We’ve now covered questions for both maternity providers and pediatric providers, but there is still an important aspect you need to investigate — THE HOSPITAL — if you’ve decided that is the location where you will deliver.
The questions you ask your provider are important, no doubt. But often in the hospital setting, the doctor or midwife only pops in from time to time and then when it is time for the birth. The hospital policies and staff are frequently the elements that will impact your birth experience the most.
Unfortunately, if your chosen provider only has privileges at one facility or you are constrained by insurance networks, you may not have much leeway to make a choice regarding WHERE you deliver. I still would encourage you to ask these questions so you know what to expect.
Asking the right questions will help you prepare your birth plan as it will give you details that are particularly important to address. For example, if it is very important to you to be up and moving during the birth but the hospital where you will give birth requires continuous fetal monitoring, you will want to find out if they offer fetal monitoring by telemetry. If it is important to you to have a natural birth but the hospital has a 40% primary c-section rate, you’ll want to find out what they offer to help you succeed in having giving birth naturally. You get the idea.
You will likely find that it is a bit more difficult to get answers from a hospital than from an individual provider. There is a lot more bureaucracy to get through in a large facility than a small doctor’s office.
So where do you start?
I recommend you start by calling the labor and delivery floor of the hospital. Let the person who answers know that you are pregnant and you have a few questions. Ask them to direct you to the best person to help you. Hopefully, they will know exactly what to do and who to send you to so you can move on to getting the information you need. However, if they aren’t helpful, you might have to contact hospital administration to get answers which will likely be even more difficult.
Understand that no matter who you talk to you, you are going to hear what the policies are and often the person with whom you are speaking has no control over those policies. Rather, they are required to follow them. This is why it is so important for you to learn what the policies are. You need to be prepared.
If you start asking questions early, you can do the research you need to do to figure out ways to have the birth you want even if policies seem to stand against your wishes. Or, of course, you can look at alternative providers or facilities if you happen to be looking at a hospital that provides no wiggle room.
Another element you need to consider is that your experience at a hospital depends heavily on the nurse who is assigned to your care. I say this with as much sympathy as I can for any nurses that might be reading because I am a nurse and I have been there. I worked in labor and delivery from both ends of the spectrum. I have been all-in with the medical interventions thinking that women wanting a natural birth were “crazy”. Years later, after learning what I’ve learned, I have also been all-in with moms who want to labor naturally, thinking the medical interventions were mostly unnecessary. Depending on which side I was on when you had me as your labor nurse, you probably have completely different opinions of my care.
So, as with any aspect of life, personality, beliefs, and attitude can greatly impact the whole situation. If you are assigned someone who loves their job and loves supporting women’s birth choices, you’ll have a great experience. But if you get assigned someone who is having a bad day, or worse, hates their job or hates having their routine altered (like natural birth can sometimes do), it may be a rough road for you.
You CAN ask for a nurse who enjoys working with moms in natural labor when you are admitted. Hopefully there will be a nurse like this on shift. Remind them as they are going off shift to let the oncoming charge nurse know of your request as well.
So let’s look at some of the questions you may want to ask hospital personnel when choosing where to birth. Again, like I said with the other “Questions” blogs (LINK), you will need to prioritize and decide which questions are most important to you because it is highly unlikely that someone will have time to answer all of these questions for you. Mark the ones that you feel are most vital for you to make a good decision and then work in others as you have the opportunity.
- Where do I go when I think I’m in labor?
- Where do I park?
- What does parking cost?
- Will I have a private room?
- Are all of the rooms like the ones we will be shown on the tour or are some smaller or not renovated?
- On average, how many babies are born here per day?
- How many people are allowed in my room during labor?
- How do you manage laboring women if all of your labor rooms are full?
- How often does this happen?
- Is there a waiting area available for other family or friends who aren’t allowed in the room?
- Do you permit doulas?
- Do you have a policy in place that can prevent callers from knowing I’ve been admitted if I choose?
- Is there a bed or cot available in the room for my support person?
- Can I wear my own attire during labor or do you require hospital gowns?
- Do you allow photos and video to be taken during labor and birth?
- Do you require intravenous access and fluids? (i.e. do you require either or both)
- What tools do you have available to help moms during labor like birthing balls, peanut balls, squatting bars, etc?
- Do you offer water birth or laboring in water?
- If you only allow laboring in water, when would I be required to get out of the water?
- If you offer water birth/labor, how many rooms have this option available?
- Do you require continuous fetal monitoring?
- If so, do you offer continuous fetal monitoring with a telemetry unit to allow for ambulation?
- Do you require moms to labor in a bed or can they ambulate in the room or halls?
- How often are vaginal exams done?
- Do you require moms to give birth in a bed or do you allow other positions?
- Do moms stay in the same room for postpartum recovery that they labor in?
- Is your staff comfortable working with patients who desire to labor naturally?
- Do you honor birth plans?
- Do you allow delayed cord clamping?
- Do you offer nitrous oxide for pain management?
- What percentage of your moms give birth naturally?
- What percentage of your moms receive epidurals?
- What percentage of your moms are induced?
- What is your primary c-section rate?
- What is your overall c-section rate?
- What happens if a c-section becomes necessary?
- If a c-section becomes necessary, do you have any natural or family-friendly options like a clear drape or skin-to-skin in the OR after birth?
- Is my support person and/or doula allowed in the OR with me if a c-section becomes necessary?
- Do you have anesthesia staff in-house at all times?
- What is the typical wait time to get an epidural after I request it?
- Do you have a doctor in-house at all times for emergencies?
- Do you support skin-to-skin time after birth?
- Is your staff trained to assist moms with breastfeeding?
- Do you have a lactation consultant on staff?
- If I need a breast pump during my stay, do you provide one?
- What percentage of moms who deliver here are exclusively breastfeeding at the time of discharge?
- Is there a NICU in this facility?
- If there is no NICU, how do you manage the care of babies who might need intensive care?
- Do you offer couplet care/rooming in or are babies taken to the nursery?
- If my baby is taken to the nursery, will he/she be brought back to me when she needs to nurse?
- Do you routinely supplement breastfed babies with formula?
- Do you give babies pacifiers?
- Are moms or dads permitted into the nursery when the baby is receiving care there?
- What security systems do you have in place to protect babies from being abducted?
- Do you routinely give vitamin K injections after birth?
- If so, can I opt out?
- Do you routinely put erythromycin ointment in the baby’s eyes after birth?
- If so, can I opt out?
- Do you routinely give the hepatitis B vaccination after birth?
- If so, can I opt out?
- Is there a TV in every labor room?
- Is there a CD player in every labor room?
- Can I bring my own music?
- Is there free wireless internet?
- Can I bring and use essential oils?
- Do you allow moms to eat or drink during labor?
- Is there a hospital cafeteria? If so, what hours is it open?
- Will I receive while I am admitted to the hospital?
- What are your visiting hours for postpartum patients?
- Do you allow children to visit?
- Is this a teaching hospital?
- If so, will there be students in my room during labor or delivery?
- When will I be able to go home?
- Do you offer any classes to new moms like infant CPR?
- Does your staff complete all of the necessary paperwork for the baby’s birth certificate and social security application?
- Does the hospital have a policy for releasing placentas to their owners?
- Can I sign up to take a tour of the labor unit?
Whew — that was a lot.
There really are so many variables with hospitals that there are many things you need to research. If you weren’t able to get all the answers you wanted, ask around and see what you can find out from other moms who have birthed in the hospital where you will be.
You might also search around the hospital’s website to get some information. Many hospitals today have robust web pages with lots of pictures and details of the labor and delivery facilities they offer because they really want you to come give birth there. Bear in mind that it’s bad advertising to put ugly pictures up, so what you see will be the best of the best and might not tell the full story.
Something else to think about — More and more moms are desiring a natural birth, and labor units are cash cows for most hospitals, so they WANT you to be happy (whether they realize it or not). If you are getting hard “no” answers on things that are important to you, dig a little deeper. Ask what compromises could be made. Let them know kindly that you have choices in your care and that you want to choose their facility, but you need them to work with you. You never know what you might accomplish until you ask!