labor management in hospital

2junebabies · May 2013

Hi ladies! Today I had my birth plan appointment. I was feeling good about everything, and the nurse midwife told me I didn't even have to request things like no episiotomy or forceps/vacuum delivery because they don't do those as regulations anyway. She also said I could be monitored intermittently. I tried to ask when they would recommend pitocin if my labor was slow (previously I had been told that they'd recommend it if dilation hadn't progressed in 5 or 6 hours...I don't even know if that's reasonable or not...), but she said she couldn't say because it would all depend on how the baby was handling everything.

Anyway, she also gave me a big packet of things to read about hospital tests and policies once I'm in labor. Now that I am reading it, I feel like I signed up to be the mouse in some mad scientist's crazy experiment. For active labor, it says things like "baby's heart rate and contractions will be monitored...using belts on your stomach or we may apply a monitor to the baby's head and one inside your uterus." Um, what? I definitely don't want an internal monitor. It also says "the nurse will do vaginal exams to determine your progress in labor" and then it says "your water will be broken if not already." WHY? Why do they need to break the water automatically, and why can't they just wait until it happens on its own? It also says "we may consult anesthesia physician to help you with pain control" and "you may be offered medication if you experience discomfort." Hello, it's a birth, I know that there will be discomfort, but that doesn't mean I want you shoving meds in my face. I'm just frustrated because when I initially asked another OB in the practice about all of this, she said that the nurses and doctors would explain anything they wanted to do and that I had the right to say no to whatever I want. I am hoping that's still true, but this stupid handout makes it sound like I have no say in what they do to me. Have any of you ladies had a similar experience where your doctors seemed natural birth friendly but the hospital policies threw you for a loop? Did you have trouble declining stupid things like tons of cervical checks and rupturing of membranes? Am I overreacting? FWIW, I am planning on staying at home as long as possible. Thanks!

tokenhoser · May 2013

You always have the right to decline.

If you labour at home as long as possible, much of it becomes irrelevant. My hospital birth was lovely, and not really "by the book" as far as they were concerned.

2junebabies · May 2013

tokenhoser:
You always have the right to decline.
If you labour at home as long as possible, much of it becomes irrelevant. My hospital birth was lovely, and not really "by the book" as far as they were concerned.

Thank you! I always appreciate the helpful info you post here about natural hospital birth. I guess "no" will become my new favorite word.

SarahinMD · May 2013

Yeah as PP said, labor at home as much as possible. When you first call your midwife when you think you're in labor, make sure she knows that's what you want to do. My midwife was a great resource for not rushing us to the hospital because her first question to us (there are 4 MWs in our practice,so it's whoever is on call) was how we wanted the labor to go. When I told her I wanted to labor as home as long as possible, she said ok, and we'd check in every couple hours. In the end, I decided when to go, but it was good knowing she was fine with us not going sooner. We arrived and discovered I was fully dilated, and so the vast majority of those issues never arose. But yes, you can always decline-make sure your DH or support person knows what you want too, since depending on what stage of labor you're in, you may be more inclined to follow suggestions (like if you're in transition).

annabelle.27 · May 2013

babybrown2013:
tokenhoser:
You always have the right to decline.
If you labour at home as long as possible, much of it becomes irrelevant. My hospital birth was lovely, and not really "by the book" as far as they were concerned. 
Thank you! I always appreciate the helpful info you post here about natural hospital birth. I guess "no" will become my new favorite word.  

if you anticipate having to put your foot down, make sure your partner is well aware of your wishes and feels comfortable advocating for you. In advanced labour you may not feel that you can articulate your wishes. With my first labour I had a hard time getting words out and ended up going along with a few things I hadn't planned on doing because I was not able to go against the flow. Even though in the moment I was still against what was going on, like pushing on my back, but trying to fight against it did not seem possible in that moment because so much of my mind was on other matters.

Good luck!

oliversmommy32912 · May 2013

You do not have to do anything you don't want to do. It sounds like they are explaining what could happen at the hospital but your dialogue with your midwife suggests otherwise. I would highlight the sections of the packet that you have concerns about and address it with your midwife at your next appointment. You have the right to decline anything you don't want to do. Just say no thank you and tell them you are willing to sign a waver if necessary.

I went into my hospital birth expecting to fight the whole way through. I just said no to what I didn't want and they didn't give me any resistance for most things.

tokenhoser · May 2013

I would also say you need to teach your partner to say no for you, as I really could not communicate my wishes near the end of my labour. If you're really nervous (or even if you're not), consider a doula to help you negotiate the system. My doula gave me so much more confidence to stay home a while, and made me more relaxed in the hospital setting.

hooligans4 · May 2013

make sure your partner knows what you do and don't want in the delivery room and make sure he will fight for your wishes. the dr's will break your water to make the birth go quicker. do not let that happen. they broke my water with my first and oh boy did I see stars after that. my second my water broke on its own when I was pushing and it was so much better. as for the internal monitor if the baby is in distress they screw a small wire into the babys scalp. if babys heart rate is dropping for too long it might not be a bad think. think what is best for baby. but def talk to dr about all of your concerns. while you are in labor and in pain you might agree to just about anything so make your wishes known ahead of time. best of luck to you and all I can say is that I enjoyed both of my births because I was in control and I could feel everything and I felt powerful and strong.

best of luck

2junebabies · May 2013

Yeah, thankfully my DH has been reading up a lot (he read Ina May's Guide to Childbirth and he's reading The Birth Partner now), and he knows my wishes and is fully on board with them. He agrees that natural birth is best and he is more than willing to speak up for me, so that is a relief. Thank you for all of your replies. Hopefully the experience will not actually be as combative as I was thinking.

RMama2012 · May 2013

I'd bring that handout to your next OB visit and discuss. My understanding is ultimately it is up to the Dr for a lot of things. No nurse ever offered to check my dilation. I was lucky in that my OB was around so he was the only one to really check.

I second speaking with your support person as well.

The best thing for me was that my dr had me visit his office, not the hospital. He doesn't have an issue with epis but he does agree that Interventions, being in the hospital too long, epi too early, often lead to csections. Ultimately, his help with avoiding the csection is what helped me achieve my med free birth.

nosoup4u · May 2013

RMama2012:
I'd bring that handout to your next OB visit and discuss. My understanding is ultimately it is up to the Dr for a lot of things. No nurse ever offered to check my dilation. I was lucky in that my OB was around so he was the only one to really check.
I second speaking with your support person as well.

Definitely all this. Talk to your provider about that handout - it could be it's a detailed list for women who don't have the background/knowledge about interventions you have.

Do you have anything in your birth plan about having providers discuss any and all interventions before they happen? We had a pretty bad experience after DS1's birth (related to him, not me), and had a specific line in my birth plan for DS2 about nothing being done without our explicit consent.

And in all honesty, it's hard to say no when you're massively pregnant and in labor (early or late). Especially if you have pushy providers (something you might not know until you're in the room with them). I thought I was well-versed and outspoken about what I did and didn't want, and then I found myself stuck in the hospital in much earlier labor then I had planned, and with some jerk MWs.

Make sure your partner/DH knows your wishes, wave that birth plan around, etc. This is a good post to read, too: https://rixarixa.blogspot.com/2010/12/dont-ask-just-do.html

hollowstar · May 2013

JUST SAY NO.

Make sure your partner (or doula if you have one) knows your wishes as well.

The paperwork may also not be totally reflective of the staff that day. Each nurse is different. My midwife warned me that a couple nurses where I'm delivering are pushier about certain things, and made sure that I knew I could just tell them no!

I agree though, it's stupid that you even have to fight so hard for your own patient choices and rights. Just do your research so that you're prepared to decline things with confidence.

aylafsu88 · May 2013

oliversmommy32912:
You do not have to do anything you don't want to do. It sounds like they are explaining what could happen at the hospital but your dialogue with your midwife suggests otherwise. I would highlight the sections of the packet that you have concerns about and address it with your midwife at your next appointment. You have the right to decline anything you don't want to do. Just say no thank you and tell them you are willing to sign a waver if necessary. I went into my hospital birth expecting to fight the whole way through. I just said no to what I didn't want and they didn't give me any resistance for most things.

I agree. It sounds like they are explaining what could happen. From what I understand is it ultimately up to the care provider to decide what to do and when. If you talked to your MW about most of these concerns and she gave you other answers I think you can relax a bit. Set yourself up for a great birth by laboring at home as long as possible and refuse any interventions you do not want. I had a hospital birth and I said no to a couple of things (like a Hep lock, ointment, first bath). No one argued with me and everyone was OK with it. GL!

alphahelix · May 2013

I also had a great natural birth in the hospital - it can be done! Even though MH and I were both ready to fight for what we wanted, it turned out we didn't need to. In addition to the great advice you were given by PP's, I would also suggest the book 'Natural Hospital Birth: the best of both worlds". It has lots of great tips for declining interventions and dealing with hospital staff. I think in the end, the best thing you can do is to be informed and labor at home as long as possible. You'll do great!

mandy522 · May 2013

alphahelix:
I also had a great natural birth in the hospital - it can be done! Even though MH and I were both ready to fight for what we wanted, it turned out we didn't need to.

Totally agree. Keep in mind most people who deliver in a hospital WANT all those things, but if you are clear upfront about your birth plan (keep it to one page and stick to the medical stuff, which is what the nurses need to know), good nurses will work with you. My nurse read it, noted a couple things on the white board in my room (including No meds) and that was that. My nurse thought it was awesome that I wanted to go natural and did everything she could to help.

Also, be nice to the nurses Smile . You will spend much more time with them than with your MW or OB, so while it is important to be prepared to advocate for yourself, it will all go much smoother if they like you. Just don't walk in assuming they are going to fight you on what you want.

2junebabies · May 2013

Thank you again for all of the replies. I will definitely be nice to the nurses and attempt to work with them instead of against them. I will also brush up on when an intervention would be medically beneficial. I don't want to risk the baby's health if something is truly needed, I just don't want them to push things for arbitrary reasons like time limits. But the advice on here is very helpful and I'm feeling better. I will also take that packet to the next appointment and discuss it. I'm guessing that they just give it to you so you are aware of everything that could possibly happen, and not because they will automatically do everything to you when you're there.

VABride2008 · May 2013

maymomNY:
One thing that is really important to me is that pain meds never be offered to me at all by anyone. It's the only thing on my birth plan that is bold and underlined. As pps mentioned, I know there will be times when I will not be as able to resist such a suggestion. I am well aware of my options and will ask if I change my mind. This is something I've discussed with each individual midwife at my practice as well, just to make sure they're totally on board.

At my hospital it was policy for the anesthesiologist to come in and make you aware of the risks, procedures, etc. of getting an epidural and to sign a consent form. Basically so that if you decide in a panic that you have to have an epi right now, you will be ready. I declined signing the consent form, though. It was annoying that I had to talk to him even though I knew I was not going to get an epi.

SweetPeaK26 · May 2013

They can't do anything you tell them not to. I declined the internal scalp monitor, but in the end, did have the other internal monitor because I was having so much trouble progressing.

To me, it doesn't sound like the paperwork is forcing anything on you. you have to remember that there are other moms who WANT to know these things, and will WANT these things. Just take it with a grain of salt.

labor management in hospital

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