birth plans, moving around during labor - which hospital will support?

[Anonymous]

Hello everyone. This is my first post here and my first pregnancy. I am 8 weeks along and have an OB in town. He delivers at Sibley and is very open to birth plans, natural childbirth, and other things that I want to aim for with my birth and deilvery. I have been hearing from other mothers, however, that it doesn't matter how supportive your doctor is, the only way you will be allowed to have a completely mobile childbirth (squatting, hands and knees, walking around, showering, standing, side-lying birth, etc) is to have a home birth with a midwife. I have been told that once you get to a hospital, you are stuck in the lying down or slightly upright position with a fetal monitor strapped to you from hour one.

In fact, my good friend is a nurse at GW. She told me that if I don't want to be strapped to a fetal monitor, my only option is to labor as long as I can at home because once I'm there that's pretty much what I can expect. She also told me that GW delivers in the semi-upright but still back-lying position. I do not have any friends at Sibley to speak about their policies, and a friend who delivered there had a c-section, so she doesn't know either.

From research I've done on childbirth, it seems remarkably clear that this is NOT the best way to give birth. I wonder if my friend is correct that this is the preferred position? I am 35, so I would like to benefit from the safeguards I feel I'll get in a hospital surrounding, but I still want to be sure that I'm allowed freedom to get up and walk around, intermittent fetal monitoring, and the ability to change positions during labor. Obviously, if I find myself in a situation where safety dictates otherwise, I will follow medical counsel. But I don't want to go into it knowing that I'm going to be on my back in stirrups or otherwise overly restricted during labor.

This may seem like a remedial question to some of you, but I just can't believe that with all we know about labor now, that hospitals would continue to insist on back-lying positions. So I am wondering if anyone has any experiences and if you can recommend one are hospital over the others. I like my OB, but the birthing experience is important enough to me to consider changing if there were serious advantages to be had at another hospital.

Thanks so much for any input.

F.

[Anonymous]

I'm 29 weeks along and delivering at Sibley. We recently toured the maternity floor and they are basically okay with whatever your doctor's okay with. Pretty much everything there is physician-directed (if you push lying down, if you are on continuous monitoring, episiotomy or not, etc--btw, they have squatting bars there, if that's how you choose to push). I asked my sister-in-law if that was, in fact, her experience when she delivered there, and she said it absolutely was--she had an unmedicated birth with intermittent monitoring, laboring on a birthing ball, walking around, etc. When we discussed it with my OB, he said the same thing--Sibley will let me do whatever he lets me do, and he'll let me do whatever I want as long as there is no medical emergency.

[Anonymous]

15:47 poster here--one more thing, the person who gave us the tour said it would be good for us to give our birth plan (which we're calling our "preferences") to the OB and have him include it in the prenatal file that gets sent to the hospital before the due date so that they can try to assign a nurse that has experience with unmedicated births to me. We're doing hypnobirthing and she said we can even ask for a nurse who has experience with hypnobirthing when we get there and if there's one available they will assign her to me. They seemed incredibly flexible and supportive when I was there. As my doctor said to me, he and the nurses are there to support me and he doesn't want me to see them as the enemy (which, honestly, a lot of the books I've been reading, written mostly by midwives, seem to suggest doctors and nurses are). Oh, and my doctor is Dr. Footer (Robert, not Richard).

[Anonymous]

Lying on your back is usually NOT the preferred position as it doesn't allow the pelvis to fully open up. From the reading I've done, the best positions are usually squatting or on all four's. However, with an epidural, lying on your back (or perhaps sitting up) is essentially the only way you can give birth since you don't have the ability to move your lower body. I would guess that at a hospital such as GW, most women end up with an epidural, so that's why the nurse thinks that's the only "acceptable" position. I gave birth at Georgetown, so I have no insight on how things are at Sibley, but my general impression is that the OB can usually override the hospital regulations (perhaps with some exceptions, such as monitoring during a VBAC or something like that), so your best bet is to discuss your preferences with your doctor.

[Anonymous]

Hi there, OP here. All of this is reassuring, because I do think my doctor is flexible. What I've heard is really just solely related to GW and the deliveries my friend has seen.

PP 57:14, is your Dr. Footer the partner of Dr. De Souza? I have an appointment with Dr. De Souza this Thursday. I have liked him so far, although all we did initially was confirm the pregnancy. At that time, I didn't even know to ask all of these questions about labor.

I intend to write a birth plan (or preferences, which may indeed be a better way to put it) but will respect my doctor's decisions of course. The more I read about labor and delivery, the surer I am, however, that I DON'T want to deliver on my back. Sure, if I cave and get an epidural (I don't plan to, but I won't say never) I understand that will limit my options greatly. If it gets to the point that I want an epidural, however, it will probably mean that I've exhausted too many resources to squat, anyway! Bottom line is that if I endeavor for a natural birth, I don't want to be stuck in a position that will undermine my success or aggravate my pain.

Thanks for all previous and any further insights!

[Anonymous]

I was induced at GW, and I got the feeling that the only reason that I gave birth lying down on my back was because I had an epidural. Until I got the epidural, they were totally fine with me taking off the monitors and walking around. I had to ask for the narcotics I received before I got my epidural, too, and they asked me whether I wanted the epidural; they didn't assume I'd get one.

[Anonymous]

I gave birth at GW and also had the flexibility (and was encouraged) to walk around, but I ended up choosing to lay down (semi-upright) eventually because the pain reached an intensity where I didn't feel like I could stand. At that point, I also got an epidural.

[Anonymous]

15:47 poster again--yes, my Dr. Footer is the one who is backed up by Dr. De Souza (and backs Dr. De Souza up). I haven't met with Dr. De Souza yet (will meet with him him a little later in the pregnancy just in case he has to deliver my baby). Dr. Footer said Dr. De Souza is just like him in terms of being open to whatever I want as long as there's no medical risk.

[Anonymous]

I gave birth twice at Sibley and they had no problem with me walking around, using a birthing ball, rocking chair, etc. until the point when I wanted an epidural (as per my birth plan) and then I had to be monitored, so I was limited to the bed. But I thought all the nurses were great. They were supportive of my 13-year old being in the room and cutting the umbilical cord.

I have a friend who gave birth at GW, on hands and knees, unmedicated. But I don't think the staff had much choice about it -- she said she barely got her pants off before the baby came out. (Second baby, so it was a short labor and fast delivery.)

[Anonymous]

The thing is, any nice doctor is going to tell you how open he is ahead of time. "Sure, whatever you want" is what they will tell you. And I really do think they believe it. Then, when the moment comes, OF COURSE they want you lying on your back for the delivery. Or of course they want you to have the IV or of course they want you on the monitor as much as possible - and there is always some reason that seems unique to your situation. What you should do ahead of time is ask very specifically (this is just one example) if he will *actually* deliver the baby while you are on your hands and knees, or standing in the bathroom, or squatting next to the bed. Or will he, at the last moment, request that you lay down. Ask him how often he really catches a baby in some alternative (ie, not lying down) position. Also, just a side note, even if you have an epidural you can (depending on how strong it is) still deliver your baby in a squat or hands/knees. Though I've only ever seen midwives allow that.

[Anonymous]

I go to Dr. DeSouza. I am planning a natural Bradley birth. I agree that some doctors will say they are okay with it when that might not be their practice, but when I brought it up to Dr. DeSouza he told me all the reasons a natural birth was good, which reassured me that he will support my choice. He also told me I can labor at home with this one (my first, he said I'd have to come to the hospital sooner with a second) until I am close to fully dilated.

As for Sibley, you just have to have someone with you (a doula preferably) who will advocate for minimal intervention which would limit your movement. They do have squat bars, so even if you are birthing in the bed you can be squatting. They are a hospital, and 95% of women there have epidurals, so of course that's what they are good at and you're going to have to be more prepared to fight for what you want...no matter what they tell you on the tour about how natural birth friendly they are.

[Anonymous]

My sister-in-law had an unmedicated birth at Sibley earlier this year and didn't feel that she had to fight at all. She didn't have a doula--it was just her and my brother--and she thought the nurses were great and very supportive. She had a very long labor and they never pressured her to do anything she didn't want to do (Pitocin, epidural). So while I think it's important to have a birth plan and to be confident in your decisions so you actually stick to your plan, I don't get the sense from talking with my sister-in-law and the two other friends who delivered at Sibley this year that the nurses had any kind of agenda. The friend who had an epidural went in knowing she wanted one, and I think that's pretty common. So looking at epidural rates alone might not mean much--it might just mean that a lot of women who choose to give birth in a hospital also choose to get an epidural.

[Anonymous]

I gave birth at Sibley last weekend unmedicated (not by choice). I had a FANTASTIC L&D nurse who had previous training as a doula. I thank heavens for her, because I was terrified.

I was able to get up and walk around no problem whatsoever, go to the bathroom, etc. They did require fetal monitoring every 30 minutes, for about 15 min at a time. My only complaint is that the nurses didn't check on my progress often, so everyone was in shock when I went from 3 cm to 10 within 1.5 hours and had to ask to be seen by the doctor because I was in so much pain. At that point the epi was out of the question. But, I felt NO PRESSURE to get an epi until I asked for it...but once I did it was too late.

You can pretty much do what you want unless/until you get the epi. Then you're on the bed on your pack, period.

[Anonymous]

Anonymous wrote:I go to Dr. DeSouza. I am planning a natural Bradley birth. I agree that some doctors will say they are okay with it when that might not be their practice, but when I brought it up to Dr. DeSouza he told me all the reasons a natural birth was good, which reassured me that he will support my choice. He also told me I can labor at home with this one (my first, he said I'd have to come to the hospital sooner with a second) until I am close to fully dilated.

As for Sibley, you just have to have someone with you (a doula preferably) who will advocate for minimal intervention which would limit your movement. They do have squat bars, so even if you are birthing in the bed you can be squatting. They are a hospital, and 95% of women there have epidurals, so of course that's what they are good at and you're going to have to be more prepared to fight for what you want...no matter what they tell you on the tour about how natural birth friendly they are.

Hi, thank you -- Dr. DeSouza does seem very supportive of a natural birth. I have heard quite a number of recommendations to hire a Doula but I'm not sure it's the right move for me. My husband and I are both very independent and good at self-advocacy, and I don't really want a crowd in the delivery room. How well do you get to know the Doula? I'm so private, that I think I would much rather NOT have yet another person in the room focused in on me in that situation, but that might be cutting off a resource. We are fortunate that if we want, we can hire a doula, but I haven't decided yet. I'm wondering if anyone else thought it might be intrusive or if that's just really crazy. I do intend to take the full-on intensive Bradley child-birth class.

[Anonymous]

Hi, PP who sees Dr. DeSouza. As for the doula question, I am having a family member in the room who is an OB nurse so we didn't hire one. I just think you need someone there to enforce your decisions with the staff. While you are normally independant (all Bradley students are pretty Type A), you will be vulnerable from all that oxytocin and your husband's job is to coach you and take care of you, so we wanted one other person to protect our space for us.