Want a Natural Birth in a Hospital Setting? 10 Questions to Ask
Tuesday, February 17, 2009 Due to a variety of very odd geopolitical realities and bureaucratic idiocies I chose to have my baby delivered by an obstetrician in a hospital. I knew going into it that my choice of birth setting and birth attendant meant that my chances of having a natural birth were significantly lowered. But I was committed to ensuring that in the absence of any significant medical problems that I would be able to deliver my baby naturally.
For me that meant reading a lot of the right books and developing a strong birth plan. It also meant having a doula to support me and ensure that my needs were met during the birth and that I was as comfortable as possible at all stages. In the later stages of my pregnancy, I prepared my birth plan and reviewed it at the hospital with the obstetrician to ensure that all of my wishes would be respected within the framework of their model of care. In the end, I had a quick, uneventful, dare I say easy, natural birth and was able to start breastfeeding within a minute or so of delivering. The hospital was respectful of my needs and my doula ensured I had the support and assistance I needed.
In the past few days, I've seen Sara (lil_gruntlings) of Custom-Made Milk tweeting a lot about the need to ensure that your hospital is truly supportive of natural birth (if that is your preference). She ended up changing hospitals at the last minute when she discovered that she was not going to get the support she wanted for her choices. I thought that was a really great point and when I saw a great new article up on Mothering called 10 Maternity Center Questions, it seemed like a perfect complement to that conversation and her recommendation.
The 10 questions the Mothering article recommends you ask are:
- Are there any restrictions on who is allowed in the room?
- Can I eat and drink during labor?
- Can I walk and move around during labor?
- What are the rooms like?
- Will I have to change rooms during my stay?
- Are there rules about what I can wear and what I can bring?
- Do I have to deliver lying flat on my back?
- Can I nurse my baby immediately?
- Can my partner stay with me after the baby is born? What accommodations are available?
- How does the hospital support breastfeeding?
The 10 Maternity Center Questions article has more details on the importance of each of those questions and why you might want to ask them. I'd encourage you to check it out!
In the event that you cannot have the perfect birth environment or that something goes differently than planned, you should also consider what you are willing to compromise on and what you would dig your heels in about. The hospital staff is there to work with you and if you are confrontational the first time there is a disagreement about something, it could set the tone for a difficult birth. But if you are willing to bend on something that is not that big of a deal, then they might be more accommodating of other wishes too. For example, I wanted to wear my own clothes and the obstetrician had said I would be able to. In the end, the nurse insisted that I wear the hospital gown. It wasn't what I wanted, but it wasn't a big deal either. However, when the nurse suggested that I might want to get up on the bed and put my feet in the stirrups when I really didn't want to do that, I put my foot down and said that I wanted to continue labouring standing up at that point in time.
Did you have a natural birth in a hospital setting? What did you do to ensure your wishes were respected? How did you prepare? Did you run into any obstacles?
Reader Comments (67)
I thought with holding food in labour went out in the 50s? I had three (out of four) hospital deliveries and was never told not to eat or drink.
The Montfort has a good reputation for being midwife-friendly. I had my third child there and it was great... I don't think I even saw a staff member other than the OB who came to consult on my ultrasound before I was admitted. They just gave us the space to let us do our thing and then go home! :)
I had three hospital births and one home birth, all with midwives. The beautiful thing about midwifery care is they act as your advocate AND it's considered routine that you go home after the birth. As in, right after. You can stay if you want, but there's no pressure or expectation. So many of the problems I hear with hospital births are with the post partum care, and I'm so glad I never had to deal with nurses and all that stuff, I just had my babies and went home!
My second one was born so fast that the pizza we had ordered before going to the hospital was still hot when we got home :) I was gone less than two hours start to finish.
Also, on the flip side of this I had an issue with my third with the midwife not wanting to grant my request for an epidural. I was induced for leaking/low fluid (post dates), he was posterior and labour was hard. I couldn't sit or lie down at all and after 10 hours of labouring standing up my legs were killing me, it was the middle of the night and I was exhausted. I knew I really wanted an epidural so I could sleep for a few hours and have some energy to deliver the baby. The midwife kept trying to talk me about of it, saying 'but remember you wanted a natural birth!'. Yes, I did but things have changed and now I want an epidural. And while I'm not ok with them being routinely pushed on women I think they are an OK option sometimes. She kept putting me off and putting me off and trying to talk me out of it, even though (between contractions) I would remind her that this was not my first baby, I'm not afraid of natural birth, I've had a natural birth before and YES I was really sure I wanted it! Finally my SO stepped in and insisted she get the anesthesiologist and she was all grumbly and grumpy about it. I went from 4-10 cm in 4 hours, had a nice nap and woke up in time for them to taper it off so I could deliver naturally. It was the right choice for me, I don't regret it but years later I'm still annoyed that she didn't respect my wishes and decision.
Whether you have a doula, a strong spouse, a sister or whoever with you, make sure there is someone who can advocate for you!
This is absolutely true. Many doctors *think* they support natural childbirth but don't actually have much familiarity with it. Some just know what answers to give to appease a client. And some may truly intend to support you in birthing the way that works best for you, but might not be great resources during your birth. I was told by an OB that I would absolutely be able to choose my own birthing positions, but when it came down to it, his partner's habit was to get the mother into semi-lithotomy position. I'm very compliant in labor and did not advocate for myself, even though inside my head I was very upset about it. Make sure that you talk about these issues with your partner, a doula or another person who will be present at your birth. Develop a plan for different ways for them to remind you of your original birth plans and to advocate for you if necessary.
One important thing for me was the type of language used. Rather than "wouldn't you rather do X?" didn't work for me because I was so compliant. If I had been asked "which would you rather do, stand by the bed or lay down?" I would have been able to respond with my actual preference. I was so glad that my midwife for birth #3 understood this about me and thought carefully about how she phrased suggestions!
I'm sorry your wishes weren't supported Sarah Jo.
This is where having a doula really comes into its own - having someone who you aren't emotionally entangled with (ie. they can remain objective) and who has supported lots of births (not just yours, or their own births) makes such a difference.
Alot of people trust their husbands or mothers to be able to advocate for them - but when they have a doctor in their face telling them that your labour will go nowhere without x/y/z intervention they want you to have, husbands and mothers are often just too emotionally invested, stressed and sleep deprived to be able to remain objective about what they're being told. And they'll usually defer to the "expert" who knows more about the process than they do. When the mother is resisting or asking too many questions, it's a pretty common tactic for staff to turn their attention to the support people and have them continue to push their agenda by proxy. If you won't listen to the doctor, you might listen to your husband/mother/sister - seems to be the train of thought.
On the list of questions up there: I would add a couple more - What will happen if my baby is breech at term? And what is your primary caesarean rate?
The answers to both of these questions will tell you a lot more about the birth you're likely to have with that care provider than asking about the rooms will ;)
I agree Emily that it's absolutely not as simple as writing a detailed, comprehensive birth plan. I'm a doula and I've supported births in a wide range of settings - I always tell my mums that a birth plan is not insurance. For that matter, neither is having a doula.
Here in Australia we have a situation where all births in the private system are OB attended - midwives cannot catch babies in private hospitals. Naturally, this means the private system has a MUCH higher rate of all interventions, and caesarean section. I often get women coming to me looking to take a doula and write a good birth plan as insurance against a system which they KNOW has a much higher rate of all the things they don't want. Yet they still choose it, because they want their own room where their partner can stay, or the hospital is five minutes closer or whatever else.
Choosing the birthplace and the caregiver is THE single most important decision you will make in terms of the type of birth you end up having. No birth plan, no doula can really make much difference if you aren't completely open and honest with yourself about the risks and benefits attached to your choices in this regard.
The hospital where I gave birth in 2006 and 2007 has an ice chips only policy. It was definitely a factor in my decision to go for a home birth, because I am prone to blood sugar crashes with fainting if I don't eat, and I was terrified I would have one at the hospital. Two home births later, I'm glad I never went back.
With my son, I was allowed to eat and drink until I decided to get an epidural, at which point I was only allowed jello, popsicles or ice. I am currently 35 weeks pregnant with baby #2 and planning for a natural birth. Last time, I had pitocin and could not stay on top of the contractions. I've educated myself a LOT since then and will do anything to avoid going down the pitocin slippery slope again.
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natural childbirth
Is something that shouldn't be taken lightly. It is important that you understand the possible outcome in both situations, drug-free or not.
I had a natural, OB attended, hospital birth. My desire for a natural birth was twofold, first, I felt it was safest for me and my baby, second, I had spinal surgery which would make an epidural near impossible and I was not down at all with taking narcotics. We made a detailed birth plan and hired a doula. Unfortunately, I was positive for Group B Strep and had to go into the hospital immediately after my water broke, despite having no contractions. Almost immediately, I was being pressured by residents to start Pitocin. Luckily, I had done a lot of preparation/reading and knew that would put me at risk for a C-section. I literally felt I had to argue with the residents but knew I was not at a point that intervention was necessary. I had also asked to eat and they were up in arms about giving me an actual meal but, luckily, my OB approved it and I was able to eat throughout the day. I didn't even start contracting until about 7 hours after my water broke and it didn't get regular until about 15 hours after. I was then told I needed to sleep as my labor would likely be extremely long (they were predicting late afternoon the following day, approx. 32 hours after my water broke) or would be too exhausted to push, so they began trying to convince me to take Morphine. I trusted my body and was able to keep my resolve with the help of my husband and doula. My OB was supportive as well. It was the nurses and other docs who were not. I delivered a healthy baby girl after 21 hours (only 6 hours of true labor). In retrospect, I wasn't prepared for so much pressure from hospital staff. My OB trusted and supported me but she wasn't there much of the time, I wasn't prepared to have to argue with strangers and it made me very uncomfortable. Next time, I will likely look into a home birth. Unfortunately, we don't have any birthing centers in my area or that would be my first choice.
I have 4 kids, all hospital births; #1- epidural, #2 and 3 drug free and #4 stat CS under general.
I wanted to go drug free with my first but my nurse was horrible. I wasn't really educated and she made me feel like I had to lay down FLAT on my back. She kept asking me if I wanted the epidural(after I told her I didn't) and she warned me that it would be too late soon(I made it to 6cm). My OB was busy with an emergency, when he came to check on me he asked why I was flat on my back. He actually said I could move around because it would help with the pain, but by that time, I was so uncomfortable, I couldn't handle it.
After that, I educated myself more, I knew what I wanted to do, what I was ok with and what I was not ok with. I LOVE my OB and we are on the same page when it comes to what we both expect. #2 and 3 were both BIG babies (9lbs and 9lbs 7oz). My OB was totally supportive, didn't try to scare me about the babies being too big. My nurses weren't super supportive but they kind of just left me alone, which was fine with me because that's really what I wanted.
My 4th was not the birth I wanted, but it was the birth that needed to happen because my baby was in distress. I had a feeling it would happen(with my other births it wasn't a thought in my mind). My OB again was really supportive, he tried hard to get me to have a normal delivery but it just wasn't in the cards.
Anyway, I think when giving birth in a hospital, your provider is very important! Working in L&D now, if you have certain OBs you are just going to have all kinds of interventions. Also, there are other things that you can't really control, like, having a supportive nurse that may help or take away from your birth experience. Women need to educate themselves as much as they can so they know what their OBs/MWs/RNs are talking about. They also need to know that they can refuse ANYTHING.
I was very well educated, and looked forward to a natural birth. I decided (mostly because of some family pressure, but also because I am not one of those natural-birth proponents who hates doctors) to birth in a hospital setting with an OB, but the nurses at my hospital were very supportive of my birth plan. Several OBs at my practice were, also, but I got stuck with the one I hated for most of my labor. That said, though, I only saw him twice, because that's the way it works in a hospital setting with an OB!
My water broke and I had to be induced with Pitocin...this threw a huge wrench in my plans. I "labored" on my own for several hours before I would take the Pitocin, but even midwives at the birth center would've transferred me to the hospital for induction if I had gone 12 hours with a ruptured amniotic sac and no progression in contractions. The Pitocin was very intense. I labored for 12 hours on Pitocin before I just couldn't handle it anymore and got the epidural. I don't regret it even one tiny bit. I got the "late and light" and I was able to sleep for a while before it was time to push, and I felt all of the pushing (which hurt, but was also amazing).
The doctor I hated came in after I had been on the Pitocin for about 18 hours and was only at 8 cm and told me "this baby doesn't want to be born vaginally." I told him to get the hell out of my room! hahaha. But I had a doula there who was very supportive, helpful, and diplomatic.
I guess my point is that you have to keep an open mind, know what's important to you, and be knowledgeable. I knew that having the energy to push and having my baby vaginally were #1 for me. So the epidural was a compromise I was willing to make.
And guess what? My baby was born very healthy and the a-hole doctor went off shift about an hour before I started pushing, so one of my faves ended up being the delivering doctor. It was one of the greatest days of my life and I'll never forget it!
After doing research I decided on a natural childbirth. I was very clear to my OB my dicision and she agreed to everything. When I arrived I was immediately bullied into an I.V. When I asked what she was putting in the i.v. I was told saline (later I found out it was pitocin). I was strapped to a fetal heart monitor the entire time, nurses were panicking, and I was forced to labor on my back. No food or drink available and random people wandering in and out of the room. When it came to pushing my OB stood and screamed at me to push like it was a race. I ended up with a 3rd degree tear. The cord was cut immediately, not delayed as requested and baby was taken away to be assessed and primped. I don't ever want to deliver in a hospital again!
Ladies,
I am a mother of two beautiful boys both delivered without pain medication. I was a secretary with my first son and a registered nurse with my second. I now work in an LDRP unit (labor, delivery, recovery and postpartum). I'd like to enlighten you on why we fight for some of the things that we do when you labor in a hospital. I, too, just wanted an unmedicated "natural" birth. I did not use pain medication. With my first son, however, I needed Pitocin because my water broke but I never contracted. Not my vision, but it was what needed to happen.
When you come to the hospital to have a baby we have one mission: healthy mom, healthy baby. We must say this to each other at least 100 times a shift. The reason that we monitor you continuously is because there are things that we can see on the monitor (like a cord that's wrapped somewhere or when the baby starts doing poorly because of something like meconium) and the earlier we correct problems that we see on the monitor, the better the chance that your baby will be born without complications. Most of us who care about our patients will work with you to let you reposition in anyway you'd like so long as we can monitor you and some doctors are completely ok with intermittent monitoring if the baby looks great. The problem is that if we didn't monitor the baby and it didn't survive because of something that we could have seen HAD you been on the monitor, you'll sue the doctor for malpractice. You'll also blame us and yourself if the baby doesn't make it and all it would have taken was being stuck on the stupid monitor to have seen the problem. We don't want to take the chance.
The reason we place an IV is in case the baby's heart rate drops and we have to do a crash C-Section (which means that the baby would die or have severe complications) and need access to give you medication and fluids or the baby needs it. It isn't to tie you to a pole while you labor. Most doctors will let you be free of fluids as long as there's access in place, so long as you aren't dehydrated and the baby looks ok (an intervention for a strip that looks bad is IV fluid).
We only place oxygen when it looks like the baby needs it. It isn't about you or "medically" interfering with your birthing process, it's about getting oxygen to the baby.
We offer an epidural and pain medication because people sometimes change their minds. In some instances women are so uncomfortable that they can't open their cervixes because of the tension in their body. This is someone who benefits from an epidural because they still have vaginal delivery versus C-Section. It is not easier for us to call an anesthesiologist, get medication and pumps ready, and chart everything than to let you labor naturally. The easier thing for us is natural labor.
There's no eating or drinking allowed in case you need emergency surgery. A lot of doctors will let you have sips of clear liquids (gatorade, apple juice, water). The other thing is that during the later stages of pregnancy many women vomit. The more on the stomach, the worse the vomiting.
Do you know why we roll our eyes at birth plans? Because we're only worried about your baby and what it takes to delivery him or her healthy. What you want is just in a best-case-scenario birth. You have patient rights which allow you to refuse ANYTHING anyways. You have to be aware, though, that we don't recommend things JUST BECAUSE. We are trying to bring a health baby into the world. We have all seen babies die. It is soul crushing. We would rather have you mad and complaining about a medical birth than living with the pain of losing a baby that could have been saved by a C-Section or continuous fetal monitoring. And we don't want to live with the guilt of thinking that we could have just been willing to ruin your birth experience and have saved a baby instead of "yes, ma'am-ing" the whole thing to make you happy and consoling you when there's a bad outcome. If you don't feel like your nurse is being supportive ask for another one. There's a way to have enjoyable hospital births and there are times were home births are completely appropriate too. Just know that we aren't there to ruin your plan...we're there to protect your baby.