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.
Inexplicable Ways 
Amen! Preach it sister. 😀
ahhh, yes… the tree which moves in the wind is much stronger than that which breaks because it refuses to bend.
Such a wise old soul in a petite, perky(former cheerleader?!?), soft-spoken doula. 😉
I LOVE this post and am looking forward to more tips on making hospital births as smooth as possible. I will be passing this on to my hospital birthing students!! Thank you for some great info…
That was so encouraging, Julie. Thank you.
For a lot of us, the hospital IS the compromise. While I don’t advocate bursting into the delivery room ready for a fight, I do think the outcome of your birth rests solely in your own hands. It’s likely something isn’t going to go according to plan. It’s up to you to make choices you’ll be happy with and allow yourself to realize you’re doing what you need to in order to have a positive outcome, even if it’s not the one you expected. Sometimes it just boils down to perspective, which only you can control.
What are some things you would suggest doing to influence hospital policy outside of your own birth? The majority of us never really come in contact with L&D staff outside of our own experiences.
Jenn, I was hoping you would share your perspective. And, of course, you would ask the elephant-in-the-room question. 🙂 The answer really deserves an entire post (or an entire ICAN meeting).
How to influence hospital policy? Wow. No easy task, I realize. I think the first step is to understand who the decision makers are and how the hospital machine works. So, you need an insider. A local physician and my nurse mom have helped me but I still have a ways to go in getting the complete picture. If you represent an organization (like ICAN), you are in a good place to request a meeting with a decision-maker. If you are an individual, letter-writing might be a good beginning. If you’re planning a hospital birth, write to the hospitals you did not select and explain why you didn’t. If you had a hospital birth, write to the hospital after your experience and give feedback–both positive and negative.
The information on evidence-based maternity care is out there. That work has been done and is being done on a national level. http://www.childbirthconnection.com is a great resource for national health reform campaign and documents available for sharing. Check out their Maternity Quality Matters Initiative. The baby-friendly hospital initiative is another campaign that can be implemented on a local level. And finally, my favorite source, the Cochrane Database provides the most recent research available.
Now the most important piece–the consumer. Maternity care is the money-maker for most hospitals. If we can empower and educate the consumer on best-practices (physiological birth, continuous labor support, vertical birth positions, etc), then they will drive demand for change.
I know–easier said than done. Thanks for asking the million dollar question, though.
I couldn’t agree with you more. I know I have only so much wiggle room within the confines of hospital procedures, but knowing what some of my options are even with limitations makes me feel a lot more comfortable and secure with my birth place.
Love this post. I do feel like I am going to have to put up a fight. So, we’re looking for the hospital AND doctor which most agrees with our birthing beliefs. If you have one but not the other it’s still going to be an uphill battle.
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