Sample of my Birth Requests for the Hospital

Here it is so far...

This is what we'll be giving to the nurses and midwives. At this point it sounds like the request for vitamin K drops might be out, depending on the pediatrician/availability. I have made a few minor changes to this document since my son was born, and of course, this is always a living document and work-in-progress. Feel free to comment.

Birth Requests Thank you, Samaritan Hospital Team, for helping us make this a special experience!

During Labor and Delivery Please knock before entering the room

Jacuzzi Tub I prefer to labor in the water for as long as possible.

Vaginal Exams Please ask each time before examining me, I am easily startled!

Pitocin, Analgesics and Anesthetics Please DO NOT offer these. We will discuss the need for these with our doula and midwife. We would like a natural childbirth modified only by conditions that directly threaten the health or safety of the mother or child.

IV We would like to avoid the use of an IV, if possible, and prefer to hydrate with electrolyte drinks. If the IV becomes necessary, please allow alternation between glucose and saline.

Monitoring We would like to avoid as much monitoring as possible. Please allow intermittent monitoring so that I may maintain mobility and change positions often. Please allow us to turn the machines and lights down to create a less stressful environment. We may ask to use the Doppler in addition to the fetal monitoring system to gain a more accurate picture of the baby's heart rate.

Natural Progression We would like to allow our labor to progress naturally, without pressure to speed it up for any time constraints, unless there are circumstances that truly threaten the mother or child. I may decide to change positions often and hope the nurses and midwives will facilitate any birthing positions I feel I would like to try.

Episiotomy We would like to avoid an episiotomy with the help of perineal massage, warm compresses, and taking the time to push slowly during key moments.

In Case of Cesarean Epidural. Please suture the layers one at a time. Give Toradol post-op.

Immediately After Delivery We request that the baby's cord be clamped and clipped only after it has stopped pulsating, or at least 2 minutes after delivery. Please place the baby on my chest and allow 45 minutes for nursing and bonding before bathing the baby etc. The father would like to clip the cord.

Routine Tests We ask that our baby not receive Vitamin K shot or eye ointment, please. We would like to request Vitamin K drops as an alternative. Please delay routine testing procedures for 45 minutes, and check with us before they are done.

Circumcision In the event that our baby is a boy and choose to have a circumcision performed during our stay: we would like a non-Gomco clamp circumcision and a local anesthesia applied.

Vaccinations/Medications We would like to waive the erythromyacin ointment.

No Bottles or Pacifiers, please!

I tried to keep this pretty simple, only mentioning the things that were really important to us. The nice thing is that several of the items on here were also questions on the hospital's pre-admission paperwork. Of course we can't know exactly how things will happen. I've removed my midwives', husband's and doula's names for their privacy. It all fits nicely on one page :) I've also written a document with requests for my doula and husband during the labor...but I think I'll wait to post those.

Pregnant in America

Just finished watching "Pregnant in America". This isn't so much a review of the film, as it is a record of interesting things I wrote down as I was watching.
I have two things to say first: #1) Yes, this film does sort of try to make you so afraid of the medical establishment that you'll want to give birth at home (but its not completely unwarranted). And #2) If this film doesn't make you cry a little, you must have a heart of stone!

At the beginning of the film, the documentarian is interviewing random people on the street about hospital birth. One woman says,"I don't know how have a baby on my own. If I did, I'd do it on my own." This made me so sad! I wanted to tell her, "No! Of course you know how to give birth on your own. You just don't know you that you do!"

I love it that they interview Ina May Gaskin in this film, because she is totally my hero and the mother of modern midwifery. If you read her, she will totally be your hero too. She shares the words for "midwife" in various languages. I love the French word: 'sage-femme' meaning 'wise woman.' That's exactly what a midwife really is.

Cesarean
The U.S. ranks 28th on the list of infant mortality rates in the world. What the heck? Why is that? How is the U.S. medical system different than other developed nations? The premise of this film is that our high infant mortality rate is due to our high rate of epidurals, high rate of "convenience cesareans", and high rate of "convenience inductions". Personally, I'd argue the root of this stuff is women not educating themselves about labor/delivery/risks/options and also corrupt doctors. (As a side note, I want to point out that we have no system of recording maternal morbidity rates and/or their relation to hospital interventions).
In the '70s the cesarean rate in the U.S. was something like 5 - 7%. In recent years its been something like 23 - 29%. In certain hospitals, its rumored to be as high 80%! The World Health Organization (WHO) warns us not to exceed a rate of 15%. Part of the reason the rate has gotten so high is because it is "more efficient". A C-section takes 20 minutes, whereas a doctor might have to wait as much as 30 hours for a woman to labor and deliver on her own. The people we're asking to care for laboring women aren't trained in attending normal births; they're trained to be surgeons. Sometimes they're just looking for a reason to perform surgery.

We like to think a woman wouldn't put her baby in danger for the sake of convenience (but Victoria Beckham scheduled her children's births around her husband's soccer schedule).

Induction
One expert in the film states that 50% of women who are induced end up with a C-section (though it doesn't state whether that number is for artificial induction or all types of inductions). From 1990 to 2000 the rate of women who were induced shot up from 10% to 20%. During the same 10-year period, the number of babies born Monday thru Friday shot way up. Hmm, you don't think doctors would tell women they need to be induced when they really don't...do you? (Watch the film and see for yourself!). Marsden Wagner from the WHO says,"Artificial induction of labor is one of the most serious and dangerous interventions you can make and should only be done if there's and important medical risk." When you look at the list of risks associated with induction, its just plain unethical that doctors are inducing women with drugs at the rate they are. A personal note on ethics: a friend of mine whose husband went to a well-respected medical school, told me they only spent about one afternoon teaching their future doctors about ethics in medicine. Groan. There is one section of the film in particular that discusses corrupt doctors, and it made me sick to my stomach.

The case for home birth
Animals choose the safest place give birth to their young. The basic need for all mammals to give birth is privacy--not to feel observed. Dogs, horses, cats...any mammal giving birth will go find a comfortable, safe place to hide. Human women are no different.

I saw in another film that primates who have a C-section will reject the baby and not care for it. When a woman gives birth she releases a complex cocktail of hormones--love hormones, but having a C-section interferes with the release of those hormones. I wonder if these unnecessary C-sections are robbing women of a special feeling of bonding with their baby?

The evil insurance companies
If you've ever watched the news in the last 5 years, I probably don't need to tell you that insurance companies and drug companies can be pretty evil. This film goes into that fact in some depth that I won't. One woman said,"We're victims of our insurance, so whatever [our insurance company] says we have to do is what we have to do."
I feel absolutely blessed that the insurance we have assigns us to a military obstetric office in which I am cared for through my pregnancy and delivery by wonderful midwives--unless there's an actual reason for me to see an OB/GYN!

All this to say: No, not all doctors are corrupt, and No, you're not doing it wrong if you choose to have your birth in a hospital with an epidural, but please be informed! Your doctor probably isn't going to list every single risk associated with every intervention they might do in the hospital, and you're certainly not going to be in a state to learn about it and respond rationally when you're in labor. So please--I beg of you--inform yourselves!