10 little-known surprises at hospital births

Came home late last night from a beautiful vaginal birth in a Manhattan hospital. Awesome and exhausting and leaving my mind reeling. So, on the train back home, I finally compiled this list that has been on my mind for a while: all the minor moments that make a hospital birth a hospital birth, what you’d never know until you’ve been at one, and what always seems to shock or surprise me and the moms I work with. I’m not at all against hospital births, and I specialize in natural (or at least, gentle) hospital births. But I do think it’s unfamiliar territory for most people, and expecting couples should know what to expect in advance to make it a smoother experience.

*Note also that every single hospital is different, as is every doctor and nurse. These notes are a compilation of my general experiences in over 15 hospitals in New York City and should be taken as a starting point for doing your own research on your particular institution and caregivers that will ultimately determine your unique birth experience.

 

1. Partners cannot sleep over. Visitor hours are from about 10am to 10pm and often moms stay alone their first few nights with their newborns, or else pay upwards of $300 (or surely more… come on, it’s Manhattan) for a private room. Some private insurances may cover a portion of this cost, others won’t.

2. Only two people are allowed in the labor room, and at some hospitals, this includes the doula. Only one person can be in the triage room with you, and also during epidural insertion and for a c-section. Be prepared to choose between loved ones and, if you’re the doula, to wait downstairs without an update on your client for a good while. If mom is up to it, this is when we text and I hang out with dad or another family member and we strategize how to work together to support mom’s birth preferences.

3. Getting out of triage after admitting, and getting into a postpartum room (that allows for visitors) after delivery can take a very long time, up to a few hours, when the staff aren’t in a hurry. If your visitors rush to the hospital as soon as the baby is born, they may very well have to wait.

4. Nurses change every 12 hours, usually around 8am and 8pm. If you start with a terrible bedside nurse, you may get a new one before your labor is up! Adversely, if you absolutely love your nurse by hour 12, you will have a bittersweet goodbye just hours before your big moment. And the transition is always awkward.

5. If and when you send your newborn to get a bath, it can easily turn into a multiple hour affair. Babies don’t regulate their own temperature well and water makes them very cold, so you might not see him for hours while they use the warmer to restore body temperature. Ask to bring him to your chest, which works better than any warmer, or hold off on the bath for a day or so. Baths aren’t medically necessary at birth, and you can do a sponge bath or ask that staff help you bathe him yourselves in the room. Some hospitals wait at least 8 hours to bathe newborns for this very reason.

6. IV bags of dextrose are really hard to negotiate out of, as is pitocin after the birth to help the uterus contract. Negotiate in advance, and bring along proof.

7. The possibility of an epidural is ever present… You may be asked to sign a consent form when you are admitted, and if you arrived at under 5-6 cm and are showing signs of tiring, the nurses may mention it, frequently, because hey – they care about you! It’s not about your ability to handle the pain as much as your ability to stay relaxed enough to dilate, and endure it for hours without losing all your strength for pushing. Epidurals really are handy as a means of getting rest in a hospital setting, where there’s less hands on help, you often tire quickly, and your energy will only last so long. Thus, if you don’t want to even consider an epidural, find a birthing center, homebirth, or experienced doula so you can get acupressure, massage, and rejuvenate in other ways. Labor is usually harder than you think and if the epidural option is dangling, chances are you will take it.

8. For partners and visitors: Hospitals are like Fort Knox, with more security than most banks. Expect to be asked more than once where you are going and what relation you have to the mother, and you’d better have a good answer.

9. Ask early and often for what you want. Gently remind nurses if you want your baby returned to you for feedings, inquire about free girdles (“binders”) or hand breast pumps, and ask repeatedly to see the lactation consultant (which should be provided to you) before you leave. Embrace the role of a vocal, needy patient (or doula), and be extra nice and grateful so that no one notices. Thank you cards with photos or a small gift are always appreciated, and may soften up a hard nurse for the next woman she sees.

10. I have yet to see a doctor apply substantial counter pressure or warm compresses during pushing, nor allow women to try different positions during pushing or pushing for less than 3 rounds of ten long counts, and I have seen far too many vaginal tears. The pushing stage is when I feel most ineffective as a doula, as it is strongly managed by the doctor and nurse and usually is far more forceful than what women see in natural and water birth videos. It’s more like the movies in which everyone is screaming PUSH! and mom is looking wildly around the room. Maybe other doulas can weigh in here, but I feel like this is a neglected stage of labor in childbirth prep and doctor-patient negotiation.
Any thoughts, from moms, doulas, or other interested parties? What has your experience of hospital births been like? What do you wish you had known in advance?

3 thoughts on “10 little-known surprises at hospital births

  1. Thanks for sharing your observations and for such a thorough website! From my experience as a doula in Minnesota, it seems there are some differing points. I know at the two hospitals I worked at as a doula, United Hospital (http://www.allinahealth.org/ahs/united.nsf/) and Woodwinds (http://www.healtheast.org/woodwinds.html) the partner can sleep over. There isn’t a bed for the partner but a couch they can scrunch up on. I know every hospital is a little different – so it’s always important to do your research and find out ahead of time.

    As far as having more than two people – I have been in a scenario at United where there was the husband, sister, and myself present. I believe I heard them make a comment there was a limit- but they seemed to stretch it for us. Other than that, at Woodwinds, usually it was just partner and mom plus me – I am not sure if there is a rule, but it was more of a pattern I noticed.

    At Woodwinds, doulas are allowed in the room during a C-section. Our doula coordinator (yes we have a doula coordinator) was the person who worked really hard to allow us in there. I still ran into an issue with a midwife who didn’t know that, so she pardoned me after they knew they were going to do a C-section. I told our coordinator and found out that the midwife was in the wrong and would be talked with.

    Also, at Woodwinds (where I have most my experience from), they encourage lots of position changes, and I even witnessed my first natural birth there! It totally depends on WHO your team of nurses are (almost more so than the midwife/ob) – since they spend the most time with the mom and mom receives most of her care/information from the nurses. Some women who have nurses who are pitocin-happy will feel the pressure and likely be drugged (sometimes even without informed consent), while others may feel the luxury of time and a non-fear based approach.

    I like this article 10 tips to Create a Positive Hospital Birth (http://www.jodithedoula.com/2012/08/12/10-tips-to-create-a-positive-hospital-birth/) to offer the bright side of things – that it is possible to have a positive birth at a hospital – but as you mentioned in most cases, the mom will need to be more intentional about her wishes – which is why doulas are even more necessary in hospitals in my opinion 🙂

    My biggest piece of advice to doulas in hospitals is make friends with the nurses. Ask how you can assist them and you start to build rapport and when the synergy between mom, nurse, and doula are working you get a happy midwife and baby.

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  2. Wow, I am very shocked to hear that partners are kicked out for overnight stays in NYC. I’ve attended multiple hospital births as a doula in Baltimore and Chicago, and all of them included an open door policy at least for partners. At one hospital I worked at as a nurse in the Chicago area, any visitor could come 24 hours a day. One thing I enjoyed when I was working L&D as a nurse, was the rare opportunity to collaborate with the rare doula that accompanited a patient.

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  3. I am not a doula, but I am nurse and a mother of three young kids. I had all my kids in MN and the hospital did allow my husband in the delivery room and he stayed with me in the postpartum area. I couuldn’t imagine if he was not allowed in or he couldn’t stay with me — with no family members here, I don’t think we’d have other kids.
    Your observations will help a lot of new parents/parents to be. I’m sure glad I had my kids here in MN and not NY. Even as a nurse, I never worked in labor and delievery or heard of a doula until recently.

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