Earlier this year, I had a lovely client who was smart as a whip. She was having her first baby and chose the hospital for her birthplace. She made excellent choices during her pregnancy–selecting great care providers and preparing for an unmedicated birth. Then her baby was breech. A persistent breech. Every trick in the book and still stubborn breech. Of course she wanted a vaginal birth. And we talked about available options to deliver a breech vaginally. She knew that her current care providers would not deliver a vaginal breech. She chose to continue care with them, labor spontaneously, and hope that baby might turn in labor. She waited until the last possible moment for baby to turn (literally about to push) and when baby didn’t, my client had a c-section. Did my client fight the c-section? No. Because she knew going into her birthplace the limitations of her environment.
If I choose a homebirth, I understand that I’m not going to get an epidural.
If I write in my hospital birth plan that I want a waterbirth, it isn’t going to happen. In fact, someone might laugh at me.
Some things are what they are.
When choosing the hospital as a birthplace, it is helpful to understand the culture and expectations of this environment. Even hospital to hospital, policies and procedures are different. But there are some basic norms. In my region, the norms include–no eating/drinking during labor, bloodwork done upon admittance, intermittent monitoring, hep-lock, loads of consent forms, a vaginal exam in triage. I realize that the patient can decline procedures AMA or refuse consent. But some refusals, in real life, play out very ugly. I know. I’ve seen them. Do you really want to be angry, defensive, and fighting during your birth? If you decline a bath for your newborn, it usually isn’t a big deal. If you decline to have any fetal monitoring, it is a pretty big deal. You’re in for a bumpy birthing.
Take the hep-lock. Not many people go to the hospital for ANY procedure without getting an IV or hep-lock. My husband had a 15 minute diagnostic procedure at the hospital and guess what? He got an IV. Hep-locks give hospital workers quick access in case of emergency. Is it necessary in a normal birth? Probably not. Is it policy? Absolutely. Is it your right to refuse? Sure. Is it easy to refuse? No.
I’m planning for my own birth now. I am making choices and preparing for what I expect to happen. Still I realize that I get the birth I get. If I go into labor at 34 weeks, my experience will be wildly different from what I planned. If I were to have a cord prolapse, I would not waste a breath questioning a c-section. We make the best decisions we can in the environment we birth and with the birth we get.
What I’m encouraging is a sense of reality and compromise when it comes to birth settings. Most expectant couples do have choices when it comes to choosing a birthplace and choosing a care provider. Not sure what your choices are? Email me. Ask around. Call a midwife. Post on a natural birth message board.
Please don’t get me wrong. I am all about informed consent. And my job as a doula requires that I support my clients in their choices (even when I don’t agree). But my files aren’t reviewed by hospital administration. I don’t have JHACO or whomever reviews the hospital looking over my shoulder. Nurses and doctors are human–they want patients to be happy. They also want to keep their jobs and they don’t want to be sued. Open communication with your care provider early in pregnancy can go a long way to either smoothing the path to a gentle birth or clueing you in that maybe you need to find another care provider.
In my next post, I’ll discuss some ways to have a smoother hospital birth.
ETA: I do not think we should stop trying to change outdated obstetric practices like refusing food and drink to laboring women. However, I’m not sure your own birthing is the best time to change the hospital policy.