Tuesday, July 28, 2009

The business of being born

Childbirth is a big business. A recent article in the Minneapolis Star Tribune, Definitely, Not Your Mother's Maternity Ward, explores the multimillion dollar maternity wing renovations in the Twin Cities area done in the hopes of luring in potential customers. Rain showers, iridescent tile, whirlpool tubs, massages, wi-fi, and spa services are some of the amenities available in the updated birthing rooms. Click here for a list of the featured hospitals and amenities mentioned in the article.
At Ridgeview Medical Center in Waconia, women can now give birth in rooms with whirlpool tubs and wi-fi. At Fairview Southdale, new moms can hire a massage therapist or a portrait photographer. Even Hennepin County Medical Center has upgraded its maternity ward, with pastel decor and a deep tub for water births. All three are part of a major marketing offensive by hospitals to win a coveted demographic: mothers....

Many women have taken childbirth preparation to a new level. Bombarded by marketing from retailers such as Babies "R" Us and websites such as babycenter.com, and inspired by reality shows such as "Maternity Ward" and home birth videos on YouTube, this generation has grand ideas about labor and delivery.

Some tour multiple hospitals before deciding where to deliver. Insurance policies mostly let women go where they want, though they might be constrained by where their doctor can practice. "[Childbirth is] a business that's very competitive," said Ted Blank, director of marketing at HCMC. "It's a planned thing and they have the luxury of shopping around."...

Obstetrics doesn't enjoy the fat profit margins of specialties such as orthopedics or heart care. But it makes up the difference in customer loyalty. For many women, it's their first time in a hospital. "If that's not a positive experience, they're not likely to come back," said Meri Beth Kennedy, birthplace director at Fairview Southdale, which redid its maternity wing a year ago....

The marketplace is so competitive that Fairview Southdale has an advisory board made up of women who have given birth there. To read the rest of the article, click here. The article is 4 pages long, so be sure to read the whole thing.
When I was a graduate student, I took the tour of the new maternity wing and NICU at our large university hospital. Much of the PR material emphasized the maternity wing's hotel-like amenities, such as room service, internet access, and "custom beds" (which are the same kind used in just about every other hospital, the Stryker Adel). I was quite happy to see large whirlpool tubs in every labor room. Waterbirths were allowed, although when I was there none of the midwives or doctors were really doing them. I hope that has since changed. Overall, I was definitely underwhelmed with the multi-million dollar renovation.

What I want in a maternity service isn't the outward signifiers of a home or hotel--spa services or flat screen TVs or beautifully decorated rooms. I want policies that encourage physiological labor and birth, that follow evidence-based practice, and that, most of all, uphold women's autonomy and respect their need for dignity and privacy. The room's decor is largely irrelevant to me. The changes I want to see in maternity rooms cost little or no money, but are probably harder to introduce than the most expensive spa services. Things like rooms that promote movement and non-supine positions, policies that follow the best evidence, or nurses and doctors and midwives who are used to seeing women laboring unattached--free from monitors, IVs, and catheters.

In the Star Tribune article, Jeanette Schwartz, clinical director of Woodwinds, remarked that the new maternity renovations are "about customer service. It's all about giving moms choices in their care."

Really? In a country where almost 50% of hospitals ban women from having VBACs, where it's unusual to be allowed to labor without constant fetal monitoring or IV access, and where the majority of women receiving episiotomies were not consulted before they were cut, the rhetoric of "choice" rings hollow. Until I can freely choose those things and more, I will happily forego the "massages, manicures and nicer linens" and stay put in my own house where the real choices are mine to make.


  1. I had to repost this article and the first 2 comments got lost--I'm cutting and pasting them here:

    7/27/09 10:58 PM publichealthdoula said...

    Just last week I got a tour of a county hospital's L&D and while they were right to be proud that their rooms weren't tiny flourescent-lit closets (like some county hospitals) I didn't like the emphasis on window dressing. Who cares if you have the oxygen tubes hidden behind a framed picture? (Also the administrator told us having showers was great because "women in labor get really sweaty and want to rinse off". Um, water as excellent labor aid? Okay, never mind).

    To me, the tubs rankle the most. I feel that they're so often promoted and when the time comes, there are a million reasons you're not allowed to use them: water's already broken, no waterproof monitors (and required continuous monitoring for whatever reason), IV running, etc. And in some places even if you can labor in them, you can't deliver in them (as you noted). Very bait and switch.

    7/27/09 11:02 PM
    cileag said...
    This is my local area and I read that article when it came out a few weeks ago. The best part of it for me was finding out the things my hospital offers--that I didn't even know about as an L and D nurse!

    While I can get behind whirlpool tubs and more space for families to stay--I'd really like a double fold out bed in each room--most of the improvements are just aesthetics.

    My other big issue with many of the special offerings are that they are exorbitantly expensive. Our photography at our hospital recently switched to a more "studio quality" company and the lowest price is now $99. That's the bare minimum and you only get one print for that. It's extremely cost prohibitive. The spa services start at $49, which I think is still too much for many of our clients to afford.

  2. Am I a bad person because I laughed and laughed through this article??

    Go ahead and put all the sparkly tile and wi-fi you want in hospital rooms. It doesn't change a damn thing. Stop worrying about the decor and start worrying about THE WAY YOU PRACTICE. I gave birth in an empty house with nothing but a futon, a pool, and a few boxes of supplies, and I infinitely preferred it to being in the fancy-schmancy hospital with their watercolor paintings and pastel duvet covers.

    And now that I'm done laughing, I'm pissed off. Because A) doctors think women are stupid enough to be wooed by a whirpool tub (which you probably wont' even get to use!), and B) doctors would rather blow millions of dollars on renovating rooms instead of renovating their minds. What the hell, man??

  3. all I can think of is that I'm glad when I labored and gave birth, it was in the comfort of my home, on my terms. no meddling doctors or nurses, and baby checks postponed every time I refused to be touched.

    and while I labored, all I remember noticing were the faces of my support team, not the curtains, art or tile in my bathroom.

    and I want to say more, but I don't even know where to begin on the business aspect of it. it's almost as bad as treating pregnancy as an illness rather than a part of natural human existence. shame on insurance companies.

  4. This post and everyone's comments are priceless. Thank you, Ladies! I love this: "In a country where almost 50% of hospitals ban women from having VBACs, where it's unusual to be allowed to labor without constant fetal monitoring or IV access, and where the majority of women receiving episiotomies were not consulted before they were cut, the rhetoric of 'choice' rings hollow."

    Kinda like the way doctors coerce women into unnecessary inductions or cesareans because they're "concerned about the baby." Really? So much rings hollow in American maternity care!

  5. A big, beautiful new hospital opened in my town last year. It has labor and delivery rooms designed by people who design for hotels. I was due around the time that it opened. Several people asked me if I would "*get to* go to the new X hospital (emphasis mine) to have my baby." GET TO go to the hospital? Ummm... no thank you! I'll stay in my own cozy little house, away from any strangers. Because no matter how nice it looks, it doesn't change the staff there or the policies and practices that they have. It's sad how all too often, some people really are taken in by things looking nice.

  6. We are all of like minds here, in a big way! I posted about this recently on my own blog, with the exact same reaction: http://dou-la-la.blogspot.com/2009/07/article-on-swanky-new-l-departments.html

    When are "they" going to get it? It's not about the perks, it's about the POLICIES.

    Very well put, Rixa & commentators alike.

  7. Wow, it's crazy what hospitals are doing to entice patients.
    I have had all three of my babies in the hospital and my last two I know I needed to have them in the hospital because my water broke at 33 and 31 weeks so I needed to be at the hospital for my babies to be close to the NICU. That being said, I was not very pleased with my birth experience of my second child. With my third I knew what I wanted and told them I would be up and moving and doing whatever felt right to me. Even though I delivered in the OR (connected to the NICU...hmmmm...I wonder if that has anything to do with babies more often being in distress after a c-section)I put my foot down and told them I would stand, sway, walk, squat, do whatever felt good and right so I could work with my body. I was fortunate and had an awesome nurse who worked with me so I coulod do what I needed to and left me alone for the most part. It's sad that in the hospital, that rarely happens. My last baby (3 months old now) would not have survived had we not been in the hospital when he was born but I am so glad that I had the opportunity to have little interference with my labor while in the hospital. I KNEW what I wanted though and I knew I had to put my foot down and be pushy to be able to have as natural a birth as possible in the situation and that is really sad to me. I really wish more mothers knew what an amazing experience it is to give birth naturally and that the hospital would appeal to those things.
    I had the most amazing labor experience of my three babies with my last. I didn't tear or have an episiotomy and my recovery was so much better then my others. I felt so absolutely amazing after giving birth and I really wish that I had been put my foot down with my other two to experience that with all three of my labor and deliveries!
    I just wish that women were more educated in the area of natural childbirth and not just hoping that they can get to the hospital in plenty of time to get the epidural so they don't feel anything!

  8. The really sinister thing about the posh renovations and "spa-like" feel of the room is that it actually ENCOURAGES women to be detached from their labors and births. One goes to a spa to relax, be pampered, and feel wonderful. While relaxing is important in birth, and birthing mothers need attention and support, it is NOT the same, or even similar, to a 5 star spa resort. These types of atmospheres encourage women to seek pain relief immediately, feel nothing of their labors and births, and be as detached from them as humanly possible. Rather than feel their labor and working with it, they and their husbands are watching TV and typing on their blackberries.

    Ditto the tubs. Ladies reading this about to give birth, *never* be impressed by the presence of a tub in a hospital, unless you know from your dr/ midwife or another women that the tubs are USED. I know of so many cases in which the tubs are there and the nurses don't want to use them, so reasons are invented why a woman can't get it. (Seriously, they say they're broken, or the hot water doesn't work, or anything, not only reasons related to labor.)

    While the article is gross, it is also a bit empowering. Our voices *can* be listened to if we make them loud enough. The stronger the home-birth movement, the more (economic) pressure it puts on hospitals. Appallingly enough, the only thing hospitals care about is the bottom line $$$$ (rather than you know, providing optimal care to patients). So we damage them when we opt out; maybe we can force change this way.

  9. Thanks for writing about this. I gave birth at one of the hospitals that just had the renovations done, and I'm angry with their decision. They're sacrificing patient care for window dressing. Instead of making the "birth center" a safer place, they've made it a prettier place. It didn't matter what the room looked like when I was literally bleeding to death with an OB between my knees because the anesthesiologist had decided to go home for the night, and it took him an hour to get his butt back to the hospital. (And then they wondered why I didn't want to donate to that facility to buy some fancy-schmancy kleenex holders when they called me at home.) All the amenities like wi-fi, birthing tubs, and hotel like decor don't make a safe environment for birthing moms.

    Anyhow, it's good to see that someone, besides me, can see through the crap they're putting out there.

  10. Enjoying your comments so far. To be fair, we shouldn't place the blame at doctor's or even insurance companies' feet for these types of renovations--this is more the work of hospital administrators who know how much they need childbirth customers.

    What really frustrates me is that for the 90-odd percent of women who can't or don't want to give birth at home, they have to still give birth in these places and, despite all the money being thrown at the birthing rooms, the policies aren't changing. And most women don't know to even think about hospital policies when they're touring the birth rooms--which is why these types of cosmetic changes ARE so effective. When I was touring the university hospital I mentioned in the post, women were oohing and ahhing over the new rooms, saying things like "this looks just like a hotel!" (which really, it didn't, at all...) And yes, the old rooms at that hospital were awful. Simply awful, so it was a nice improvement. But their policies didn't change one bit.

    An episiotomy (most likely performed without consulting you first) is still an episiotomy, no matter if you have brand-name sheets to bleed upon afterwards.

  11. I am somebody who prefers to deliver in a hospital rather than at home. I have a wonderful OB who is completely supportive of me wanting as natural a childbirth as possible. For my second, she is the one who pushed me out of the epidural, when I was in a LOT of pain, and ready to give in. She is the one who made me change positions etc... Anyway,regarding, the decor of the new L&D rooms, honestly, it is way TOO much. As long as the room is clean and functional, who cares about SPA features ? I was happy to find a shower when I delivered my first, because I went to the hospital directly from work, and needed a shower to refresh, but besides that, the L&D rooms at my hospitals are fine and not hotel like.
    On the other hand, my hospital renovated the postpartum floor, with SPA like bathrooms, large flat screen TV, etc... and I really don't care about all these perks I would have preferred them to build mores private room at a more affordable price with less amenities.
    For my first, I stayed on the old floor, and it was completely fine. For my second, the old floor was closed for postpartum, so I stayed on the new floor, and I did not really look at the wood panels, etc... My baby was having all my attention.
    Bottom line : after I give birth, I need some privacy, and I prefer to have a private room, but I have to pay more $$$ because of all those useless perks...
    Hospitals administrators : mothers are more interested by their babies, than by the spa like room when they give birth and when they recover after. Offer them, clean nice rooms, affordable or even free private rooms, good healthcare and they will be much happier !

  12. I think it's telling in the article, that the hospital folks admit that what they are doing is trying to hook women into giving birth there, so that they will have customers for life -- the woman will return there for birth, will go there for other care she needs, will take her husband and children there, etc. It's the same philosophy that led doctors (in the early days of obstetrics, or perhaps even prior to it) to attend births -- even if they had only seen a handful of births and never attended one -- namely, that attending women in childbirth was a way to build up your practice and get lots of customers for life.

    When I think of what a "typical" first-time pregnant woman wants from a hospital or what she thinks/plans when contemplating the upcoming birth, I picture the hospital "birth class" (using the term **very** loosely) I attended when I was first pregnant, in case of a transfer. There were several couples there, but I was the only person who had brought anything for taking notes; I was about the only one who asked questions (although a few people's eyes brightened when I started asking questions, as if for the first time in their lives they realized they had choices in birth, and could ask questions). They were the biggest group of sheeple I have ever seen.

    I would expect them to be in awe of the way the hospital room looked, and if they had not yet made up their minds which hospital to choose, they would pick the nicest looking one. "C-section? Oh, they only do that when necessary! I don't need to know their rates. Episiotomy? I'm sure if I get one, it's because I'll need one or the baby will die! IV? Oh, everybody gets that -- it's necessary to get one!"

    This actually seems like all the gadgets and amenities women can get for their infants -- cribs, layette sets, tiny outfits they can only wear once, johnny jump-ups, exersaucers, etc. -- they may not be bad in and of themselves (although some might), but they're a waste of money for the most part, and certainly not necessary. The things an infant really needs do not require any money -- just mom's touch, mom's milk, mom's care. Likewise the best things in labor are not gadgets (except perhaps tennis balls for counterpressure or a rebozo, or other low-tech devices), but people. But just as pregnant women can get carried away with all the external trappings for their babies, so they can get carried away with all the external trappings for their hospital rooms. If they have the basics as well as the extras, that's fine; but the bigger problem comes when they have only the window dressing, but not the true basics.


  13. "Waterbirths were allowed, although when I was there none of the midwives or doctors were really doing them. I hope that has since changed."

    The UIHC does have some really posh tubs, and I was privileged to use one during my first birth. It rocked. But stop the presses - they USED to allow waterbirths there? Huh? It seems to me that the UIHC has long been "in the review process," but it never has okayed waterbirths, and the midwives at least, are adamant that it is. not. allowed. You have to at least stand up out of the water to birth the baby. One of them actually said, "Even though I am 57 and fat, I will jump in there and haul you out myself if I have to." This is one of the three main reasons (the other two being overzealous peds. people and the unrestful mama-baby unit) why we be birthin' at home this time around...

  14. Wonder if the fancy bedspreads are "just like a hotel" also never washed? Ick.

  15. I worked in a place that had fancy bedspreads....and for the most part they weren't washed.

    And as far as my feeling on this post...ditto just about what everyone has said.

    It is common knowledge (so I thought) that the maternity wards in hospitals were where money was poured into because its the aesthetics that hooked the customers for life. And it would be really bad for business if the stuff that mattered was advertised.

    And I love the word "sheeple". It's my new word.

  16. Of the two different hospitals where I gave birth, and the one I watched my sister give birth at, I noticed a trend that the better the "amenities" were, the worse the service was, and visa versa.
    For example, my second hospital rocked in terms of policies and how they treated me, but they food they gave me was horrible, truly inedible. My sister's hospital, a nice new one with all the extras had bad policies and routines, but she got to order whatever she wanted and the food was awesome. She had cheesecake with every single meal b/c she could and it was so good.
    Overall, I will take good service any day, but I wouldn't mind the tub and shower and cheesecake too. Can't we have both?


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