The hospital is making me sick.
May 25, 2007 8:46 AM   Subscribe

How do I make a hospital birth not suck? Suddenly midwife-less. Local hospital a horror. Bitter, depressed. What does a doula actually do? Etc, etc.

I had a midwife; was going to stay home. I moved, and now I don't have a midwife. I am, so far, pretty happy with the obstetrician here she recommended, but.

We toured the local hospital's maternity ward, and, hell. I left almost in tears. This is a rural hospital with a couple of wee labour rooms straight out of Monty Python. Apologies for the length of this; I'm a bit obsessive at the moment. Of course nothing's helped by all the people who I thought would be weird about home birth having said "Fantastic idea. I would've loved to. The hospital was awful."

They're in the middle of L&D ward renovations, many of which are supposed to be completed by the time I'm ready to go (early August). It's not clear how much things will improve, though.

The hospital would like to send Mr Kmennie home, but hang on to me for 24h. Modern they are not. The OB's fine with me leaving four hours after the fact. That he and the meddlesome-seeming nurse contradicted each other a fair bit seems to suggest an adversarial position (towards the hospital) for us parents-to-be whether we like it or not.

Do I need to get all his "Sure, you can go home"-type assurances in writing? Do I need to go further than that, and bother the hospital about it before the fact?

And, can somebody explain the value of a doula here? Everyone makes them sound fantastic. The studies on them are nice. I asked the OB's opinion. "My secretary's a doula... My wife and I had one with our third child; just great... Get a doula."

I can't stand massage and have no interest in aromatherapy or anything else many of them seem to be offering, along those lines. What I would like is somebody to run interference with the seemingly meddlesome nurses and keep them and their monitor out of the room, but a few doula web sites say: that's not their job.

So I'm confused as to what a doula might actually do. The one thing I am going to look for is a labour assistant with enough training to find out how far along I am so I can stay at home as long as possible, but I don't know if that's to be found around here. If you had one, can you explain even minutiae of what she did while with you? At the moment, all I can see is somebody who'll fetch me the right variety of cold drink.

What else might I be planning to make it less sucky? (And, that said, I'm not going to get nuts about anything going exactly as planned.) This is our first; first-hand experience is badly wanting. The hospital's clearly not big on dignity/privacy, or even birthing chairs/balls/etc; there's not much beyond a bed and just one (too bad if somebody else is there) tub. (Creepy leg-immobilizing attachments were well within view, just beyond the massive Baby Bothering Box. The irony is that this is a low-tech rural hospital; if there's any real problem, I'll be immediately fired off to the city. Where I'm tempted to go in the first place, but: I like this OB, and I like being a very quick drive, for the go-as-late-as-possible idea.)
posted by kmennie to Health & Fitness (35 answers total) 6 users marked this as a favorite
The city would possibly be worse; more high tech interventions whether needed or not.

Your thought of waiting till the last minute to go to the hospital is a good one.

As to dignity and privacy-in the last stages of labor you won't give a rip about either.
posted by konolia at 8:58 AM on May 25, 2007

First hand experience (recent) here. Do with it what you will.

- The panic you're feeling is normal. Baby-birthing is a big deal, and it's not often we do something so momentous with absolutely zero previous experience.

- Births never, ever, go as planned -- or as hoped. Which is why (1) a hospital is not such a bad idea, especially if you like your OB, and (2) Don't fret about leaving after 4 hours. I guarantee you will want to stay longer -- possibly much longer than that.

- Doulas: I suggest getting one, especially is you want them to "run interference with the seemingly meddlesome nurses and keep them and their monitor out of the room." That's what doulas do -- good ones, at least. Find someone the hospital or your Dr. reccommends -- someone who's worked at that hospital before, and knows their routine. They will be your advocate, and your virgil.

- About those "meddlesome nurses" and their infernal monitor: They may very well save your life -- or your baby's. (See my comment above about births never going as planned). Our child is alive and healthy today because of nurses who can run fast, and act quickly, calmly, and professionally after that monitor tells them the baby's heartbeat has stopped while still inside you.

Good luck and god (or whomever) bless.
posted by turducken at 9:08 AM on May 25, 2007 [3 favorites]

What does a doula do? I think that the wikipedia section on it describes it well. My cousin-in-law is a doula. Basically they do a lot a lot of the handholding that you desire - especially since it is your first child (and your hubby is likely to be overwhelmed; mine sure was). A doula may have a ball or a birthing stool, too. Given your situation I think it would be a great idea to have one with you.

I think you should fight to have your husband there, and between him and the doula you will have advocates for you and what you want, which, IMO is key to having the birth experience that you dream of.
posted by frecklefaerie at 9:12 AM on May 25, 2007

Response by poster: I guarantee you will want to stay longer...

I might've thought so, but. As it stands right now, there're no private rooms, and they boot the fathers home.

My wanting him around aside, I could not get Mr Kmennie to go home when I was in hospital overnight apropos of a miscarriage last year (@ a city hospital, with accomodation for that); it would seem cruel to have him pitch a tent in the parking lot. That, and sending Dad home afterwards seems bizarre to me. Freakish, unhealthy. Rooming-in with the baby isn't even the default at this hospital. Everything about the set-up for after the birth skeeves me out. We visited not on some scheduled tour but a 'call in advance, any night so long as it's not busy' non-busy night, and the couple of new mothers there were not getting anything like peace, quiet, privacy, etc.
posted by kmennie at 9:21 AM on May 25, 2007

I had two hospital births, and there were some things I'd have liked to have had done differently, but in the end? It was a tiny piece of my life and I was pretty distracted from my surroundings anyway. When I reminisce about my birth experiences, I'm not really thinking so much about the hospital.

I delivered in a highly forward-thinking hospital and couldn't possibly have been less bothered to use tubs, showers, balls, etc. I couldn't even stand the music I had lovingly compiled for myself. I couldn't have cared less about my own birth plans.

I was happy to stay the full 24 hours after my first delivery, but after the second my OB signed off on my discharge papers after about 16 hours and the hospital cheerfully complied. But in both cases it was definitely a go-with-the-flow thing on my part, with my doctor as an advocate for us.
posted by padraigin at 9:46 AM on May 25, 2007

Our recent experience (though I'm speaking from the Dad perspective):

* We had a doula. I had been a bit concerned about the expense, but it was worth every penny. Having someone in the room who's been at births before, and is on your side, is not to be missed. We had great staff at the hospital, but at the end of the day they have their jobs to do and you're just another customer. It also meant that I wasn't on the hook to make suggestions and such, which was good as I was pretty emotional that day ;)

* Staying over. We have a medical plan with semi-private coverage and opted to bump that up to private. We were in the hospital for a few days, and I hardly left. The situation for the rest of the dads didn't even occur to me until I witnessed "the exodus" one night. I'm glad we weren't in their situation.

* Privacy. The staff are taking care of mother and child, and therefore will tend to show up at all sorts of times both day and night. We were happy to get out of that situation!

I don't know if that helps, but if nothing else, and especially if this is your first child, I'd recommend a doula (be sure to interview a few and find one you like).
posted by lowlife at 9:47 AM on May 25, 2007 [1 favorite]

I've had two kids. With the most recent, my husband went home for the night to be with the firstborn while newborn and I stayed in the hospital. To be honest, I liked it that way. I got to spend the entire night with just me and her. Both my kids wanted to do nothing but nurse when they were first born. My husband could hang out change diapers, but the babies wanted me, me, me. And I wanted them, them, them.

Regarding the nurses, etc: the creepy leg-immobilizing devices can be useful -- I needed them (I'll spare you the reason why). But if you don't want them, it's not like they're going to force your legs in to them. The nurses were wonderful at both the hospitals I was in (one conventional, one like a "birthing center" but still with delicious, refreshing epidurals).

Dignity? Privacy? Hee hee hee... Trust me, you just won't care when you're in labor. You'll have a whole 'nother set of priorities. And that's okay.

Do I need to get all his "Sure, you can go home"-type assurances in writing?

No. What good would they do? Again, they're not going to physically restrain you. If you and the baby are okay they'll let you go as soon as you want. If you're not, they'll recommend that you stay. I stayed with both mine, even though I'd planned on leaving, because I had a mild fever and there'd been some misadventures with meconium.

Try not to worry about it. It's just one day. The important thing is that you and your baby are healthy.
posted by The corpse in the library at 9:54 AM on May 25, 2007

How do I make a hospital birth not suck?

The simple answer is to keep your mind on the end rather than the means to reach that end. Whether you've got an unshaven earth-matron chanting incenced mantras to the Goddess or 17 beeping electro-probes hanging from your bestirruped nether regions you will soon be holding a fabulous, amazing, writhing, little bundle of baby and frankly, as long as all goes well, you'll never give a shit from that day forward how you got it from the inside to the outside (nor have time to really).
posted by Pollomacho at 10:04 AM on May 25, 2007

I had a doula who is somewhat famous in her world, having birthed over 3000 babies in her career. She is a tiny old bird of a woman, very commanding and wise, with an outstanding reputation at all of the hospitals here.

She was fantastic in that she supported me to have the experience I wanted for me and my baby. She wouldn't let me do a lot of things that suddenly seemed very appealing in the moment. She met me at the house and kept me in the tub up until the very last minute, so I wouldn't be at the hospital long enough to be messed with. I asked for an epidural twice, but both times I was at home with no access to one, and she kept me calm enough so that even when I was asking I knew I could do it just fine. (By the way, she did check my progress when she arrived at the house and a couple more times. When I said I really wanted to push, she checked again, I was at six CM and we went to the hospital then.)

I had my baby eleven weeks ago today - first child, no drugs, and a six-hour labor. The main reason I had her so quickly and with so little pain was because of the doula - she reminded me over and over again to calm down, and kept me calm and focused. There was no hypnovoodoo or ridiculous imagery or candles. On the other hand, she had a strong reputation with the nurses so they knew that as long as she was there they couldn't bully me into a bunch of monitoring or drugs. (She didn't run interference b/c she didn't have to, but she would have reminded me of my original birthing plan if someone was trying to do something different.) She kept me away from the hospital, and once I was at the hospital, out of the bed, until the very last second, so that the baby was really ready to come once I started to seriously push. She encouraged me to do whatever I felt I needed to do to get the baby going, from marching in the shower to swaying my hips to squatting. Once I was in bed, the baby came so fast that the MD didn't have time to put his gloves on! She stuck around for a couple of hours after the baby was born to make sure everything was okay, and to see if we could get the baby to nurse. The baby was on my chest, skin to skin, for the first four hours of her life.

In essence, my doula supported me - the mom - and fiercely defended the space for me to have the birth that fit me and the baby

With locally available doulas, your results really may vary. I would interview several and ask for references, so you can find the doula who works best for you, that you really "click" with. (We interviewed four.) Do write a birth plan and get it on file with your hospital when you preregister. Ask to go over it on the phone with the head of the OB unit at her convenience, but before you arrive in labor. (I have a simple one if you want a sample.) I also read lots - Hency Goer's "A Thinking Woman's Guide" is really good, and I got a lot of strength from reading other natural birth stories on the bulletin board.
I had the perfect birth that I always envisioned, but I think a major reason is because I put so much faith in my doula and myself. Good luck!
posted by pomegranate at 10:15 AM on May 25, 2007 [4 favorites]

I'm a dad who loved loved loved having a doula. Best money I ever spent at a hospital. Interview to get the right one.

For $150 US we got an registered nurse with 25+ years experience in birthing rooms as a coach/consultant in the room with us through the process. It was our third child, and I kicked myself for not getting doulas earlier.

The doula was our instant consultant/agent, the only one in the building with nothing but my wife's comfort, emotional well-being and interests in mind.

She cut through the crap the (overburdened) floor nurses tried to get my wife to put up with. She was an instant resource on snap decisions like epidurals, episiotomy pros and cons, and Pitocin dosages and timing.

She was a pro to discuss c-section with who didn't care about the hospital staff's shift changes or profit margins. And if we wanted to differ with the hospital staff, she knew all the lingo and studies to argue for our preferences.

Sure, you have to get one who does what you want. But: Doula.
posted by sacre_bleu at 10:22 AM on May 25, 2007 [1 favorite]

pomegranate, congrats!!! I remember you were trying to get pregnant a while ago - I'm so happy everything went so well! Welcome to motherhood!
posted by widdershins at 10:25 AM on May 25, 2007

Ok, it's been a while but here goes.

The hospital is what it is. Their job is to keep you and baby safe and healthy. The moniroring equipment is not a ploy to get more money, it is not there to annoy anybody, it is there to make sure things are really ok. The "meddling" nurse has attended hundreds of births *in the last year* and in my case, was there being helpful through almost everything, despite having to change scrubs multiple times because of the various fluids I ended up getting on her (childbirth is not a dignified experience, sorry). She and the Resident spent more time in the room with me than the Attending Physician (who turned out to be the partner of the guy who'd actually done all the prenatal stuff; be prepared for the idea that your doc may not take call the night the baby decides to arrive). Your experience will be more pleasant if you stop seeing the nurse as an enemy, and try to make her your ally (not to discount the value of a doula. who couldn't want an extra ally?).

Home birth is a not a good idea, particularly for a first pregnancy. Too much can go wrong, and two lives are at stake. People who say "Nonsense! Women used to give birth without a doctor around all the time, and in many places they still do" need to be reminded that the places where that is the case have higher maternal mortality rates. [Insert Diety] forbid anything bad should happen, but if it does, you will need the resources of a hospital, and you may not have time to get there from home.

When you go home is not up to you. It will depend on your state of health after delivery, and that is not something you can predict or control.

I don't think I even had the option of considering a doula (I won't go into details, hospital politics). From what others have said above, they sound like a good thing.

If you are concerned about that hospital, see if you can dig up some OB stats online. If it's the only game in town, then the bad news is you may not have much choice, but the good news is that surely there are moms near you who have given birth there and can share their experiences and things to look out for.
posted by ilsa at 11:04 AM on May 25, 2007

Disclaimer: we had a home birth with two midwives in attendance. Other than a very long labor (50+ hours from start to finish) there were no complications that warranted medical attention.

We had friends who were suddenly without a midwife after Katrina. They coped by having the husband fiercly defend their birth plan. Several times the doctors and nurses tried to force an epidural, inducing, and a c-section, and every time he said exactly what's necessary to prevent any actions taken which they didn't specifically want. Apparently it was quite a scene.

I fully recommend a doula. They can be an advocate for you in a time when you're not feeling like dealing with administrative policies.
posted by spikeleemajortomdickandharryconnickjrmints at 11:31 AM on May 25, 2007

I'm sure some doulas are GREAT people. But some are new-agey, parasitic emotion junkies. Interview, interview, interview.

And if you don't like the local hospital ... go find a new one. For our second child, my wife and I had the delivery literally two days after a cross-country move. We just showed up at the midwife's office (that we had heard about through a friend's recommendation) and said, "Wanna deliver a baby tomorrow?" And the experience was far superior to our first baby's.
posted by frogan at 11:36 AM on May 25, 2007

I really, really, REALLY wish I'd had a doula, if only so someone would have gotten my goddamn mother-in-law out of the freaking room! Jesus, that woman...she just wouldn't leave. Even when the doctors were physically moving her out of the way when Baby and I both went into shock, I really needed a fullback there to throw her out and sit on her or something. Stupid cow. Not that I'm bitter or anything. ;)

In all seriousness, I don't know your medical history, and I'm not a doctor, so I can't suggest home vs hospital, although I can tell you that if I hadn't been at a hospital, I would have died in childbirth, and the odds are that Boy would also have died. They had about 3 minutes to get me into surgery, and I'm 20 minutes from the hospital.

That said, if you're healthy and young and have child bearing hips and want to do it at home, check the national registry and find a midwife near you:

There's one for doulas too:
posted by dejah420 at 11:44 AM on May 25, 2007

Response by poster: Home birth is a not a good idea...

Oh, for chrissakes.

Meta-analysis of the safety of home birth.

BACKGROUND: The safety of planned home birth is controversial. This study examined the safety of planned home birth backed up by a modern hospital system compared with planned hospital birth in the Western world. METHODS: A meta-analysis of six controlled observational studies was conducted... RESULTS: Perinatal mortality was not significantly different in the two groups (OR = 0.87, 95% Ci 0.54-1.41). The principal difference in the outcome was a lower frequency of low Apgar scores (OR = 0.55; 0.41-0.74) and severe lacerations (OR = 0.67; 0.54-0.83) in the home birth group. Fewer medical interventions occurred in the home birth group: induction (statistically significant ORs in the range 0.06-0.39), augmentation (0.26-0.69), episiotomy (0.02-0.39), operative vaginal birth (0.03-0.42), and cesarean section (0.05-0.31)... CONCLUSION: Home birth is an acceptable alternative to hospital confinement for selected pregnant women, and leads to reduced medical interventions.

When you go home is not up to you. It will depend on your state of health after delivery, and that is not something you can predict or control.

What I'm objecting to here is hanging around -- in a very unpleasant setting not conducive to recuperation -- when no problem is apparent. Nothing supports the idea that I should be there for 24h on a just-in-case basis.

As for the monitor business -- uh, no. Five minutes here is enough to indicate it's a bad idea in the absence of complications (in short, it's more likely to create them than it is to do anything else at all). Yet. Nurse, cheerfully: "And the first thing we do when you get here is hook you up!" Despite good intentions, I'm not viewing that as being on my side.

On preview: I'm healthy etc etc; the problem is just that I can't get a midwife this late on to do a home birth where I live. The first one was willing to travel herself, but couldn't get a back-up willing to head out to my part of the sticks.

(And WTF is it with grandmothers who like to hang around labour wards? That one weirds me out. Not, thankfully, a problem here.)
posted by kmennie at 11:51 AM on May 25, 2007

I forgot to tell you that I had the baby at 9:25 AM and I was cleared to leave with said healthy baby that night. Unfortunately, the person in charge of birth certificates had already left and b/c of stupid admin crap I had to stay over after all.
I did not have a monitor - They would place the monitor over my belly/pubes for less than a minute at a time, and each time I would ask firmly for them to stop, after they heard enough heartbeat to reassure themselves. A good way to get them out of your way is just to keep moving - shower to toilet to squatting to shower to toilet to squatting seemed to be my pattern.
The nurses are well intentioned but having the right doula really helps with their confidence in you.
Also- my doula kept my mom, sister, and mother-in-law outside the room, how I'll never know. I was more grateful for that than anything else.
posted by pomegranate at 12:21 PM on May 25, 2007

I seriously, seriously doubt the hospital will try to keep you if you want to leave. When I had both of my kids they were shoving me out of the doors right away while I was kicking and screaming (especially with the second one) to stay somewhere I could rest. Hospitals are all about turnover; they're worse than Waffle House. Somebody else needs that room and they'll make more money if they kick you & Jr. out quick. If you want to leave, just leave. If you don't - and you might not, believe me - than be glad that they'll actually let you stay. As far as Dad having to leave, just ignore it. Hospitals often act all tough about the rules before the case but you can usually just get around them. If you want him there. Personally I wanted no one around me at all except the baby. Also, if you go to the hospital too early - i.e., you're not dilated enough - they will send you home. They sent me home both times (I'm slow; over 24 hours for each kid.)

I never had a doula; is there some reason why Dad can't be your advocate? You will need one and he's going to be right there. You have a right to say no monitor (I didn't want one either & I had natural childbirth with both kids as well) and no to whatever else you don't want and it's Dad's job to make sure that the hospital listens to you. An extra person probably wouldn't hurt if you really like them but again, I didn't want anyone else around. You'll find, though, that L & D nurses are indeed your friends, no matter what you think now. They're some of the coollest people around and when you're in labor I guarantee you that you will be so very happy to have them there.
posted by mygothlaundry at 12:32 PM on May 25, 2007

D'you think Mr Kmennie could function effectively as your advocate? The Hub told me years before we had kids that he would probably faint if he had to be in the room, so he got a pass to leave when things got ... icky.

An experienced doula could at least be someone who's been there before and not bail on you at the last second.

The Dr. for my second birth was cool - I could walk around, eat what I wanted, squat, whatever. I ended up with pitocin and an epi anyway because the kid's head was HUGE, but that's another story.

Laws vary from place to place. There could be liability issues involved. Your profile says Canada, I'm in the US, so YMMV.

What you're looking for is calm. Lots of it, in huge doses, frequently. Get a doc and/or nurse and/or doula who has been through the process at least 100 times, who will actually listen, and who will explain your options. And let you know when you're going off the deep end.
posted by lysdexic at 1:03 PM on May 25, 2007

All I can suggest is this: Get as much support as you can. Keep your husband by your side, call your mom, sisters, whoever you can find who wll stand by your side while you're expressing your wishes and opinions to the nurses and doctors.

My experience was completely different than mygothlaundry's. The staff of the hospital my daugter was born at cut every corner, cajoled, bullied and outright lied to my girlfriend and me. They ignored our opinions and preferences, and would have railroaded us if the combined might of our two families hadn't been there to back us up.

I'm not trying to give you the fear, I'm trying to impart to you the importance of having somebody watching your back. My experience was miserable, but a lot of people have perfectly fine birthing experiences, but I'm sure that even those could be made better simply by having strong support.

I'm not really familiar with doulas, but if they act as professional patient/birthing advocates, I'd say go for it. Hell, get two if you can afford it.
posted by lekvar at 1:06 PM on May 25, 2007

Response by poster: D'you think Mr Kmennie could function effectively as your advocate?

Yes. He does a nice job of asking the 'and how often do you do X?' questions and finding out that the first OB I saw was c-section-happy, for one. Plus, I'm kept in high spirits by his mutterings about asshole episiotomies for doctors who perform unnecessary surgery.

That said, I don't know that it's a good idea to make that his primary job. I'd rather have him doing the emotional and physical support and let a doula deal with the, er, practical running of interference. Kvetching at hospital employees AND propping me up might be a bit much.
posted by kmennie at 1:37 PM on May 25, 2007

Our hospital experience (in the US) with my first was horrid. The actual labor and delivery itself was okay... it was afterwards that sucked. They let the baby room in with me, and they let my husband stay, but the nurses were constantly giving me bad information, barging in the room every hour, taking the baby away when I was in the middle of using the bathroom so I couldn't go with him, and some of them were just actively hostile people. I finally called my mother in tears and she came to the hospital to sit in the room and basically bar the door so I could get three hours of sleep. The staff told me they'd let me leave but keep the baby 48 hours no matter what. They screwed up our establishing breastfeeding with their interference and bad info; it took me two weeks to straighten it all out.

Of course after that I wanted a homebirth. It didn't work out with my second and we had to go into hospital. Our initial encounter with the nurses was not pleasant (it was end of shift and they were very cranky), but I had one nurse assigned just to me during labor/delivery, she did a good job, and after I had the baby, had a nap, and we both had baths, they let me go right home: I was there all of 12 hours total. That was awesome. The guidelines and procedures for the midwives/hospital staff are different here in Canada, I think that's what helped - although of course in a backwards small hospital, it may not have trickled over yet. In a bigger hospital, no question.

Seriously, if the hospital and staff is already bothering you this much - did you consider if you can't get a midwife to handle a homebirth out in the sticks for you, you could get one to handle a hospital birth in the city for you? - assuming you can find one willing to take you on this late? If you think you might have an easier time at a city hospital (I really think you might) it's something to consider. Certainly a bigger hospital will let your husband stay with you, let the baby room with you, and let you leave within hours if you don't want or need to stay! - those are dealbreakers for me, especially if you do need to stay more time; obviously births often don't go as planned. Also, yes, in labor, privacy and dignity are minimal; but you will feel better the more you can stick to your birth plan and a bigger hospital is less likely to interfere with you, and to have better accommodations in the birthing rooms for you.

Staying at home until the last minute sounds great, but they want you to do that anyway - they'll send you home if they don't think you're ready - so don't use that as the crux of your decision to stay with the closest hospital. If you feel like the city hospital isn't an option, ask your OB, in detail, what he is willing to do to help you have a better experience. In my experience the OBs are pretty much gone once you're done delivering and everything checks out okay... leaving you to the nurses. Will he override the nurses and sign you out so you don't have to stay any longer than you need to? If you leave early do you get to take the baby with you? Ask him how willing he is to back you up against the staff. If you're already feeling it's going to be adversarial.... yick.... I myself would be really checking out the city hospital option even if the OB was totally awesome. The staff can make or break your experience.

If you stay totally get a doula. Interview her and let her know what you need her for - running interference with the nurses and so on. Can your OB recommend anyone? You can't sign over the decision-making to the doula but you will feel so much better having someone adamantly on your side who knows what to expect. When it's your first you have no idea, and it's easy for the nurses to barrel over you. I thought I was prepared with a birth plan and all - and my husband and I are hardly shrinking violets! - but no matter how hard we tried to stand our ground with those people we got nowhere; we were worn out and demoralized by the whole thing.

Good luck - I totally feel for you!
posted by Melinika at 1:55 PM on May 25, 2007

My 1st two were rural hospital births and our last was a home water birth with midwife. We also moved during that last pregnancy and the only available midwife became very ill just 2 months before I birthed. I was also in a huge panic! There was no way I was going to birth in a hospital again, even if we had to do it ourselves at home.

Luckily I found a midwife in the next state who was licensed here and willing to drive. Our home birth was the most wonderful and beautiful experience of my life. All our children participated and our oldest, along with dh, caught the baby.

To answer specific questions you have -

Tell you OB beforehand that your DH will be staying, no ands ifs or buts. It's your birth and your choice.

Yes, you and the baby can leave after 4 hours, you can do whatever you'd like (I left 20 hours after the 1st birth and 3 hours after the 2nd- both times the baby stayed with me in my bed the entire time or dh was with him).

You can refuse those monitoring straps, foot rests, iv's and anything else you don't want. You can turn over on your knees, your side, whatever, in order to give birth - see below about birthing plans.

The value of a Doula is that she is there to serve you and your wishes. Yes, she will run interference for you. No, she won't use massage or aromatherapy or anything else you tell her you don't want. They won't bug you and are good at reading your silent cues. They are gentle and supportive.

I suggest you do a lot more research about home births; you'll find out a lot about making your hospital birth as positive as possible. There are birth plan templates on the internet - find one and use it to figure out what you want and give copies to the hospital and your OB.

Most importantly, realize that this is your body, your baby and your birth. You own it all, no one else does.
posted by LadyBonita at 3:02 PM on May 25, 2007

About not staying after the birth--Most hospitals want to push you out the door because of insurance and over-crowding issues. In Tampa, where I was born (but didn't have my kids), they now offer Moms a free night to make sure they stay over-night. Yes, FREE. Why do they do this? Because they are tyrants who want to ruin your birth experience? No, because most complications, including infections (which are common), occur in those first crucial 24 hours after delivery.

Wait as long as you want to go to the hospital, but be aware that if your water breaks, you need to have that baby within the first 24 hours or complications can turn really nasty.

Monitors suck. They also serve a purpose. I started to feel a little uncomfortable, talking with hubby, no big deal, have the monitor on me. Nurse runs in--turns out I was 8cm and my boy was footling breech. I would gladly have given birth then, would have wanted to push, pain wasn't bad at all, didn't want any drugs--and it would have been COMPLETELY the wrong thing to do, as the cord was around his neck and in that position he would have lodged in the birth canal.

The two best tips I can give from personal experiences:

1. Have an advocate of some kind, whether it's your guy or a doula. You need this in a hospital, especially with your first child. And your husband will stay if he wants--I can't see them physically carrying him out, and the hospital I went to didn't encourage it either, but my friend's husband stayed (mine didn't, I wanted him to get some rest).

2. If you can pay a little more and get a private room, do it.
posted by misha at 3:20 PM on May 25, 2007

It will be okay.

Whatever you choose you will have a baby at the end of it.

My first and third child were born at home with two midwives, my second was born in the hospital with an OB catching the baby (the midwife did all the real work supporting me and running interference). When I say home birth, I actaully mean my parent's house because my house is too small (I had 15 family members in attendance during the actual births). The home births were much nicer for everyone involved. The hospital birth was stressful, no privacy, no support, no empathy from the OB, noisy etc. The drive from my home to the hospital was just under an hour and was not uncomfortable (I gave birth 3 hours later). I was ready to push before that but the OB was busy so I had to wait until his other patient gave birth. My midwife was VERY apologetic. After he caught the baby he left for the next woman, total time with me was probably less than five minutes. He told me as he left that if I wanted to contact him I could call his office but be sure to identify myself as the woman that lost a baby because he wouldn't be able to remember me otherwise (my daughter died shortly after birth). Other OBs are very good at their jobs though - I just got a rotten one. Keep in mind most OBs only catch babies, they do not give support during labour.

Do you have the option of driving back to the city to give birth at a friend's or family with your original midwives? Babies generally give quite a bit of advance notice before appearing. Can you have the hospital birth with the OB and the midwife attending? I know in Ontario midwives always travel in twos, but it can't hurt to ask if your midwife would gve you a homebirth with a Registered Nuse assisting. I assume the OB won't do a homebirth. I have heard of some doctors that do homebirths. If you go to the hospital I strongly suggest you have a doula with a fierce personaity to run interference; your husband needs to be supporting you, not having hushed conversations in the hall while you are alone in the room. (Sorry I don't know any doulas out your way, only in the GTA) My sister was told hospital policy was she had to stay several hours after her midwife/hospital birth but another nurse told her to just leave the premises with her baby and belongings whenever she wanted, it wasn't like they would chase her down in the parking lot. If you go the hospital route bring your own birthing ball (oh god yes! I sat on mine and read) and whatever your OB says/wants trumps the nurse; he says you can leave, not her. If all else fails stay at home as long as possible and then call the ambulance: ooops! we waited too long. The attendants will arrive just in time for your home birth.

And for what it's worth, I did not find my (drug-free) labour or delievery painful; I have the home movies to prove it; wanna see?
posted by saucysault at 5:31 PM on May 25, 2007

Adamantly refuse an episiotomy unless absolutely required. Routine episiotomies are an outdated practice, and they statistically increase the risk of severe tearing.
posted by BeaverTerror at 7:10 PM on May 25, 2007 [1 favorite]

I've got lots of info and resources to help you out. I'm facing a MAJOR deadline by Tuesday next, so I totally can't deal with this now. Email me (in profile) so that I flag it to send you some info/resources. FWIW I'm a sociologist with research and personal experience relating to birth politics/practices midwifery etc.
It IS doable, and there are ways to increase your likelihood.
posted by kch at 10:08 PM on May 25, 2007

Man, birth threads are almost as bad, with the kneejerk raging, as circumcision threads. Good lord.

Are you able to pick up a copy of "Ina May's Guide to Childbirth"? It has a section specifically on how various couples achieved low-intervention births in a hospital setting.

If I can tell you one thing: don't listen to the fearmongers. Just don't listen to them. Tune them out. Turn away. Put your fingers in your ears. Think about your perfect, healthy baby, think about how your body can do this (IT CAN!) Read nice birth stories. If you know any women who had pleasant births, call them and demand to be told and re-told their birth stories.

Surround yourself with the most positive expectation of birth you can. Don't listen to the other people. Their birth stuff is their birth stuff, and it has nothing to do with you.

A doula could be wonderful for you, because a doula is going to be a person in the room who isn't fretful (your husband) or making you feel like you need to hurry up, or do something different. Having a calm person nearby when you're under stress makes you feel better. They're FABULOUS. And they won't massage you or wave incense at you if you don't want them to. But don't underestimate the value of having a calm female figure present who knows, even when your own knowing flags, that you can do this. It's very, very valuable.

My best wishes for you, your husband, and your soon-to-arrive baby!
posted by thehmsbeagle at 11:14 PM on May 25, 2007

IAAOBGYN, and my main advice is to talk to your obstetrician in more detail about what's important to you in your birth plan, and what he/she feels comfortable in accommodating.
People's anecdotal experiences may not be that helpful. Some women deliver in 4 hours with no analgesia, and some have a failed forceps and a c-section after 48 hours. Those are both successes in my view, as long as they get a healthy baby. It's important not to view increased intervention as a failure, and not to imagine that your obstetrician is trying to medicalise your birth. Having said that, if your obstetrician cannot promise one-to-one care from a nurse you like and trust, then book a doula.
posted by roofus at 5:32 AM on May 26, 2007

Home birth is a not a good idea, particularly for a first pregnancy. Too much can go wrong, and two lives are at stake. People who say "Nonsense! Women used to give birth without a doctor around all the time, and in many places they still do" need to be reminded that the places where that is the case have higher maternal mortality rates.
This is not true. I live in a modern country where homebirth is normal and our maternal mortality rate is comparable to that of the USA.

It must totally suck to not have your midwife, and people telling you that this is actually a good thing are not helping at all, of course. I do agree with the sentiments that no birth goes as planned and that in the end that does not matter and you should accept what is and not stress out about what cannot be changed. That does not mean it is not a good idea to be prepared. I was happy to have my birth plan. I would also totally recommend a doula. I wish I had had one. We were completely overwhelmed during and after the birth of my daughter and it would have helped enourmously if there had been someone to encourage us, step up for us, and make sure our wishes were followed. Sometimes medical procedures are necessary, but as you know yourself, they can be the cause of problems as well. If you talk with the doula about this, she will (I assume) be able to speak for you when you feel unable to.

I wish you all the best!
posted by davar at 7:49 AM on May 26, 2007

Response by poster: 'BeaverTerror' is a perfect name to denounce episiotomies with...

Many, many thanks for all these replies piling up here.

"Get a doula" -- got it!
posted by kmennie at 1:50 PM on May 26, 2007

I'm late to the party, so you may not see this. I tried hard to have a good birth experience, but had medical problems along the way, and a surgical birth, followed by a post-partum/ post-surgical infection, and some typical post-c-section complications, not major, but still not fun. One of the bad things was the subtle but real crap I got for 'selling out'/not trying hard enough and having a surgical delivery.

Keep your focus on the goal of a healthy baby and healthy mom. Childbirth class mentioned that c-sections happen in between 1/5 and 1/4 of births, but no other information was offered. I was totally unprepared for it, and the complications after.

Make sure your partner is ready to be ferocious in protecting you, and knows what you want. I got bullied into more meds than I wanted, and it made it a worse experience. The pain was not bad; passing out between contractions was. My partner had concerns about a hospital staffer, and made sure to check them out.

I could make my experience of labor and delivery sound really awful (2 day stress test, x hours induced labor, surgery), but it wasn't horrible until I had to return to the hospital with the infection. But all I had to do was look at my healthy son, and none of it mattered.
posted by theora55 at 9:56 AM on May 30, 2007 [1 favorite]

Best answer: Full disclosure: I am one of those meddlesome labor and delivery nurses.

It sounds like you will be miserable in the hospital, not because hospitals are inherently miserable places to give birth but because you believe that they are. You're very clear that you have no interest in the interventions that are standard at the hospital, and you already seem convinced that your relationship with the hospital staff will be antagonistic and fractious.

The hospital will have policies in place about standard practices for fetal monitoring, IV access, presence and absence of family members at certain times, visiting hours, etc. You can argue with these policies, as is absolutely your right, but the bottom line is that the hospital has instituted them and its employees are obligated to follow them. If doctors and nurses don't adhere to them and something goes wrong, people blame them. This blame is often delivered in a fancy envelope from a lawyer's office.

Do I think you personally would sue someone? No. (In fact, if anything, the opposite--you don't sound like you've got the "everyone else's fault" mindset of our over-litigious society.) My point, though, is that people do it all the time. Every nurse I work with has been supoenaed at least once. My turn will come, I'm assured.

So if our hospital policies say that if in my educated opinion your baby's heart rate is non-reassuring and requires continuous monitoring, I will strap those monitors on you without a second thought, partly because I believe that your baby needs it, and partly because the hospital by which I'm employed states that it's necessary. If you refuse to let me do it, I won't hesitate to call the nursing supervisor, the hospital administrator, or social services. Because your baby is my patient, too, and I have a responsibility to care for you both according to the best practices of nursing care and according to the policies of the hospital at which I work.

If you're unwilling to allow the nurses to care for you as they have been taught to do in school and as they are mandated to do by their hospital, don't go to the hospital and don't put yourself in their care. Spare yourself, and them, the conflict that will inevitably arise.

If you can't find someone to catch your baby at home and there aren't any free-standing birth centers available to you and it turns out that the hospital is your only choice, my advice is speak to the nurse manager first about the policies and procedures you can expect to encounter. She can explain which are non-negotiable and which may have some wiggle room. She can communicate to the staff any special circumstances you're requesting for your delivery so that when you arrive in labor, everyone will know what to expect.

I hope it doesn't sound disingenuous to say, after all that, that I really do wish you a wonderful birth experience, and I hope that you're able to find a way to get that experience with a minimum of stress on you and your husband.
posted by jesourie at 7:41 PM on May 30, 2007 [1 favorite]

The reason women and babies die in (or shortly after) childbirth "in those places" is not because the baby isn't hooked up to a monitor. It's because there's not soap and hot water.
posted by bilabial at 4:48 AM on June 1, 2007

Response by poster: Thanks, jesourie.

(Though now I wonder how much of that, especially given the mention of litigation, can be disregarded in Canada? If any.)
posted by kmennie at 2:55 AM on June 3, 2007

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