While you are discussing your birth plans/hopes with your care provider, it's also a good idea to tour the hospital and ask about their policies. When you arrive at the hospital in labor your doctor will likely NOT be there. You'll be triaged to confirm you are in labor, they'll call your doctor or midwife to discuss if they should keep you or send you home, and your doctor can give orders over the phone. If you want anything outside the norm as far as hospital policy, generally your doctor will have to explicitly state that's okay - to including getting in the shower or tub, eating or drinking anything, declining the IV/heplock, doing intermittent monitoring instead of being kept on the straps in bed, etc. You need to discuss all of these things with your doctor/midwife in advance and include them in your birth plan, but ultimately it's the doctor giving permission while you are in labor that makes it possible. If they cannot reach your doctor to get the go ahead, be prepared to have any of those wishes denied! (I had to wait for the okay from my former midwife to even get into the tub while laboring with my second birth. Not amusing.)
Other important questions to ask on the hospital tour are do they have an anesthesiologist in house? They will say they have one "available" 24 hours a day but as I learned in my second birth, available sometimes means they are at home asleep in bed and have 30 minutes to report to the hospital from the time they are called. Most hospitals do NOT have someone physically in the hospital around the clock, generally just the larger university medical centers (like downtown Dallas & Fort Worth.) Hospitals may have a nurse anesthetist available, but not an anesthesiologist (an MD.) Both can provide epidurals, both do surgeries, but it's something to learn more about as this is a person sticking a needle into your spine. 🙂 And once you are in labor and have decided you want that epidural then you're going to be feeling desperate and not wanting to ask questions. Better to ask BEFORE you're otherwise occupied!
Ask about their nursery, as more hospitals are claiming they have NICUs when really they have well baby nurseries with oxygen on hand for emergencies. That does not make a NICU! You don't want to discover this when you go into labor prematurely and learn your hospital is not equipped to care for a baby born before 36 weeks so your infant is being put into a helicopter and flown an hour away. (And yes, I've heard of this happening in our town.) It is better to transport a mom than a premature baby, and you don't want to be hospitalized in one city with your preemie in another location! Explore what options your hospital provides for premature babies and if a premature arrival is possible, determine where you would feel the most comfortable giving birth. (As 1 in 8 babies is now born premature, often with no warning signs, this is important for all parents to discuss.)
Ask about their c-section rate, as it varies widely from hospital to hospital in our area. If it's higher than the national average, why? And what does this say about the staff's feelings towards c-sections and how quickly they will jump to that option during your labor? For at least one downtown hospital I know their c-section rate is higher than average because high risk pregnancies are often transported to them, to include a floor of women living at the hospital on bedrest. In their case the c-section rate can be easily explained as it's special cases. If the hospital is NOT a major university medical center with high risk cases and yet they have a high c-section rate, why? Are they elective, repeat, or emergencies? (Ask the staff all these questions when you tour!)
Ask about their VBAC policy. Some hospitals are now banning VBACs, stating they do not have the staffing available to offer that option. ACOG guidelines state VBACs should take place in hospitals that can handle an emergency, specified as having an OB and anesthesiologist in house in case of an immediate cesarean birth being needed. However, if a hospital bans VBACs because they cannot handle an emergency c-section, then the hospital is not prepared to handle ANY emergency in labor. I know I was surprised to birth in a hospital and discover that little bit of information, that if I were to have an emergency the staff had 30 minutes to even show up? And then start the surgery? And I know many other parents have been surprised to hear that as well. If you are birthing in a hospital because you are concerned about having immediate medical access for the rare case of emergency, then make sure you are in a hospital that is actually prepared!
More to come. 🙂