It is so important to know what you’re getting into before you’re in labor! Interview any OBs, midwives, hospitals, and birth centers you are considering and make the best decision for you. Also, a great new website, The Birth Survey, provides consumer reporting for doctors, midwives, and hospitals (at this point you can take the survey, but the results are said to be formulated by Fall 2008).
Here are some questions to ask your hospital or birth center to make sure you find a place that is on the same page with your birthing beliefs. These are taken from Gentle Birth Choices, written by Barbara Harper, 2005, p. 246 (a great book, also in my library).
- Does the hospital [/birth center] encourage women to follow written birth plans?
This is a question for a hospital [/birth center] but it may also be asked of the physician.
- Could you tell me how a routine vaginal birth is handled here?
- When do I need to check into the hospital [/birth center]?
The longer you stay at home in early labor, the less possibility there will be for interventions.
- Can I labor, give birth, and stay with my baby in the same room?
The concept of labor, delivery, recovery, and postpartum (LDRP) in the same room has been promoted for the last ten years. If your prospective hospital is one that still transfers women into a delivery room, request that they make an exception in your case. (There is nothing worse than being moved right before pushing!) Also be aware of the “cosmetic cover-up” discussed in chapter 8. Not all LDRP rooms are alike, and not all allow women to do what they want.
- Do you routinely require an IV?
- Do you routinely require electronic fetal monitoring during labor?
- How often does someone do a vaginal exam to assess progress?
- What mechanism is in place so that I can refuse routine interventions like vaginal exams?
- How soon after my labor begins will you (or the doctor on call) come to see me?
- Whill you stay with me during labor?
- Can my partner stay with me the entire time?
- Can the rest of my family members, including my children or my mother and father, be present during labor and birth?
- Does the hospital have showers or baths in each room?
- Can I eat and drink during my labor?
- Do you encourage women to walk, squat, or be on their hands and knees during labor?
Understanding the philosophy behind why you need to remain active during labor encourages women to move. Lying still on a bed during labor is probably the hardest thing for women to cope with.
- Can I birth the baby in the position of my choice?
Hospital beds often break apart at the foot to “allow” a woman to semi-squat. What some women have found easier is to simply put the mattress on the floor or be supported by their partners while they squat on the floor. Assess early on if those alternatives are acceptable to your doctor and the hospital.
- Can I use a warm bath for pain relief during my labor, even if my water has broken?
There is absolutely no reason to restrict the bath even with ruptured membranes. One woman at Santa Monica Hospital was promised that she would be able to use the brand-new baths that had been installed for labor. What her doctor did not tell her was his list of restrictions: A woman could not take a bath if her water had not broken and the head had not engaged into the pelvis (for fear of a cord prolapse), and she could not enter the water after her water had broken (for fear of infection). She never once used the new baths and ended up with an epidural and her baby experienced the application of low-forceps.
- Can I stay in the water to birth my baby?
Find out right away what position your doctor takes on waterbirth. It might be your opportunity to educate him or her.
- What kind of pain medication do you routinely use?
- What kinds of nonpharmacological pain management techniques do you recommend?
- If I want an epidural, what are your guidelines?
Some doctors offer a “walking epidural” which is a different kind of epidural. Question your doctor carefully about the kids of medication used and the guidelines with which they are administered.
- Do you do episiotomies? Why? In what percentage of births?
Does your doctor think that episiotomies are necessary? Is he or she willing to allow you to try other techniques? If a doctor cuts more than 10 percent of birthing clients, look for a new doctor.
- Do you ever use vacuum extractor? In what percentage of births?
Vacuum extractors were developed to take the place of low forceps. A large suction cup (usually made of hard plastic and sometimes silicone) is placed on the baby’s scalp. The cup is attached to a tube that is attached to a vacuum. When a suction on te baby’s head has been achieved, constant suction will quite literally pull the baby out within ten to twenty minutes. There are some risks with extraction, such as perineal lacerations, hematomas on the baby’s scalp, and pain for both mother and baby. It requires a fully dilated cervix, a baby with at least some part of the scalp visible in the birth canal, and the cooperation of the mother. Vacuum extraction is preferred over the use of forceps.
- Do you ever use forceps? In what percentage of births?
- What is your policy concerning stripping or rupturing membranes?
Rupturing membranes is often the first intervention that doctors do to “get labor going.” Ask your doctor if a labor can progress normally and slowly without rupturing the membranes. Will you be informed of his or her desire to break your water? Do you have the right to refuse this intervention? Assess your doctor’s guidelines for ruptured membranes. How long will he or she allow you to go without starting labor? What lab tests are required? Some doctors take white blood counts every twenty-four hours and body temperatures every hour and leave a woman alone. Others want her hospitalized immediately and induce labor with Pitocin. Studies have shown that women who walk and remain active have fewer cesareans and generally give birth before those who receive Pitocin.
- How long will you allow me to labor before starting interventions?
Does your doctor go by the book in judging length of labor? What are his or her considerations: maternal exhaustion, nutritional needs, movement?
- How long will you wait to cut the cord and deliver the placenta?
(Cutting the cord after it stops pulsing allows the baby’s organs to perfuse with much-needed blood, replenishes iron stores, and creates a smoother transition from oxygen from placenta to oxygen from baby’s lungs)
- Can my partner cut the cord?
Is cord cutting viewed as a medical procedure or simply part of the process of birth that the couple has shared? Are fathers included in this process?
- Is it necessary to put antibiotics in the baby’s eyes right away or can we delay that for 24 hours?
State laws mandate that an antibacterial agent be put into the baby’s eyes to reduce the incidence of blindness from venereal disease that has been passed from the mother to the baby. The use of silver nitrate has been abandoned by most hospitals. More common antibiotic agents are now used. Find out from your doctor what he or she recommends, and ask if you can choose not to use anything at all, especially if your baby is not at risk.
- Do you routinely give vitamin K shots to newborns?
Vitamin K is routinely given to prevent hemorrhagic disease in newborns. The incidence of intracranial hemmorhage is extremely low. The administration of vitamin K has also been given to counteract the possibilities of bleeding after circumcision. There has been an unusually high incidence of childhood ancer linked to vitamin K shots. Oral vitamin K has not shown any relationship to cancer in children. Ask your doctor if oral vitamin K may be substituted and if he or she has access to the latest research.
- Can I breast-feed immediately after birth?
- Can I delay weighing and measuring the baby for at least an hour?
- Can the baby stay with me in my room (rooming-in)?
- Do you routinely recommend circumcision?
If your doctor is still suggesting circumcision and does not stress the normalcy of the intact penis, take the opportunity to educate him or her before you find another doctor.
- How soon after the birth can we leave the hospital?
Most doctors recommend a short stay in the hospital. Some are even willing to discharge after twenty-four hours. Find out if your doctor is open to discharge after six to twelve hours, especially if you have given birth vaginally and you have adequate help at home.