Choosing the Right Birth Facilityby Ginger Garner
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As an expectant mother, you probably daydream about the moment you will actually meet your baby for the first time. What he or she will look like? How will it feel to hold that tiny miracle in your arms for the first time?
Pregnancy is a journey whose big finale is birth, that sacred experience when you meet your baby for the first time - hear their cry, smell their tiny newborn head. It is a joy you get for just a few breaths, mere moments, out of an entire lifetime.
You may envision a birth where you are given dignity, control, respect and are able to make truly informed decisions. You may imagine having the constant support (of your choosing) of your partner or coach for the miraculous event. Sadly, this is not happening in many labor and delivery units across America today.
I have interviewed dozens of women who shared their birth experience stories. Many were marred by traumatic or dehumanizing treatment in the hospital. One mother said her terrible hospital birth experience was at least 50% of the reason why she chose to only have one child. She said she felt like nothing more than a “cattle cow being herded along” as quickly as possible through the big business that is birth. And yes, birth is big business in America, as Ricki Lake states in her film, The Business of Being Born.
In today’s hospital setting - where 98% of births take place, a woman has about 16 caregivers during the course of her labor. However, the majority of time she is alone during a hospital birth, says cultural anthropologist Robbie Davis-Floyd in her book Childbirth and Authoritative Knowledge: Cultural Perspectives. Yet birth rights champion and longtime midwife Ina May Gaskin reports that when women are assisted by a constant caregiver (usually a woman), they are able to birth over 90% of the time without being anesthetized.
However, no matter what type of birth you choose, whether with or without pain medications, your rights should not change. Women today may not realize they have the right to hire (or fire) a caregiver when they feel they are not being treated fairly and with respect and dignity.
Every woman in America should also have access to a Baby-Friendly Hospital. A concept born from the World Health Organization and UNICEF, their vision is for America to be a nation that appreciates breastfeeding and the benefits it provides for mother and baby. The number of Baby Friendly hospitals has grown from 86 in 2009 to 134 in 2012, but that is still too few, considering that, according to the AHA, there are approximately 5, 815 registered hospitals in the US.
For these reasons, I recommend every mother interview their hospital or birth facility BEFORE showing up in labor.
Your Life, Your Body, Your Birth
Keep in mind that you do not have to give birth in a hospital just because it is near your home or because you think you must birth there. Although controversial, studies do repeatedly show home birth to be even safer than hospital birth. Click here for more information and research on this topic. For books on this topic, click here and here.
Hospitals, particularly, have set policies and rules that they will not deviate from, even when the policies are not supported by medical science. No laboring mother wants to check into a facility to suddenly be hit with a list of “can’t do’s” - like finding out that she cannot labor freely, must be separated from her baby for a set amount of “observation” time, must birth in lithotomy (flat on back and feet in stirrups, which actually narrows the pelvic opening for birth), or cannot use simple tools like a birth ball or tub. It may sound far-fetched, but in my own search I encountered all of those restrictions in hospital policy.
Your body and your birth are yours. No woman should have decisions made about her body and birth made without her consent, especially when they don’t follow sound medical science (like the lithotomy position, for example). I did (finally) find a birth facility (after interviewing three) and caregiver that enabled me to have the kind of birth experience all women deserve.
You don’t have to be pushy or demanding to easily find the right birth facility for you. You don’t have to make complicated requests or have an extravagant birth plan, although I do recommend having a simple one. What these questions will do is empower you to make an informed decision about where you give birth.
How to Find the Right Hospital or Birth Center for You
Every hospital will give a tour of its birthing center and laud its facilities, but it’s up to you to investigate whether the hospital is truly “baby friendly.”
Step one: Schedule a tour of the hospital’s birthing center, preferably a private tour rather than a group one. A group tour is more likely to resemble indoctrination into hospital policy and procedures. It is also less likely to allow time for serious questions to be answered. A hospital should be willing to do a private tour. If they do not, mark them off the list. A private tour takes no longer than about 15 minutes. And don’t forget your health care provider may be able to provide a tour. My caregiver, who happened to be a midwife, offered to give me a personal tour.
Step two: Be prepared with a list of questions. That way you are less likely to forget something, or lose the nerve to ask a difficult question. Here are a few “Red Flags” that should immediately knock a facility off the contender list:
Red Flags (that you should consider a different facility)
1. The hospital tour guide, usually a nurse on the L&D (labor and delivery) floor, cannot or will not answer these questions. Birth outcomes are public knowledge, so you have every right to know about them (i.e. C-section rate, epidural rate, maternal and infant mortality rate, etc.) in this hospital. So ask. Question authority.
2. You get answers that you do not like about one of the questions below. The questions below can help ensure your basic needs are met for a mother-centered (that is to say, the mother is in charge) birth. A progressive, Baby Friendly hospital will honor and respect your rights, even those as simple as knocking before entering the room and as large as asking permission for doing a type of exam or honoring a mother’s request to breastfeed exclusively. Finally, you should receive answers that give you confidence, not doubt, about the hospital and your birth.
Top 8 Questions To Ask A Birth Facility (before you preregister or arrive in labor)
1. Can I birth in the position I find most comfortable?
Secondary questions: Do you have a birthing ball, tub, shower, or other means for comfort measures and pain management? Can I bring my own music? Can I wear my own gown? Can I bring my own birthing ball and tools for pain management?
The answer from the hospital staff person should be an emphatic yes! You have the right to birth in whatever position and with whatever methods you find most comfortable. Any birth position is actually better for you and baby OTHER THAN the lithotomy position. If a hospital requires you to birth in a certain position or won’t allow certain methods to be used - run away. Do not preregister. Do not ask any further questions. Find another facility.*
Informed women know helpful birthing positions can be different for each woman, depending on her body. I gave birth to all three of my children in various forms of side lying, but some women choose all fours, squatting, supported squatting semi-reclined with their partner or husband holding them up, or a combo of all of them. Lastly, make sure all requests for pain management are a part of your birth plan.
2. How much care can you provide for my baby without having to take him or her to NICU, if that is needed? What level is your NICU rated and what does that mean?
For ideal bonding and breastfeeding, mothers and babies should remain together as much as possible during the hospital stay. However, should your baby need higher level care, many larger, teaching hospitals and medical centers will provide lower level or step down care in your birthing suite. This option is very Baby Friendly.
Some hospitals still maintain outdated “observation” policies, where it is “mandatory” that the baby be taken to the nursery and “observed” for up to 3 hours after birth, even when they do not need NICU. This is not necessary nor beneficial for mother or baby.
Separating mother from baby can make breastfeeding more difficult or even impossible. Baby Friendly hospitals will promote “kangaroo care”, or skin to skin contact and immediate breastfeeding after birth. “Latching on”, or learning to breastfeed can be difficult for mother and baby, so a hospital should prevent separating mother and baby whenever possible.
3. Do you require bathing, vitamin K injections, and eye ointment? If so, how do you do this and when?
Baby friendly hospitals will allow baby to stay in room with you while all of these procedures are done. Furthermore, a baby friendly hospital would also give you the choice of delaying or opting out of these procedures. In other words, a hospital who does not give you the right to elect out of these procedures or request when they are done is not baby friendly.
4. What is your C-section rate?
A touchy one – but one you want to know. The C-section rate has skyrocketed from under 4.5% in 1965 (Taffel et al 1987) to a whopping 33% of all births in the United States today. This is far higher than the recommended 5-10% by the World Health Organization, which could also explain why infant and maternal mortality has been steadily increasing in the US and further, why the US ranks below 49 other countries for maternal and infant mortality rate.
5. How will my nurse handle my birth plan? How many patients is an L&D nurse assigned? (FYI: If you are pregnant and have not started a birth plan - start now.)
They should be open and receptive to helping you achieve the birth you want, which includes encouraging inclusion of a birth partner (husband, doula, or family member coached). There should be no stutter stepping or hesitation on the part of the nursing staff to answer this question. Also, learning how many other patients a single nurse is responsible for will give you a big clue into how much support you’ll actually have from her during labor.
6. What percentage of mothers receive inductions or epidurals?
Inductions notoriously result in higher risk for birth complications and medical interventions. Share with the nurse that your intention in asking these questions is only to make sure you can labor freely - walking, groaning, whatever strategy it may be - without being repeatedly badgered, asked to be quiet (this happens), or offered pain medications. This is also something you should discuss with your caregiver (ob/gyn or midwife).
If a mother does choose to birth naturally, repeatedly offering pain meds can break down a mother’s will and her ultimate wishes because it makes her feel as if she is failing and she “cannot do it (give birth).” Laboring moms should be empowered, encouraged, and supported at all times, not derided or mocked for their birth plan, whether it includes pain medications or not. I have heard these stories time and again from mothers who were literally mocked, ignored, or belittled during their labor.
7. What is your policy on CFM (continuous fetal monitoring)?
Hospitals usually “require” CFM or at least a trial of intermittent fetal monitoring (FM), despite the fact that it has not decreased cerebral palsy or fetal deaths since its introduction into obstetrical practice in the 1970’s. Although fetal monitoring has only increased the rate of C-sections and forceps vaginal deliveries, it is still mandatory hospital policy throughout most facilities in the US.
However, at the least, a hospital who requires FM will “allow” you to be free and manage labor for 45 minutes of every hour. Which means you will only be physically restrained by FM (which means you cannot walk or move around during a contraction) for 15 minutes every hour. It is important that the hospital have a flexible policy on FM, since the more a mother is restrained the more likely she is to feel higher levels of pain.
8. Bonus question: Can I eat and drink during labor?
Historically hospitals or physicians have limited mother’s access to food or drink while they labored – and without hard science to back the policy.
However, this policy is changing now that the Cochrane database reports that, according to a review of literature, there is no scientific evidence of any risk when a mother eats or drinks during labor. Make sure the hospital you choose does not still adhere to the antiquated policy. Further, not eating or drinking could lead to hypoglycemia, fatigue, dehydration, or an inability to manage the demands of labor, which require increased medical intervention and could lead to birth complications.
Other questions to ask:
• What is your policy on visitors? Can siblings visit? When? How long?
• Are there separate rooms for birthing and recovery (usually there are)?
• Are cameras or video allowed? Many hospitals are increasingly banning them.
• If I do have a C-section, can photos be taken of the birth? Can the drapes be lowered to watch the birth?
• Are IV’s required?
• Do you have a lactation consultant?
You Deserve a Better Birth
You have the right to ask questions of the facility and should receive respect during the process. A facility that refuses to answer questions, belittles, humiliates you or your family members (which I have seen), or dismisses your questions as ignorant or a result of being uneducated about birth, is exactly the kind of facility which could use intimidation or humiliation during your birth experience, all under the guise of “hospital policy.” It’s up to you to arm yourself with the knowledge of your rights and your options for birth in order to have the birth you want.
Happy birth facility hunting- and don’t forget - you are in charge of your body & your birth.
*Keep in mind that in order to choose the facility you want you must find a caregiver that has hospital or birth center privileges. Meaning, the caregiver can admit and care for you at the facility. Therefore it is important to interview not just your caregiver, but also the potential birth facility. My next blog will discuss interviewing your baby doc or midwife.