Tuesday, October 4, 2011

Best Hospital Birth Possible

Learning to navigate your way through a hospital birth can sometimes feel overwhelming. After all, hospitals are institutions with policies and procedures designed to meet the needs of the average patient and protect themselves from litigation. Sometimes these general policies line up with our own personal preferences, but not always. In addition, standard hospital practices do not always measure up to industry acknowledged best practice guidelines.  For the safest and healthiest birth possible, you will need some basic skills to help you negotiate the institutional jungle.

First, learn about pregnancy and childbirth by taking an independent childbirth preparation class. Sometimes, hospital based antenatal classes are designed more as hospital preparation classes rather than childbirth preparation classes. Independent or free-standing antenatal classes ensure that the information you are receiving is un-biased and based on medical facts rather than based on hospital policies or procedures. There are many different types of antenatal classes. Look for a certified instructor: LCCE (Lamaze), ICEA, CBI, AAHCC. Choose an instructor and approach that you gel well with, and start learning as much as possible.  Once you have a knowledge base, you’ll know what kinds of questions to ask your care provider and hospital staff, and you will have a better idea of what your own preferences will be.

Second, know the terrain. Take the full hospital tour and ask lots of questions! Visit the labor, delivery, and recovery rooms. Explore. Ask about what resources are available. Do they have a bath or shower to labor in? Do they have birthing balls, birthing stools, TENS, or squatting bars? Also ask questions about hospital standard care procedures. What are their routine procedures for laboring mothers- continuous or intermittent fetal monitoring? Heplock or continuous IV fluids? What are their episiotomy or augmentation rates for first time mothers? What are their primary cesarean or VBAC rates? What is their postpartum care and newborn procedures? How do they support breastfeeding- do they have 24-hour lactation consultants available? Do they support mother-baby friendly policies like rooming in or breastfeeding on demand? Also- ask for copies of the pre-admittance papers. Go over them carefully, ask questions, and fill them out before you go into labor. Once you know how the hospital as an institution operates, you will be able to work better with your primary care provider and the hospital staff as individuals.

Third, organize your team. Labor and childbirth works best when mothers are surrounded by a supportive and cohesive team. Discuss with your husband who you want to be there with you at the birth. Make sure that everyone there understands your wishes and supports them. Consider hiring a doula- an experienced and trained woman who can provide emotional and physical support for you during labor; in addition, a doula will advocate for you- do her best to make sure that your voice is heard and respected, help your husband or other family member know how to best support you during labor, and help you avoid unnecessary medical interventions. 

An obvious member of your team is your doctor (or midwife if you are birthing outside of Kuwait) and your newborn’s pediatrician. Make sure to go over any concerns or questions with your doctors before labor begins so that you are both on the same page. Ask your primary doctor to sign your birthing plan well in advance – that way you can show it to the hospital staff if your doctor is not there yet. All hospitals have a “Patient’s Rights andResponsibilities” document (click on this one to view one from the New Mowasat Hospital). Make sure you understand that you have the right of informed refusal as well as informed consent. For example, if you go to the hospital after your water breaks, and your labor has not yet begun, you may still want to go back home again and wait for labor to begin before checking into the hospital. Many hospitals will tell you that they want you to stay there. You have the right to hear and understand their recommendations, have then explain any alternative "treatments", and the risks and benefits of all of these options. If you choose, you can then refuse to follow their recommendation (Informed Refusal). You could go home, and then return again once a normal labor pattern has been established. Before refusing or consenting, make sure you are truly and fully informed.

Fourth, use your body and verbal language to clearly express yourself at your check-up appointments and at the hospital once you check in. The first form of communication between people is their body language. Make sure your body language at your appointments and at the hospital reflects your own personal desire for autonomy and respect.  If you come to the hospital, undress yourself and lay yourself down on a patient’s bed with your legs spread apart, do not be surprised if the nurse begins to do procedures to you without asking your permission first or explaining what they are. This is your body, your baby, and your birth. Before you lay down on the table, wait for the nurse to ask you to do something. This gives you the opportunity to ask for further explanation first, or to express your wish to do something different if that is the case. You get to decide if and when anyone else touches or does anything to your body or your baby.

For effective and productive verbal communication with your doctor and at the hospital, be positive, firm, and team building: “I trust my body and my baby to go into labor at just the right time for us. I would appreciate your support, patience, and encouragement as we wait for labor to begin and progress naturally, free of any unnecessary interventions.”  If there are hospital policies that are not congruent with your birth plan, you can challenge them in a way that is not confrontational or belligerent. “I understand that you usually have women lie on their backs when you attach the external fetal heart monitors. When I lie on my back, it makes my labor more painful, and I am concerned that it will slow my baby’s progression by working against gravity. Maybe if we all work together, we can find a way to attach the monitor to my belly while I sit on this birth ball. Let’s give it a try, OK?” This helps hospital staff to feel like part of your birth team, rather than your opponent. 

Often it is difficult for mothers to speak calmly and clearly- they may only be able to verbalize: “No, I don’t want to get on the bed. It hurts.” If that is the case, your husband, mother, or doula can help translate that into something that is more positive and team building. In addition, taking a moment to say “Thank You” or “Please” to your hospital staff, care provider, or husband can go a long ways towards creating a positive and cooperative atmosphere. Expressing gratitude can also help you to cope with your pain better. One mother I worked with dedicated each of her contractions to someone she was grateful for. She would think of what she was grateful for or just their name. It helped her to avoid a negative spiral and created a positive birthing environment.

As you learn more about birth and your hospital birthing environment, learn to articulate what your wishes are, and surround yourself with a supportive birthing team- you will find that no matter what curve balls your hospital birth throws at you, you can have an empowering and beautiful birth experience.


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