Hospital tour #2

I just got home from touring another hospital in my area that is about 30 minutes away. Like my home town C., the town of L. is the county seat and has a population of around 15,000. The hospital is fairly new--perhaps 6 years old. The Maternity Center in L. has four LDRP rooms, two with jacuzzi tubs and two with large showers. It sees about 400 births per year. There are four OBs who attend births at this hospital. They usually attend their own patients' births, although they do rotate call after-hours so there is a small chance you might not get the OB you have been seeing during pregnancy.

The hospital has a lower than average cesarean rate; in was 21% in 2008 (compared to the 2007 national rate of 31.8%). The hospital has 24-hour anesthesia and offers VBAC (vaginal birth after cesarean). I forgot to ask the nurses how many VBACs they see per year, but they sounded quite supportive of them. They couldn't think of any special policies or requirements for VBAC labors, but instead said they would be treated like any other labor.

Standard admittance procedures are a 20 minute monitoring strip and, once they've made sure the woman is in active labor, a saline lock (done in conjunction with the standard blood draws). They say the physicians usually don't require actual IVs, so women just have saline locks unless there's a specific indication for an IV drip, such as antibiotics for GBS+, Pitocin, epidural, etc. I asked about how hard it would be to refuse the saline lock, and they said they'd advise you why they suggest a saline lock and then give you a form to sign saying you declined the procedure. So it seems that if you have a strong preference about not having a saline lock in place--I've had one before for a non-birth-related issue and it HURT constantly--you can assert your wishes and simply sign any necessary paperwork.

The official policy for eating and drinking in labor is ice chips or sips of water only, but the nurses all emphasized that it is your body and your choice. They would simply document that they explained why they suggest not eating or drinking. Then it's up to you if you want to eat or drink. One of the nurses, when we were chatting about this and other topics, said, "I remind people in my childbirth education classes that you don't check your rights as an individual when you walk in the hospital door." There is a small kitchenette stocked with food and drinks by the nurse's station: milk, juice, pop, yogurt, cereal bars, etc. The nurses said that if you wanted healthier choices, be sure to bring your own snacks and drinks with you.

I asked about how common inductions and epidurals were. The nurses replied that they do see a lot of both, but they are definitely not pushed on the women. Instead, a lot of women insist on being induced or on having anesthesia. It's not the physicians pushing induction or the nurses pushing medications. They didn't give me any hard numbers, but I got the sense that the epidural and induction rates were probably lower than in the hospital in C. The nurses talked for a while about how inductions and epidurals are so common everywhere now and how they're most often patient-led. I got the feeling that they liked working with women who want unmedicated births and spontaneous labors.

If a woman doesn't have an epidural or Pitocin running, they encourage her to walk around, to have intermittent monitoring, and to use the jacuzzi tubs. They usually do intermittent monitoring via a strip every hour (usually 15-20 minutes I think) but if you want intermittent auscultation rather than going on the monitors periodically, you can request that. They do not have wireless monitoring (telemetry); I encouraged them to get a wireless & waterproof unit so women could get closer monitoring if needed, but still be completely mobile and even in the shower or tub.

I wasn't able to take pictures of the rooms due to security reasons (which I've never heard of before), but they were fairly typical for a new hospital. The labor room has a delivery bed, rocking chair, couch, baby warmer, monitor table, wooden cupboards, and handwashing sink for the staff. The bathrooms are a good size with either a jacuzzi tub or a large shower. They have Hill-Rom beds, which are a lot more adaptable than the Sryker beds at C. Hospital in my town. The nurses mentioned using the squat bars, and I saw birth balls in some of the rooms. The jacuzzi tubs are large corner units, roomier than the ones in C. Hospital. There's also a showerhead in the tubs if you'd like to take a shower. The two rooms with showers only at least have large showers, probably 5x3 feet. There's a shower chair in there, so you can sit down and rest while you're showering. All rooms, of course, have private bathrooms--pretty much standard in modern maternity wings.

Of the four OBs, Bob and Ted were recommended as being more used to women birthing in less conventional upright positions than the two newer physicians Sara and Joseph, who are more accustomed to the semi-sitting position for giving birth (aka the "stranded beetle" position). Bob and Ted did their OB training in a hospital that had a lot of midwives, so they are used to more flexible, less conventional care of laboring women. However, the nurses said to be clear about your preferences with your physician, and they will all work with you to honor your preferences.

The Maternity Center in L. is currently working on becoming Baby-Friendly certified. They don't have a well-baby nursery, so babies always stay with their mothers. I asked about what happens immediately after the birth. Unlike C. Hospital, where babies go immediately to the nursery for weighing and measuring and where they have a 3-4 hour stay in the nursery a few hours after the birth, the Maternity Center keeps the babies right with the moms the whole time. They ask the mother what she would prefer--baby skin-to-skin on her chest, baby on a towel on her chest, or baby cleaned off a bit in the warmer and then put on her chest--and they follow the mother's wishes. There is a small room with two warmers and one incubator for special cases where the baby is having medical issues and needs constant monitoring, but otherwise there is no mother-baby separation (except briefly towards the end of the stay for the newborn metabolic screening, etc). They said their breastfeeding rates have gone up quite a bit recently, probably due to the baby-friendly practices that they follow.

Like C. hospital, the Maternity Center in L. does not have a NICU. If the baby is severely ill, it would be transferred to a larger tertiary care center about 1/2 hour away. Both hospitals refer out high-risk cases to larger medical centers, so if you went into labor before 35 weeks, for example, you probably wouldn't be able to give birth at either C. hospital or L. Maternity Center.

Things I forgot to ask:

• if there's a limit on how many people can be with the woman during labor & birth
• can you photograph or videotape the birth
• what is their typical and their fastest decision-to-incision time for a truly emergency cesarean
  
• what happens to the baby after a c-section (since they don't have a nursery, I'd guess that they baby would be with the mom ASAP in most cases)
• when standard newborn procedures are usually done (such as weighing and measuring, bathing, etc)
  

I would definitely choose the Maternity Center in L. over the hospital in C. as my backup hospital unless I needed immediate care. The 30-minute drive would be worth it for two main reasons: the hospital's lower cesarean rate and their Baby-Friendly policies. Not to mention their bigger tubs and, it seems, physicians who are a bit more used to working with "unconventional" birthing practices. For women planning a hospital birth, there is more continuity of care, since the physicians usually attend their own clients' births.