Natural Childbirth in a Hospital

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Even in the structured setting of a hospital, parents can choose a very quick and natural labor process.

Having a baby today in the “establishment” manner can be a spirit-crushing and money-consuming experience, and a growing number of couples are seeking out more natural methods of delivering their children. Not everyone is ready to insist on birthing their baby at home, however, and — for the couple who can’t find a doctor who will do home deliveries or the folks who are downright leery of non-hospital births — there is an easy, inexpensive and much more human middle ground: a well-planned hospital stay of only a few hours. I’ve done it twice myself and recommend it.

You can start making this idea work for you early in pregnancy by learning — at home or in the classes given by a local preparation for childbirth group — the exercises and breathing techniques of one of the natural delivery methods. The Lamaze method has worked well for me twice and I recommend the book, Six Practical Lessons for an Easier Childbirth by Elizabeth Bing. This excellent guide is often used as a text in formal classes. Next, you’ll have the task of locating a doctor and a hospital.

Finding the Right Hospital

With very few exceptions, doctors seem to consider a pregnant woman incapable of making decisions about herself and her baby. Why should she when she’s paying them to do it? Furthermore, most obstetricians — in addition to being insanely expensive — have been trained to think of childbirth as a medical problem best treated with drugs, and they routinely fail to inform expectant mothers of the facts about these drugs. For example:

[1] All drugs used in childbirth have produced undesirable side-effects, some merely unpleasant (such as a headache of a few hours duration) and some as serious as death of both the mother and her baby.

[2] This is not a justifiable risk. Only if the safety and comfort of the mother is in jeopardy should any drug be used in the course of a normal labor and delivery.

[3] The cost of the drugs adds a great deal to the hospital bill. My own conclusion (and some doctors agree) is that any medication should be reserved for the relatively infrequent (4 to 6 percent) medical complications of childbirth.

Financially, a pre-natal clinic attached to a teaching hospital is preferable to a private doctor. Not only are the charges more reasonable ($200-$500 usually covers all pre-natal care and all hospital expenses for the mother and infant) but the care (medical, not personal) is better. At the clinic you’ll be seen by more than one doctor — diminishing the chances of an undetected problem — and you won’t have the emotional burden of worrying about “disappointing” your doctor when you enter the hospital. By the way, you really don’t need a doctor for emotional support. That’s what your husband or partner is for. In a normal delivery the function of a doctor is to observe the progress of labor and to assist you if complications arise. Period.

If you don’t have access to a clinic, a private doctor will have to do. Try to find a doctor you like and one who won’t hassle you to death. Make sure he’s enthusiastic about natural deliveries: it could make things easier in the long run. Then there’s the hospital. Avoid hospitals that do not allow husbands into the labor and delivery rooms. It’s your husband’s baby too, and he belongs with you. Arm yourself for arguments on this point by reading Robert M. Bradley’s book, Husband-Coached Childbirth: The Bradley Method of Natural Childbirth. Find out if the hospital has private labor rooms. It can really be upsetting to hear some medicated woman groaning in the bed next to yours, and you need to concentrate on yourself while you’re in labor. Additionally, they’re sure to toss your husband out if you aren’t the only “patient” in the room.

Getting to Labor

With your hospital selected, think about how you want to be treated when you enter in labor. The usual procedure is pretty fierce: after getting you into a gown, a nurse “preps” you (shaves your pubic hair), gives you an enema and prepares you for a pelvic examination. The “prep” and the enema are unnecessary, irritating, distracting and — in the case of the enema — quite painful to a woman in labor. Many hospitals have stopped giving one or both, proving the point. Anyway, you own your own body. You have every right to refuse to submit to these procedures. A hospital cannot send you home for refusing. Such action is called abandonment and the hospital can be sued for it.

The pelvic exam is useful. It tells you how advanced your labor is and if it’s progressing normally. After the examination your husband will join you in the labor room to time contractions and keep you company. When you’re ready to deliver, you’ll be moved to the delivery room. Your husband will be given a cap and mask and will accompany you. If the staff balks at this point and tries to keep your husband out, refuse to go without him. This almost always works if you are both firm about it. The anesthetist may try to talk you into some medication at this point. Refuse: the best part is yet to come.

When the baby’s head is about to be born, the doctor may do an episiotomy (a small incision to make the delivery swifter and to avoid tears in the perineal muscle). Ask him not to do so unless it’s really necessary: often — even with first babies — the head is delivered quite easily if the doctor knows enough to tell you how to breathe properly. Otherwise, the episiotomy is quite painless and sometimes necessary. As soon as the baby is born and is breathing well, ask to hold it. Again, youhave the right. The baby is yours, not hospital property. Begin nursing the baby right away. This causes the uterus to contract and expel the placenta. It’s also a wonderful experience to nurse your child for the first time. The doctor may now want to give you an injection of oxytocin to help your uterus stay firm and to prevent excessive bleeding. If you want the drug but don’t like injections, ask for it in pill form. Hospitals always have it and it’s easier to take.

Legal Rights in the Hospital

If your child is a boy you’ll be asked for permission to circumcise him in the delivery room. You can refuse if you prefer not to have him circumcised. This is an unnecessary surgical procedure with some dangerous complications (mainly, severe bleeding) and babies have died as a result of circumcision. Not often, but it does happen. At about that point, a nurse will want to clean the baby and take it to the nursery. Don’t let her. If you like, let her wash the baby a little and give it back to you. The nursery is a source of infection and, anyway, the baby belongs to you and your husband. The medical staff will have fits about this (routine is routine) and won’t know what to do. They’ll probably plead with you, threaten you and — in general — be complete nuisances. If you are firm and seem to know what you’re doing, however, they’ll find some place to put you, your husband and child for a while.

Somewhere along the line you should tell the staff that you’ll have to be running along soon (you left a cake in the oven?). Whatever you do, though, don’t mention this to anyone in the hospital until the baby is born. If you tell the doctor during your pregnancy, he may even refuse to accept you for pre-natal care. Doctors are not known for their flexibility. Best wait until the baby is born and safely in your arms before you tell anyone your plans.*

You’ll want to stay at the hospital for at least an hour — preferably two — before you leave. This greatly reduces the danger of post-partum hemorrhage catching you off guard. Two hours should be plenty and, during your short wait, the hospital will dig up a staff pediatrician to give the baby a physical examination before you take it home. When you’re ready to go, sign the little forms that say you’re leaving against medical advice. Don’t be intimidated by those slips of paper. Just smile and sign them . . . then pick up your baby and go home.

I assume that anyone who reads MOTHER would breastfeed her child. This is imperative if you leave right after delivery because it controls bleeding and ends the worry about whether or not some plastic formula agrees with your baby. If all this makes you fear for your safety, rest assured that thousands of women are now using this quick in-quick out hospital delivery tech nique with no harm to themselves or to their children. Dr. Bradley often releases his mothers from the hospital within hours of delivery . . . as do Drs. Miller, Moss and Winch of the French Hospital in San Francisco. They wouldn’t be doing it if it weren’t safe and natural.

My second delivery-a little over a year ago-was based on the suggested schedule I’ve just outlined and went like this:

On December 24, 1969, I was wallpapering our new apartment with my husband and daughter . . . and having contractions every fifteen, minutes. I didn’t think these contractions could be labor, however, because they weren’t the least bit painful nor remarkable in any way. My due date was the 25th, though, and my husband kept muttering that I must be in early labor.

At five that evening we went off to do some last minute Christmas shopping and, while we were in the store, the contractions became so strong (from pressure, not pain) that I couldn’t keep walking. I still thought it was all a joke . . . and my husband still muttered. We stopped in to see some relatives and have a drink or two at six thirty. We all laughed about the contractions which, by then, were five minutes apart. Still no pain, no bleeding, no anything.

At seven thirty I started bleeding slightly (many ah-hah’s from my husband and my mother). We left our little girl, Trilby, with the grandparents and started for home to pick up a few things for the hospital. At home we milled around calling people and timing contractions for another hour. When the contractions were a minute and a half apart, getting hairy and a bit difficult to control we decided to leave for the hospital. After a few funny scenes in the hall with neighbors, we did leave . . . and signed in at the hospital at 9 p.m. I was still afraid I was having false labor and would be sent home, I was getting quite aggravated about the discomfort and I was snapping constantly at my husband.

The nurses in the labor room, upon talking to me, became nervous and called the doctor immediately. I later realized that, when I had said that this was my second child, they thought I had said seventh. . . and had gotten upset about it. So the doctor came running in, examined me and yelled, “Get her into the delivery room quick!”

Much rushing around, hurried wheeling down the corridor, etc. I hopped (really) onto the delivery table and pushed away an obnoxious anesthetist who ran over and tried to jam a mask over my face. I looked up at the doctor and — just as my husband (looking very confused) came running into the room — the baby kind of whooshed out. The doctor held up our son (Ethan) for us to see and the baby promptly squalled and urinated all over me and the nice sterile drapes across my thighs. We cracked up.

I had needed an episiotomy just before the baby was born (no discomfort or anything, he just had a big head). I asked the nurse to give Ethan to me, the doctor said, “Oh, what the hell, let her have him,” . . . and I nursed the baby while the doctor sutured me up.

When that was done, I sat up and told everyone that we’d be leaving in an hour or so and . . . uh . . . would they please find a pediatrician to examine Ethan and would they bring the papers to be signed.

The nurses squealed like angry pigs and the doctor just said, “Well, we sure get the nuts on Christmas Eve.” They put us back in the labor room and gave me a glass of water while the baby was checked over: 7 Ibs. 10 oz., 24 inches long and perfectly healthy. One nurse snipped in and out glaring at us and generally making an ass of herself. Everyone else was nice and friendly . . . if a bit bewildered. The obstetrician came in with the papers for me to sign and told us to go home and enjoy the holidays. So we did.

At eleven fifteen I was at home with my husband and baby having a cup of coffee and calling everyone I knew in the territorial U.S. to tell them how great it was. And it really was.

JOHN STARR, M.D. COMMENTS: I would remind Sharon that some post-delivery complications can develop well after the two-hour waiting period she mentions in her article.

Additionally, no matter how you handle the admittedly-touchy problem of notifying the doctor of your plans, it should be done in a way that leaves the hospital door wide open for your return in case a later complication does develop.