doula, and dh and I are taking the Bradley class.

I plan to spend as much of my labor at home as possible.

It was suggested to me that I modify the hospitals std consent form to say I will not allow xyz interventions. I don't think I have the fight in me to do that. Check out my thread here about whether a hospital has to follow my birthplan. There's a link with legal info about modifying consent forms.

Do you have options for OBs? If you had one you trusted and had a good rapport with, you could find out exactly what you'll be up against when you are admitted.

Best wishes to you. I'll look forward to reading other suggestions...
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have you looked into the risks of inducing at 39 weeks?
No way I'd agree to an induction. I would find a way to homebirth. With an induction your chances of a section go way WAY up. Not to mention the risk of all sorts of interventions and risks for you and the baby. Bad news.

I'm also fighting an induction. My ds was born at 39 wks 2 days after induction, and the birth was awful. Have you had one so you know what it involves? If you really have no choice, and must be induced, may I suggest that you find out what they use and look into it carefully first. For example, I had cytotec. Knowing what I know now, I'd have never allowed it. There are also natural ways of induction that you could try first, and natural ways of encouraging labor that don't require more meds. But that means you need to have the freedom to move, walk, and preferably eat and drink.
I really think that agreeing to an induction is pretty much setting yourself up for an intervention-filled birth. I hate having to say that to you, but it's true.

Now, for a hospital birth, I have had one with all of my children, but my last was the best. The difference was my midwife. It was just her and a nurse in my room with me and dh. She was great, and made sure I didn't stay in bed or hooked up to anything. She talked to the nurse about the benefits of just occasional monitoring, and how me moving about was sooo good for labor and etc. It was nice.

But that induction...they are really NOT good things, I wish that doctors and mothers alike would realize that they should only be used in emergecy situations. I would encourage you to have second thoughts about it, especially if your goal is to have an intervention-free birth...
More caution from here on agreeing to an induction.

That being said, if you do decide to birth in a hospital, perhaps you could arrange a meeting with the nurse manager well ahead of your edd - ask him/her how you can peaceably arrange to waive their liability for monitoring, etc. - that's all they're worried about, anyway -- ask if there are forms you can sign giving an "informed refusal" for such things as continuous monitoring and other similar hospital policies.

Or, do what I did during labor -- take the monitoring belt off and politely tell the nurse to "Just document that I refused it" -- she had no problem with that, as I think she privately agreed herself and stated "Okey doke. I can't do anything you don't consent to!" and cheerfully helped me off with the apparatus.

Staff are really just worried about liability - remember that L&D lawsuits have an 18 year statute of limitations, and their major issue is the documentation and the paperwork.

Good luck with your decision making!
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I've had three inductions - one at 42.5 wks, two at 37 wks. My doctors have justified the last two because I have a condition where my brain doesn't regulate my bp properly. I pass out with less than 30 seconds warning usually, and in some cases lose control of my bladder. Really the effects resemble a seizure in some ways, but I've been tested and they aren't seizures. My bp during pregnancy is very low, and the closer I get to the end the more I pass out & the lower it gets. Can't take any meds during pregnancy that would help either.

I do plan to try a diy induction (herbs, etc) with this one, but a scheduled induction at 39 wks doesn't give me much time to experiment.

Hospital induction is my last choice, but the thought of laboring alone at home while dh is 8 or more hours away (truck driver), mom is refusing to help, and supervising a 4 yr old w/special needs is scary. If it were just my 2 dd's who are 8 yrs old and 1 yr old, I wouldn't have much to think about, but my ds needs constant supervision. He has autism, and finding a caregiver in our rural area has proven impossible so far. Not many people want to watch a kid who runs away at every possible opportunity, isn't potty trained (and has some serious bathroom related issues), doesn't talk much to indicate his needs (prefers to scream), and has so many more problems.

My doctors have never used cytotec, thankfully just pitocin, but I've never delivered with this ob before so who knows what she might try to sneak in. I do have a birth plan, but my main concern is that it has been totally ignored during my last two births despite my dh & myself insisting that it be followed.

With this birth I plan to go without meds (except pitocin), want to be able to change positions, want baby to be evaluated in the room & given to me to nurse as soon as they have their precious apgar score, do not want them to bathe the baby, don't want baby going to the nursery, want to leave the hospital with the baby within 12 hours of birth, and no eye ointment or vaxing.

My last labor consisted of 3 or four hours of active labor after they started pitocin, so they won't have to deal with me for long. You would think that it would just be easier to give in on most of this stuff, but I guess they view it differently.
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This was my midwife's advice (she's a CNM so she's worked in L&D units too)

She said DO NOT get in the bed. Every person who walks in the room, tell them "Do not touch me, you do not have my informed concent for any procedure." After that anything they try to do to you would be considered assult. They CAN NOT kick you out in labor, and they cannot make you do anything you don't want to do.

Granted, this all goes out the window if you agree to that induction. You are just setting youself up for a million interventions.
I just fought this battle 3.5 wks ago. I simply refused to get onto the bed, kept pacing & rocking around the room. They strapped on a monitor that I could walk around with & my labor wasn't very long but had it been, I would have limited the monitoring to a few minutes out of each half hour. They wanted to break my water & I simply refused. You can refuse anything, sometimes you'll need to sign a waiver to do so. I also refused an IV, they can't hold you down & stab one into your hand.

As far as taking the baby before 24 hrs, I'd just hang out for that long, I know it sucks, but the paranoia of having CPS show up just isn't worth it IMO. Plus, I think you'd have to have the PKU done twice if you left early, the hosp. won't let you leave without having that done & it's pointless if you do it before your milk comes in. That was a deciding factor for us.

If your Dh isn't a strong vocal support person, I'd consider hiring a doula or at least a strong-willed friend to back you up while in labor, my Dp was useless.
And I second what everyone else said about being induced, that's just asking for trouble (more interventions & possible problems) if you spend most of your labor at home, you'll have a better chance of avoiding intervention at the hosp.

Good luck, mama!
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I understand where you are coming from~ Inductions do not automatically mean more intervention~ Yes you are starting with one intervention but it does not have to spiral out of control~ My last labor was an induction at 35 weeks due to leaking fluid for the 13 weeks prior~ I was allowed to move around, sit on birth ball(MFS encouraged this), go to the pooty do whatever I needed~ The nurses were wonderful & supportive during the entire birth(mainly just sat there & left tme alone )~

Are you delivering at the same hospital? If so go now & talk with the head of L&D & then the hosp administrator about their policies~ You have a legal right to refuse anything~ I know that during labor is not a fun time to have to fight for your rights~ I am a little concerned about that with this delivery(new provider, new state, new everything)~
There has been some good advice:
Don't get on the bed sit on a rocker or birth ball
Go to the potty alot
Bring a birth ball it they don't have one
Find a good support person(doula) for you & your husband
Be very consise on your birth plan & file one with the Dr, L&D & the hosp administrator(cover all your bases)
Try some natural induction methods the night before:~)

Best of all good luck!
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Are there any doulas in your area? That might help a whole bunch. And most are willing to be very flexible about payment. Just having someone else in the room to be your support person and advocate, and be paying attention to interventions that get sneaked in.

Also, as I posted earlier, I just finished Ina May's Guide. In it she describes castor oil for "natural" induction. You might like to look into it.
It totally doesn't matter how much you use natural induction techniques, if your body isn't ready, then the baby is not going to come without major intervention (pitocin).

I also vote for the no-induction thing, but if you do have to be induced, then you certainly open yourself up to their intervention. IF you have pit, you definitely need to be monitored, in my opinion. Pitocin contractions are outside the norm and I would want to be sure the baby is tolerating labor well. I don't see any reason why you couldn't move within the limits of the room and monitor, but I seriously doubt that they would feel it's safe to allow you to wander the halls, etc.

A hospital birth does not always equal an interventionist birth (I've had two that were non-intervened with) but when you allow an induction, you do let them into your birth. When you accept their help, you accept their risks.
My first two births were induced with pitocin. Two different hospitals. The first one I was allowed to wander the halls, move any way I wanted, as long as they could monitor baby for a few minutes every half hour. The second hospital would not allow me to walk the halls, because they wanted to constantly monitor baby's hb, but I could be in any position or sit/stand anywhere in my room, bounce on a ball, whatever.

With pitocin you will have to have an IV . . . can't refuse that because that's how they get the pitocin in you!

I know your chances for further interventions goes up with pit or any induction . . . but in many cases (such as mine) everything goes very smoothly. Not that I'm advocating induction. I'm not. Frankly, pitocin is horrible, and this last birth that's coming in August for me is going to be natural all the way, which I'm thrilled about. I just wanted to point out to you, the op, that if you have to be induced (which it sounds as if you do because of your bp) then most likely things will go well for you.

Not sure what to tell you about hospital policy. This sounds as if it's a different hospital than the last . . . so hopefully that'll be in your favor that they will be better informed and more up-to-date with what's best for a laboring mama and her babe. I'd ask your OB or the head nurse of maternity/L&D what restrictions will be put on you with being induced with pitocin. Share your birth plan with your OB and the head nurse of maternity and ask if there's anything on it that goes against hospital policy. If something does, ask to see the policy written out so you can check it . . . to make sure it's not just their personal opinion they're expressing. Be clear with your OB about what you want to happen with babe right after the birth. Then tell every nurse you come into contact with when you get to the hospital what you expect to happen and what you want. Make sure your DH is going to back you up. If they really put up a fuss about leaving after 12 hours, then I'd probably stay until 24 hrs, just to avoid the hassle, personally. I've only stayed 24 hrs with the two previous births, and was itching to get out of there by that time, even though docs and hospital would have preferred I stay 48 hrs. Especially talk to the head nurse of L&D because it is the nurses that will help you get what you need. They are the ones doing the caretaking and most involved in your birth.

Good luck, mama! I hope everything goes as you wish.
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It might sound silly, but one suggestion I've heard is to bring some cookies or other goodies for the nurses, and give them to them when you get to the hospital. They might be nicer to you and more helpful if they see that you are a person rather than another random patient.

I also agree that a doula is probably the #1 way to help have the birth that you want.

Good luck!
Please contact a local Bradley Natural Birth Class teacher. These classes are designed to help you conteract the hospital stuff. You may not have time for a class, but I guarentee the instructor would love to talk to you and help you out, and she will also be very up to date on your hospitals' policies. She may even offer to attend your birth, or to help with childcare. I can't reccommend this enough.
Thanks for all the suggestions. I will get in contact with the head of L&D. This is a different hospital, so hopefully a few minutes on the monitor every 30 minutes will satisfy them. The thought of being induced again when I was so excited about a homebirth literally brings me to tears, so anything proactive that I can do now helps.
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