Patient's preferences during birth

TTE7 · Jan 4, 2008

I forgot to mention. My doc stripped my membranes with the third, without asking me. That's why I went into labor.

Also, with group B strep, do you have to take the antibiotic via IV?

Thanks!

Tammy

cad4296 · Jan 4, 2008

I'm definately not a nurse yet, still just a student, but your post reminded me of this book I read, Pushed: The Painful Truth About Childbirth and Modern Maternity Care by Jennifer Block. It was a real eye opener. It discussed the frequent use of pitocin and inducing labor and such. I think if you're wanting a natural birth it would be best to seek out a birthing center or midwife. I was watching Baby Diaries on Discovery Health and this woman wanted a natural birth as well in the hospital and her doctor eventually started her on pitocin because she wasn't progressing fast enough. When all was said and done she didn't have a natural birth at all, she had pitocin, and epidural and the doctor used forceps. My friend has had all 3 of hers naturally through a midwife at a birthing center. Maybe try discussing it with your doctor, but if he didn't follow through with your wishes before, chances are he won't this time either.

RNmama05 · Jan 4, 2008

There is a lot of information out there that's difficult to sift through. If you're serious about natural childbirth I would recommend you read "Ina May's Guide to Childbirth" by Ina May Gaskin and check out The Bradley Method http://www.bradleybirth.com. I would also make sure that your care provider is a midwife and that, if possible, you look into giving birth in a birth center.

Finally, to answer some questions: No, you do not necessarily "need" an IV to give birth. Most hospital staff are comfortable with them because there is a chance that a woman could hemorrhage during or after delivery, and the IV is a safety precaution. Also, if your labor is managed with pitocin or if you get an epidural or narcotic pain medication or if you need antibiotics, you would need an IV. Many women are willing to compromise and get an IV with a heparin lock so they're not hooked up to tubing during labor.

The answers to questions 2 and 3 are tricky. Do you want to spend your labor and postpartum course "fighting" with staff? How committed are you to a natural birth? Why do you want it? (I find the "I'll wait and see" attitude usually ends up with a woman being tempted during the throes of hard labor to throw the idea out the window.) It seems to me that if you already know how a place works, it would be a waste of energy to try to buck the system. I am not anti-hospital (I work on an L&D unit), but the system is set up to be efficient and to make our jobs easier. Most of us are willing to work with women who have requests for natural birth- some of us more than others, but if you really want a natural birth, you might want to look at hospital alternatives.

So after this book I've written...here are my questions:
1. Is an IV really necessary when you first go in? I always feel like a sick person dragging this thing around. They always tell me to stay in bed.
2. Do you think it's possible to try for a more natural birth at this hospital, or should I drive 45 minutes or more to a different place? The alternative place has l/d rooms with tubs and private suites and the baby rooms in with mom the whole time.
3. On the same note, do you think since I am more educated and experienced I can just have this baby where I have before and just "make" them give me my kid?
The place I usually go is just more convenient because my parents live close by and will have my other kids. That's really all that's making me question this move.
Any opinions and advice are welcome from all of you experienced nurses!!
Blessings,
Tammy

clhRN2b2010 · Jan 4, 2008

I'm sorry to hear about some of your experiences.

I can't answer many of your questions, but beginning with some good reading will help. Try Obstetric Myths versus Reality by Hency Goer, Gentle Bith Choices by Barbara Harper, or Heart & Hands by Elizabeth Davis. All will give you great info to arm yourself with and encourage you in what might be a bit of a battle.

Second, consider the services of a Birth Doula and make sure that she is one who will support your choices and has enough equity within the hospital to actually make a difference.

Talk to your OB or preferably Midwife about your desires. Are they supportive? Do they have solid suggestions for how to help you achieve your goals or are they just giving you lip service? After a while, you will learn to tell the difference. Unfotunately, many providers will tell you whatever you want to hear only to give you the pat answer "Well, the (insert whatever) is required by the hospital" when you're in labor. If you aren't feeling it or they clearly aren't interested in your desires, GET A NEW PROVIDER! Yes, their are reasons why some of these interventions are needed, but convenience shouldn't be one of them.

Lastly, you really must get the skinny on hospital policy. My local hospital likes to smile and say quickly "Hospital policy is that a laboring mother must remain on the fetal monitor a minimum of 20 minutes out of an hour" but the reality is that once you are hooked up, almost no one comes off and you are then usually confined to the bed. This just wasn't going to work for someone like me who likes to walk, walk, walk up until transition.

I was fortunate enough to have the option of a Midwife staffed free standing birth center located a few miles from the hospital in my town. If you have that option or an option for homebirth, even if you think..."Oh I could never..." just do some research, check it out and talk to someone who has. You might surprise yourself!

Best wishes and Congratulations!

NurseNora, BSN, RN · Jan 4, 2008

I think you'll be happier at the second hospital. It sounds like they would be more willing to go along with what you want. That said, I've noticed that women who have to travel far to reach the hospital tend to come in sooner. The sooner you are admitted to the hospital, the more time there is to convince you that certain interventions are necessary (break your water to speed things up, start a little pit to speed things up, give you medication because you're tired).

When you went into labor spontaneously, you did not have to have your water broken. If left to itself, it usually breaks spontaneously at about the time you are completely dilated. The only times I've agreed that the membranes had to be ruptured was when the baby had delivered and the membranes were still covering its face. Then they have to be torn so the baby can take its first breath. Other than that, it's not necessary. There are legitimate reasons for doing an artificial rupture: it may speed up a niggling labor, or help an induction to be successful, there may be some question as to the baby's well-being and an internal monitor applied to the baby's scalp would give better information about the baby's status. Notice that I said "may" not "will" speed up labor or help an induction.

Once you are in the hospital, you are still your own person; you do not have to do anything they tell you to do. To touch a person without their consent is assult. So, you could refuse to have an IV, or stay in bed, or have constant fetal monitoring. You may be asked to sign some sort of "Against Medical Advice" form. Do so. If it's not the IV so much as having to always walk around with the pole and the tubing, you could agree to a saline lock. They get an intravenous catheter in place with a gadget on the end of it so that in an emergency, all that would be necessary is just plugging the IV tubing into the gadget. If your veins are not the best, it's a good way to go. The hospital people are happy because they have immediate access in an emergency and you aren't bothered with the tubes and such. If you have good veins and have not had a problem with excess bleeding in the past, you'd probably be OK with nothing. (Once again, note the "probably"). Whenever you refuse something that is recommened medically, you have to do so with the understanding that refusing this intervention could result in the injury or death of you and/or your baby. Withour an IV there will be some delay in getting emergency drugs into you in the event of an emergency; less of a delay with a saline lock in, but still some delay. How often are those emergency drugs needed? Not very, but often enough that we medical people tend to like to have everything in place just in case.

As far as keeping the baby with you, they can't take the baby without your permission. That's kidnapping if you want to make a fuss about it.

Visit both hospitals. Make an appointment with The OB directior and discuss your concerns. Also talk to your doctor about your concerns and wants. You may have to make a separate appointment with your MD to talk as they don't schedule much time in their regular OB visits. Tell him what you want and why. They will almost never promise you everything you want as they are aware that at any time something could go wrong and interventions could be necessary--beware of the doc who does promise everything without mentioning exceptions, he's probably lying or just not listening to you. Be sure you have someone with you who will help you stick to your guns when confronted with opposition from staff--your partner, and/or a doula can be very helpful. But I think your best bet is to so someplace where you don't feel that you have to fight for your right to give birth in your own fashion.

And you thought you wrote a book!

33-weeker · Jan 5, 2008

Read and educate yourself some more. You are on the right track.

There are a lot of good books out there. Try New Atlantean Press if they are still around.

You are in charge of most things in the hospital. You just have to speak up and politely insist things be done the way you want. If you don't want your baby to leave your side - insist on it - unless of course your baby is ill. Consider making a birth plan and or hiring a doula (professional labor support person to help you get what you want).

Some mothers compromise on the IV thing and have a 'hep-lock' with no fluids dripping in. This gives the staff an IV access for meds or for use in an emergency without you being tethered to an IV bag and pole.

Getting up an walking around can decrease pain and improve progress of labor. If you are healthy, you are not on Pitocin and the baby is tolerating labor well, there is no reason you have to be on the monitor all the time. Avoiding a pitocin drip during labor decreases pain and stress/danger to the baby. You probably won't need that epidural if you move around and avoid the Pit.

As far as whether GBS meds can be given via another route, I don't know. You'd have to research that one. They are important for sure.

fsaav · Jan 5, 2008

I agree with what a previous poster said about The Bradley Method. I also wanted to experience natural childbirth but it's difficult and I know I wouldn't have been able to do it if I hadn't prepared myself. The Bradley Method prepared me more than I could have hoped for. Try the book: Natural Childbirth the Bradley Way.

Make sure that you have a health care provider who supports your wishes. I am almost positive that my births wouldn't have gone as well as they did if I had had a doctor instead of a midwife. My midwife actually asks her patients to write up a birth plan, then months before the due date we went over it together and she let me know which things I wanted were reasonable or not. She initialed the plan saying that she had approved it and then put a copy in my office chart and another copy went into my hospital chart. Then when I got to the hospital I didn't even have to argue about anything that wasn't "hospital policy" because they were already aware of everything including a hep-lock instead of full IV tubing, no continuous fetal monitoring, etc.

Also make sure that your husband is able to speak up for you during labor about things that you want/don't want. In the middle of labor you probably won't have the strength to argue with the staff or explain your feelings on things. If he isn't very assertive then a Doula is a good alternative like others have already said.

Good luck!

Mumma · Jan 6, 2008

Hypnobirthing is another natural childbirth method. It worked great for me. It is using self-hypnosis for pain control. I had 21 hours hours of labor pain-free. In my case, there is a woman locally who teaches this method. Check out http://www.hypnobirthing.com. It explains hypnobirthing in greater detail. Ask around in your area for anyone who may teach the method.

Good Luck!

Mumma :)

SheaOBRN · Jan 7, 2008

Here are some of my suggestions.....you need to have a heart to heart with your physician as far as what you would like during your care and delivery (ie stripping your membranes without you knowing, although it is a more natural way of attempting to get labor started rather than induction). If the physician is not on board with you, you need to find another physician. You may just be better off with a midwife in a birthing center and going into labor on your own (what a novel idea). They are definately less pushy and more patient. You probably wont have the option of an epidural in a birthing center though. The other thing is that doctors want to do things on their own schedule (not your baby's). I think there is also a huge apprehension because people sue so easily even though, unfortunately, there are still bad outcomes no matter what interventions are made. maybe its the interventions.....

As for some of the other concerns.... you should be able to have just a saline lock instead of a flowing IV all the time. I have not heard of oral antibiotics for GBBS, but they should be able to hook you up for the antibiotic and unhook when it is done infusing allowing more freedom. it is good however to have that IV access in case of emergency-stat c/s requires medication and fluids, or if there are issues with blood pressures or bleeding afterwards.

I would try to go the 45 minutes to cut out some of the other hassle-you shouldn't have problems with having your child with you then. but, many of the nursery procedures can be done at bedside if requested-if they will grant that (but i've seen it, its possible!)

as for the glucose water...your babies may have had low blood glucose, but in that situation should have been given the opportunity to breast feed first then been given sugar water with your consent.

and last but not least-my biggest advice-have a "birth plan" in mind but DON'T WRITE IT DOWN! usually written birth plans jinx you to a c section! just let your wishes be known and your nurses should be able to follow as much as their policy and procedures will let them. also remember that you have the right to refuse interventions if you view them as unnecessary.

Good Luck!

TTE7 · Jan 7, 2008

Thank you all so much for the response! I knew this was the place to go:)

The closest birthing center would be over an hour away, so I don't think my dh will go for that. He is ok with the 45 minute drive. We did check it, and it is 45 minutes.

I'm not sure if there are any midwives that deliver at this facility. Do midwive use hospitals? I'll have to contact the hospital and see.

That was a very good idea about getting the antibiotic and then stopping the drip when it's done. Hadn't thought of that.

This made me feel more confident and I realize I'm on the right track. I just need to educate myself as much as possible. I hope this thread will help someone else when they need it.

Blessings,

Tammy

mommy2boysaz · Jan 9, 2008

I am a L&D nurse (and student midwife) and I work in a hospital where midwives do practice. That would be a great situation for you, I think. Also, at our hospital, IV's are NOT standard. Some doctors have routine orders for them, but you do have the right to refuse. If you are not Group B positive this pregnancy and you haven't had a previously infected baby, I don't think you should need antibiotics in labor. I don't think there's another way of getting your antibiotics though, if you are positive. And you do need an IV if you get an epidural. Other pain meds can be given as a shot in the hip, without an IV. Also, where I work, the moms pretty much call the shots. Rooming in or not is totally up to the mom. So are the use of bottles (except in the case of medical issues such as low blood sugar).

This should be a special and joyous time for you, not a constant battle to have your wishes met. I would definitely find a different facility and a different provider.

Good Luck!

Let us know how it goes!