Getting the Hospital Birth you Want

It’s not just about getting there on time

Nearly all women in the west today give birth in hospitals, a large percentage of whom want to give birth naturally. Some achieve this without any preparation but they are the lucky few. So many women have been left startled and confused by the journey their births have taken within this system of care. Preventing this happening to you is about understanding the protocols of your chosen caregiver as well as getting informed about how an unfamiliar environment can affect you in labour.

Don’t Worry!

You can have the natural birth you want in hospital. It is important to look at what challenges you may face within this system of care so that you can prepare yourself ahead of time. Hospitals are places that look after people who are sick. Pregnant women do not fall into this category and yet are often treated as if they have an illness. Feeling like a ‘patient’ makes us feel passive and helpless but natural birth is a healthy and safe function that your body is perfectly designed to perform. The only person a woman should submit to when giving birth, is herself.

Hospital policies are not about individuals

Much ‘box ticking’ takes place in hospitals. These institutions rely on order, rules and routine to function optimally. This undoubtedly is essential to the day-to-day running of a hospital but is not conducive to giving birth. Birth is not “one size fits all” and every woman will experience it differently. The time it takes to give birth varies dramatically from woman to woman, some women will want to be left alone, others will want more support. Birth needs flexibility and there is room for manoeuvre within the system if you understand how it works. This requires asking questions of your caregivers before you check in at the front desk with 5 minute contractions!

Routines

The procedures that women in a labour ward are commonly subjected to are inductions (when labour has not progressed within the policy time limit or if you are past your due date), routine cervical examinations, permanent monitoring of the baby, observations by student medical staff and midwives changing shifts.

Room for negotiation

The knock on effect of one or more of these factors can alter the course of a normal labour. Apart from when your midwife comes to the end of her shift, all other interferences are negotiable.

• If your care provider wants to induce you, you or your support person can negotiate more time. If it is unavoidable (make them give you a damn good reason as to why it is) have a say in the type of induction and discuss the possible implications with your doctor.
• Examinations to see how far you have dilated are routinely done as often as every 4 hours in many hospitals. This invasive procedure is uncomfortable and very distracting. Experienced midwives should be able to see your progress not just by internal exams but also by watching your behaviour. The outer signs of a woman in labour are very strong indicators to where things are at. Make sure the midwife asks before performing cervical examinations, and if you don’t want one, just say “no, not now.”
• It is normal for a babies heart rate to fluctuate during labour. Unnecessary panic can arise when the babies heart rate is listened to too often. Constant foetal monitoring is totally unnecessary in a women who is labouring naturally so make sure that your baby is monitored intermittently by your midwife.
• Student medical staff do need to learn, but you most certainly do not have to be the guinea pig in this scenario. You may be in a public building, but treat your room as your own private space. If any unwelcome people enter you have every right to ask them to leave.

How hospital environments impact on birth

External distractions can be regular occurrences in a hospital. Talking, lights, observation, noise and eye contact can all have an impact on a woman in labour. These things may seem insignificant and yet the simplicity of silence and darkness can have a profound effect as to how a birth unfolds. These are simple but important details. Having strategies to create an environment in which to feel safe and undisturbed will certainly help you to give birth naturally in an ‘un-natural’ place. If this involves taking enough personal objects along to redecorate a small house, then so be it! Why not?!

The First Hour after Birth

No matter how your baby arrives in the world, the significance of the first hour after the birth cannot be over emphasised. Most caregivers now realise the benefits of immediate skin to skin contact for mother and baby. Mother and baby should ideally be left together without distraction for the first hour after birth. This is a magical moment. Hospital routines such as cord clamping, weighing, measuring, heel prick test and injections can wait. If, for any reason you could not be with your baby this time, then have the baby skin to skin with your support person until you can do so yourself. Give equal importance to what happens after your baby is born when writing your birth plan.

Retain your Autonomy

Perhaps it is the years we all spend in institutional education that makes some of us submissive in front of figures of authority. Mothers to be often don’t want to ask questions of their doctors and midwives purely because of the authority they exude. It is their job to put you at your ease and tell you everything will be alright but this should not put you off asking as many questions of them as you like and questioning every decision that is made on your behalf. Communication is a key element of good care. This is not about being obedient, although polite and friendly will most certainly work in your favour. Friendly but firm is the best way to negotiate. Better still, have your support person do the negotiating on your behalf, while you concentrate on more important things.