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When I was pregnant, I was the annoying one. In my childbirth ed class, I knew every answer. I was the one reminding my midwife which tests and shots I was due for. I went on my hospital tour before I was even pregnant (and made my husband come too). No one quite understood my fascination with knowing as much as humanly possible about this thing that my body was going to do all by itself. “You know the baby’s going to come out no matter how many books you read, right?” they’d say, as I made a pros and cons decision matrix about the five different OB practices I had interviewed. (Oh, of COURSE I interviewed my OB! But that’s a different post for a different day.) No, what I was worried about more than anything else — more than the pain of labor, more than fear of breastfeeding issues, more than realizing I had no earthly clue how to raise a whole other human being — was the moment a doctor or a nurse might come in and say, “No, you’re not allowed to do that.”
In the last week of my childbirth ed class when I was pregnant with my first son, another couple came into class looking pretty upset. They shared that they had been on their hospital tour the previous weekend. Mom had asked the nurse giving the tour where the shower was, and was told there were no showers in the Labor and Delivery rooms.
“Oh,” mom had said, “I was hoping to be able to labor in the shower, with the hot water to help with the pain.”
“In the shower?!” the nurse had replied, a little shocked. “No, no, we don’t do that. You’ll be in bed on a monitor anyway, so that really wouldn’t work.”
“Well, I can walk around though,” mom said. “I want to do intermittent monitoring.”
“Intermittent?” replied the nurse, getting a little annoyed. “No, we don’t do that either. It will be a continuous monitor.”
“So how can I walk around?” asked mom, getting a little concerned.
“You won’t be,” replied the nurse. “You’ll be in bed. You have to stay in bed.”
“But my doctor said I would be able to walk around during labor,” said mom.
“I don’t know what to you tell you, dear,” the nurse replied. “These are the rules. You’ll be in bed.”
The couple went on to say that they called their doctor and asked, in so many words, what the eff was going on! The doctor said that, yes, she would LOVE to have mom walk around during labor, but if the hospital said no, then the hospital said no. It was out of her hands. Everything we had been learning in our childbirth ed class about non-medicated pain management — moving around, using heat and water, and staying off our backs — was now not an option for this couple. And because mom was 39 weeks pregnant, it was probably too late to switch to a new care provider at a different hospital.
That night I vented to my husband about how confusing it was that she and I both lived in the same city, that her chosen hospital and my chosen hospital were (literally) eight miles away from each other, yet their policies were completely different. My hospital had bathtubs for laboring in, encouraged moms to walk around, and didn’t even have continuous monitoring in the “Birthing Center” wing. I lamented that this other mother didn’t have time to look around for another option, because she was due next week. “Why didn’t she go on her hospital tour earlier?!” I cried to my husband. “Babe, I hate to break it to you,” he replied, “but you’re the only one I know who goes on hospital tours for fun.”
I’ll let you in on a secret: when you go on hospital tours for fun, you begin to notice the difference between hospitals. One tour guide may tell you ALL about the cafeteria and the wifi and how many cable channels you will get on the TV in your room, while at another hospital, the guide will tell you about where your baby will sleep and how many people can be with you during labor. One place will emphasize their NICU and their operating room, and another may emphasize their bathtubs and collection of birthing balls. (Sidenote: all these things are important, but HOW important they are is up to you. It’s ok if you and your other pregnant friend differ on what’s most important in your birth setting.) When you ask the same question at multiple hospitals, you’ll start to get a feel for the routines they usually follow. Let’s say you ask nurses at two different hospitals “How do the Labor and Delivery nurses feel about moms pushing in different positions?” The nurse at hospital #1 says “Oh, yeah, we’ve seen everything. We say, ‘If you can get the baby IN in that position, we’ll help you get the baby OUT in that position!’” Then the nurse at hospital #2 says, “Um, uh, I’m not really sure, um, I guess you’d have to ask around, I mean, I’m not sure anyone’s ever really been asked that.” I bet you can guess which hospital has mom pushing in lots of different positions, and which hospital routinely has her on her back in a hospital bed.
But my doctor calls the shots, right?
Well, depends. Some hospitals have many different OB and Midwifery practices who all have “privileges” there, meaning they’re allowed to deliver babies there, even if they don’t work FOR the hospital. In those cases, they have to follow the rules set by the hospital, or else they may lose their privileges. If your doctor is telling you one thing, and the hospital is telling you another, find out RIGHT AWAY who’s in charge. You can ask to speak to the nurse manager for the Labor and Delivery department, and have them confirm which rules are hospital policy, and which are at the discretion of the delivering doctor.
But the hospital only has tours as part of their Childbirth Ed class/doesn’t have tours.
You’re going to get sick of me saying this, but ask anyway. Call them up, ask for the Nurse Manager in Labor and Delivery, and say you want to come in for a tour. If they say you have to be part of a class, ask when the class tour is and say you will be tagging along. If they don’t offer tours at all … well, that would make ME suspicious, but if there are no SCHEDULED tours, ask to make an appointment for a private tour. Hopefully they WANT you to have your baby there, and they should WANT you to see the place before you’re in active labor — it makes their life easier if you know what’s going on.
But it doesn’t matter, because this is the only hospital in town/covered by my insurance.
Go on a tour anyway, and ask your questions anyway. Sometimes there are rules in place that are only there because no one’s asked to change them yet. So many rules governing Labor and Delivery are holdovers from when policy-makers didn’t really understand how laboring bodies worked, and many have been refuted by modern research — things like time limits on dilating, eating and drinking during labor, and the “you-must-have-this-baby-by-40-weeks” rule. So if there’s a rule that doesn’t jive with your plan, ask what can be done. Want to labor out of bed? Ask for it. Want to have immediate skin-to-skin contact with your baby? Ask for it. (Are you sick of me saying that yet?) Want to have a steak dinner delivered to you during active labor? … I doubt you’ll want to, but who am I to tell you what you want?! Be the annoying one and ASK FOR IT! Even if something is simply not available at your hospital, like Nitrous Oxide or Birthing Balls, asking for it is the first step to the hospital being aware that there is a demand for it. The more that mamas ask for what they want, the more the hospital is going to want to provide it, because they are a business, just like any other.
But I don’t know what to ask!
You didn’t think I’d leave you hanging, did you? Here are some of my favorite questions for hospital tours (click here for a printer-friendly version):
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Arriving at the Hospital in Labor:
Can I pre-register or take home the paperwork I will need now, so admitting will be easier/faster?
Is there a Triage process before admission (observation with a Fetal Monitor)?
How many people can be with me during Triage?
Do I need to be in Active Labor to be admitted? Is there a minimum I have to be dilated?
Labor and Delivery:
Are there separate labor/delivery/recovery rooms, or just one room throughout stay?
If separate, when does mom move from one room to another?
How many Labor rooms are there? ___ Delivery Rooms? ___ Postpartum Rooms? ____
Are they private? Shared?
How many people can I have with me during labor? During pushing?
How many people can I have with me during a Cesarean birth? Can my doula stay in the OR with us?
Can I wear my own clothes? Or is a hospital gown required?
If my partner/support person/doula is with me during labor/birth, does he/she have to wear anything special?
What is your Nurse-to-Patient ratio during Labor?
During Delivery?
During Postpartum?
What will the nurse do to help me during labor?
Can I eat and drink while in labor? Before/after epidural?
Is an IV required for everyone?
If IV is required, can a Hep-Lock be placed instead?
What kind of fetal monitoring is allowed/required? Continuous/Intermittent? Electronic Fetal Monitoring (EFM) or hand-held Doppler monitor?
Can I move around freely during labor? Walk in the halls? Or will I be confined to bed?
What non-medicated things does the hospital have than can help with labor pain? Shower? Tub? Birth Ball?
Is there any reason these things would not be available to me when I arrive? (Restrictions? Complications? How many balls/showers/tubs are there for everyone?)
What are my options for medicated pain management? Narcotics? Epidural/Spinal block? Nitrous Oxide?
Will I be able to push in any position that feels good? Or will I be confined to bed?
What things does the hospital have than can help with pushing? Swat bar? Birthing stool?
Is there any reason these things would not be available to me when I arrive? (Restrictions? Complications? How many balls/showers/tubs are there for everyone?)
Newborn Care:
What immediate newborn procedures are required (Vitamin K, Eye Ointment, weighing)?
Can these be delayed, and for how long?
When/where are these done?
What other newborn tests or procedures are required before discharge (hearing tests, PKU test, regular weighing, bathing).
When/where are they done?
Do babies usually room-in or stay in the nursery?
Is there a NICU (Neonatal Intensive-Care Unit)?
What level (I, II, or III)?
If not, where is the nearest hospital with a NICU?
Is there a Lactation Consultant on staff? How are the nurses trained in breastfeeding?
What is your breastfeeding rate? At discharge? At 6 weeks? At 6 months?
Postpartum:
How long is the average stay after an uncomplicated vaginal birth?
After a C-section?
Can partners/Dads stay over?
When can other children visit/stay over?
Other visitors?
Other Statistics/Information:
Are most deliveries performed by OBs? Midwives?
What groups (OB offices, midwifery practices, etc.) have delivery privileges here?
What is your Cesarean rate?
Epidural rate?
Induction rate?
Augmentation/Pitocin (speed up labor) rate?
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That may seem like a lot, and you may feel awkward being the one asking so many questions when no one else on the tour is asking anything, but believe me, those Silent Sallys will benefit from your Needs-To-Know-It-All-Nancy-ness. You have my permission to be the annoying one and get your questions answered. Birth is unpredictable, and you may not know how you’ll handle things once labor gets going. But knowing the ropes of that hospital will be one less thing to worry about.
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