Print
Dec
01

The Hospital “Birth Plan”

Author // Molly Remer, MSW, ICCE

There is a fairly normal course of events for women giving birth in a hospital setting. In order to be truly prepared to give birth in the hospital, it is important to be aware of today’s standard hospital procedures. All hospital procedures and interventions can be refused under your right to informed consent, but doing so requires knowledge, strength and attentiveness. I hope the following list of things you may encounter in the birthing room will encourage you to talk with your medical care provider in advance about hospital routines and your own personal choices, as well as help prevent unpleasant surprises during your baby’s birth.

This list has been modified from content in Woman-Centered Pregnancy and Birth. These points might not necessarily reflect how your own hospital operates; that’s something for you to investigate and discuss with your medical care provider.


Appearing in Issue #24. Order A Copy Today

The following are typical, routine procedures encountered in hospital births. If you are made aware of their standard protocols, you’ll be better prepared to deal with them if and when they arise:

  • To have at least some separation from the person who brought you to the hospital due to filling out admission paperwork, parking the car, providing a urine sample, being examined in triage, etc.

  • To be told to remove all your clothing and put on a hospital gown.

  • To have staff talk over you, rather than to you, and to have many different people walk into your room whenever they want without your permission and without introducing themselves.

  • To have your cervix examined by a nurse upon admission and approximately every hour thereafter. If you allow it, you may have multiple vaginal exams per hour by more than one person.

  • To have an IV or a saline lock inserted into your arm.

  • To be denied food and drink until the birth. (At best, expect clear liquids or ice.)

  • To be asked to give a urine sample and perhaps a blood sample.

  • To have an ID bracelet attached to your wrist.

  • To have to sign a consent form that states your doctor will be responsible for making the decisions about your care—rather than you.

  • To have a fetal heart rate monitor attached around your belly—two round discs on straps that will often stay with you continuously until you give birth (or, at best, for 15 minutes out of each hour of your labor).

  • To have your water manually broken at about 4 centimeters. Afterward, they might go a step further and screw an electrode into your baby’s scalp to measure the heartbeat and place a tube in your uterus to measure your contractions.

  • To be offered pain medications repeatedly, even if you have stated you do not want them.

  • To be offered Pitocin at some point during your labor “to speed things up.”

  • To be told you must remain in your bed through most of your labor, especially when pushing.

  • To either have your legs put in stirrups or held at a 90 degree angle at the hips.

  • To be told when to push, and perhaps even told you are not pushing correctly.

  • To be given an episiotomy if someone else determines that your perineum will not stretch.

  • To have the cord clamped and cut before it finishes pulsating.

  • To have your baby suctioned repeatedly.

  • To be given a shot of Pitocin to make your uterus contract and deliver the placenta.

  • To not be asked if you want to see the placenta.

  • To hold your baby on your chest for a few minutes, before it is taken away to be dried, weighed, warmed by a machine and checked over.

  • To have antibiotic eye ointment put into your baby’s eyes without first being asked permission.

  • To have your baby receive a vitamin K injection without first being asked permission.

  • To have your baby receive the Hep B vaccine without first being asked permission.



It is important to note that much of this treatment is different from what you deserve, and that you have the right to refuse any of the above procedures and recommendations. At minimum, what you deserve are what Lamaze calls the Six Healthy Birth Practices:

  1. Let labor begin on its own.

  2. Walk, move around and change positions throughout labor.

  3. Bring a loved one, friend or doula for continuous support.

  4. Avoid interventions that are not medically necessary.

  5. Avoid giving birth on the back and follow the body’s urges to push.

  6. Keep mother and baby together—it’s best for mother, baby and breastfeeding.


So, how do you work around these routines and achieve your desire for a natural birth?

  • Go through the above list and decide which procedures you do and do not want. While you might accept certain procedures, you have the legal right to refuse anything. You might also want to develop a backup plan for how to deal with any unexpected situation that arises.

  • Take an independent childbirth class (e.g. Lamaze, Bradley, HypnoBirthing, Birth Works, etc.) and learn a variety of techniques that focus on trusting your body so that your “toolbox” is well-stocked.

  • Hire a doula, or bring a knowledgeable, helpful, experienced friend with you. It can help to have a strong advocate by your side—particularly if this isn’t a role your husband or partner is willing or able to assume.

  • Never ask permission, but proceed with what you want to do until hospital staff attempts to stop you. (An example of this is eating, or getting up and walking around during labor.)

  • Bring light foods and drinks and quietly partake as you please. Restricting birthing women to ice chips is not evidence-based care.

  • Leave the hospital early, rather than remaining the full length of your allowable stay. This will minimize unnecessary separation from the baby and any additional interventions.

  • Request a nurse who is supportive of natural birthing. Better yet, ask your doctor or the hospital staff in advance for the names of those nurses, and request whichever of them is on duty at the time of your birth.

  • Put a sign at eye level on the outside of your door saying, “Natural birth in progress. Please do not offer pain medications.”

  • Labor at home for as long as possible. If you arrive at the hospital too early, you will increase the risk of unnecessary medical intervention. Once your contractions require your full focus and attention, start heading to your birthing location.

  • Use the hospital bed as a tool, not for lying down.

  • Retreat to the bathroom if you feel you need to get away. People tend to leave us alone in the bathroom; you can use that as your place to focus and regroup. Also, because we are conditioned to relax our pelvic muscles when seated on the toilet, spending some time there can actually relax you and help the baby descend.

  • Use the “broken record” technique: If asked to lie down for monitoring, say, “I prefer to remain seated,” and continue to reinforce that preference without elaborating or arguing.

  • Do not lie down, even if you agree to fetal monitoring. Sit on the edge of the bed, on a birth ball or chair near the bed, or kneel on the bed and rotate your hips during the monitoring.

  • Bring a birth ball with you and use it—sitting near the bed if necessary. Birth balls have many great uses for an active, comfortable birth.

When any intervention is recommended during your pregnancy or labor, remember to use your “BRAIN”—that is, ask about the Benefits, Risks and Alternatives, check your Intuition, and ask what would happen if you did Nothing. If an intervention is aggressively promoted during your birth, you can not only refuse that intervention, but you can also ask, “Can you guarantee in writing this will not harm my baby? Please inform me of the risks and then show me the evidence supporting your recommendation.” A classic example is the recommendation of Pitocin due to “failure to progress.” Pitocin not only increases your chances of unnaturally intense contractions, but dramatically increases the likelihood of subsequent interventions as a result of the risks it introduces. Keep in mind that each and every medical intervention has been shown to increase the use of further interventions. All interventions have potential risks for you and your baby.

A great birth, where you are in control, is possible in any setting—provided you understand your rights, know what to expect and have strategies to protect yourself from unnecessary medical intervention.

Finally, birth is not a time in a woman’s life when she should have to fight for anything. If you feel you are preparing yourself for “hospital self-defense,” that’s a cue to explore other birthing locations and care providers. Also, remember that hope is not a plan. If you find yourself hoping for what you want (rather than simply being confident that you’ll get it), it could indicate your intuition is onto something, and it’s time to take another look at your current birth plan.



Before You’re Admitted

Choose your doctor carefully. Don’t dismiss feelings of doubt and uneasiness. A key point is to select a provider whose words and actions match. For example, if you are told episiotomies are only done “when necessary,” then make sure you ask specifically for their statistics to ensure you are dealing with facts and not rhetoric. If you don’t want surgery, don’t hire a surgeon. Find a midwife or family physician who attends births and is skilled at delivering babies, rather than an OB with a high cesarean rate who is skilled at surgery.

If there are multiple hospitals in your area, choose the one with the lowest cesarean rate rather than the one with the nicest birthing rooms or most decadent postpartum meal. Hospitals—even those in the same town—can vary widely on their policies. Practice clear and assertive communication with your doctor and reinforce your preferences often. You deserve quality care that is based on your unique needs and wishes.

Do not choose your birth options based on insurance coverage, but rather on the location where your needs will be met most effectively. We take out loans for cars, houses and other material objects—recognize that your investment in supportive care providers for a birth of your choice is much more important, as it will affect your child’s well-being for the rest of his or her life.

Discuss in advance the type of nursing care you would like and request that your doctor put any modifications to the normal routines in your chart as “doctor’s orders.” If your doctor is unwilling to do this, consider it a potential red flag.

Read empowering books, watch natural birthing DVDs and connect with women who have had natural births. This will instill confidence and trust in your body, your baby and your innate birth wisdom. Use affirmations to help cultivate a positive, joyful, welcoming attitude.

Suggest that your partner read a book like The Birth Partner or Fathers at Birth.

Practice prenatal yoga, such as on the Lamaze Yoga for Your Pregnancy DVD.

Learn relaxation techniques. A calm mind and deep breath cannot be taken away from you, no matter what happens. The book Birthing From Within contains several breath-awareness strategies.

During pregnancy, ask questions and research any medical procedure that is recommended to you, such as a non-stress test, a regular sonogram or a gestational diabetes test. A good place to start is at Childbirth Connection (childbirthconnection.org), where they have the full text of the book, A Guide to Effective Care in Pregnancy and Childbirth, available for free download. It contains a summary of all the research behind common forms of care during pregnancy, labor and birth, and whether the evidence supports those procedures.

Ask for the blanket consent form in advance and decide whether to sign it, or modify and initial it as needed. Ensure you are truly giving your voluntary informed consent rather than signing away your rights in advance of your birth.

Consider the ways you might be sabotaging yourself. If your greatest fear is having a cesarean, then don’t choose a doctor with a cesarean rate higher than the 10 to 15 percent range recommended by the World Health Organization. If you are giving yourself an excuse like, “I can’t switch doctors this late in my pregnancy,” know that you can switch—no matter how far along you are. A great book to help you explore these kinds of questions is Mother’s Intention: How Belief Shapes Birth, by Kim Wildner.

Believe you can achieve the birth of your dreams, so that you and your baby can enjoy a beautiful, empowering and positive birth!


Molly Remer

About the Author:

Molly Remer, MSW, ICCE, is a certified birth educator, writer and activist. She is a La Leche League leader and the editor of the Friends of Missouri Midwives newsletter. She has two wonderful sons, Lann, 6, and Zander, 3, and lives in a straw bale house in central Missouri. She blogs about birth at talkbirth.wordpress.com and midwifery at cfmidwifery.blogspot.com.




Pathways Issue 24 CoverThis article appeared in Pathways to Family Wellness magazine, Issue #24.

View Article References

View Author Bio

To purchase this issue, Order Here.