8.06.2011

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.

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

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. 
  •  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.

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.
  • 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.

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

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.

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

7 comments:

  1. My sister and I ( a labor and delivery nurse and a certified nurse midwife!) have a hospital gown company... www.laborlooks.com so our gowns work exceptionally well with hospital environments.

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  2. Jenna, I totally get the hospital gown thing. I was adamant that I wanted to stay in my own clothes when I got to the hospital. The thought of putting on that hospital gown made me feel like I was going back in for another C-Section and not a a normal vaginal delivery. Even though it was such a small thing, it made me feel like I had control over what was going on. Great post!

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  3. Thanks for sharing the link Brittani!

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  4. I was so suprised at how hard the hospital I was looking into having my first baby at fought me about not wearing my own clothes. I was like, "are you freakin kidding?"

    "they'll get dirty" (um, DUH.)
    "we might have to cut them in event of an emergency" (Ok. fine.)
    "we cant wash them in our laundry. You don't want to have to take dirty laundry home with you." (seriously??)

    I ended up trying for a homebirth with my first.
    With my second I was in a hospital, and wore a swim suit top under my rob. That way when I really wanted to be naked I ripped off the rob and went into primal mode. Primal mode plus swimsuit. ;)

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  5. MaryElizabeth... LOVE your comment.

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  6. At first when I heard of the fashion statement labor and delivery gown that's now available, I rolled my eyes. -- But then I thought back to those first pictures and my lovely traditional tatty gown that kept slipping off my shoulders.
    labor & delivery gown

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