Birthing in the Hospital... What to Expect

I often support women giving birth in hospitals.  Birthing in the hospital means that there will likely be routine procedures and potential interventions that take place... it comes with the territory.  It's important that women and their partners are familiar with 1) what these procedures and interventions are, 2) why and when they may occur and 3) what the risks and benefits are to each.

To be clear- the point of this post is not to list out the pros and cons, but to instead list the most common routine procedures and interventions so that they are all in one place.  My hope is that clients of mine, fellow doulas, and parents looking for a list like this can use it as a springboard and do their own research.  I want people to KNOW what can be expected when laboring and giving birth in a hospital.  Follow the rabbit trails of links and suggested reading and be very familiar with what these common procedures and interventions are.

So without further adieu, I give you the list.

Amniotomy or Artificial Rupture of Membranes (AROM) aka "Breaking your Water"
This is often suggested as a way to help induce (start) labor OR to augment (speed along) labor.

• Very detailed article on AROM at PregnancyToday

• Information on AROM along with other induction measures at American Pregnancy Association

Routine IV Placement
Upon being admitted, it's routine for either an IV (Intravenous Fluids) to be started or for a saline lock sometimes called a "Hep Lock," a hold-over from when heparin was used, to be placed.  IV fluids are administered to help with hydration.  If an IV is not started, but the saline lock is placed, it's done so medical staff can have quick access to veins should the need arise.  The jury is still out on whether routine IV placement is the best standard of practice among low-risk pregnant women.  What is important for you to know and to discuss with your care provider is what your options are.  Do you absolutely need to have an IV while in labor if you're not planning to receive pain medication and/ or not needing antibiotics because you didn't test positive for GBS?  Do you need to have a saline lock placed at admission or is your care provider comfortable with waiting to have it placed until you need it? Once you know what your care provider and your place of birth require, you can plan accordingly for your labor. 

• Quick rundown on IV's during labor from the blog Suite101

• Lamaze International's stance on IV use during labor

Denying Food and Water During Labor
For many years, it's been common procedure to restrict eating solid foods and drinking liquids during labor.  Spoonfuls of ice chips have been the main "soup du jour" in many hospitals.  This is mainly due to the concern that should a woman undergo general anesthesia for a Cesarean, she could aspirate anything she'd eaten or drunk while in labor, a condition known as Mendelson's Syndrome.  However, in recent years, there's been much debate on the current likelihood of this happening since general anesthesia routines have changed over the years. 

• The Cochrane Library review on restricting oral food and liquid intake during labor.

• ACOG's (American Congress of Obstetricians and Gynecologists) 2009 statement on food and water during labor.

•  Very, VERY informative article on NursingCenter site with LOTS of links to other resources on the subject.

• Article on MedicineNet discussing food and liquid intake during labor.

• Article on PubMed evaluating the debate on eating during labor.

• Sheridan Ripley of the blog Enjoy Birth writes a post on eating and drinking during labor and links to previous posts on the subject as well. 

Electronic Fetal Heart Monitoring (EFM)
Your baby's heart rate is monitored throughout your pregnancy and during labor and delivery.  During pregnancy, this is typically done with either a fetal doppler or in the case of a non-stress test, with an external fetal monitor. During labor, the external fetal monitor is primarily used and in some instances, the internal fetal monitor. 
EFM is heavily relied upon in hospitals.  Most hospitals and care providers require continuous EFM, but a few allow for intermittent EFM.  It's important that you know what is routine where you'll be delivering and to talk with your care provider accordingly.  

• WebMD takes a look at external and internal fetal monitoring.

• Editorial piece in the American Family Physician (AAFP) online journal on why EFM is being used; very informative.

• SUPER detailed article from the American Family Physician journal on the interpretation of EFM.  More info than you'll likely want to know, but very thorough.

• Article from 2011 in the American Journal of Obstetrics & Gynecology on the use of EFM and its relation to neonatal and infant mortality

• Post from The Clinical Advisor on EFM vs. Intermittent Auscultation (IA)

Vaginal Exams, Cervical Checks, Pelvic Exams
It's not uncommon to want to know what your cervix is up to in the last few weeks of pregnancy and during labor.  Many care providers will offer to begin checking at 37 weeks.  It's important to know that it is YOUR choice to have a vaginal exam or not.  This is true both during pregnancy and during labor.  It should be noted that checking your cervix and reporting the findings cannot and will not indicate when labor will begin and/ or how it will progress.  There are a few different things that can be measured during a vaginal exam

• Well-written and thought-provoking post on the ICAN of Western Maryland site: "Routine Vaginal Exams During Labor"

• Another thought-provoking post on Dare to Birth Naturally site: "The Vaginal Exam During Labor: Is It Necessary?"

Hospital Gown
To some, this may seem like a silly thing to list as a routine procedure and to others, this might be really important to consider.  It's common for a woman to be encouraged to change into a hospital gown when she is admitted during labor.  We've all seen them... the lovely open-in-the-back kind.  There is absolutely nothing wrong with using the hospital gown.  At the same time, there is absolutely nothing wrong with requesting to stay in your own clothes.  For some women, the thought of putting on a hospital gown makes them feel like they're a sick patient vs. a healthy woman who's in labor and happens to be birthing in the hospital.  If you want to wear your own clothes, this is something that you'd want to check out with the L&D at your hospital.
Some alternatives to wearing a hospital gown that I've seen are: a sports bra or nursing tank and loose skirt, a short tank-style, loose-fitting night gown, nothing at all, a custom made labor gown (see links below), or a sarong, to name a few.

• Pretty Pushers

• BINSI

• Gownie by Baby Be Mine Maternity

• B.Y.O.G.

I realize there are more procedures and interventions to write about and I plan to do so in future posts.  These include the use of epidurals, Pitocin, Cytotec/ Misoprostol and Cervidil and various newborn procedures such as Vitamin K shot and eye prophylaxis (Erythromycin).  The ones listed above are what I tend to see as the basic standards of care during labor at the hospitals in which I've attended births.

You might be asking, what now?  I suggest asking questions and conversing with your care provider about what you've read.  Take a tour of the hospital you're planning to birth in and ask questions of the tour guide and/ or the head nurse.  The more you know about what it will be like when you are laboring and birthing in the hospital, the more informed you will be.  The more informed you are, the easier it is to be ready for the routine procedures and possible interventions that will be offered.  As mentioned earlier, the main goal is to be aware and have information so you, along with your care provider and birth team, can make the best decision for your labor and birth.  It's important to remember that in choosing to give birth in a hospital, there are rules and procedures that come along with that choice.  Some of those are flexible and others are not.  In talking with your care provider, my biggest suggestion is to do so without an agenda and without an "Us vs. Them" approach.  Instead, do your research and engage in an open discussion.  If you feel you're not getting anywhere or coming up against resistance, remember you are the one who gets to choose who you're entrusting your care to.  If you want to find a new care provider who might be a better fit, you can. 

As you prepare to give birth in the hospital, keep this in mind, with any suggested intervention- use your BRAIN.

Further Online Resources on Routine Procedures and Medical Interventions
Lamaze Healthy Birth Practice #4
Common Medical Birth Interventions You Should Know
Routine Labor Care