Tuesday, January 27, 2004

Hospital Birth How-To’s

Hospital Birth How-To’s
Andria Brown

I didn't want to deliver my baby in a hospital. My ideal birth would have been in a cozy birthing center, surrounded by happy, earthy midwives and vanilla-scented candles, but unfortunately, there isn't a birthing center nearby. I considered homebirth, but like many women who have had trouble getting or staying pregnant, I was reluctant to face the unlikely, but nonetheless terrifying, possible complications of labor in my own house. Or, more accurately, I wasn't willing to face my own concerns on top of the inevitable mountain of fear and stress coming from my friends and family. So I resigned myself to a hospital birth, but to make things even more complicated, I was determined to have a low-intervention labor and delivery. I certainly couldn't have done it without some serious preparation, so I've compiled the following list of things I did (and wish I'd done) for anyone who hopes that "hospital birth" and "natural birth" are not mutually exclusive terms.
Read everything. Wait, not quite everything.

I don't think I'm the only first-time mother to spend an exorbitant amount of time reading books about pregnancy and childbirth, but I may be one of the few who didn't so much as touch What to Expect When You're Expecting. I went for the more supportive options out there, like Henci Goer's The Thinking Woman's Guide to a Better Birth, Penny Simkin's Pregnancy, Childbirth and the Newborn, and my favorite for its warm tone and supportive birth stories, Ina May's Guide to Childbirth, by midwife Ina May Gaskin. For me, one of the biggest obstacles to a natural birth was the skepticism and well-meaning advice of others, so it was crucial to arm myself with outside information that supported my decision.

Write a birth plan. Right now.

It seems like a lot of women spend their entire pregnancies putting together a birth plan. I think I showed up at my two month check-up with mine. I figured that a birth plan should be a guide throughout pregnancy, not just at its conclusion. It helped me choose my doctor, my labor assistant and my hospital, and it helped all three of those parties communicate. Believe it or not, the hospital staff actually read it and even took steps in advance of my delivery to follow it. I'm sure it helped that I worded my plan with respect and provided them with ample time to review it.

Fire the OB.

Okay, you don't really have to fire her. But I did, and I think everyone should at least know that it's an option. I began my pregnancy with a very competent and highly esteemed obstetrician, but when I handed her my birth plan, she said "I'll show this to the other [five] doctors in the group and let you know the response." She also reported that her group had a 25% caesarian section rate, and that while she herself did not perform routine episiotomies, she couldn't speak for the other doctors in the practice, any one of whom could be on call when I went into labor. That was all I needed to hear. I got in touch with the local homebirth midwives, and they referred me to their back-up physician. It was a match made in hystero-heaven. Having a doctor who views childbirth as natural and normal is probably the most important factor in having a normal, natural birth.

Hire a doula.

Follow me to the soapbox, will you? I should admit, I go a little fire-headed when I hear a husband/partner give a smug smile and say "I'm the doula." Because unless you're a certified expert on the physiological and psychological processes of pregnancy, and have gone through specific training, including providing support to a number of different women in a number of different birth scenarios, and, oh yeah, have a vagina, you ain't no doula. The invaluable role of a father during labor cannot be overstated, but it is not the same as the doula's role. A doula is a friend, a coach and an advocate, but most importantly, a clear head and outside perspective during an emotionally and physically strenuous time. The statistics showing the benefits of having a doula are undeniable— shorter labors; fewer interventions; happier, healthier babies and moms. It's really this simple: I've talked to women who said they regret not hiring a doula; I've never met anyone who regretted hiring one. Having a doula was essential to laboring on my own terms.

Go to class.

I had a feeling that the free childbirth education classes provided by the hospital weren't going to cut it, so I took a course offered by an independent educator who specializes in natural birth. This was probably the only way I was going to learn about pain relief techniques that don't involve needles. Plus, I was reinforced in my goal rather than ridiculed for it. (If you don't know where to find this kind of class, contact ALACE, Birthworks, or The Bradley folks.)

Choose wisely.

Of the several available to me, I chose the hospital that was an extra twenty minutes away because it had a much smaller (but equally advanced) maternity ward and a staff that was familiar with my obstetrician (and his occasionally off-beat patients). If you're lucky enough to have more than one hospital option, try to gather as much information as possible about each one and make your decision based on more than geography.

Prepare the whole self.

All that stuff in the books and classes about practicing your comfort measures? They mean it. I wasn't much for exercising, but I did practice breathing, relaxing and positioning, and took a pre-natal yoga class. Feeling able to focus during an extremely intense experience was, in my opinion, much more important during labor than how many sit-ups I could do.

Stay at home.

I was at home during the first 18 hours of labor, so by the time I got to the hospital, I was eight centimeters dilated and in full-on transition. I would highly recommend this approach. For one thing, I was pretty much past the point of no return—I was so close to the pushing stage that it would have taken a lot of convincing to get an anesthesiologist to give me an epidural at that point, and even narcotics would have been discouraged. On a more personal level, being at home and in a comfortable place made things so much more manageable during early labor that I was more confident in my birthing ability.

Keep it moving.

If I had been forced to stay in bed during labor, I would have wanted drugs before I was even halfway through. Just having to lie still while I had my first electronic monitoring made me realize why so many women who plan natural births end up asking for epidurals. Some people are comfortable lying down during labor, but for me, it made the contractions exponentially more difficult to handle. Instead, I walked, rocked, squatted, stretched, and even spun around in circles. (I also made some really fantastic noises.) Being able to assume whatever position is comfortable is every birthing woman's right. Finding a facility that respects this right is another important issue to consider when choosing a hospital, as is hiring a doctor or midwife that will sign off on intermittent monitoring and a heparin lock IV, two tools that allow true mobility.

Be positive.

Before having my baby, I hadn't been admitted into a hospital since, well, my own birth. I was not enthusiastic about celebrating my child's first days in what I assumed would be a cold and sterile environment. This less than optimistic outlook was a burden during my labor, because I was nervous about leaving home and was more stressed during the trip than I needed to be. Those of us who hang in alternative parenting circles don't often hear it, but there are benefits to a hospital birth, especially if you've chosen a supportive hospital. For starters, no one ever really tells you how messy labor is, so not having to worry about clean-up was a big bonus. There's also a measure of reassurance knowing that, in an emergency, help is just a call button away. The real perks kicked in after the baby was born, though. I don't have family nearby, so being admitted for a few days meant that I had around the clock care, three square meals a day, and help doing basic things like getting to the bathroom and taking a shower. I was also lucky to have nurses who not only advocated breastfeeding but were always at the ready to help me succeed at it.

So if, by choice or circumstance, you will be having your baby in a hospital, remember that these institutions exist to help and heal you. As it turns out, my baby didn't really care where we were - all that mattered was that we were together.

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