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Childbirth Cubby

How can I have a low-intervention hospital birth?
~ A Message Board Archive

From Rosssy ~ Does anyone have any advice for me regarding having a low- or no-intervention birth at a hospital? Delivering at home or using a birth center are not feasible for me, so the hospital seems to be my only option.

A little background information on the hospital: It is a teaching hospital, which means that there are lots of medical students who are eager to practice what they are learning. It's definitely a high-intervention atmosphere. My delivery will be attended by whichever OB and med students happen to be on call at the time.

Everything I've read stresses the importance of trust and communication between the mother and the OB in ensuring a positive birth experience. But I'm not sure how much this matters since it's unlikely that my doctor will happen to be on call when I go into labor.

I plan to labor at home as long as possible to reduce the amount of time I actually spend at the hospital, and I'm going to investigate hiring a doula. What else can I do?

Thanks for your help!

From hunter ~ Absolutely hire a doula, or have an additional friend or relative who has experienced a good birth to be with you. Make sure that your husband and the doula/friend/relative know your wishes and are both ready to advocate for you. The problem most people in a hospital encounter is that staff will generally not listen to anyone except the mother. Your husband may have to say "Honey, he's picking up scissors for an episiotomy," so that *you* can voice your own opinion, rather than saying, "She doesn't want an episiotomy," which may not be regarded.

Find out what is required by the hospital and what is negotiable. Staff will tell you anything they want and claim it's policy, so you have to educate yourself beforehand, and know what your options are. They might tell you an IV is policy, but you can probably get a hep-lock instead, which allows quick access if you need fluids or drugs, but makes it harder for them to slip you something (see below.) Monitoring is always an issue; some women agree to be monitored for a certain number of minutes every hour, and the monitor is removed if things look good. If they insist on continuous monitoring, then you might insist on a cord-free unit so your mobility isn't hampered, or move furniture so you at least have more room to work. When my sister needed a c-section, the nurse said only one person was allowed in, but I knew that "up to three" were allowed by hospital policy, and so I got to be there!

Also, make sure that your husband or your doula inspect every shot, every IV bag, anything they want you to swallow. They *will* slip you Pitocin or pain meds against your wishes. You'd be amazed at the number of women who find out they were given something when they read their medical reports! This is especially important if there are any substances that you are allergic to (penicillin) or really want to avoid (Cytotech if you're VBAC, or glucose if you're diabetic.)

Finally, remember that even at a teaching hospital you have the right to refuse anyone or any procedure! You are there, first and foremost, for a safe and healthy delivery, and the teaching aspect should not get in the way of that. Mental and emotional health are just as important as your physical health, albeit not as well-emphasized in medical schools, and giving birth is one time when you are mentally and emotionally as vulnerable as you are physically. Make sure your husband and doula understand that and are willing to protect you from unnecessary intrusions, rude staff, and unwanted procedures. Good luck!

From JulieD ~ I *absolutely* agree with hiring a doula. My husband knew what I wanted and we took a great birth class, he agreed, etc. but when it got right down to it, he was unsure of himself and afraid of the pain I was in, etc. A doula is trained to be very level-headed and looking out for your interest especially (where as a husband or family member isn't as impartial and trained to be on the look-out).

My husband was supposed to really make sure they didn't pull on the umbillical cord to hurry and get the placenta out but once my son was born, he never even looked and sure enough, they pulled it out by tugging, etc. Your husband may be different but family members are attached where a doula is hired. You know?

Anyway, other than that, bring a birth plan (a very detailed one) to the hospital before you go in labor - ask that they put it in your file. Also pack one in your bag and give one to whomever your nurse is when you arrive - this way it doesn't get "lost" and everyone is aware of your wishes. I know it sounds kind of corny but I was going to bring cookies with me (pre-made of course) when I went to the hospital for the nurses; I have heard that small gestures like that go a long way for you. (I ended up planning a homebirth however).

Do stay home as long as you can - I progressed to a 7 pretty well but stalled there for a very long time. If I'd been in the hospital they would have insisted on a c-section immediately (we were at 7 for over 12 hours and according to hospital policy they almost always insist you progress 1 cm/ hour) but when we went to the hospital I progressed from that point to a 10 on regular "time" and delivered vaginally.

Stuff yourself with information on all kinds of intervention, when and why they are needed, etc. The more information and knowledge you have, the more respected you will likely be and the better decisions you will be able to make. (A doula with the same kind of information is also very helpful).

From Rosssy ~ I really want my husband to be able to focus on helping me without the distractions of dealing with hospital staff, procedures, etc., so it sounds like a doula is a necessity. Great idea about bringing some cookies for the nurses. I'd like to have everyone on my side, and cookies can't hurt.

From hedra ~ In addition to the great advice above:

1) Create a bullet-list version of your birth plan. Students will scan, not read. Bring many copies (20?) so they can each have one. Note alternatives you prefer to the things you don't want. "NO active IV line, hep lock is okay. NO episiotomy, warm compress support and natural tearing preferred. NO lithotomy position, will choose a position that works at the time." etc. I recommend that you put a place for them to sign that they have read and understood the plan list (not necessarily agreed to, but understand your preferences). You can also note that any deviations from the plan must be addressed with the care providers at the time.

2) Make signs for your door: "Shhh.. Gentle birth in progress. Please talk outside." Students tend to talk a lot about you, and often get it wrong, which can stress you out unnecessarily. Have your doula tell them to take it outside. It makes a HUGE difference, especially if they are talking about risks of c-section, abruption, etc., etc., etc.

3) Coach your doula and your husband to remind the doc/resident/etc. to deal with YOU first, and the students second. The students can hear just fine, but you are the client - address the client. (I've had to ask the doctor to please tell ME what my son's diagnosis is, thank you very much, and not just talk to the students.)

4) Approach the situation with the attitude that the students are there to learn FROM you, not ON you. Any time they try to learn ON you, push back (or have your doula push back, or your husband push back).

5) Get a doula. Better yet, have her bring a student doula of her own, so you have two (one of them a student on YOUR side). (student doulas are usually free)

6) Books that have more info: The Unofficial Guide to Having a Baby (I think there's a whole section on low-intervention hospital birth in there), The Birth Partner, and possibly Birthing From Within.

And get there as late as you can. But also keep in mind that there's a strong tendency for them to push for even MORE intervention when you get there close to the birth, because they don't 'have a handle' on your birth process, and they over-react and try to control. Just be prepared to push back right from the get-go. Practice saying "I refuse that procedure." They can be sued for doing anything you have actively stated that you refuse, and they know it.

I know this sounds negative, but I truly enjoy working with students. I have yet to meet a student, intern, or resident who has not learned something valuable from me. I've taught them that natural birth is not only possible, but reasonable. I've taught them that they are not gods, and that their patients know themselves best. I've taught them to respect mothers in labor. I know that at least two nurses and one resident from my last labor have very different attitudes about birth because of me. And I love that.

Cookies for the nurses is great, BTW. Or a muffin basket, bagels, or other 'sustaining' foods. They often don't get a break to eat.

Oh, and I've also heard of people posting a note on the door saying "Please do not offer me pain medication. If I want it, I will ask for it. Thank you!"

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From JulieD ~ The best part of being prepared with the information (and great suggestions hedra! I especially like the signs on the door ones . . . I wish I'd had that!) is that you are free and able to concentrate on your birth rather than having to constantly think "Now do I want that??" and telling your husband or others "What are they doing?", "No, do this" - if you do it in advance, it will really put your mind to ease.

From Journey's end ~ You've gotten some great advice. Just one thing to add. Put a sign on the door that includes "Knock Before Entering". Make it nice, cute or whatever but trust me make it. Carry it with you to the postpartum room.

One, you'll get annoyed really fast at the number of people in a teaching hospital that forget this courtesy. Two, requiring it is a nice reminder about manners and treating you like a unique person and not a 'case' that will carry over.

From JanB ~ I like the idea of cookies for the nurses -- a lot of medical providers get a little freaked out and defensive when they are presented with a birth plan, especially one that has a lot of "I do not want X" and "I do not want Y" as I think they see it as kind of a "I hate the entire medical profession and wish I didn't have to give birth in this stupid hospital and you people are going to try to mess up my birthing experience" attitude, although obviously that is wrong. Bringing cookies or muffins might be a gentle way of expressing that you have no problem with the nurses, you just want to avoid interventions when possible.

I would also like to suggest taking a birthing class, such as Bradley, that focuses heavily on the actual mechanics of labor and delivery so that you know what your body is doing. Know when an intervention actually is necessary, and then you will be able to make an informed decision to have it if it does become necessary. I still strongly believe that the reason I feel my unplanned C-section was a positive and even joyful experience was that I knew exactly what my body was doing, knew that the C-section was necessary, and made an informed decision to go ahead with it. If I'd felt like things were out of my control because I didn't really understand what was happening, I might well have had a horribly negative experience instead.

PS: It IS possible to have a low-intervention hospital birth. My L&D nurses were fantastic. I was 10 hours into an unmedicated labor with a baby that was completely malpositioned and having hideous back labor, before one of them finally timidly said, "We know you said you didn't want medication, but if you wanted to consider it at any point, just let us know . . . " It was the first and only mention of meds. (I did decide on pain relief about half an hour later.) They also brought out the birthing ball for me, took me to the birthing Jacuzzi, had me try out various positions, the whole shebang. They were really wonderful.

From hedra ~ I also have to hand it to my L&D nurses the last time - even though they started out saying "We'll turn up the pitocin until you can't stand the pain anymore" (honestly!), and then later checked me through a contraction after agreeing NOT to . . . but having gone through a few hours of labor clearly not having any trouble with it, my nurse was the only one who stood there and said "you don't need an epidural" when I asked for one (at transition, because I thought I needed it in order to relax my back, go figure!). The rest of my entire team was SO shocked by me telling them I wanted one, they couldn't put two words together, and were afraid to say anything back to me.

But the L&D nurse said, "no, you have been doing SO great, I would hate to see you give in to meds at this point, I think you've just progressed really fast all of a sudden, and I don't think you really need one . . ."

I was very grateful to her, too. They'd have happily given me one without even checking for dilation, too. Ugh. But the L&D nurse checked me (and NOT during a contraction this time), and when she told me I was 7 cm (I'd been 4.5cm 30 minutes earlier), I dumped the whole concept of epidural.

You can get them on your side. They tend not to enjoy watching or listening to women scream and rant, though, so a good childbirth class like Bradley or HypnoBirthing that will help you relax through labor is a help. If your choice to not use interventions looks like a sane one, they'll generally be in agreement.

Granted, I also had the most senior nurse on the floor tell my nurse to get a grip and treat me properly . . . (they were apparently discussing my 'weirdo' labor at the nursing station, without realizing that their senior nurse also worked with my midwives). There was a major attitude shift after that conversation, though at the time we didn't know why. I think the food basket would probably serve the same purpose, though - make them think of you as a person.

Oh, and there are diplomatic ways to word the intro to the list of 'no no no' items. We had on ours that we understood that births seldom go 'as planned', and that we expected to work with our providers as labor progressed, to adjust the plan whenever necessary.

From Tigo ~ Just wanted to say thanks for posting this! I'm hoping for the same thing. Although I'm not in a teaching hospital and my OB is rather anti-pain medication minded, he is not anti-intervention. I've actually never heard of a case where he didn't break someone's water.

Anyone know of the best way to find a Doula? I'm in a small town and there are none officially listed in the phone book, etc. I knew of someone I was going to ask but I'm hesitating for a couple of reasons.

From hedra ~ DONA.org You can search for certified ones on their website.

From Rosssy ~ Thanks again! I like the idea of encouraging the hospital staff to see me as a person, rather than just another patient. I'd like the whole experience to be positive for me and the nurses, doctors, and students that I encounter.

My daughter's birth was a very positive experience, even though I had some interventions, because I was encouraged to let things happen naturally, and was not offered an epidural. If I could move back to Germany and have this baby with my midwife there, I'd do it in a heartbeat! But I'm trying to make the best of the current situation.

Tigo - you could call a local birth center or midwife and ask them for the names of doulas in your area.

From Tigo ~ We don't have an birth centres and only 2 midwives for 900,000 people - over a very large area. Sad state of affairs it is. Anyway I have found a Doula working in our area - she's not certified yet but she's close and there is also another lady who I'm considering asking. She'd not a doula but she's homebirthed a couple of her children (including a set of twins), and is very knowledgable of this sort of thing. I'm just a bit unsure of whether I want to have someone else there besides my husband. We'll see.

From hpy2bamom ~ I'm a hospital and homebirther and all of my births have been gentle and non-evasive (even the twins with me in preeclampsia).

My first birth I labored at home as long as possible and went in at dilation of 8. This I can thank the doctorr for, it was a Holiday and he was 45 mintues away and told me to hold out till midnight so I didn't get charged for holiday fees; since I didn't know anything about laboring this was a Godsend.

My next two were at home so as non-invasive as one can make it. Finally, the twins were planned to be born at home and I went into preeclampsia and started going toxic. We didn't know there were twins but knew baby needed to get out.

Trying to make a long story short, you can make your birth more natural and pleasant by the ideas listed in previous posts and by knowing what your body does during labor . . . surrendering to it. Using the positions that will help baby move down naturally (ie getting off your back), etc. I really like the Hypnobirthing book too; it explains how to "breathe down" and focus which is very important in labor. We amazed the hospital staff with our delivery. I think they thought we were a handful (we didn't walk in with a birth plan but made our intentions known). They were amazed with how easily we delivered babies that weren't suppose to be born yet and it being twins on top of it. The medical community is still talking about us (as I hear through the grapevine). My problem was all the lab work they did on me when I did not request or have knowledge of but that really doesn't pertain to the labor.

I had my husband (not a doula) who is a medical professional; therefore, he knew what was going on, when, etc, allowing me to relax and go within so I could deliver and not worry about the outside world. If your support person is not medically aware, then definitely hire a doula; it is worth the money.

For pain control I use a TENS unit but may use Acupuncture this time, or maybe even both (my husband asked if I want to deliver the baby while making a batch of cookies . . . heehee). I am also reading about Hypnobirthing but do not have an instructor in my area so I may not get the opportunity to use it fully unless something starts clicking.

Getting baby down I LOVED the birthing ball and breathing down with a contraction, I probably would have delivered on the ball if they would have let me.

I deliver on my hands and knees or you can look into a birthing chair, which I would love to try, or squatting.

I had an episiotomy with #; we didn't even know he was going to do it. The rest I allowed myself to rip naturally, if it was to be so, and what little rips I did have healed a whole lot faster and less painfully than the episiotomy.

Focus on your husband and or doula and the nurse up by you. The rest of the room is non-existent to you.

Remember, this is very important, every birth, even your own, are going to be different. Listen to your inner voice. Trust it.....not anyone one else.

From Lisa Jo ~ You have gotten some really wonderful advice and tips here. Like you, I was planning a hospital birth and wanted as few interventions as safely possible. I'll share what worked for me.

You mention laboring at home, and I think that is possibly the most important factor in having a low intervention birth. My sister is a labor and delivery nurse at a hospital and she was with me throughout my labor at home. We rented a doppler and she brought examination gloves for checking my cervix. I labored in the comfort of my own bedroom and bathroom, and at the point she discovered I was "8 cm and stretchy" we went to hospital, which is only 1 mile away. Natalie was born 15 minutes after we got there, with virtually none of the usual interventions.

I informed my doctors (group practice) of my plan and they were sort of lukewarm about it, telling me not to wait too long, and worried about the things that can go wrong. I listened politely to their concerns, but simply decided to stay in charge of my own birth and do things my way. I was very confident in my ability to manage the pain.

Having the freedom to move about, change positions, go out for a walk down the block, and just be in comfortable, non-threatening surroundings was wonderful. My sister checked my cervix several times during my 6 hour labor and it was amazing how much more painful the contractions were when I was laying down. The pain was completely manageable; I didn't spend one second wishing I could have meds. It angers me that the medical profession has brainwashed women into thinking that it's normal to labor lying down in bed and normal to deliver on your back with someone holding up your legs and telling you when to push (my first child's birth). I was most comfortable squatting or kneeling next to my bed, sitting on the toilet, or draping myself over the bathroom counter. At the hospital I delivered on my side. The doctor asked me to roll to my back as I was delivering but I ignored her. It all went so beautifully that if I were having another child - which I'm not - I would be planning a homebirth.

I understand that having my sister able to help as she did is unique. It may be possible to hire a private nurse (monitrice I believe) if you wanted someone who could monitor the baby's heartbeat and your cervix. You certainly could have a doula with you at home until the point you both felt it was time to head for the hospital. Once there, all the other suggestions given should really help!

BTW, books that I found very helpful include The Thinking Woman's Guide to a Better Birth, The Birth Partner, A Good Birth, A Safe Birth, and The Birth Book. Best wishes to you!

Additional Resources:
   · Creating a Positive Hospital Experience

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