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Discussion Starter · #1 ·
I have some questions as I am preparing a hospital birth and want to be on top of my game as far as interventions go. My 1st was induced at a hospital and I fought the emergency OB tooth an nail about Cytotec (he pushed it for 5 minutes until he realized I wasn't budging and then gave me cervidil) and that was something I had learned NOT to use from my childbirth class if we needed induction.

#2 was born at home, but for a host of reasons, HB is not happening this time.

I am lucky to have found a wonderful and very natural OB. She had her own babies at home and wants for every woman to have a natural birth. I do trust her.

I'm trying to get info on when certain interventions are necessary and when they are used to simply avoid possible liability issues. My OB stated that she does NOT routinely used IV, extended fetal monitoring, etc.etc....so. assuming I am not being induced and am not having an epidural...

1...when is an IV necessary (assuming they are NOT going to induce. What are reasons they (nurses) might want to put one in that it would not be medically necessary (other than to hydrate, which should be fine if I keep myself hydrated)

2...when is extended external fetal monitoring necessary? My doc said that when I arrive I don't have to get in bed, but they'll want 15-20 minutes of fetal monitoring as a starting point. The hospital protocol is to monitor for 15-20 minutes I think every hour, which my OB agreed was not necessary and that they can hold a dopplar up to my belly unless there was a problem. What are good reasons to be monitored for that long and what are not-so-good reasons...what is the minimum of what the heartrate should look like before there should be considered worry. How do I know if it's necessary (my doula said there's nothing they can do if I rip the sucker off of me and she's seen women do it
)

3...Are there any good reasons for internal fetal monitoring (is that different from screwing that monitor into babies head?)

4...I pushed #1 out in 20 minutes and #2 in 15 minutes so I assume this one won't be a problem either. Are there any good reasons to allow doctor to use forceps or vaccuum extraction?

5...Doc said the only thing from my birth plan that the nurses might have issue with (not the doc) is not giving baby a bath at the hospital before I leave. Is there anything that can legally protect my right to not do that? Is that just an intervention that I can refuse to allow?

Can anyone think of anything else I might want to arm myself with as far as possible interventions might be?

Thanks for the help!!!
Sarah
 

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1...when is an IV necessary (assuming they are NOT going to induce. What are reasons they (nurses) might want to put one in that it would not be medically necessary (other than to hydrate, which should be fine if I keep myself hydrated)

Most hospitals want to have at least a medlock in place in order to administer emergency medications if needed (like in case of postpartum hemorrhage). As far as having an actual line hooked to it, that would only be necessary for hydration or medication administration (like pitocin or antibiotics.

2...when is extended external fetal monitoring necessary? My doc said that when I arrive I don't have to get in bed, but they'll want 15-20 minutes of fetal monitoring as a starting point. The hospital protocol is to monitor for 15-20 minutes I think every hour, which my OB agreed was not necessary and that they can hold a dopplar up to my belly unless there was a problem. What are good reasons to be monitored for that long and what are not-so-good reasons...what is the minimum of what the heartrate should look like before there should be considered worry. How do I know if it's necessary (my doula said there's nothing they can do if I rip the sucker off of me and she's seen women do it
)

The hospital wants to make sure your baby is "ok" before they let you go off the monitor. It is for liability and I guess just reassurance. They are looking for a "reassuring" fetal heart tracing, which would include moderate variability, accels, and no ominous decels. All of these details can't be picked up with a doppler, nor does the doppler provide an tracing. That's why they will say they need to do this, although no studies have actually shown that having these "reassuring" characteristics present improve outcomes. The down side of doing this is that if they DON'T see the reassuring stuff, they will never let you off the monitor. I don't know of a hospital that will take the "liability" of letting you refuse at least a 20 min strip, though.

3...Are there any good reasons for internal fetal monitoring (is that different from screwing that monitor into babies head?)

There are two types of internal monitors -- an IUPC (intrauterine pressure catheter), which measures contractions, and FECG (fetal scalp electrode), which sticks in the baby's head and measures the heart tones. The IUPC can actually quantify the strength of the contractions (although I don't always trust them), so if pitocin is involved it can help in titration. Both are most useful in cases when contractions or fetal heart tones are difficult to pick up with external monitors. both have risks and should not be taken lightly.

4...I pushed #1 out in 20 minutes and #2 in 15 minutes so I assume this one won't be a problem either. Are there any good reasons to allow doctor to use forceps or vaccuum extraction?

The only reason that vaccum and forceps are really used (legitimately) are fetal distress and maternal exhaustion. Sometimes if a mom has been pushing for 3 hours and just doesn't have any more in her, it's a better alternative that a section. Or if the baby really looks like it's in trouble and needs to come out fast, it's better than a crash section. It helps to really have a provider that you can trust on this one, though because fetal distress can be rather subjective when pushing (decels are common when pushing and not always a major concern), and there are other things to combat maternal exhaustion (letting her rest, changing positions).

5...Doc said the only thing from my birth plan that the nurses might have issue with (not the doc) is not giving baby a bath at the hospital before I leave. Is there anything that can legally protect my right to not do that? Is that just an intervention that I can refuse to allow?

Why should anyone bathe your baby without your consent? There is no medical reason to do it. Be prepared for some resistance and harassment, but stick to it. I refused it when my son was born, and I heard crap from several nurses, but who cares? Let them wear gloves to handle him, it's better for him anyway...

Hope this helps....
 

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Discussion Starter · #3 ·
thank you--you also gave me some things to bring up with my doc--much appreciated!!!

Sarah
 

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Does your hospital have a central nursery or baby gets to always be with you in the room?

If not, request rooming in with the baby (you might have to pay out of pocket to have a private room).
 

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Discussion Starter · #5 ·
Baby's always stay with mom at this hospital unless a problem. They don't have a nursery, only an NICU. so that's good.

sarah
 

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One reason to concider a medlock is if you are inclined to low blood pressure, or there is some other reason to think that in case of an emergency, it might be difficult to get a vein. Some people regularly seem to have a hard time with this.

The bath - they can't make you give the baby a bath, however, there is an argument that hospitals tend to have a lot of germs that are not in your home, and that a bath just before leaving can help to remove some of those germs before you take them home. Sometimes they are quite willing to let the mom give the bath. Why is it that you want to avoid it?
 

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Discussion Starter · #7 ·
Quote:

Originally Posted by Bluegoat View Post
Why is it that you want to avoid it?
well, for one thing, it's not necessary--dries out the skin and has possibility of lowering body temperature, but I also found that with my son who was born at home, that first bath is such an intimate and transitional event. I love the way babies smell when they are born (gross, right?) and I want to keep that...maybe a bit selfish on my part, but I just don't think I'll be ready for that transition in the first 24 hours of baby's birth.
 

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Also, the vernix it beneficial to the baby's skin and has protective qualities -- it may serve a purpose to protect the baby against all those hospital bugs. Also, if the baby isn't bathed, hospital personnel will be inclined to wear gloves when touching baby which will help protect even more.
 

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Quote:

Originally Posted by mamatoady View Post
well, for one thing, it's not necessary--dries out the skin and has possibility of lowering body temperature, but I also found that with my son who was born at home, that first bath is such an intimate and transitional event. I love the way babies smell when they are born (gross, right?) and I want to keep that...maybe a bit selfish on my part, but I just don't think I'll be ready for that transition in the first 24 hours of baby's birth.
I think if you bring it up this way to the hospital staff members they won't bother you. Let them know the first bath is something special and sentimental to you and you want to do it at home. Tell them it is a family tradition or a religious ritual that you do.
 

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Quote:

Originally Posted by mamatoady View Post

Can anyone think of anything else I might want to arm myself with as far as possible interventions might be?

Thanks for the help!!!
Sarah
I know you mentioned not wanting your newborn to get a bath. What about the other newborn routines: vit k, eye ointment, circumcision, hep b shot, PKU?

vitamin k helps with blood coagulation. There are rare disorders that prevent the blod from clotting. However, it is very rare, and most babies will have their natural supply of vitamin k built up by the 8th day after birth. 2 reasons that I can think of to give vit k: if your baby is having a medical procedure done (i.e. surgery or circumcision) within the first 8 days of life, if the birth is traumatic and there are signs of bruising on the baby.

the eye ointment protects the baby from transmission of an STD infection to the baby that could lead to blindness. If you have an STD, you might consider this.

Circumcision--well, there is a whole forum dedicated to that subject, and I won't get into it all in this post.

Hep B shot-- the first in the vaccination series is typically given immediately following birth. I don't know how you feel about vax's, but the way I see it... even if you will be getting your baby vaxed, hep B is transmitted through contaminated needles and unprotected sex with an infected partner. So unless you have hep b, it's not really necessary for babies.

The PKU screening tests for a number of rare disorders. It is legally required in many states. There is some evidence that the most accurate PKU readings are gained 24-48 hours after breastfeeding begins. You might request having this done at baby's first pediatric appointment instead of at the hospital. It would also be good to request that you nurse your baby while they are doing the screening to help with any pain from the heel pricks. You might have to be forceful with asking to breastfeed (I requested this with my baby, and the nurse told me she couldn't get a good position like that... I wish I'd been more insistent)

Oh! Pacifiers, formula, bottles-- If you're planning to breastfeed, ask them not to give or use any of these things. Make an appointment with the hospital's lactation consultant.

There are a number of new born procedures that hospitals typically perform unless you ask them not to. If you think that your hospital will be okay with your requests, that's great! It sounds like your dr. is very supportive. If you think that any of these requests are going to be an uphill battle, then you can either:
1. Prepare for the battle and put all of your requests in writing. This is your baby, after all.
or
2. Pick you battles. Know which of your requests are most important to you. You may not have the energy to fight all of them and if you know which ones are most important, then you can let go of the rest.
 

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Not a birth professional, but I wanted to let you know a efw things about my (wonderful) hospital experience.

We had to do a strip but it was not 20 minutes- just however long it took to get a few contractions recorded which for me was only 5 minutes.

Also, they didn'y do IV's/heplocks unless you were planning to get and epidural or had some other complication. So normal vag deliveries did not get heplocks.
 

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Just as a datapoint - I'm in Toronto, the biggest city in Canada with big, well respected teaching hospitals. There is no hospital, not one, that does routine IVs or saline locks. Not one. I *only* see them for administering abx (GBS+, maternal fever), as part of epidural prep and for administering oxytocin. I've never seen one for maternal dehydration - drinking does just fine.

We do not have intrauterine pressure catheters. Internal fetal monitoring definitely does mean that wire they screw into the baby's scalp (aka "scalp clip"). A scalp monitor can, at times, save a motherbaby from surgery for fetal distress, so they have their place.

I rarely see forceps any more. Vacuums are much more common. It's always worth asking about changing positions before consenting to a vacuum.
 

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Unless you're going to a very normal birth friendly hospital Pick your battles very carefully.
Never forget it's their house their rules as they will never let you forget that. So if you come in with a long list of birth plan demands that is a sure way to have it disregarded and writing out every last detail requested is not what works.

Have you read this very interesting perspective aobut dealing with a birth plan from a homebirth midwife that also has privileges at her local normal birth friendly hospital. Very sensible advise that i have recognized to be true over the 19 years I'm a birth professional. Too often I see overly detailed birth plans (including how the staff should talk to the laboring women!!) and the birth becomes the antithesis of what a client wanted to happen at the hospital.

BTW are you using a labor doula ?
 

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You can choose to do oral vit K which is much less invasive. US hospitals and insurance co prefer the shots as they get a lot more money from them. (they do separate charges for the pieces). Our insurance did not reimburse for the oral, but we felt it was worth it.
 

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Quote:

Originally Posted by ladyg View Post
You can choose to do oral vit K which is much less invasive. US hospitals and insurance co prefer the shots as they get a lot more money from them. (they do separate charges for the pieces). Our insurance did not reimburse for the oral, but we felt it was worth it.
I'm trying to understand the US system. What do you mean about charging separately for the "pieces"? And are they using something different for oral administration? In Canada, afaik, the same liquid is used for either route of administration - you either draw it up in a syringe, or attempt to administer the solution orally. The injection is preferred because it seems to be more effective, because it's difficult to ensure the dose goes in orally, and because the oral dose has to be repeated twice over the next couple of months, and they don't think parents will follow through.


Our guidelines are here: http://www.cps.ca/ENGLISH/statements/FN/fn97-01.htm
 
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