by Rosemary Romberg
If you are planning to have your baby in a hospital, there are a number of possibilities which you may wish to consider and discuss in advance with your doctor, midwife, or other hospital personnel.
In the past hospitals have tended to be rigid and bureaucratic about their rules, with doctors running the show. Within recent years however, many hospital maternity departments have changed their practices and have become more open and understanding towards what new parents desire for their babies and birth experiences. Much of this has come about as a result of new ideas that have been discussed in childbirth education classes, and because many parents have sought to give birth at home or in alternative birth centers.
This article was originally written in 1976. At that time most of these concepts were considered quite radical and innovative. Most parents asking for these changes met resistance from their doctors. As a childbirth instructor I encountered much criticism for writing this and suggesting such ideas to my students. But by the 1980’s and 90’s most of these suggestions became commonplace in many hospitals.
As you read over the following suggestions, you may decide that all or nearly all of these considerations are important to you. Perhaps only some of these things matter to you while others do not. Or perhaps you will not consider any of these things important. What is important is that you think through for yourself about what you truly desire for your birth experience.
Most doctors and medical personnel are humane and caring people. Only by open communication can they know what people desire for their birth experiences. Their attitudes and practices may have been influenced by what other patients have asked for in the past. For example, the doctor who remembers women who begged and pleaded for medication during labor may have difficulty understanding the mother who is trained by natural childbirth and wants no medication. The nurse who remembers women who were glad to have the nurses taking care of their babies in the nursery until they went home may be surprised to encounter other mothers who want their babies with them all the time.
Please communicate with doctors and other medical personnel in a manner that is confident but not defiant. If your attitude is militant or fighting the system, or if you hit your doctor with a dozen different requests all at once, you will probably encounter a human nature resistance on his or her part. You will make a better impression and have more cooperation from them if you present your desires calmly and rationally while making it clear that this matter is important to you.
If your birth attendant firmly refuses to accommodate your requests or does not seem to be listening to you, it may be time to shop around for a different doctor, midwife, or birth option. (If their answer is “we’ll see” – this probably means that they are going to forget about your wishes and do whatever they want.)
It is important to discuss these matters and make arrangements for what you want for your birth in advance of the actual time of labor and birth. Labor requires your complete attention and concentration and should be as peaceful and undisturbed of an experience as possible. When you are checking in to the hospital this is not the time to be asking for special options or refusing specific procedures. The nurses in the hospital do not usually make the rules. Fighting with a nurse who is trying to give you an enema or pubic shave will probably get you nowhere and will make everyone miserable. If avoiding things like this is important to you, make this known to your birth attendant ahead of time.
If you are planning to give birth at home or in a birth center, many of these considerations will still be important. Some birth centers are more hospital-like than others in the types of medical procedures they use. Some home birth attendants bring all sorts of equipment to a birth and want to set up a medical type of environment in the home. (For example, there are home birth attendants who bring portable delivery tables!) So make sure you have a clear picture of exactly how they normally handle birth and decide if this is compatible with the way you would like things to be.
Also, with a home birth or birth center birth, the possibility always exists that you may need to go to a hospital, so you may wish to discuss these matter with your back up physician, if possible. (Remember, however, that in the presence of true complications many things such as pubic shaves or position for giving birth will have secondary importance. Also be aware that many things which are provenly unnecessary for a normal, uncomplicated birth [such as an IV or an episiotomy] may become medically necessary if a difficulty arises.)
Finally, remember that not that many years ago such innovations as fathers in the labor and delivery rooms, taking classes in prepared childbirth, and delivering with little or no medication were considered radical and controversial. Today these things are widely accepted and practiced almost everywhere. (For my own baby boomer generation our fathers probably paced in the waiting rooms and our mothers were probably heavily medicated when we were being born.)
Changes like this have come about because people have wanted and have continually asked for these things. In the future increasing numbers of hospitals will be questioning and changing their policies in the following areas as well:
1. Routine enema? In some hospitals an enema is nearly always given to women in labor upon admittance. For some women this can be beneficial. If she is constipated this can make labor more uncomfortable and may even impede the baby’s progress. However, a diet full of whole grains, fresh fruits and vegetables, and plenty of liquids will prevent most people from getting constipated. Also, many women experience a “natural enema” (a soft loose stool) on their own shortly before labor begins.
Another reason that enemas are sometimes given during labor is out of an attempt to keep the birth area clean when the baby is actually being born. Sometimes when a mother is pushing her baby out some bowel movement may come out at the same time. (If this happens to you, don’t be embarrassed about it. This is very common and labor/delivery nurses have seen everything!) However, sometimes when an enema is given, the results of the enema may come out during birth, which is much messier!
There are some intriguing new medical speculations that this normal course of events in which a baby comes into contact with the mother’s intestinal bacteria (through her stool) is actually good for the baby. If the baby becomes colonized with the mother’s bacteria, he may be less likely to develop a dangerous infection from alien germs elsewhere, such as in the hospital nursery.* (An argument in favor of home birth is that people normally have a natural resistance to their own germs but can pick up more dangerous alien infections in a hospital 0r birth center environment.)
An enema stimulates ones intestines. During labor the intestinal contractions can in turn stimulate labor contractions and so may speed up labor. Therefore, an enema is one method, however uncomfortable, of inducing or augmenting labor. Some impatient women who have gone past their due date have tried giving themselves enemas at home (with their birth attendant’s approval) in the hopes of bringing on labor. This may or may not work, but is probably safer than inducing labor with artificial chemicals.
Many women find the ordeal of an enema during labor very disturbing and uncomfortable, especially if it is given when they are quite far along in labor and the contractions require a great deal of control and concentration. (There are occasionally instances of babies being born in the toilet or on the bathroom floor!) Many women would prefer not to be given an enema at all during labor as long as things are progressing normally.
As another alternative, if your birth attendant recommends that an enema be done, he/she may be open to allowing you to give yourself your own enema at home during the very early stages of labor.
2. Routine Pubic Shave? In most hospitals it has been common practice to shave the mother’s pubic hair prior to the birth of the baby. This is also done in some birth centers and even by some home birth attendants. The assumption at one time was that shaving the area would make it cleaner. If someone is to have surgery in a location of the body that has hair, sometimes the hair is shaved off (prepped) in that area prior to the surgery. The attempt on the part of hospital personnel has been to subject normal birth to routines which were already established and apparently appropriate for surgery – a philosophy which many people question today.
Curiously practices like this are often slowly diminished over the years rather than abandoned all at once. At one time it was common for all of the pubic hair to be shaved off of women during labor. Later this was modified to shaving off of only the hair around the vagina while leaving the hair in front. Still later, the practice was to shave only from the middle of the labia back, or perhaps to just clip the pubic hair.
Studies have shown that an unshaved pubic area is not any less sanitary than a shaved one, as long as the area is washed.
Another concern has been that if an episiotomy is performed the hair might get in the way of where the mother will have to be stitched. However, almost all episiotomies are made straight down the perineum where no hair is growing.
Many women feel that they disliked being shaved while in labor, or find that the hair growing back is itchy and uncomfortable. Today this practice has been abandoned entirely in a number of hospitals.
3. Routine Medication? At one time childbirth instructors had to advise their students to make sure that their doctor and hospital personnel knew that they were trained in natural childbirth and did not want medication unless it were absolutely necessary. Today, due to the widespread popularity of natural childbirth classes, in most areas hospital personnel are familiar with and generally supportive of prepared childbirth. They no longer need to be convinced that prepared childbirth works and medication is not normally necessary. Today most hospital personnel will not routinely offer (much less force) medication to mothers who are trained in natural childbirth and are using the techniques.
Medication can greatly help some women during labor, particularly if she is not trained in natural childbirth techniques, or is having an unusually difficult or complicated labor. No woman should consider herself a failure if she does decide to accept medication during labor.
However, medication for labor and/or birth can have disadvantages. Medication may not necessarily eliminate the discomfort of labor contractions, but may hamper one’s concentration abilities needed to use natural childbirth techniques. The birth of one’s baby, however uncomfortable, can be an immensely exhilarating, joyous experience forever cherished in one’s memories. But a heavily medicated mother may remember her baby’s birth only in a blur or not at all.
Babies born to heavily medicated mothers are often sleepy and listless. The effects of medication will wear off soon in an otherwise healthy baby, but may seriously affect the health of a baby born with other defects or problems.
Some types of medications interfere with the mother’s ability to push, making it more likely that the baby will be delivered by forceps. Some medications are offered so close to delivery that they hardly have any positive effect on labor, or hardly seem worth the effort after possibly hours of labor. And some medications can have adverse after effects, possibly causing more trouble of discomfort than they relieved. (For example, immobilization of the mother is often necessary after use of spinal anesthesia. Severe headaches can result if she raises her head for the first several hours.)
If any type of sedatives, tranquilizers, analgesics, anesthesias, inducers, etc. are offered, — what they are, what they will do, and the reasons for using it should be explained. You have a right to know every procedure and why it is indicated. The final decision as to whether or not to have this medication should be yours.
4. Routine I.V.? In some hospitals an intravenous solution of glucose and water is routinely inserted into a vein in the mother’s arm during labor. This also may be done in some birth centers. Even some home birth attendants provide I.V. equipment for mothers.
While use of an I.V. has some medical justification in certain situations, many have questioned its routine use for all women in labor. Many birth attendants do not prescribe I.V.’s as a routine procedure.
Women are sometimes told that the I.V. will give them additional energy. This may be true, especially for a woman who is dehydrated or is having a very long, tiring labor. But many women experiencing normal labors tend to find I.V.’s an encumbrance.
Some birth attendants like to use routine I.V’s because this keeps a vein open in the rare event that the mother should hemorrhage suddenly after delivery and will need a blood transfusion. While hemorrhage is a serious problem which must be treated promptly, almost all are treated by much simpler means (such as administering chemicals to stimulate the uterus to contract). It is extremely rare for a woman to need a blood transfusion after giving birth. There are definite risks to blood transfusions and many doctors are understandably reluctant to resorting to such a drastic measure, even if the mother may be temporarily anemic following the hemorrhage.
Delivery room nurses are trained to set up an I.V. for a blood transfusion very quickly should the actual need arise.
Many people question the wisdom of administering a routine procedure as a “just in case” thing to all women in labor when only a tiny percentage may actually benefit from it.
5. Position for Delivery? In traditional obstetrics women have been moved from the labor room to the delivery room shortly before giving birth. They were then placed flat on their backs on the delivery table with their legs in stirrups as a right angle from the body. This practice came about as a result of the medical profession’s attempt to pattern birth in a manner similar to the set up for a surgical operation. Also, if a mother is heavily anesthetized so that she is out at the time of birth, obviously she must be placed in a passive position which is convenient for the doctor. If spinal anesthesia is used, it is necessary that the mother not lift her head for several hours after it is administered. (Doing so may cause headaches.)
Most women who are having prepared, unmedicated births find that they desire less restraint and more freedom to assume their own most comfortable position for giving birth.
In the past, one of the arguments in favor of giving birth at home or in a birth center was that the mother did not have to be moved at the time or delivery or be placed on a delivery table. Today, many hospitals are providing labor-birthing rooms with beds (it may be a special bed which can be set up with stirrups or other delivery table options should the need arise.) In hospitals without birthing rooms, or only one birthing room which may already be in use, some birth attendants will allow the mother to give birth in the labor room if they desire this. This option is especially nice for the woman who has given birth before. Birth can sometimes take place very rapidly with little or no pushing, especially if it is not the mother’s first baby. Such women sometimes undergo considerable struggle holding the baby back while being moved onto a delivery table. Also, the first time mother, who may have to push for a long time, is often greatly benefited by the freedom to assume less conventional positions for pushing.
c. 1981 (Revised – 2012)