Tuesday, June 02, 2009

I'm allowed to do that?

A hospital's birth policies and routines can vary dramatically from one to another, as Rebirth, a nurse-midwife blogger, illustrated in My Last Shift. She is a L&D nurse who recently became a CNM and just found a new job working as a midwife rather than as a nurse.

On her last day at her old job, she took care of a laboring L&D nurse who worked at another hospital with a more old-style approach. This laboring mother was constantly surprised that she was "allowed" to do things like drink juice, avoid frequent vaginal exams, "labor down" (when you have an epidural and wait for the baby's head to descend to the perineum, rather than begin pushing as soon as the cervix is 10 cms dilated), sit or squat to push, or keep her baby with her after the birth. Her post illustrates the importance of doing your research and asking lots of questions before you choose a provider or a location for your birth. There is no generic or universal hospital experience. Or, for that matter, birth center or home birth experience.

For example, contrast some of the policies and intervention rates at two of my local hospitals, C. Hospital and L. Hospital. Both are small, rural community hospitals with similar populations, doing about the same number of births per year, and serving mostly lower-risk women with full-term (35 + weeks) babies. Here's a brief overview of some of the differences between the two hospitals:

C. Hospital:
  • C-section rate is "above the national average" of 31.8%--so perhaps 35% or higher?
  • VBACs not allowed
  • the 3 doctors and midwives rotate call, so you have no guarantee of continuity of care
  • mothers and babies are routinely separated: right after birth for weighing and measuring, and then again a few hours after birth for a 3-4 hour stay in the nursery
L. Hospital
  • 2008 C-section rate was 21%
  • VBACs allowed (although I learned from someone who used to work there that very few actually happen there--not sure if that's patient-led or physician-led)
  • during office hours, your doctor will attend your birth. After hours, they rotate call.
  • the hospital is working toward its Baby-Friendly certification, so there is no routine separation of mother & baby and in fact, no nursery at all!


  1. Regarding L-hospital...although very few occur, I birthed there following two cesareans! That is better than even our larger teritary centers. The sad truth about the midwest is most people don't travel and aren't familiar with anything other than what they have always practiced in their specific facility. They naively assume that's how everyone does it and because it is necessary to do so. A northern hospital H-Hospital has an 80% episiotomy rate, yet only perform them "when they are necessary."

  2. Speaking of the midwest and hospitals, if any of the readers are in the OH area, there is a fabulous birth center in Dayton (integrated into the hospital but SEPARATE from L&D).

  3. I know that birth centre! I birthed my baby there and it was quite good. Unfortunately, they are still bound by lots and lots of hospital policies, but it is much much better than you can find in almost any hospital.


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