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Natural Birth
BootsOrHearts
member
Ignoring hospital policies during labor?
BootsOrHearts
member
I'm delivering at a hospital that is relatively NB friendly, although I am still learning all their specific policies. One of them is a ban on solid foods during labor, but I'm thinking, what are they going to do? Kick me out for eating a granola bar?
So I just got to thinking, if hospitals have any kind of policies we don't like - what can they really do to enforce those?? If they have a policy about needing an IV - and you refuse to have one put in for example, can they hold you down and do it anyway? Can they ask you to leave? Just wondering what people's experiences have been. . . .
**Warning: Losses and living child mentioned**
BFP#1 1/31/12, EDD 10/6/12 Harrison Gray born sleeping @ 18w6d. You changed our lives little guy.
BFP#2 EDD 10/29/13, C/P 2/25/13, Bye little Ish, we barely got to know you.
BFP#3 EDD 12/21/13, Baby Boots born 11/23/13 My rainbow baby!
January PAL Siggy Challenge: Good Advice
BFP#1 1/31/12, EDD 10/6/12 Harrison Gray born sleeping @ 18w6d. You changed our lives little guy.
BFP#2 EDD 10/29/13, C/P 2/25/13, Bye little Ish, we barely got to know you.
BFP#3 EDD 12/21/13, Baby Boots born 11/23/13 My rainbow baby!
January PAL Siggy Challenge: Good Advice
This discussion has been closed.
Re: Ignoring hospital policies during labor?
No, they cannot force you to do anything without getting a court order. You have the right to refuse any procedure, exam, or drug. They can't kick you out over something like that either (I'm not a lawyer but I believe that would be an EMTALA violation).
I think if you deliver in a hospital, requesting a heplock is a good compromise to consider. That way you don't have an IV, but they still have easy access in case of an emergency. In a hospital, you have to pick your battles and they are usually willing to meet you halfway on this one.
I had my husband sneak me some juice and crackers during my first delivery. The nurse turned a blind eye. I say eat if you are hungry.
I think that some things you may have to compromise on (like getting a hep-lock instead of an IV) but I think most hospitals are pretty easy going with your requests as long as the doctor has ok'd it.
I never had a formal written out birth plan and just talked to my doctor about my requests and she wrote it in the notes that were given to the hospital. I had a hep-lock and ended up getting some fluids for about 15 minutes during my labor because I felt like I was going to pass out at one point. But I wasn't hooked up for the rest of my labor and delivery. I also had intermittent monitoring where the nurse put the monitor on me for 5 minutes of every hour which even that bothered me but I knew it had to be done. They have wireless/waterproof monitors so I was even able to labor in the tub through it all. I was also approved to do a waterbirth, but I changed my mind at the last minute because of baby's position.
I would just be up front and honest to your doctor and discuss your wishes with him or her.
Re: food, I just ate at home and labored there as long as I could. By the time I got to the hospital, I was too far along to want to eat. But my plan was definitely to have food and to eat when no one was looking (if it even seemed to be a problem). They actually offered me apple juice when I was laboring at the end though (b/c I had no IV...)
Re: the IV...my friend who I took Bradley classes with showed up to the same hospital I delivered at and immediately her H told them "no IV"...they got some very snide comments from nurses, including "why did you even come to the hospital to give birth then?" but they gave him the form to sign and that was that. I was also very far along and when they attempted the IV, they messed it up....blood everywhere, needle pain, not cool. At that point, I could feel the urge to push and was in transition and struggling and I just said, "NO IV! I want the waiver form!" The nurse gave me a little bit of crap (I was GBS+...) "A single dose of antibiotics will help protect your baby..." (which is BS). I told her as much, and she was disgusted with me, left the room to get the waiver form and talk to my MW (who was very supportive of my decision), and she never returned. They sent in a much more supportive NB-friendly nurse instead.
So anyway, I guess the point of my stories is that you can decline whatever you want, you may hear some crap from the nurses about it but they cannot force you. And ultimately, despite the one snooty nurse I had, I still felt completely supported in my choices and had a wonderful hospital birth experience.
Getting your OB/MW to sign-off on as much as you can ahead of time is huge.
Picking your battles is the key. You want your nurse to advocate for you and be on your side. If you go in there with guns blazing and ready to fight every single policy, it puts the hospital staff on the defensive.
I also had a very positive low-intervention birth experience in a hospital. I think the main reason for that is that I labored at home for so long and arrived fully dilated and pushing. DD was born less than 90 minutes after we checked in. Trust me - eating and drinking were the last things on my mind. I ended up with an IV because I was so dehydrated, but I really didn't care. I also had a continuous fetal monitor, but it was not a big deal at all. I still had the freedom to push in whatever position I wanted.
It amazed me at how many hospital policies my L&D staff ignored because I was so far along. I did not get antibiotics for being GBS+ (my water didn't break until right before DD emerged, so she had better protection than what any drug would offer) and I did not have any admitting blood work or monitoring done.
So, my advice would be to labor at home as long as you can. But maybe not quite as long as I did!
I'd recommend picking a few things that are really important to you and talking to your Dr about those ahead of time. Some things are just not going to be a big deal. For example, before I had my DD I was also concerned about having the freedom to eat during labor. But once I was in labor, food was the last thing I wanted. I couldn't even eat a lolipop b/c it made me feel nauseous. I did have lots of cold gatorade though (thats what I wanted).
Also, I was GBS+ so my birth center wanted me to have a hep-lock. I hated having it but it didn't limit my mobility at all, I was able to labor in the tub and shower, and in the end- I needed some IV fluids because I hadn't eaten. So it ended up being a good thing. I think they actually hooked me up to the IV while I was in the tub. It wasn't an issue at all.
My advice would be to focus on your goals for delivery rather than the individual policies, and then talk to your Dr about making that happen. Good luck!
You'll want to talk things over with your OB.
They do have their hospital procedures in place for a reason...though often to protect against worst-case situations, which are unlikely but can still happen. IVs so they can quickly get medicine into you (say if you were hemorhagging). Things like not eating solid foods while in labor are in case there is a turn of events and you have to be quickly intubated (if you were to vomit food while under general and intubated, the vomit could get in the lungs and compromise breathing, etc). Again, not that these things will happen...but I found the hospital nurses were very good about balancing my needs with their need to be able to provide me quick care. They placed a heplock later on, offered me food up until the last minute, kept offering juice or broth (though I didn't want anything but water while laboring either), and only did intermittent monitoring with a wireless.
If you still don't want any of those interventions/compromises, then you might want to consider a birth center or home birth perhaps. Otherwise, you might be fighting mini-battles constantly, which certainly isn't relaxing or allowing you to focus on birth.
While I agree with picking your battles, completely (and I was absolutely going to have an IV just so that it wasn't a battle I had to pick...until the nurse botched mine, made me bleed and seemed all sketchy and panicked, all while I was in transition), it is just as easy to quickly get pitocin to you in case of hemorhagging via a needle in the thigh. I really don't understand the hospital's dire need to automatically give IVs to all laboring women. It really irritates me.
I totally agree with this!
Agreed! And not all hospitals see the value as a blanketed approach. My hospital never even mentioned an IV/Hep-lock to me. I was told at my first CNM appointment that they only recommend them if a patient starts to get dehydrated.
Some of these policies are pointless. I once read that not eating/drinking while in labor is the same as telling someone not to eat/drink before getting in a car. Because after all you could get into a car accident and need emergency surgery.
I haven't posted on here much but am so surprised at these hospital policies!! I live in Australia and in the public hosp system (Medicare) it is standard to be encourage to eat and drink during labour. My nurses were pushing water and sandwiches on me and encouraging walking around etc. I think it's a lot different over here as in the public hospital system all babies are delivered by mw's unless a dr is needed. I think our gov encouraged low intervention natural birth as it is cheaper!! Our private hosp system (where u take out insurance to deliver with a ob at a private hosp) sounds more like the us system.
I really think we should be lucky in aus that the things you guys fight so hard for in hospitals are standard and available to anyone free.
NO, they can't force you to do anything but they can scare you like crazy and have you sign tons of paperwork to remove their liability and they can even call a social worker and report to CPS in some circumstances. During your most vulnerable time, when you hear that if you don't do x,y and z, your baby may die, it is a bit hard to ignore.
For instance, if you refuse the IV because you are GBS+ they sometimes will require you to have baby tested and in some situations will mandate that you stay a full 48h or more for "observation" and in even some situations they will just automatically administer antibiotics to baby as if, he/she was exposed and is septic. If you decide to check out AMA (against medical leave) then they can and sometimes do get social services involved.
So while the simple answer is no, you have complete free will to determine your care, it can be a fight. It is important to just know your rights and then to determine what is important to you and what you are willing to fight for. HOpefully though your hospital is more natural birth centered and already has a great deal of freedom and flexibility in place to allow more options to the birthing mother.
9 angels in heaven-3 in my arms and 1 in the NICU
Mono/di twin girls: Josephine born to heaven and Evangeline born Earthside at 25w
I made sure that I ate before I got there. Once I was in hard labor, I wasn't exactly interested in eatting but after I had the babies, I was starving so I was glad I had brought snacks.
I didn't get my IV at the non-NB friendly hospital becuase they never got around to it. It didn't put up a fight at the friendly one. It's not that big of a deal. Just annoying tryign to get to the bathroom.
They cant force you to do anything if you are coherent! If you pass out and are in danger its another story...but no one can hold you down lol. I plan on sneaking some cheerios and granola bars in as well... labor has to be exhausting and calorie consuming!
An IV and what everyone is referring to on here as a hep lock are the same thing. It is actually called a saline lock. The IV is inserted into a vein with a needle but the only thing that is left in the vein is the plastic tubing which is then connected to the tubing. You do not have to have fluids running through it but it is all the same.
More than likely you will have to sign paperwork that you refused those things. They can't make you have anything you do not want. If you eat food they can't kick you out but you should educate yourself on why they limit your intake. If for some reason you needed to have an emergency c-section and were put to sleep (this is the natural birth community so you wouldn't have epidural access) your at risk for that food you ate to be aspirated into your lungs. You could end up with pneumonia or worse.
All the policies are put in place to prevent problems and keep you safe. Just remember if you refuse an IV your at risk for bleeding out, emergency hysterectomy, and death. IV access would significantly reduce these choices.
Lurker here, usually hanging out over on the knot and nest these days...
I'm not yet pregnant, but would I would love to go the natural birth route, so I've been lurking on your board learning a great deal from you ladies
As a nurse, I wanted to give my opinion. If you're giving birth in a hospital, you have to understand that as nurses, we're all for you to choose what you want and what you don't - that is fine. But, having recently taken care of a post postpartum women that aspirated during intubation for her c-section, developed very bad pneumonia, and eventually Adult Resp. Distress Syndrome (ARD's). She was on a ventilator her entire ICU stay, kept very sedated as to ensure proper breathing with the ventilator, and very sadly did not make it. Eating while laboring, if you're at risk of needing a c-section, could lead to these scenarios.
I would also seriously suggest not ignoring the need for a saline lock for access. If something goes wrong, and you were to need emergency intervention, it can be very difficult to obtain access on some people. Now, on a 20 something with great veins and otherwise healthy, I'd probably feel comfortable in my abilities to start an IV on you within 15 seconds either way, and be more comfortable without having access that way. But if you have poor veins, or are are beginning to become dehydrated (and your veins can get a lot harder to hit), it gets a lot trickier.
If you're ok with taking those risks, then be polite to your nurses and don't crop up an attitude right away, explain why you feel the way you do - listen while they explain the risks - and sign any paperwork you need to. I'm a little sad at the bad rap nurses are given on this board (from my reading thus far) - I can only think it's because it's one of the few things you can't plan for in advance (aka - you can't interview and pick a specific nurse ahead of time).
Thanks for all the info ladies...learning more everyday from you guys
FF
Oh good lord.
Not that that's the worst case scenario or anything.
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Did that woman eat?
Or did she aspirate something she ate many hours ago, or just plain ol' stomach acid?
Life is a risk. Birth is a risk. Nothing is risk free. There are pros and cons to choosing to eat - the pro, of course, being that I was well fueled and capable of pushing for 2 hours. If I would have quit eating at the first twinge of labour, who can say if I would have had that strength 14 hours later.
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She had eaten about 6 hours prior.
Life is a risk, as you said..so is birth. I just didn't quite like that nurses get such a bad rap here - we aren't asking you not to eat to torture you, and we're not asking for IV access just because the hospital policy tells us to. We break hospital policy all the time when pt's request, and simply chart "pt explained risks/benefits and continued to decline IV access at this time". Experience tells us that, without IV access, we can't give you many drugs that would save your life (yes - we can also give many critical drugs into your bone or right down an endo tube in your lungs - but IV access is the fastest, most reliable way). I'm sure some nurses are pushy about it though, and you're all right - if you're healthy, and going through a natural life process of child birth, I agree - you shouldn't need an IV just as a precaution.
And has many PP's have said, you can refuse ANYTHING at the hospital as long as you are of sound mind and not under medication (once we sedate you, for instance, you can't sign any consents or sign out AMA until your sedation wears off).
FF
My hospital actually didn't even want to place an IV when I got there. And they didn't. I was fine with a saline lock - and I ended up with one post-birth to administer antibiotics. It simply wasn't necessary, so they didn't do it.
The ACOG guideline is to not eat 6-8 hours prior to surgery, so that poor woman that had aspiration complications actually followed the guideline. The problem is that digestion slows in labour - and, of course, that you can aspirate stomach acid. It is a risk, but it's a pretty rare one. You can bet I'll eat when I feel I'm hungry next time. You can also bet I'll stay home as long as possible again, too. I like the safety net of delivering in a hospital, but until they're working with me to avoid interventions, I'm not showing up a moment before I need to. My one and only recollection of my labour nurse is her saying "Should we get her on her back?"
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