When people email me or call me about classes, one of my first questions is "Where are you currently planning to having your baby?" The word "currently" throws them off, but I want them to know upfront that it's not set in stone. More than 50% of people that take my class do switch their care provider and/or birth place.
It seems that most people choose their hospital because that is where their OB delivers. They've been with him/her for years and just loves him! They honestly believe that their OB will support their decision to have a natural birth. This post is not about your OB however, but the hospital.
Fact: You are more likely to have a c-section in a busy hospital than elsewhere. Define busy? Well, the hospital I had Daymon averages 30 babies a day. I'd call that pretty darn busy. There's a hospital in the Ft. Worth area that touted more than 5000 babies a year on a billboard. It is normal to think, Oh good, they do this a lot, so they must be really good at it. Practice make perfect, right? If you do the math, that average is almost 14 babies a day. Doesn't sound so bad after the average of 30 a day I just threw out! This particular hospital's c-section rate is 35-40% -- straight from the horse's mouth.
But does practice make perfect? Why would a busy hospital have a higher c-section rate? Let's face it -- it's like the Olive Garden (I worked there for 4 years and love the OG, so this is not a slam on them!) and you cannot sit at a table all night. We need your table. The lobby is filling up and your server needs to make money. We cannot allow you to take up this table any longer!
And so it is with labor. They simply will not allow you to occupy a room longer than a day. At 24 hours, or very close to it, your time is up. The OB can make up a million reasons why you need a c-section (fetal distress, baby too big, water broken for 24 hours, failure to progress, maternal exhaustion, the list goes on and on), but ultimately, your time is up. You failed to progress on our time frame.
If you've seen Born In The USA, a PBS documentary, you've witnessed the scene where the residents are sitting around a conference room discussing a particular labor where the woman had a c-section because her time limit was up on pushing (my words, not theirs). Part of that dialogue includes an OB explaining that it goes against their very nature to not do anything in the hospitals. She explained that in the hospital, nurses and doctors are constantly monitoring and assessing, monitoring and assessing. They will not just sit around and wait on your labor. You expect a baby out of this, and darn it, we will be the ones to do that for you!
So, we have imposed time limits. Next, we simply have hospital policies. Things such as: continuous electronic fetal monitoring (EFM), routine vaginal exams (usually every 2-4 hours), no walking after water breaks (which you're not doing anyway if you have EFM), and a routine IV. I talk about all of these things at length in class, so I don't want to spoil all the fun here. Suffice to say, none of these things are good for your labor. You are more likely to have a c-section when these policies are in place. These are red flags! Run! The local hospitals that have these policies have 60% c-section rates. Ultimately, your baby is left to figure labor and birth out on his own. You will not be moving around, changing positions, rotating hips, or using gravity to assist the baby on his way down and out. Labor is harder for mom and baby under these conditions.
Another red flag along the lines of policies are no VBACs (Vaginal Birth After Cesarean). Over 800 US hospitals banned VBACs in the last decade. ACOGs recent statement said that women should be given a "trial of labor" -- don't get me started! -- but I haven't seen any change as of yet. A hospital who does VBACs is hopefully following evidence-based maternity care in other areas as well (allowing women to eat and drink in labor, intermittent fetal monitoring, hep-lock instead of IV, and no routine vaginal exams).
Honestly, I believe you are more likely to find this type of care with a midwife than an OB. The vast majority of OBs simply are not trained in normality. They are trained in the management of labor and birth. And make no mistake -- they will manage your birth. If your hospital does not even have midwives, this is also another red flag. Midwives bring a different attitude and philosophy of birth to a hospital. As long as the staff is open and willing to listen to the evidence, midwives can make a huge impact. If the doctors won't listen to the midwives and let them be midwives, again, run.
Birth is very political. I was speaking with a CNM the other day about this topic. She's only been out of school for about a year. She said they didn't talk about how political things are in birth while she was in school and she's been shocked by it since working in the field. It's like I always say, as long as the baby is still inside, you have options. I've had a handful of women change their plans in the middle of labor! Don't let your birth be a political battlefield. Fighting with the staff is not an option. This also is not good for mom or baby and is not how anyone should remember their labor.
No matter how scary you think it may be, changing care providers or hospitals (or even switching to a home birth!) can be the difference between a c-section and a vaginal birth. If you have an outcome you are not happy with, you will always wonder what would have happened if you had switched to a better birth place. Like Tim sings, "There's no such thing as what might have been, That's a waste of time, drive you outta' your mind." (Had to sneak him in there!)
You might have to drive a titch further, but in the long run, you'll only give birth to this baby one time. Regret is a yucky thing, especially when you had the red flags laid out before you and you chose to tie your blindfold on and hope for the best. Don't be a victim of bad hospital policies!
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