Advice on Delivery in Hospital

May 12 2009

While perhaps not technically an intervention, women need to realize that if they choose a birthing center or home birth, the possibility always exists that they may need to be moved to a hospital. The reasons for this are varied. You may want more pain relief than is safe in an outof-hospital setting. Your labor may fail to progress and you may need augmentation. You may have thick, meconium-stained fluid. Your baby may not rotate into a good position for birth or there may be nonreassuring signs in the fetal heart rate patterns.

Moving to a hospital does not necessarily mean that you will have an intervention for the rest of labor or for birth. Sometimes, a labor that progresses slowly starts to move more quickly after transfer. Sometime, a little pain medication is all you need for the rest of the labor to go smoothly.

Transfer is included in this section on interventions because it can be traumatic for the mother. The actual physical reality of transfer can be stressful. The emotional disappointment can be great, if you have not adequately prepared yourself for the possibility that your labor and birth plan has to change.

Every birthing center and midwife or physician who practices home birth has policies for transferring the mother, or the baby after birth. You should become familiar with these. Everything you want for birth-a healthy baby and a healthy mother-are independent of the birth site. With this in mind, your experience can be satisfying and happy after transfer.

A Bit of Advice

Labor might be easier to handle, and certainly more convenient, if it could be planned. Child care arrangements or work-related activities would be more manageable if you knew exactly when labor would start. Pain might be more tolerable if you knew exactly when it would end. You might have more energy for pushing if you were certain it would last no more than 47 minutes. Women today are used to being in control of their lives, scheduling things well in advance, living by their weekly, even monthly, calendars.

The process of labor, fortunately or unfortunately, was not designed for convenience. Predictability is not a word that can be used in its description. Most pregnancies classified as at-risk or even highrisk actually need few interventions. An occasional pregnancy considered perfectly normal may require several interventions, even a cesarean delivery. Since you cannot plan or predict, all you can do is be prepared. Be aware that an intervention may become necessary even one you assumed you would never need.

Know your physician’s or midwife’s practices in advance. Be sure you are comfortable with their answers to the following questions:

Will they induce at 42 weeks with a cervical ripening agent if your cervix is not ready, or continue fetal surveillance?

Do they use prophylactic forceps?

Do they prefer forceps or a vacuum extractor?

Will you be admitted to a hospital if your membranes rupture before labor or will you stay at home, taking your own temperature?

Will they induce labor within a set period of time if your membranes rupture, or will they practice watchful waiting?

Do they do a cesarean for all babies in the breech presentation? If not, what is their experience delivering vaginal breeches?

Remember, many of these questions have no absolute right or wrong answers. What is right is that you and your physician or midwife have similar feelings and attitudes. In the final analysis, your care provider should be someone you are comfortable trusting.