Hospital Birth

The hospital is a relatively recent invention in the scope of mankind. Hospital birth is even more recent.

There is debate about whether it is the safest place to birth babies. But aside from any controversy or research about birthing places some women just feel most comfortable birthing in the hospital.

There are some advantages to a hospital birth and some definite disadvantages. You will have to weigh this yourself.

It's also very important that you research each particular hospital that you are considering. Your care could differ vastly depending on which you choose.

Different Hospitals, Different Birthing Environments

As a general rule large teaching hospitals will have the most modern equipment and a doctor on call always. It is a good place to birth if you worry that you will need immediate backup.

However, the hospital may be largely inflexible about what you can do and how you can do it. You may also be attended by residents or students - something you should take into consideration.

Some teaching hospitals are more progressive than other hospitals.

A smaller community hospital birth place is more likely to have an intimate, friendly atmosphere. There will be a smaller staff and fewer women in labor at one time.

You may be able to negotiate more than you would at a larger hospital birth. You may also have a better chance at natural childbirth because medications are not always available. But some small hospitals are more inflexible and may push procedures and medications.

Doing your research is wise. Take a tour and get to know what procedures are routine at your hospital. Find out what may be flexible and what will not be.

You should be your own advocate, and at a hospital birth, you may need to be. It is probably best for you and your partner to head to the hospital prepared for a fight. Just be pleasantly surprised if things go exactly as you would have them go.

Your "Risk" Factor

Sometimes the hospital is the best place to give birth. If you have a pre-existing condition such as a heart condition a hospital birth may be best for you.

If you develop a disorder such as pre-eclampsia you'll need to be in the hospital for your baby's birth. You can help make sure that you do not develop such disorders by being vigilant in your self-care and nutrition prenataly.

It may be safer to be at the hospital for twins and most likely for higher order multiples. Some doctors feel that breech babies should always be born in hospitals.

Research your doctor's and your hospital's policies carefully - some may not even be willing to allow you a "trial of labor." That means you have no chance of a vaginal delivery for your twins or breech baby.

Even if you find yourself in one of the above situations you can still have an empowering hospital birth. Preparing throughout pregnancy and getting to know your body will help. Take steps to put yourself in control - The Pink Kit is full of information and skills that will put you in controll of your birth - no matter what kind of birth it needs to be for you and your baby.

If you are "low-risk" for obstetrical complications (meaning you've had a healthy pregnancy and there are no indications that anything could happen at your birth) a hospital birth may be the riskiest for you.

Studies have shown that home birth or birth center birth can be safer than hospital birth. This is usually because in the hospital you are put through routines and procedures that may hamper the normal birthing process.

Birth is "managed" as opposed to letting women do what they instinctively need to do. You may also receive interventions that cause more problems. Henci Goer's book The Thinking Woman's Guide to a Better Birth explores these issues in detail.

Your Prenatal Care

Your prenatal care will probably be handled at your doctor's office or clinic. If you're seeing a midwifery practice, your appointments will be at their offices.

Some people complain of "assembly line" prenatal care. Many doctor's offices are over crowded and pregnant women are herded through like cattle.

The visits with the doctor often last mere minutes. These types of appointments can leave women wondering what the point of the office visit was. Besides having standard tests done at each visit there doesn't seem to be much more to appointments.

If you are going to a clinic or even to the hospital for you prenatal care you might see a different doctor at each visit. You might also see a student doctor. A clinic may seem as rushed and impersonal as a busy doctor's office.

Of course there are plenty of offices where this is not the case. You may have a warm, open doctor who is willing to spend the time with you that you need. You may also have a doctor with a small, non-crowded office.

Careful selection of your prenatal care provider can make the difference. If you're seeing certified nurse midwives you may enjoy the midwifery model of prenatal care.

Be sure that you are very responsible with your self-care during your pregnancy. It is probably the best way to assure that you remain healthy and gives you the best chance for the natural birth that you want.

What You May Face

Hospitals are governed by rules. They are business organizations that must operate within certain guidelines and policies. You will be part of that and expected to conform to their defined protocols. Find out beforehand what your hospital birth will allow and will not allow.

Find out if you can fill out pre-admission forms to your hospital. They allow you to breeze through the check-in procedures when you are in labor.

Otherwise you may be separated from your partner for a lengthy amount of time, or you may have to fill out paperwork in labor - when you definitely don't want to.

You will probably have an IV placed right away and be set in bed and hooked up to a fetal monitor belt. The belt is strapped around your abdomen and leaves you with no choice but to stay in bed.

Depending on your hospital you may be able to opt for a heplock instead of an IV. After an initial time period on the fetal monitor you may be able to have intermittent monitoring with a Doppler as you would have a birth center or home birth.

If your labor is not moving along as quickly as the hospital would like, or you are not having a "textbook" labor you may be started on synthetic oxytocin (Pitocin).

Realize that contractions induced by synthetic oxytocin are much harder on you and on your baby than natural contractions. You might also be offered or required to accept synthetic oxytocin to get your labor going if you haven't started labor when you care provider wants you to.

You should be wary of any types of induction techniques. Agents to ripen your cervix and artificial rupture of membranes are interventions that are more likely to happen at the hospital.

Artificial rupture of membranes ("breaking your water") could be done without your consent, so be clear about your wishes for your membranes to stay intact unless you agree to have them ruptured.

There is a huge controversy about dangerous induction practices going on currently. Ina May's Guide to Childbirth goes into depth about some of them - the book is an excellent read to prepare for a natural birth and to understand the hazards of common interventions. I suggest you read it no matter where you're going to give birth.

You may see many different care providers during your labor and hospital birth. Shift changes could bring new nurses and new midwives. You may not see your doctor until your baby is about to be born.

You might not see your doctor at all if he or she uses a backup doctor during certain hours, or if you use a large practice. Keep this in mind as you make your birth choices.

During a hospital birth your chances of episiotomy and surgical delivery increase. There are conflicting studies on episiotomy but most agree that they are completely unnecessary. Evidence is showing that natural tears heal as well as episiotomy if not better.

The cutting of one of the most intimate parts of your body is not something to take lightly. A skilled care provider can minimize any tearing by helping your baby be born slowly and with support. And if you do tear a skilled provider can asses the need for sutures and do a complete, compassionate, and professional job.

Some Advantages

As has already been noted for some women a hospital birth is truly the safest. A hospital has many interventions available on-site, and probably has a staff that is prepared to deal with major complications.

A cesarean or assisted delivery can be performed on site. Note that a good birth center or home birth midwife will have a similar "decision to incision" time as the hospital - about 30 minutes from deciding a cesarean is needed. A hospital can do a true emergency cesarean within just a few minutes.

For hospital birth there is access to high level support for the newborn, and depending on your hospital, a NICU (newborn intensive care unit) on site. In some cases this may be very desirable to you. In other cases it could lead to a baby being sent to the NICU for no real reason.

Pain medication is available at a hospital birth. Depending on the size of your hospital it may be offered around the clock. If you are planning a natural birth this could end up being a down-side for you!

The lack of medication at home or the birth center could help you to find other ways to cope with pain. Some hospitals tend to push medication - especially around the time the anesthesiologist is going home for the day.

When Baby Arrives

The hardest thing to deal with at some hospitals is baby care procedures. Many hospitals today are becoming more aware of what is best for babies and for mothers. They will place your baby right up on your chest and allow you plenty of time to bond.

Others will only place your baby on your chest for a few seconds and then whisk him away, or worse, they will hardly let you have a glimpse of your baby.

Your baby's cord will probably be clamped and cut right away, your baby subjected to all newborn procedures, and then he'll be bundled and finally brought back to you.

You may not want this for your baby. You may want your baby to be given right to you and all procedures delayed until after you have had time to bond. You must be your baby's advocate!

If the hospital has any hint that something may possibly be wrong with your baby she may be taken away for a full infant workup, which is painful for her. Medication will also be started right away, even if it later turns out there is no problem.

Hospitals feel it better to be safe than sorry. This can be a good approach, but it's highly disruptive for your healthy newborn.

There will be varying levels of support for breastfeeding. Again it depends on your hospital. There are also varying levels of tolerance for your other children and the rest of your family.

Your hospital will want you and your baby to stay for at least 24 hours and most likely 48 hours before you go home. The hospital may want the baby to be in the nursery for at least a few hours for "observation" or they may even want your baby in the nursery more.

Again, you will have to advocate for your child. If you want to leave before the hospital's set time period you'll have to sign that you are doing so against medical advice.

Most hospitals and doctors don't do any follow up care the days following your discharge. Some communities send a health nurse for one follow up appointment. You will have a postpartum check around six weeks.

Your doctor will be able to do family planning counseling and will have plenty of recommendations for you. Depending on your care provider, you may or may not get good information on what natural or non-hormonal options you may have.

Choose What is Right for You

A hospital birth may give you peace of mind, and it may be the right choice for you. Be sure you decide what is important for you in your birth experience, and then find out how likely that will be at your hospital. One way you can increase your chances of a great hospital birth is to hire a doula.

Careful research and planning are essential to a good hospital birth, as well as communication with your care provider (this is really true for anywhere you plan to birth!)

Visit the birth center pages, or the home birth pages for more birth place options.

Choose a birth preparation course like The Pink Kit so you'll be totally prepared for your hospital birth. I recommend the Pink Kit because you will become aware of your body and gain all the skills you need to be in control of your birth - even a hospital birth.

Natural Birth and Baby Care.com