Birth Plans

Hospital Birth Planning

If you are planning a hospital birth, you will be faced with some unique birth planning questions. Though none of the questions are difficult, they will take some time and effort to answer. In most cases, a tour of your local hosptial will provide you with nearly all the information you need to make the best plan for your family.

Making the Move

You may not know when you will move to the hospital, it may depend on the way your labor progresses. But you should have an idea of what signals the need to move to a hospital. You will also want to be sure you know at least two ways to get to the hospital and which entrance you are supposed to use. Where do you park, and can you be dropped off by an entrance to avoid a long walk? If you plan to bring a lot of bags, is there a cart you can use to transport them to your room?

Once you are in the hospital birthing center, what forms will you need to sign to be admitted? Can you fill out some of the paperwork ahead of time? Does your midwife meet you at the hospital or will you first see an on-staff midwife? Can any of the admission procedures be delayed if you are in active labor or arrive pushing?

Hospital Procedures

The very nature of a hospital, being a facility that provides care to many at one time, requires strict adherence to standards of care to ensure every person receives a minimally acceptable level of care with as little risk as possilbe. This strict adherence also ensures the next shift of nurses and midwives know what has been happening in your labor and what they are to do next. These routines and protocols may interfere with your prefered environment, use of comfort measures, and the type of care you expected to receive. Be sure you know what your midwife and your hospital consider to be essential and which routine procedures can be avoided. Procedures which may be routine at hospitals:

Intravenous Fluids

IV stands for intra-venous, which means "inside vein." In the case of IV fluids in labor, a needle is used to insert a thin plastic tube into a vein in your arm. Fluids are then sent through the tube straight into your blood stream.

IV fluids can help to hydrate a mother who has become dehydrated during labor. IV fluids may also allow for administration of oxytocin and antibiotics. If you choose to use an epidural, IV fluids will be given before the medication can be administered to prevent a drop in blood pressure.

Recent studies raise concern about IV fluids in labor being administered in too high of doses. It is possible that a woman receiving IV fluids in labor may develop fluid overload which can cause fluid in the mother's and baby's lungs. When the IV fluids contain glucose, the extra insulin that is produced can cause the baby to suffer hypoglycemia immediately after birth. Henci Goer reports in The Thinking Woman's Guide to a Better Birth that no studies have been done to determine what the normal (non-IV) blood chemistry is during labor. Because of this it is impossible to determine the effects IV use has during labor.

The IV pole can hinder mobility. If a temporary IV is necessary for antibiotics, use a heparin lock (or hep well) which will give access to a vein for the IV, but allow the IV to be taken off and restarted without having to reinsert it into a vein. If possible, you can choose to hydrate the mother with sips of water, ice chips, juice or beverage of her choice instead of an IV.

Monitoring

Every hosptial will have a set standard for monitoring. What that standard is will depend on where you live and what tools are available to the hosptial. In the United States, most monitoring is done with an electronic fetal monitor or internal monitor. In other parts of the world these tools are reserved for the pregnant women with severe health problems and the normal pregnant woman is monitored with a stethescope or fetoscope. You can read more about monitoring options here.

Active Managment of Labor

Active management of labor is program hospitals adopted to help prevent long labors. Designed in Dublin Ireland in the 1970's, it was hoped to help first time mothers have better birth experiences. The comprehensive program requires the mother be in active labor before she is admitted to the hospital. Once admitted, the labor is sped up with an early amniotomy and early artificial oxytocin. The mother also receives continuous professional labor support.

Using this program, the doctors and midwives at National Maternity Hospital were able to guarantee a woman would not be in labor for more than 12 hours. The program caught on around the world, but without two key factors, the strict criteria to determine the mother is in active labor and the continuous professional labor support.

The only published studies on active management show it does not have any significant impact on reducing cesarean rates, use of epidural or problems with babies. It only shortens the length of labor. However, half the women who are considered to have poor progress in labor will progress well whether they have artificial oxytocin or not. When the components of active management are evaluated independently, the only part that actually improves outcomes for mothers and babies is continuous professional labor support.

Antibiotics

Antibiotics are agents designed to fight off bacteria that may be causing infection. It is hoped that by administering antibiotics to the mother, the infection can be prevented from spreading to the baby. During labor they are administered through an IV.

Antibiotics may be used in several circumstances. They may be used to kill off bacteria that cause fever during labor. By eliminating the bacteria, the risk of spreading the infection to the baby is reduced. In mothers who have Group B Strep, antibiotics in labor are effective at reducing the risk that the infection will be passed onto the baby. Antibiotics given before a cesarean help prevent infections at the surgical site.

Episiotomy

Episiotomy is a surgical cut that is made to the perineal skin (at the base of the vagina) during the pushing stage of labor. There are two main types of cuts. A midline episiotomy is cut straight down towards the anus. A mediolateral is cut to the side. The cut made by an episiotomy is equivalent to a second degree tear, meaning that both skin and muscle are cut. Although this procedure may be done in any birth setting, the highest rates for episiotomy are in hospital births.

In some parts of the world, episiotomy is still part of the standard birth care. In other parts, it's use has greatly diminshed. This is because research has shown episiotomies are not helpful at preventing further tear, and do not improve healing time.

In places where episiotomy is more rare, its use is mostly dependent on the birth attendant's decision making in the moment. In cases of fetal distress, an episiotomy may be used to shorten pushing by 5 to 15 minutes allowing for the baby to be born faster and avoiding a cesarean. If the perineum appears to be preparing to tear up towards the urethra, many atendants will do an episiotomy to ensure the tear occurs at the base of the vagina where repair and healing are easier. If the perineum is not stretching, some health care providers will recommend an episiotomy.

Following the Rules

Each hospital will have its own rules on a number of issues that may or may not be important to your birth plan. Some hospitals limit the number of friends and family members present in your room. Some limit birth attendance to children over particular ages. Some hospitals allow overnight guests while others lack private rooms and require guest leave at a particular time.

Each hospital will also have its own collection of comfort measures for labor. Does your hosptial provide labor or birth tubs, showers, birth balls or birth stools? Do the nurses welcome repositioning the bed to utilize different positions? Is a CD player available, or are you encouraged to bring your own music selections? Does the size of the rooms allow for much movement and a variety of positions? Are hot or cold packs available for use? Can one of your family members get ice chips and water for you, or do you need to ask the nurse? How welcoming is the staff to a mother who choses to wear her own clothing?

Other rules to investigate are rules about photos and video. Some hosptials frown on video of the actual birth. Some hosptials provide a photo service for parents including a private website to share the photos of your baby.

Food services may be an issue for some mothers. Does the hosptial require laboring mothers to maintain an ice chip only diet, allow clear fluids, or not restrict her food intake. Does the hosptial make dinner trays available for women who give birth in the middle of the night. Can meals be ordered for loved ones visiting, or do they need to visit the cafeteria. Can food be brought in from home or a local resturant?

You will want to find out about the rules for your newborn. Do all babies spend time in the newborn nursery, or is it only for babies who need extra care? Is 24 hour rooming in available, or is the baby only allowed in your room when you are awake? What tests will your baby receive? What is considered an early discharge, and what would you need to leave during the early discharge time. What is the longest time you will be allowed to stay? Where are sick babies cared for? Who will have access to your baby if she needs NICU care? Is a breastfeeding consultant available? What do you need to do to speak with her?