Hospital protocols vary! Here are six to learn about before deciding where to have your baby

By the time you take childbirth classes and make a birth plan, it's typically pretty late to switch providers. That means there are things you need to know now, in your first or second trimester, BEFORE you make a final decision about where to have your baby. 

In this episode, host Anne Nicholson Weber outlines six of the most important protocols and policies that can vary widely from one birth setting to another. It's important to learn about these early in your pregnancy, so you can decide what options matter to you and make sure you choose a birth setting that will support your preferences.

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DISCLAIMER: This podcast is for educational purposes only and is not a substitute for medical advice. You can see the full disclaimer here.

Transcript

00:01 This is episode 15. Thanks for being here. Next month I'll be back with our usual format of guest interviews, but here's one more from me. 

There are some important differences in the ways hospitals deliver care that you may not learn about until you take your childbirth classes, but by then you'll find it hard to switch providers. I hope you'll join me as I lay out the options you should research and consider before you decide where to have your baby.

00:33 Welcome to the Birth Guide Chicago podcast, conversations about building your circle of support in the childbearing year. We connect you with experts in our community who can help you conceive, stay healthy during pregnancy, have a safe and satisfying birth, and embrace the joys and challenges of becoming a new family. I'm your host Anne Nicholson Weber and the founder of BirthGuideChicago.com, where every month, thousands of Chicago area families find relationship-centered care. from conception through the postpartum period. 

Our sponsor for this episode is Chicago Family Doulas. We want you to know that Chicago Family Doulas is hosting a birth and baby conference called Baby in Bloom, which will be held on Sunday, September 29th at the Arbery in Chicago. You can find your community of support and learn from some of the most respected professionals in the Chicagoland area. It'll be a day of learning, connecting, and fun.

01:35 I talked last time about how you can gain control over your birth experience by looking at C-section and epidural rates at different hospitals, birth centers, and among home birth providers. This episode, I'm following up on that discussion to explain six additional factors you might want to research before you commit to a birth setting. These options are generally controlled at the institutional level, so you'll need to learn the hospital or birth center policies on these. Your doctor or midwife likely won't have the authority to offer you something that isn't within the institution's policy. 

So the first thing to consider is will you be free to move during labor? Moving in labor can relieve pain, shorten labor, and make childbirth a more satisfying experience. If it's important to you to have that freedom, you need to understand how different kinds of monitoring will impact your ability to move.

02:27 If you're considering a hospital birth, find out how different hospitals will monitor your baby's heart rate during labor. Most hospitals will require continuous fetal monitoring where your baby's heart rate is being tracked throughout your labor. The degree to which continuous monitoring will limit your movement depends on the type of monitor. Some hospitals use monitors that are hardwired to the equipment that reads the data, which will mean you won't be able to move far -- maybe from the bed to the chair. Other hospitals use telemetry, which means that data from the monitor is broadcast wirelessly. With wireless telemetry monitoring, your movement will be much less restricted. And there's a third form of monitoring, which is by far the least restrictive, and that is called intermittent auscultation, which means that your doctor or midwife will periodically listen to your baby's heart rate using a fetoscope or using a handheld doppler device.

03:22 In between times, you'll be completely free to take any position or move anywhere with no wires or belts to restrict you. Some hospitals offer this option, usually those with midwife practices. And intermittent auscultation is the standard of care for all home birth providers and midwife led birth centers. So if freedom of movement is one of your top priorities, and if you're at low risk, these might be options to consider. 

Very importantly, unless your baby has certain risk factors, the evidence shows that continuous electronic fetal monitoring, whether hardwired or with telemetry, does not improve outcomes, but it does increase your likelihood of having a c-section. That means that for most mothers, intermittent auscultation is just as safe, reduces your likelihood of having a c-section and gives you much more mobility. 

Number two, will you be allowed to eat and drink during labor? Hospital policies on eating and drinking during labor vary widely. Policies range from no food and no liquids, only ice chips; to allowing women to eat only certain foods, clear foods and liquids like broth, jello, and popsicles; to allowing women to eat and drink at will.

04:34 Restricting foods and liquids during labor is not an evidence-based practice. In fact, these policies are based on long superseded studies from the 1940s and are common practice simply because it's what providers are used to. This issue is not controversial. No major health organizations claim that eating and drinking and labor has been shown to be harmful. Now, it's true that some women lose their appetites in labor, and it's also true that if you eat just prior to and during labor, you may be more likely to throw up or have diarrhea. But many women find themselves wanting to eat or drink to some extent and can find it distressing to be told they can't. Your body is working very, very hard during labor and you may need fuel. If you choose a birth setting where eating and drinking are allowed, you'll be able to listen to your body and do what you want during labor.

05:25 If you don't, you can't. So you might favor a birth setting where you have the freedom to eat and drink as much or as little as you choose during labor because -- why not? 

Number three, are there birth tubs available? Can you give birth in them or will you have to get out when it's time to push? If you are attracted to the idea of laboring and possibly giving birth in water, you'll want to do your homework. Laboring in a birth tub can be a huge help in managing the pain of labor, but only about a third of Chicago area hospitals offer tubs, and if you want to have the option to give birth, your choices are even more limited. Only a handful of the hospitals that provide labor tubs will allow you to stay in the water to give birth. By contrast, all the midwife led birthing centers in our area do offer tubs both for labor and birthing.

06:15 And if you choose to give birth at home, you always have the option to rent a birth tub. So as you consider your options for childbirth, this is something to keep in mind. Are you attracted to the idea of laboring and possibly giving birth and water? Many women are. If you choose a birth setting that offers water birth, you can get in the tub at any point in labor and stay as long as the water is helping you. If you turn out to be one of those women who finds that being in the water as you push just feels right, you'll be very glad to be able to stay right where you are. 

Number four. Do you want to have more than one or two people with you as you labor? If so, you need to find out what will be allowed. You may imagine giving birth with just your husband or partner to support you, or you may imagine that you labor supported by a doula, your mother, your best friend, your sister, and your partner . 

07:05 If you have children already, there's also the question of whether you want them to be with you for any part of your labor or for the birth. Different birth settings have dramatically different policies around the number of visitors and support people you'll be allowed to have with you. Many hospitals only allow you to have two support people, while others may allow up to four. A few allow siblings to be present at the birth, most do not. By contrast, the Chicago area birthing centers have extremely liberal policies around visitors, and if you choose a home birth, of course, you're totally in charge. You can have anybody you want. Be sure you've considered who you want on your personal support team before you choose your birth setting to make sure your preferences will be accommodated. 

Number five, delayed cord clamping. More and more research studies are demonstrating the positive effects of delaying cord clamping for at least one minute after birth, and some show greater benefits by waiting at least three minutes.

07:58 But this is not yet standard practice and only a handful of hospitals offer this option. So before you decide where to have your baby, you want to research the benefits of delayed cord clamping. And if this turns out to be something you care about, you'll need to prioritize this when you choose a setting. 

And number six, will your baby be skin to skin with you from the first moments after birth until first feed uninterrupted skin-to-skin contact between mother and newborn in the period immediately after birth. The so-called golden hour can have a profound impact on breastfeeding success, bonding, and birth satisfaction. So what does that look like? Your baby will be placed on your chest immediately after birth. The newborn exam will be performed while your baby is skin to skin with you. You and your baby will remain skin to skin and undisturbed until your baby breastfeeds, which is typically about an hour. Any activities that require your baby to be separated from you, such as vitamin K, injection, eye and ointment, food and hand printing, weighing, measuring, and bathing are all delayed until after this golden hour is over. So find out whether the birth settings you're considering follow the optimal protocols for that period immediately following your baby's birth.

09:16 Okay? That's what you need to think about. Freedom to move, being able to eat and drink during labor laboring and giving birth in water, having all your people with you delayed cord clamping, and immediate and continuous skin to skin contact in the golden hour after birth. Those are six options for labor and birth that you may care about, but that only some birth settings offer. So do your research.