Sunday, January 4, 2015

Hanging Out in Labor and Delivery (And Loving It!)

This past summer, I began a project for the sheer joy of it - touring labor and delivery suites (a.k.a. hospital birth centers, a.k.a. maternity wards) at several Phoenix valley hospitals and making detailed notes of those visits for the purpose of comparing the different options for maternity care within the valley.

Though I am a dedicated homebirther, I love spending time in hospital birthing areas, and this project was a lot of fun for me. I loved getting to hear what tour guides had to say about their hospitals, and it was very interesting to compare the different locations.

In the beginning, my intent was to write a detailed summary of each hospital and then to write a comparison. However, I changed my mind on that and have decided simply to write one summary report of what I learned (see below!).

For this project, I visited three hospitals. I would like to have visited more, but making the time and arrangements to visit three was quite a challenge in itself. Perhaps I'll have the opportunity to visit more in the future.

I will not refer to the three hospitals by name. Although one of the hospitals was pretty much perfect, my thoughts about the other two hospitals did include some criticisms as well as praises, and thus I have decided to keep the names of all three hospitals anonymous.

The reasons for this are several, but primarily, hospital experiences are highly individual. One mother may have a wonderful experience, and another a horrible experience, at the same hospital - because doctors, nursing staff, and unavoidable circumstances may contribute toward very different experiences.

Additionally, hospital tour guides are, it seems, very strictly instructed in what to say (and probably what not to say!). Thus, a hospital tour may or may not be representative of the true experience that a mother or family will have at the time of birth - for better or for worse.

For the record:

- The personnel type giving the tours varied from hospital to hospital. At one hospital, our tour was given by an actual labor and delivery nurse. At another, it was a hospital aide and translator who gave the tour.

- Tours all took place in the latter half of 2014.

- All quotes are paraphrases. I made detailed notes directly after each tour so that my summary would be accurate, so all details should be accurate - quotes, however, are reconstructed paraphrases rather than word-for-word quotations.

- I have a strong preference for Catholic hospitals. I do not want to give birth (or even be) in a hospital that performs abortions, and I like being in a place that (basically) shares my life ethics.

- In my notes, I did not take into consideration various high-risk abilities, such as Level III NICU, etc. In an emergency or a severely high-risk situation, the mother and baby need be where they can get needed care. Period, end of sentence, etc. As my midwife told me, "In an emergency, it doesn't have to be pretty." My notes were simply for the normal birthing family who is looking for a hospital in which to have a non-high-risk birth.

All that being said, here are some of the observations that I gleaned from my experiences touring local hospital labor and delivery departments!

Hospitals Tend to Brag About the Wrong Things

I noticed very quickly that hospitals tend to advertise various amenities that they believe will appeal to birthing families (and which probably will). For example:

  • Free WiFi
  • Movie channels
  • Room service

However, all of those things are absolutely irrelevant to the love, respect, and quality of care that a family will receive during their labor, birth, and postpartum. 

I would much rather hear things like:

  • We offer a wide variety of labor tools (birth balls, peanut balls, birth stools, whatever!) and a nursing staff that is trained to help you use them.
  • We would love to see your birth plan and want to help you achieve your goals.
  • We respect decisions that you make for their newborns without trying to pressure you into hospital protocols. 

And I did hear some of that (especially at one hospital in particular), but on the whole, I think hospitals brag about the wrong things. And perhaps we parents are looking for the wrong things.

On another note, I noticed that hospitals also brag about high-tech things ("machines that go beep"). For example:

  • We have full-service monitoring technology that will be tracked at the nursing station at all times.
  • We have an anesthesiologist ready at all times.
  • We have a full surgery team available at all times. 

Is this a good thing? Yes, if that's what you're looking for. But, to repeat myself, those amenities still have nothing to do with the love, respect, and quality of care that a low-risk family will receive during a normal labor, birth, and postpartum.

All Amenities Are Not Created Equal 

Just because two hospitals offers a certain service does not mean that their quality of care regarding that service is the same. 

Here is one incredibly interesting example:

At two of the hospitals, the question was raised about labor tubs. (Both hospitals had labor tubs available for patient use.) Here are the responses:

Hospital #1:
"Yes! We have labor tubs! They are great for helping you to relax and get non-drug pain relief. Just give us a little bit of notice so that we can get one to your room and set it up for you!"

Hospital #2:
"Yes, we have a labor tub. But nobody ever uses it. They always stay in bed. And nobody here ever goes unmedicated anyway. They always end up begging for drugs even if they say they want a natural birth when they come in."

Enough said.

Don't Assume That Outdated Practices Are Dead

At two of the hospitals, we were strictly informed: "As soon as you are admitted, you are treated as a pre-op patient - no food by mouth, and no fluids except ice chips and IV fluids."

Folks, it's really time to stop this nonsense.

From the article linked above:
"Our study found no difference in the outcomes measured, in terms of the babies' wellbeing or the likelihood of a woman needing a C-section. There is no evidence of any benefit to restricting what women eat and drink in labor."
"There should be no hospital policies which restrict fluids and foods in labor."
But converting evidence into evidence-based practices is easier said than done. Dinosaurs die hard.


Don't Assume That All Practices Are Evidence-Based

At one hospital, I asked the question: "What is your policy on delayed cord clamping?"

The answer that I received was decidedly odd. The tour guide replied, "Um.... people don't really do that any more. You'd have to ask your doctor."

Wait a second. "People don't really do that any more?" The practice of cord clamping over the past century in the United States is moving in the direct opposite direction. The current (and past) standard of practice is immediate cord clamping, now moving (at something somewhat slower than a snail's pace) toward delayed cord clamping, which has all the evidence on its side.

One way or the other, the fact that an experienced labor and delivery nurse had no knowledge of delayed cord clamping is somewhat alarming.

Environment Is Important

Things like noise levels, decor, ambiance are not the most important things about a hospital. Granted, absolutely. BUT - they are important. The ability to relax in a comforting environment is critical for the progress of a healthy labor, and a stressed-out mother is likely to have more trouble relaxing enough to labor effectively.

Here are some of the ambiance-related factors that I noticed in the various hospitals:
  • Paint and flooring colors
  • Floor plan
  • "Hospital feel and/or smell" - Both of these are an incredible turn-off to me.
  • Sense of busyness - Also an incredible turn-off.
  • Noise levels - Often related to floor plan and general acoustic design.
Some of the hospitals made me somewhat uncomfortable, ambiance-wise, and some (okay, one!) actually felt more like a resort. When a person is in labor, these things can be more important than we know. (And really, this also applies to patients in the hospital who are there for illness, injury, or surgery. Stress-relieving surroundings can be incredibly conducive to healing, and the reverse is true as well.)

The Tour Isn't Everything

Hospital tours are meant to present a hospital's best side to prospective clients. That doesn't mean that a hospital tour accurately represents as to a hospital's true atmosphere and attitude with regard to birthing practices and policies.

Additionally, a hospital tour leaves out two important factors - your doctor (or midwife) and your nurses. One (your doctor) you get to pick, and one (your nursing staff) is a surprise. Both of those are incredibly important components of your hospital birth experience.

When you combine all of the different factors (doctor, nurses, hospital, your specific case), you can easily get many different outcomes from the same hospitals. I have heard both horror stories and "I love this hospital!" stories coming from all three hospitals that I visited.

We're Speaking Different Languages

As I toured these hospitals, I got the strong impression that the hospital staffs love their families, love their babies, and want the best for all involved.

Mothers and fathers also love their babies and want the best for all involved.

But sometimes those two groups (hospitals and families) mean distinctly different things by that statement.

When hospitals want the best for everyone, they want their mamas to follow procedures, adhere to protocols, and not rock the boat.

When I want the best for my baby, I want the complete freedom to make choices that will be lovingly respected, even if they deviate from cultural norms or hospital rules.

The tension between the desires of hospital staff and the desires of families is what can make hospitals a difficult place to achieve desired birth goals or have birth wishes respected by staff. It's what makes homebirth doubly desirable for mothers like me, who do not want to be fighting battles for themselves and their babies during labor, birth, and the postpartum.


I came away from this project confirmed in my preference for home birth. I do hope that I will never see the inside of any hospital as a laboring mother.

However, I am extremely grateful that these hospitals are there in the case of emergency. Here in the valley we are blessed to have several excellent hospital midwifery practices who accept transport cases (as well as providing excellent hospital care for mamas who choose hospital births), and I am thankful that we have supportive care providers to whom we can transfer care when a home birth moves outside of safety protocols and requires transfer.

Each hospital evoked my admiration in different ways, and I deeply appreciated the kindness of their staff in providing detailed and lengthy tours to give prospective clients information and allow them to ask questions.

The take-away message is simply to do your homework if you are planning a hospital birth. Tour the facility and ask questions. Compare hospitals and make a thoughtful choice. Be extremely selective in your choice of doctor or midwife. Take a childbirth prep class. Read, read, read. Do your research. Write a birth plan. Hire a doula. Do your homework.

As for me, I loved touring hospitals and can't wait till we're pregnant again so that I can tour more of them! I had so much fun.

Dear readers, what are your thoughts? Have you toured more than one hospital? How did they compare? How did your hospital tour compare to your birth experience in that hospital?

As always, kindly worded and non-combative comments and questions are welcomed. Impolite comments of any kind will be quietly deleted without comment.

I look forward to hearing your thoughts!