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Natural Birth
MuddyInsignia
member
Do hospitals normally require this?
MuddyInsignia
member
DH and I are planning to have baby at the hospital 2 blocks down from our house. I plan to have a natural birth and hope to labor at home as long as possible (until transition) before showing up to maintain comfortable surroundings, etc.
Yesterday we attended our 3rd out of 4 birthing class at the hospital. That class mostly covered medical intervention: epidural, induction, augmentation, etc.
One thing that was really casually mentioned was the automatic dose of pitocin given to a mother right after birth to decrease a chance of hemorrhaging. I felt like the trouble maker all class, constantly questioning what we could or could not do. Once again, I questioned about opting out of this and it sounded like it might not be an option to opt out. Is this normal--do most hospitals automatically require new mothers be given a dose of pitocin. I plan to breastfeed right away--so why the need unless there is hemorrhaging?
The other thing they seemed pretty unwavering about were automatic treatment of newborns with the eye ointment (to prevent gonorrhea) and a Hep-B vaccine. I have been vaccinated against Hep-B and I do not have gonorrhea. Why can I not opt out?
Finally they seemed to be uncertain if the doctor would allow a delivery position other than on your back on the bed. I prefer the option of other positions (squatting, all fours, standing, etc.)
For those who have experience with hospitals, how much of your birth plan could you actually achieve and how much did they just not allow?
I am having trouble updating tickers--But I am due on April 2015. I have 2 older step children: 9 and 14 yrs and I also recently had 2 younger children: 2 years and 1 year... so this means I will be having 3 under 3--and trying to fit our family of 7 into our minivan--eek!
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Re: Do hospitals normally require this?
Some of these things might be different in different states, but I can tell you my experiences (I'm in Northern VA).
There have been discussions on the post-partum pitocin on this board before, and it seems like it really varies from hospital to hospital. Some places give it automatically, some do it on an individual basis. I personally was given it after my first birth because I was bleeding pretty heavily, but my doctor didn't think it was necessary for the second one.
Eye ointment they let you delay, but I think they require it within several hours of birth. In Virginia, you can opt out of the Hep-B vaccine at the hospital, but then your pediatrician will administer it at the first checkup.
As far as birth position, this has nothing to do with the hospital. You need to discuss this with your doctor. As long as you are on the same page, the nurses and hospital staff aren't going to prevent you from getting into any position.
In my hospital, post-birth pit is standard. I didn't have an IV, so I got a shot in the thigh. I researched the pros and cons and didn't really see strong cons. This one is evidence-based. It helps shrink the uterus, too. It's easier to prevent a hemorrhage than stop one.
Vaccines and eye ointment may be mandated by the State. You need to look into your local regulations and laws.
Delivery position is between your doctor and you. If your doctor discourages women from delivering in the position they find most effective, you need a new doctor. Mine was happy to let me deliver on all fours (but I got the impression from the nurse that this was not normal for them).
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I got the pit post-birth, too. I barely noticed when she stuck me in the thigh. Like tokenhoser said, I couldn't find any strong cons to getting it, and the pros are very real.
We opted out of Hep B at birth, but DD got the eye ointment.
My hospital was open to different delivery positions, but I was most comfortable on my back as it turns out.
Thank you ladies. I am not against vaccines--in fact, I am actually a proponent for most of them. However, I think the newborn Hep-B is unnecessary since a baby will still have to get the first round of the Hap-B vaccine at the first check up.
My doctor is sometimes on call and sometimes not, so who helps me deliver depends on which day and time I show up at L&D. Even if I discuss with approval from my OB, I am concerned that the random doctor on call that day will not allow something I have wanted and asked for...
FYI, I am in CT. I think it is interesting that nearly all these rules are out the window if a woman chooses a home birth. I do not like that there is no happy medium.
PP pitocin - I was told that I could opt out of anything I wanted, but this one might happen anyway, because it's just common protocol. I decided not to opt out b/c there is adequate research showing that it has benefits. I ended up having more-than-average bleeding after birth (not as much as a PP hemmorage, though) so I probably would have gotten it either way.
HepB - I withheld this vaccine until DS was about 2 weeks old, once his jaundice had cleared. The nurses gave me no issue about it at all. In fact, one nurse went to great lengths to make sure my wishes were followed. The pedis asked more questions about it, and I had to sign a waiver, but they were fine with my waiting a little while.
Eye Ointment - I waived this entirely. I didn't see any benefit, and neither did my OBs (for a woman in my specific situation). Again, the nurses were fine with it and the one nurse was wonderful about making sure that my wishes were followed. The pedis at the hospital went into a bit of a tizzy because my STD testing records had not been transferred, but once they recieved them, there was no issue.
Pushing in different positions - Ask your OB about this. I pushed for between 3 and 4 hours with DS. The vast majority was with a nurse who was pro-natural birth. So she actually encouraged me to push in different positions, and helped me get into them. The OB seemed indifferent about it. If it's helping they probably wouldn't stop you.
BFP#2: EDD 2/11/14, MMC confirmed 7/15/13 (growth stopped at 6 weeks), D&C @ 12 weeks 7/25/13
I feel you on that; my choices are the hospital or home and that's it. I wasn't comfortable with home for my first baby, so I went to the hospital. My experience was okay, but I'm not sure what I'll do next time.
I'd suggest looking into a doula for you - we had one, and it really helped. She could help a lot with birthing in a somewhat natural-birth adverse hospital. For me, having a doula attend my hospital birth helped create that "happy medium" environment. You can also fire any nurse you can't deal with - ask for a natural-birth friendly nurse when you check in, and if you're not jiving with who you get... ask for a new one. Don't LOOK for reasons to hate the nurse, but some are obviously better than others.
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It sounds like you might be in for a bit of a fight. You do have the ability to decline any and all treatment... ESPECIALLY "just in case" treatments like Pitocin in a non-emergency. This would be something to discuss with your doctor. Hospitals have policies and it can be difficult to get them to over ride those policies without the help of your doctor. I would suggest that you go in looking for a conversation with your doctor. I'm thinking something along the lines of, "In the childbirth class they mentioned that they automatically give mother's pitocin after delivery. I'm just wondering about the benefits of that - especially as I plan to breastfeed immediately following delivery which would provide very similar benefits."
You also have to remember that the teacher of the class you attended does not have the authority to say, "oh yeah, we'll skip that for you." Write the things you're concerned about into your birth plan. I have still not vaccinated my son against Hep B because I don't have it. If people are concerned about it, I tell them not to have sex with my son and they'll both be protected from Hep B!
For each of the things you're concerned about, I would recommend doing a risk/benefit analysis. You might also consider prioritizing things you feel more strongly about so that you're not constantly fighting with your medical team. If, after that and a discussion with your doctor, you don't feel like you're getting anywhere, you might consider switching doctors/hospitals to a place that would be more supportive of your birth goals.
I was told 3rd stage pitocin was required, but I still asked them to wait on it. I didn't have an IV/heplock, so they had the thigh shot nearby to administer if required. It ended up being not necessary and not administered.
My nurse actually encouraged we wait on HepB, and seemed surprised that I didn't decline the ointment. She barely put any on. I'll be declining the ointment this time (although I'm having a home birth this time).
I didn't have Pitocin post-delivery. I guess I wasn't bleeding too badly. My concerns about it, though, had to do with its ability to cause stronger contractions and fetal heart rate irregularities -- so I would have been fine with it after I delivered, if needed.
As for laboring in different positions: talk to your OB. Your OB can often override hospital policy. Also, you're not criminal; they can't tie you to the bed!
The hospital I had DS at did this routinely as well.... we compromised and I had an IV inserted with no tubes but it was there in case they needed it. They didnt need it.
The eye ointment is state law in some places - check and see if you can opt out. With DS1, it was too much of a hassle to not do it (we needed to opt out with the state), but with DS2 (in a different state), we were able to refuse it at the hospital. We refused the Hep B vaccine at birth with both kids, and weren't given a hard time about it.
The Pitocin after birth doesn't bother me, but just talk to your provider about not getting it unless it's truly needed.
As for pushing, the hospital with DS1 was better about having me push in different positions, but with DS2, I pushed while sitting in the bed at a 45 degree angle. But! I will say that by the time I got to pushing with both of them, I was too tired/out of it to care, quite honestly. Again, talk to your provider about it beforehand. hth
DS2 - Oct 2010 (my VBAC baby!)
Just because you are delivering in a hospital doesn't mean that you lose say in what you want. You can refuse any and all treatments. They may give you major crap and ask you to sign a waiver, but you can always refuse! That being said it's always good to pick your battles figure out what's important what's not and go from there.
As far as Pit after delivery that seems to be quite common now and the research seems to support it. My hospital does not do it routinely. In fact after delivery I told them I was OK with them doing it if they thought I needed it, but they just said 'Let's wait and see." I never needed it.
As for newborn procedures we did the eye ointment even though I tested negative for STDs. To me it was one of those things that wasn't worth fighting about, plus there was a little part of me that was scared of the what ifs, like what DD really did need it? Irrational I know, but we just let them do that. As for Hep B that wasn't a problem. We just told them we were planning to have it done by our own pediatrician. The hospital pedi just said that's fine, she will need it before school and that was that.
I delivered in a pretty pro-natural childbirth hospital (they didn't even ask me to have a saline lock), and my birth plan was followed without problem. The only thing I couldn't do was have a water birth (I could labor in the tub, but had to get out and push). I knew that going in and that wasn't a deal breaker for me, so I was fine with it.
Postpartum Pit is pretty standard. I was induced with Pit, so they just kept it running. Not sure what they would've done if I hadn't been induced.
Here in TX, it's really hard to opt out of the eye ointment at the hospital. Even at the very NB-friendly hospital where I originally planned to deliver DS, I was told that I'd be in for a real fight if I wanted to opt out of that one. I don't think it's worth the fight. But I ended up delivering DS and then DD2 at home, and was happy that I could opt out.
HepB shouldn't be an issue. But with DD1, a nurse at the hospital kinda guilted us into getting it. I'm still bitter about that. But I'm sure she would've backed off if we had stuck to our guns.
Delivery position is definitely dependent on the doctor. With DD1, I mostly pushed on my hands and knees, and ended up delivering her lying on my side. My OB was totally cool with that. Actually, I think she suggested those positions.
Mommy to DD1 (June 2007), DS (January 2010), DD2 (July 2012), and The Next One (EDD 3/31/2015)
I gave birth in a birthing center located in a hospital and just down the hall from L&D. I've never even heard of Pit after birth. I did bleed a little bit too much but they never gave me a shot, they just pushed down on my stomach really hard.
I trusted my providers to do what is right...my biggest question for you is if you trust yours. Blanket hospital policies really bother me
Breastfeeding and pregnant!
I did not have pit post birth. If I had gone much longer without delivering the placenta I would have had it, but I was given about 20-30 minutes.
We were allowed to delay the eye ointment (maybe for about an hour) and completely declined hep-b while in the hospital.
In the end I delivered on my back on the bed, but I was multiple positions before that and would have been allowed to deliver in another position.
My birth was attended to by a midwife, so overall she was pretty open to our plan.
@GoldenPeaches, thank you for that link, it was very helpful.
It is interesting to hear how everyone's experiences are so different in this area, particularly when it is a natural birth forum, one would think we all have the same experience/opinion.
I think was PP said about picking one's battles is key. I will have to decide what is at issue here. I do not like the idea of eye ointment, newborn Hep-B vaccine, postpartum pit, or discouraged from trying different laboring positions. However, some may be more important to me than others.
At this point, I think my top priorities will be with avoiding the newborn hep-B vaccine and trying different labor positions. I think I can allow the others if needs be, but wish the situation were different...
Chiming in with my experience too. I had a med free birth at a hospital in MD with a midwife.
In my birth plan, I put that I didn't want the post-delivery pitocin unless necessary. My uterus was clamping down fine so I didn't need it. I breastfed right away and was really surprised at how much cramping that caused, really every time I breastfed for a couple weeks.
DS didn't get a bath for about a hour to 90 min after birth so we could do skin to skin and breastfeed. I did go ahead with the eye ointment which they put on right after his bath. My thinking was, I wouldn't want to put my finger in my vagina and then rub my eyes, regardless of not having gonorrhea. So not really a medically-driven decision on my part, but there it is. I guess I could have asked the bath focus more on his eyes, but I don't know if he would have appreciated that at the time.
We declined the Hep B at the hospital. DS got it with his first round of vaccinations at the pediatrician office at 2 months. I did have to sign a form, but no big deal otherwise.
I switched from an OB practice to my midwife practice at 32 weeks because several of the OBs in the practice were condescending regarding med free birth and I didn't want to have to fight about moving around in labor and pushing how I wanted. To me, this is definitely something worth standing up for, more so than the other things above. I tried one on-the-back push and HATED it. Laying on my side was only marginally better. So basically, completely ineffective for me. I ended up squatting on the floor to move DS down and climbing onto hands and knees on the bed to push him out. All of pushing took 20 minutes (total labor was 36 hours). I would have been there hours more had I had to stay on my back.
DS, May 2011
I don't know if it varies by state, but I have always been told you can opt out of any kind of medical treatment (I'm in WA). Make sure it is clear in your birth plan and ask to sign any waivers necessary. My doula said if they throw a fit to ask them to sign a document that you write saying that they personally guarantee that there will be no ill effects from the treatment. She said no one will sign it but they will stop harassing you.
DH and I decided we were going to pick our battles...I would rather have skipped everything but I felt that our wishes would be respected more if we weren't "those people" (Not a bad thing. I love "those people". The hospitals...not so much). We opted out of HepB, eye ointment, and we asked they not rub off the vernix/bathe the baby. Our hospital was totally fine with those choices and respected my wishes. The ped on call threw a fit about the ointment at discharge but I stuck to my guns. We said OK to the Vit K and I did receive Pit after birth. I do not know if it is routine at my hospital but the MW thought I needed it...I had a lot of bleeding. Turns out it was just my extensive tearing :-/ FWIW, I felt no negative effects from the Pit. Not even cramping or anything.
I would talk to your OB about any concerns. I found that the people teaching the courses at our hospital weren't always well-informed about what is truly hospital policy and what is the norm.
For us, I did have pitocin following the delivery due to bleeding. It was never discussed as a requirement prior to giving birth. At that point I wasn't in a position to argue - I couldn't really see what was going on down there and both the nurse and doctor commented on the blood loss and were massaging my uterus like crazy trying to get the bleeding to stop before giving pitocin. So I consented.
I also had a second degree tear and agreed to local anesthetic for the stitches.
We opted out of Vitamin K and Hep B. I think we had to sign something, but no push back from the hospital.
You've really done your research and are asking some great questions. I'm sure your OB can clarify everything for you.
Finally, someone said it! YES, you can refuse any treatment. Why is it that people think once they go into a hospital they give up any say in their own care? Or is it they are just more willing to do so and then whine later about not getting what they wanted or being coerced into things? You are responsible for your care. Do your research. Talk to your doctor and pediatrician. Decide what is best for you. Period.