Hospital Birth

Is the hospital really the safest place to have a baby? Healthy moms and babies have safe options outside the hospital, but facts are important to making a decision. There are both advantages and disadvantages to hospital birth.

Research each particular hospital that you are considering – your experiences could be dramatically different from one hospital to another!

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Different Hospitals, Different Birthing Environments

Large teaching hospitals generally have modern equipment and a doctor who is always on call. They’re a good place to birth if you’ll need immediate backup and intervention. 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 rather than your own doctor.

A smaller community hospital birth is more likely to have an intimate, friendly atmosphere. There’s a smaller staff and fewer women in labor at one time. You may be able to negotiate more and have a better chance at natural childbirth because medications are not always available. Some small hospitals are more inflexible and may push procedures and medications.

Take a tour and get to know what procedures are routine at your hospital. Find out what may be flexible and what won’t be, because every hospital, large or small, is different.

You should be your own advocate, and during a hospital birth, you may need to be. Head to the hospital feeling confident about and ready to advocate for your birth preferences (and be well-prepared to work through a natural birth – birthing classes are highly recommended!).

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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 complications such as pre-eclampsia you’ll need to be in the hospital for your baby’s birth. You can avoid developing complications by taking good care of yourself during pregnancy.

It may be safer to be at the hospital for twins and most likely for higher order multiples (though you can find home birth midwives who will attend twin births, and this is safe depending on twin type). 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 allow you a “trial of labor.” That means you have no chance of a vaginal delivery for your twins or breech baby. Research other hospitals or home birth midwives in your area.

If you’re “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 actually be riskier for you.

Studies show that home birth or birth center birth can be safer than hospital birth. The hospital uses routines and procedures that may hamper the normal birthing process and cause problems with birth!

Birth is “managed” as opposed to letting women do what they instinctively need to do. Again, you’ll likely receive interventions that cause more problems than they solve. Most hospital routines are based on tradition and aren’t based on medical evidence.

Your Prenatal Care

Prenatal care is usually handled at your doctor’s or midwife’s office or the hospital’s prenatal clinic.

Appointments involve having the nurse do basic measurements and urine tests then seeing the doctor. Generally you only have a few minutes with the doctor, so have a list of questions ready (and insist the doctor answer all of them)

If you’re 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. Many midwives allocate a full hour for prenatal appointments, so you won’t feel rushed, but you should still bring a list of questions!

Remember, your own healthy pregnancy diet and self-care are the best way to assure that you remain healthy and gives you the best chance for the natural birth that you want. Our online MamaBaby Birthing classes give you complete information on staying healthy and personalized attention as you prepare for your baby’s birth.

What You May Face

Hospitals are governed by rules. They’re business organizations that must operate within certain guidelines and policies. You’ll 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 let you breeze through the check-in procedures when you’re 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’ll probably have an IV or heplock placed, then be 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 offered synthetic oxytocin (Pitocin).

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 that you want your membranes to stay intact (unless you agree to have them ruptured).

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.

During a hospital birth your chances of episiotomy and c-section increase.  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 letting you control pushing, and by helping your baby be born slowly and with support.

Some Advantages

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. 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.

A hospital has 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, possibly around the clock. If you’re 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 work with birthing and possible pain. Some hospitals push medication – especially around the time the anesthesiologist is going home for the day.

When Baby Arrives

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.”

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.

Choose What’s 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!)

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Photo by dchasteen