Friday, December 11, 2009

Pregnant? 5 Must Ask Questions for the Hospital

First off, I would love if every woman had access to a Baby Friendly Hospital, The concept of Baby Friendly Hospitals was started by the WHO, World Health Organization and UNICEF. Their vision is for America to be a nation that appreciates breastfeeding and the benefits it provides for mother and baby. Unfortunately, in 2009 only 86 hospitals and birthing centers in the US are Certified Baby Friendly. This is sad, and so for this reason I recommend every parent-to-be interview their hospital BEFORE deciding to birth their baby there.

Your Life, Your Body, Your Birth

You do not have to give birth in a hospital just because it is near your home or because you think you must birth at a hospital. Studies repeatedly show that home birth and birthing center births are as safe (and sometimes safer) than hospital birth. For more information and research on this topic, click here and here.

You have the right to "hire" (or fire!) a hospital just like you can your health care provider. These questions can help you decide whether or not the hospital is right for you and your birth.

How To Find The Right Hospital or Birth Center for You

I cannot overestimate the importance of interviewing the hospital.
Every hospital will give a tour of its birthing center and laud its facilities, but it's up to you to investigate whether the hospital is truly "baby friendly" enough for your birth.

Step one: schedule a tour of the hospital's birthing center, preferably a private one rather than a group one. A hospital should be willing to do a private tour. They take no longer than 15 minutes typically.
Step two: Ask questions, sprinkling them throughout the course of the tour.

Red Flags that you should consider a different hospital:
1. The hospital tour guide, usually a nurse on the L&D (labor and delivery) floor, cannot or will not answer these questions. Birth outcomes are public knowledge, so you have every right to know about the birth outcomes in this hospital. So ask. Question authority.
2. You get answers that you do not like about one of the questions below. These are basic needs that a progressive, Baby Friendly hospital will honor. You should receive answers that give you confidence, not doubt, about the hospital and your birth.

This is Your Life, Your Body, & Your Birth. Reclaim it!
TOP 5 QUESTIONS TO ASK YOUR HOSPITAL or birthing center (before you preregister or arrive in labor!)

1. Can I birth in the position I find most comfortable? Secondary questions: Do you have a birthing ball, tub, or other means for holistic pain management. Can I bring my own music? Can I wear my own gown? Can I bring my own birthing ball and tools for pain management? The answer from the hospital staff person should be an emphatic Yes! You have the right to birth in whatever position and with whatever methods you find most comfortable. Any birth position is actually better for you and baby OTHER THAN the lithotomy, or flat on back and legs in stirrups, position.
If a hospital requires you to birth in a certain position or won't allow certain methods to be used - run away. Do not preregister. Find another hospital.
Informed women will choose to birth in a variety of positions. I gave birth in side lying, but women also choose all fours, squatting, supported squatting semi-reclined with their partner or husband holding them up, or a combo of all of them.
2. Do you have in room lower level NICU (neo natal intensive care unit) OR how much care can you provide for my baby without having to take him or her to NICU? and What level is your NICU rated and what does that mean? For ideal bonding and breastfeeding, mothers and babies should remain together as much as possible during the hospital stay. However, should your baby need higher level care, many larger, teaching regional medical centers will provide lower level or step down care in your birthing suite. This option is very Baby Friendly. Some hospitals still maintain outdated "observation" policies, where it is "mandatory" that the baby be taken to the nursery and "observed" for up to 3 hours after birth, even when they do not need NICU. This is not necessary nor beneficial for the baby.
Separating mother from baby can make breastfeeding more difficult or even impossible. Baby Friendly hospitals will promote "kangaroo care", or skin to skin contact and immediate breastfeeding after birth. "Latching on", or learning to breastfeed can be difficult for baby, so a hospital should prevent separating mother and baby whenever possible.
3. Do you require bathing, vitamin K injections, and eye ointment? If so, how do you do this? Baby friendly hospitals will allow baby to stay in room with you while all of these procedures are done. Furthermore, a baby friendly hospital would also give you the choice of delaying or opting out of these procedures. In other words, a hospital who "requires" these procedures is not baby friendly. They do not have to be done.
4. What is your C-section rate? A touchy one - but one you want to know. Failing them answering this question, here is another one you can ask - Do you encourage mothers to write a Birth Plan? (FYI: If you are pregnant and have not done this already - start now.) Stay tuned for a coming blog on How to Write A (diplomatic) Birth Plan.
Also ask, how many percentage of mothers have epidurals here? You may want to share with the nurse that your intention in asking these questions is to make sure you can labor freely ~ walking, groaning, whatever strategy it may be - without being repeatedly badgered or offered pain medications. Repeatedly offering pain meds will break down a mother's will and her ultimate wishes because it makes her feel as if she is failing and she "cannot do it (give birth)." Of course mothers can give birth and do it naturally - we've populated the entire earth through all of history and time! Laboring moms can be successful at a natural birth, but must have a cheerleaders or support who applaud, not derail, their birth plan.
5. What is your policy on CFM (continuous fetal monitoring)? Hospitals usually "require" CFM. This is not a positive thing. (read yesterday's blog to learn why) However, at the least, a hospital who requires CFM will “allow” you to be free and manage labor for 45 minutes of every hour. Which means you will only be physically restrained by CFM (which means you cannot walk or move around during a contraction) for 15 minutes every hour. It is important that the hospital have a flexible policy on CFM, or you likely will end up asking for pain meds because the restriction of movement that the CFM requires make it extremely difficult to manage labor pain.
6. Bonus question: Do you allow eating and drinking during labor? Historically hospitals have limited mother's access to food or drink while they labored - and without hard science to back the policy. It is a baseless policy, and could actually be harmful. Low blood sugar and fatigue can set in if a mother is restricted access to food or drink during labor. This makes it hard for moms to go the distance for natural birth, and it also causes dehydration and other symptoms - like inability to cope with pain. A hospital should "allow" a limited consumption, at least, of bland food during labor. They should also provide or allow you to bring your own 100% juices or filtered water. You'll need the hydration more than the food. But if your labor was long like mine, 36 hours, you'll need food as well.
Happy hospital hunting- and don't forget - You are in charge of Your Body & Your Birth.
*photo of my second son, just moments after his birth.

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