Belly Up

* bellies * birth * babies * breastfeeding *


Tuesday, February 8, 2011

Questions for Choosing A Hospital

(Mom, ask some good questions!)
If you have been involved in a serious car accident, it is pretty likely you will be happy to have the ambulance chauffeur you to whatever hospital is closest as you will probably have neither the time nor inclination to be doing interviews.  However, childbirth is different in that you have at minimum 9 months to look around and you can even start looking before the test shows two lines.  Here are just a few suggestions of things you can ask to gauge if a hospital is a good fit for you. 

Are there any restrictions on who is allowed in the room? If you want the baby's siblings, relatives, doula or a photographer in the room, make sure you ask the hospital what its policies are. Some hospital limit visitors to 2, others allow a frat party to be held in the room while mom labors.  Also check to see who is allowed in the operating room in case of a surgical birth. Some hospitals allow (and encourage) doulas and birth photographers in while others do not. As a side note, hospitals can also be very helpful if you are trying to keep a certain someone out of the room as well.

Can I eat and drink during labor? Many US hospitals restrict women to sips of fluid or ice chips during childbirth, but studies find that drinking and eating during labor had no adverse effects on mothers or babies; in fact, it actually improves hydration and relates to more positive experiences. So unless your idea of a complete and nutritious meal is ice chips, this is an important question.

Can I walk and move around during labor?
The medical community agrees that moving around makes labor less painful and more efficient, so ask how the hospital supports mom to incorporate movement into her labor and if they encourage intermittent fetal monitoring. Intermittent monitoring, where the baby's heartbeat is checked at regular intervals and is based on what is happening in labor rather than protocol, promotes movement and position change.  Conversely routine continuous monitoring makes it difficult for laboring moms to change positions and cope with contractions as they are tethered to machines and movement causes the flat disks to slide off mom's round belly. Continuous monitoring also creates a fair number of false alarms. Studies have shown that continuous monitoring of low-risk labors does not improve fetal or maternal outcomes but does tend to increase cesarean rates. Boo.

What are the rooms like?
Ideally, you want a large private room with soft lighting, a comfortable chair, a CD player, access to the Internet, a mini refrigerator, and a deep tub, preferably with Jacuzzi jets. In reality, outside of your home or a birth center, this room does not exist for laboring moms. However a few local hospitals do allow moms to bring in a tub for both labor and birth and a few others have a tub that is available to moms under some circumstances. Find out if birthing balls are available, and if not, if you can bring your own. If tubs are not available, ask if you can bring your own tub.

Are there rules about what I can wear and what I can bring? Can you labor in a T-shirt, or even your leopard strip string bikini, or do you have to wear a hospital gown? Many women are more comfortable in regular clothes and there is no medical reason that a mom cannot do so. If you want to record the birth, ask about any rules regarding still and video cameras. Lawsuits have prompted some hospitals to ban recording devices during some parts of labor and delivery while others allow full access. One of my favorite quotes from an OB was when he was asked about filming mom’s impending surgical birth. He simply answered, “ It’s your body and your baby so film anything you want.” Cool.

Do I have to deliver lying flat on my back? Squatting during delivery increases the pelvic opening by approximately 28 percent, reduces the need for forceps and speeds up the birthing process, however it is still common for hospitals and doctors to have mom on her back with her legs up in stirrups for the birth. Does the hospital have squat bars or other tools to help a mother who wants to squat during delivery? Will they be supportive if this is your choice?  Will they be able to find the squat bar when and if you want it?

Can I nurse my baby immediately? Studies show that infants who nurse soon after birth have a longer duration of breastfeeding than infants who are first put to breast 3 to 6 hours after birth. Yet many hospitals still take the baby after birth to be washed, weighed, and then rewarmed under a warmer in the nursery rather than in mom's arms. Ask whether you can nurse your baby immediately, perhaps even while he is still attached via your umbilical cord. Find out if the nurses are willing to do the baby's routine checks bedside or in the room with you and for what reasons your baby may be removed from your room at any point of your stay. Most hospitals (in my area anyway) are moving to the rooming in model of care but it is good to find this out beforehand as some hospitals have still not made the transition.  Those that have not transitioned generally take the baby away from the parents right at the 1 hour mark, even if you finally just got the little guy to latch on.

How does the hospital support breastfeeding? Do the nurses support rooming-in and breastfeeding-on-demand or scheduled feeding? The answer will be greatly effected by the answer to the previous question about often often the baby will be in the nursery vs in mom's room.  Also ask if there is a lactation consultant on staff and how often she is available. Some hospitals have great LCs but they only work Monday-Friday. Great if you deliver on Wednesday, not so great if you deliver on a Friday night.

3 comments:

  1. Great list, Maria! One thing I would add: Be sure to ask these questions of both your hospital AND your provider, because sometimes one will be more restrictive than the other.

    With my first baby, my OB was fine with me eating/drinking whatever I wanted during labor, but she warned me that the nurses wouldn't be as accommodating. It worked out fine, as I wasn't hungry anyway, but that way, it didn't come as a shock when my nurse told me "only clear liquids" midway through labor. I knew that just meant that if I wanted Chick-fil-A while in transition, I'd have to get the nurse to talk to my OB.

    On the flip side, when I did the hospital tour with my second baby, I asked about bringing in a birth tub. The tour guide said that the hospital had no problem with it, but did warn that some providers didn't permit it. My midwives were fine with it (of course, that's why I picked them!), but that would have been a nasty surprise if I hadn't discussed it with them ahead of time and I found out midway through labor that they WEREN'T OK with it!

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  2. Totally agree. Even at some of the best hosptials around here, there are a range of OBs and some will be more restrive. Then occasionally at a hospitals known for lots of routine interventions and policies you can find a sole OB who offers exactly what you want and will help you get it.

    So in a perfect world one is talking to careproviders and hospitals in a similar timeframe and the parents are not already locked into their choice. Just knowing the answers to the questions is not enough if you don't like those answers. Looking elsewhere still has to be an option.

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  3. Choosing right hospital is one of the most important decision you'll have to make for good medical treatment and yes there are number of thing you should look for when choosing hospital and i must say that points you made is good.
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