Where To Have Your Baby
Tuesday, August 28th, 2007Another basic decision is choosing where you will give birth. Most women choose the hospital. Some give birth in freestanding birthing centers, or at home. Your decision on where to have your baby is made in much the same way you choose your care giver. You find out what is available and ask questions that are important to you.
The Hospital
If you prefer a hospital birth, the next question is which hospital? Most care-givers have privileges in one hospital, but some use more than one. Tour each of the hospitals your care-giver uses. It also may be useful to tour other hospitals-for comparison purposes, if nothing else. You might discover that you prefer a hospital where your care-giver does not have privileges. If so, and if you do not feel a strong tie to your care-giver, you might decide to change care-givers in order to use the facilities that appeal to you. If your community has more than one hospital, you might be surprised at how different they are from one another in their facilities, policies, and philosophies of care. Most hospitals offer tours of the maternity ward. You should call the hospital itself to sign up for a tour.
What do you look for when touring a hospital? First of all, observe the atmosphere. Many hospitals have attractive private labor rooms and bathroom facilities. What provisions are there for the mother’s comfort? Some have very comfortable labor beds, while others have very narrow, hard labor beds. Some provide nice touches like rocking chairs, couches where the partner can rest, showers and tubs to use for pain relief, and beanbag chairs for getting into comfortable positions. Others make no provisions at all for the comfort of mother or father.
Does the hospital have birthing rooms [attractively decorated rooms where the mother can labor, give birth, and spend time with her newborn afterward? In some hospitals, the birthing room is the only room the mother will be in throughout her entire hospital stay. In others, she labors and gives birth in the birthing room, and then goes to a postpartum room for one, two, or three days before going home. In still other facilities, she labors in one room, is moved when she is about to deliver, may go to another room to recover and then goes to still another room for the rest of her hospital stay. Currently, many hospitals are beginning to convert their maternity facilities so that a woman can labor, deliver and recover in the same room. [A so-called L.D.R. room].
Check the nursery. What does it look like? Are the mothers encouraged to keep their babies with them in their rooms, or do the babies spend most of their time in the nursery? Do the nurses seem friendly and warm? What about the person leading the tour? Is she friendly and does she answer your questions, or is she simply herding you through brusquely? [Some hospitals are so busy that they don't take potential clients on a tour of the actual facilities. In place of a tour there will sometimes be a slideshow and discussion of policies and procedures with a member of the staff.].
Ask some specific questions about admitting procedures. Ask to see the general consent forms that require your signature when you arrive at the hospital. Be sure to read these in advance and clarify any questions you may have. It is certainly not easy to read consent forms carefully if you are already in labor.
Questions about hospital procedures need to be carefully worded. For example, if you ask,” What usually happens to the baby after he or she is born?” you will learn more than if you ask, “What is the hospital’s procedure for routine newborn care?” There are few hospital policies on these kinds of things, but there certainly are customs, and those are what you want to know about. You may ask for a step-by-step description of what usually happens after a woman in labor arrives. Do most women have a nurse assigned to them, or do the nurses take care of more than one laboring woman at a time? Are they understaffed sometimes, and what do they do if this happens? Do women usually receive pain medications, or do many women use little or no pain medications? If a women desire to have an unmedicated childbirth, is she actively encouraged and supported in this by the nurse? Do most women receive intravenous fluids, continuous electronic fetal monitoring, and rupture of the membranes, oxytocin and episiotomies? Does the hospital have a high rate of cesarean births? Ask how cesareans usually done [for example, what type if anesthetic is usually used, and is the father encouraged to be present?] Can a woman have a vaginal birth after a previous cesarean? How long is the usual hospital stay? Is there a short-stay or early-discharge program that allows mothers and babies to go home within a few hours after birth? Does the hospital provide any kind of follow up?
Clarify the costs of labor and delivery rooms, nursery charges, postpartum care, and so forth. You also, of course, will want to check your insurance policy, if you have one, to see how much you have to pay.
Out of Hospital Births
If you are considering giving birth outside the hospital, find out what services are available in your community. Are there competent people offering home-birth care? Is there a licensed birthing center in your area?
Out-of-hospital birth is a choice only for women who are in good health and who have had normal pregnancies. Interventions are often not necessary for healthy women having normal labors, but if the need arises, the woman is transferred to the hospital. Those planning out-of-hospital births, therefore expect to labor without pain medication and without medical intervention. It must be remembered that the care-givers in out-of-hospital settings have fewer facilities [and possibly less skill] should emergency situations arise. Minutes count. How long will it take to receive adequate care?
Many women, of course, are not comfortable giving birth away from emergency medical facilities available in hospitals. This disadvantage of out-of-hospital births should be carefully considered by all women contemplating birth outside the hospital.