Procedures For You and Your Baby
Planning a hospital birth? If you’re like most women, you probably are. Here’s a rundown of some of the common hospital procedures for you and your baby that you’ll likely be faced with. It’s wise to be familiar with these because then you can evaluate your options and make decisions before your birth.
Realize that you should be the one making decisions about your birth. You are entitled to decline common procedures during hospital birth if you aren’t comfortable with them. Remember that you hired your doctor to provide a service to you.
It’s important to keep in mind that your birth may not go exactly how you plan. But, you should call the shots because it’s your birth. The more you know beforehand, the more prepared you’ll be in any case.
Want to avoid any of these procedures? You need to let the staff know up front when you get to the hospital because more often than not, it’s just assumed that many of these things will be done. This is where a birth plan comes in handy!
IV- In most hospitals, it’s routine procedure to administer an IV when you’re admitted. It’s used to easily administer meds and fluid. If you plan to have a natural birth, an IV isn’t necessary. If you are planning a natural birth and don’t want an IV, a heparin lock is a good alternative just in case there’s an emergency and an IV needs to be inserted quickly.
EFM- When you are admitted to the hospital, the nurse will hook up an electronic fetal monitor (EFM) to monitor the baby’s heart rate. Most hospitals like to keep you on the EFM for at least a portion of each hour. An alternative to EFM is intermittent monitoring with a doppler, which doesn’t require you to be hooked up to anything.
Labor Augmentation- Even though every labor is different, generally hospital birth is expected to progress within certain time limits. If labor seems to be progressing too slowly, it’s very common for pitocin to be given to speed up labor. This increases the risk of c-section and makes labor more intense.
Amniotomy- Speaking of hurrying labor along, it’s also very common during hospital birth to have your water broken artificially to speed up labor. Once the water bag is broken, the baby is no longer floating above the cervix, so baby’s head comes down on the cervix, which causes quicker dilation and more contractions. Having your water broken is a better alternative to try before getting pitocin if your labor really needs some speeding up, but it does increase the risk of infection.
Vaginal Exams- Frequent vaginal exams during labor are commonplace in hospital birth. This allows the nurse and doctor to gauge how your labor is progressing. Vaginal exams increase the risk of infection and also the likelihood of intervention to speed labor. They are unnecessary as long as labor is obviously progressing. Most of the time, you can tell that labor is progressing just by paying attention to the intensity and duration of contractions without having to know how dilated the cervix is.
Pushing on Your Back- it is “standard practice” for women to give birth on their backs in hospitals. This is not to say that you don’t have the option of pushing in a different position if you want, but most hospital staff assumes you will be on your back. If you want to birth in a different position, it’s a good idea to let your doctor and nurse know that you plan to push in whatever position is comfortable for you because then you’re less likely to be fighting for your comfort at the last minute.
Episiotomy- Episiotomy isn’t exclusively a hospital procedure, but hospital providers perform episiotomies far more frequently than homebirth midwives. It’s a good idea to find out how often your care provider feels that episiotomy is “necessary.” Episiotomy can be avoided in the vast majority of births. Who wants to have to recover from being cut unnecessarily on top of all the other postpartum issues to deal with?
Vacuum and Forceps- It is not uncommon for vacuum and forceps to be used during hospital births to help pull the baby out. This is obviously harder on both you and the baby. The best way to avoid this type of “assistance” is to avoid an epidural and choose a position other than your back for pushing.
Here’s a list of routine procedures that are done to newborns. These are not all exclusive to hospital birth. As before, if you choose to decline any of these procedures, it’s best to say so beforehand.
Suctioning- Doctors usually use a bulb syringe and suction the baby’s mouth and nose as soon as the head comes out. Recent research reports that most babies will clear the fluid and mucus just fine on their own after birth, as long as there isn’t meconium in the fluid. The extra amniotic fluid inside baby gets reabsorbed into his body.
Immediate Cord Clamping- In the hospital, it’s standard to cut the baby’s umbilical cord right away. This might be something you’ve never thought of before: Did you know that by cutting the cord immediately your baby is denied up to half of their total blood volume? You may wish to research this further and consider delayed cord clamping. However, if you’ve had any sort of medication for pain or to induce or speed up labor, it’s safer to clamp the cord immediately.
First bath- babies are usually taken to the nursery shortly after birth to get their first bath and exam. The first bath can be delayed, or even omitted, if you don’t want your baby to be separated from you.
Vitamin K- Vitamin K is an essential vitamin for blood clotting. Compared to adults, babies are born with lower levels of vitamin K. So, they are given a vitamin K shot or oral dose at birth to prevent a rare condition called vitamin K deficiency bleeding.
Eye ointment- an antibiotic eye ointment is applied to baby’s eyes. This is done routinely in hospital births to prevent an eye infection that they can contract from mom’s genital tract if she has chlamydia or gonorrhea. Obviously, if you know you couldn’t have these STDs, this ointment isn’t necessary. Nonetheless, it’s a routine procedure. So, if you know your baby doesn’t need it and you don’t want them to have it, insist that it’s not given.
Hepatitis B Vaccine- Hep B is a disease that is spread through sexual contact infected blood, and needles. Obviously, these scenarios are highly unlikely for a newborn, so you may choose not to have your baby get this vaccine. However, it can also be passed from mother to child. So, if you have it, it would be wise to make sure your baby is given the HepB vaccine right after birth.
Blood Screening- It is routine to test newborns for several disorders, including Phenylketonuria (PKU), which is a serious metabolic disorder. The test is done by pricking the baby’s heel to get a blood sample. It should be done when the baby is at least 24 hrs old. Sometimes, the test is done before the baby is discharged from the hospital, and sometimes a few days later. It’s much easier and faster to get enough blood for the sample if you make sure your baby’s foot is very warm before the prick.
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