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VBAC Cubby - vaginal birth after cesarean

Ten Questions for Hospitals
by Diana Korte and Roberta Scaer
Excerpt from A Good Birth, A Safe Birth (HARVARD COMMON PRESS, 1992)

Some of these questions can be answered by nurses in the maternity unit. For the others, call the hospital or nursing administrator's office and ask who could help you.

  • Do you have a one-room option in which I can labor, give birth and recover? Is this room always staffed? If this hospital mostly offers multiple-use rooms, they will always be staffed.

  • What is the nurse-patient ratio? Ideally, according to ACOG, there should be one nurse for every two women in early labor, and one nurse to one woman who is in the pushing stage. No one knows what the national average is, but reports suggest the typical ratio is not ideal. A nursing shortage makes it likely that many hospitals will be understaffed, particularly if there are several women in labor at one time. If the hospital you're considering has a shortage of OB nurses, but in every other respect is the right hospital for you, you might want to consider hiring a private-duty nurse, or a monitrice, for your labor.

  • What is your cesarean rate? Nationally nearly one in four women have cesareans, but the rate at which they're performed at hospitals varies enormously. Government research shows laboring women will usually get whatever is typical care at an individual hospital, so that's why it's important to match up your preferences with their routine. Massachusetts, for instance, requires that hospitals provide you with the cesarean rate, so that consumers have a basis for comparison. For information about some of the other states, see the "Public Citizen Health Research Group" listing in Your List of Helpers at the back of the book.

  • If a cesarean becomes necessary, can my partner stay with me in the operating room? If the hospital says yes, ask which doctors, including anesthesiologists, arrange for partners or other helpers in the cesarean operating room. Though the presence of the partner is more common than it once was, that arrangement is not automatic, especially if you are one of the more than 30 percent of new mothers who is a single mom.

  • How many other people can I have with me? Can my doula, a helper or labor assistant, stay with me during my labor and come with me to the operating room as well if a cesarean is necessary? Some hospitals are willing for you to have two people, your partner and a doula, with you during labor. They are usually less enthusiastic about two people with you in the operating room, but it is possible to arrange this.

  • What is your epidural rate? In some hospitals, the rate is 90 percent or more. If you want to avoid this drug, it's best to avoid hospitals where its use is standard, because that's what the staff is used to offering you for pain relief.

  • Do you have a lactation consultant on staff? This is a popular option with many women, and more and more hospitals have a person like this on staff. If they do, ask if she is accredited, and whether she's full-time or part-time. (It's possible that a part-time LACTATION CONSULTANT wouldn't even be in the hospital the days you're there.)

  • Can my baby remain with me at all times from the moment of birth? When can my partner and other children visit me? Let them explain to you when your baby can't stay, rather than when he can, for a clearer understanding of hospital rules. In some hospitals partners can remain with you 24 hours a day, and others have special visiting times for your other children to come and see you.

  • What is the average cost? Costs vary, and often your choice of hospital is determined by your insurance coverage. Be sure to check your policy, as it's common now for individuals to pay a higher percentage of maternity costs than they once did.

  • Does your hospital have a policy regarding required use of the EFM during labor? Most hospitals do for malpractice reasons. If yours does, ask what is the required length of time. It's usually between 20 and 30 minutes, although if you're using Pitocin, have an epidural, or are labeled high risk, EFM use is usually required for your whole labor.

Every hospital maternity floor has two sets of rules, only one of which is written. The written rule is the OB policy, which mirrors the local medical standard of care -- or what most doctors believe to be good medicine. It's determined by the OB committee of the hospital, and includes issues such as EFM use or whether or not your partner can be with you during a cesarean.

Copyright 1992 by The Harvard Common Press. Reprinted with permission of the author.

Diana Korte is an award winning journalist and author of The VBAC Companion (Harvard Common Press, 1997) and Every Woman's Body (Ballantine, 1994), as well as the co-author of the much acclaimed A Good Birth, A Safe Birth: Choosing and Having the Childbirth Experience You Want (Harvard Common Press, 1992). She has been a La Leche League leader and is the mother of four children and three grandchildren. She's also served on local, state, and international health related boards of directors.

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