Tuesdays Topic 9/23/08

[earthgirl]

Hospital routine policies and procedures. How different are the hospitals that you work at, or how similar are they? How difficult is it for your clients to have the baby stay with them for 'work ups'. How much time do you spend educating them about things that occur after the baby is born? How much after the birth trauma do you witness?
The poll isn't all that important, but I'd like to discuss the above.

The Other Side of the Glass- A Film for Fathers.click link.

[DL]

Stacie.... The link wasn't working for me, but I was able to delete some stuff off the front & back of it in order to view it. Just thought you'd like to know. Here's what it now looks like.

http://babykeeper.blogspot.com/

[b'earth angel]

How different are the hospitals that you work at, or how similar are they? We have two hospitals in our immediate area that I've 'worked' in. We're a small rural community with two cities only 20 mins apart. One is less progressive than the other. Seems like they aren't so willing to work w/moms in many areas like VBAC but are open to different birthing postions, providing birth balls, large showers, etc. Also has one nurse on staff that seems to be negative about natural, non-medicated birth.
The other hospital is much more progressive, allowing labor in jacuzzi tubs, but no waterbirth, VBACs, doing infant assesments at mom's bedside, rooming in, provides a l & d suite complete w/it's own OR to close it off from the rest of the hospital, good security etc. It all depends on your doctor though, how far you can push things. pun intended. So far, no one has been willing to give waterbirth a TOL.
How difficult is it for your clients to have the baby stay with them for 'work ups'. Usually both hospitals do assessments in the room, if there's a problem, they may have to go to the nursery.
How much time do you spend educating them about things that occur after the baby is born? I've never timed our discussions, it is a good part of the handouts and information I share w/clients, aftercare, cord options, circ or not, shots, mandantory testings, immediate skin to skin and bf importance, etc. Most of my clients have not been first time moms, so they seem to be well aware of what happens after the birthing part is over. I take my lead from her, what does she need to know, etc.
How much birth trauma do you witness? Not so much so far. PTL A little ordering clients around by CP once and very rough handling by a nurse, same client. So far, I and my clients have been blessed with respectful CPs and staff and good birthing experiences. Although my clientel has been a small number, I'm sure that as the numbers of births I attend go up, that may be likely to change. I hope not!
Great discussion.

[DL]

Wow... About the film: How sad it is that some hospitals aren't inviting the parents into the nursery (better yet...do everything in the room, of course). I do think that babies are treated too roughly in general at many hospitals. Most times, it would be best to just leave everyone alone and let babe and mom stay together.

About the other side of the glass: Personally, I've not been to a hospital that at least didn't allow dad to go into the nursery IF the newborn assessments weren't done in the room. One time, mom was having severe complications so the dad didn't want to leave mom. The parents asked me to go with the baby to the nursery for the exam/bath and I did. I was within 1 ft. of baby at all times. The exam/bath took 10-15 min (babe was already 2 hours old by then) and then I rolled baby back to the room to be with mom and dad. Thankfully, the nurses were gentle with babe. At all other births at this hospital, either mom or dad has been with the baby the whole time. Hospitals are so different from one another; I'm always very nervous when attending a different one for the first time because of the differing policies.

[doula_char]

It's only by chance that I've worked mainly in one hospital so far. I've done one birth in a second hospital, and have one scheduled in a third at the beginning of the year.

The procedures in hospital A I've gotten to know pretty well, and they've gotten to know me- I'm "that purple doula with the wild crocks" I'm frustrated with them, because they just took the microwave out of the family kitchen in favor of a coffee maker- no more hot rice socks. They have one tub that is shared by the entire floor.

Hopsital B is one of the only level three NICU's in our state. They do AMAZING things there, but they aren't very doula /family friendly- the kitchen is locked, and requires a keycard to get in. Tubs in every room, but not huge.

It's been six or eight years since I last did a birth at hospital C- but they have jacuzi's in every room on the floor, and the nurses compete for the natural birthers- which worries me, it means that they don't see a lot of them.

Hospitals D,E,F,G & H also do L&D, but I have yet to catch a client at any of them.

[DL]

For me: Hospital A is where I mostly attend, and I usually do so with clients of the local CNM (and she's great!). This hospital is small and is very natural birth & doula friendly. Most moms go straight to the room without having to stop at triage first; each room has a Jacuzzi tub, a shower, rocking chair, squat bar, & a birth ball. Most of my clients do not receive an IV nor Heplock (only if meds are requested or complications happen), and the vast majority go without medication. Moms/babies with no complications are not monitored very often at all, and mom is given freedom to move and roam (we've even walked outside of the hospital before). I will say that most of the moms that I have supported there have had no complications. Light food and drink is offered during most unmedicated/uncomplicated labors. After the birth, baby goes straight to mom if there are no complications. Babe stays with mom and in her arms for about 2 hours--sometimes longer, at which time the baby goes to the nursery for about 15 min. (mom or dad or other significant person to the family accompanies baby inside nursery). This is a small hospital and they do not have a weight scale and such in the room, so they take the baby to the nursery for first bath, weighing, and some newborn assessments. Some assessments can (and have been) done right there in the room, so the nursery stay is pretty short if all looks normal.

Hospital B & C: Only attended once at each so far. For both hospitals, both clients had complications (one resulting in medically necessary Cesarean). I haven't supported a mom through natural childbirth at either of these hospitals, so it's hard for me to know what would be 'routine policy' at either place. I will say that they were large hospitals and felt like impersonal "baby factories". The nurses station was full of yacking medical staff and the hallways were loud. Triage took a very long time (hours) at both hospitals. At one of these hospitals, triage was SHARED with another mom in labor..not a pleasant experience.

I have a Hospital D coming up within the next week or two (first visit for me), and I'm a little nervous about it.

[doula Michele]

I mostly work in the biggest hospital in our area. Every thing is procedure and routine. Its a real fight to go against routine IV's or to even have a piece of toast. I am starting to hate it.

I occasionally work in a smaller hospital an hour away... where my grandbaby was born. I like it better. IV's are not routine, although the nurse says they are considering it. They brought Sho toast in labour, to keep her energy up. The nursery was down the hall where they dress and do the baby stuff. Shoshanna was very vocal and just said " Lilli's grampa will be going to the nursery with her, and he will be looking after her, and she CAN NOT wear hospital clothes" and then sent Dean and the diaper bag to the nursery. The nurses did as Shoshanna requested.

I just get annoyed...how can something as simple as eating toast in labour be so bad in one hospital and considered nessessary in another.

[DoulaCindy]

Tubs? Rocking chairs? Ah, how lovely that would be! We just got a beautiful new wing, but they chose NOT to put in tubs! And the rocking chairs that we had at the smaller hospital, did not get moved over nor did they put in new ones. Said they were in the plans but somehow they did not make it. Brand new beds but somehow the squatting bars didn't make it. Thankfully, someone found a couple of the old ones and brought them over. Birth balls.....seems they can never find the large one when my clients are there. So I just have started taking my own.

I'm fast learning there is a group of nurses that are great at working with moms wanting a natural birth and there are some that seem to be irritated by them. I'm taking mental notes and I also confer with other doulas when we come across an exceptional one. I'll ask if they are working when I go in with a mom. Sometimes ones I've worked with previously will "hear" that I'm on the floor and come in and see if they can help, which is great. It is definitely routine to have an IV but as long as the doctor is agreeable to it, that can be gotten around. None have agreed to allowing food and drink, so we just don't ask. One bonus is that when I get there, they seem okay with leaving us alone until pushing time. So it is easier to get the mom a snack from her bag if she wants it.

Babycare seems to depend on who the baby nurses are. At my last birth, they just stood in the corner of the room for about an hour letting the mom and dad have the baby. They checked her out but didn't do the usual stuff. I was shocked. Most of the time they are trying to take the baby within 10 minutes or so on the promise that they'll give him/her right back.

Sounds like we are back in the Middle Ages compared to some of the hospitals you guys work with!

[mommy_quigg]

I have yet to attend more than one birth at the same hospital.

Hospital A: in Ohio, I most likely won't ever attend a birth there again, I was there for my Aunt.

Hospital B: Where SIL and I delivered our sons. Several 2-person tubs, I think there's four. A shower in each room. Triage is shared though, 2 beds. Nurses there are hit and miss. Some were wonderful, encouraged me to eat and use the showers and tubs. Some tried to shove pain medications on me even though I was handling labour fine. My SIL had an epidural after AROM. The dr. tried to get me on pitocin because it's "routine" for inductions even though the gel had sent me into labour on its own. After the birth, a nurse tried to take him away, I refused so she did some procedures with him on my belly. After 20 minutes or so, they took him out to weigh him and my mom went with him. I wasn't there when my nephew was born. After triage, I stayed in one room the entire time (labour, delivery, and postpartum) which was wonderful.

Hospital C: Where my neice was born. SIL again got epi and AROM so I don't know how supportive they were. She'd had them before I got there. Nurses seemed surprised/impressed that I knew what to do towards the end when SIL's epi was wearing off. Small baths in each room. SIL had to move to a separate room for recovery. Neice was taken to NICU so I don't know how they *normally* do "workups".

Hospital D: Huge hospital downtown. Lots of high risk pregnancies. It was extremely difficult to try to do anything natural. They had their "labour progression chart" and anytime mom wasn't up to speed, 4-5 people would crowd into the room and tell her everything that could go wrong if she didn't let them augment her labour. Everything was about "policy" or "routine". It was a bad place for a low-risk mom to attempt a natural childbirth. She ended up in a c-section. The hospital has a 50% section rate.

Hospital E: new one I'll be at in December. I'm hoping for good things!

[AMotz]

Quote:

Originally Posted by earthgirl How different are the hospitals that you work at, or how similar are they?

There are subtle differences in "policy", but not much else.

Hosp1 - Not horribly natural childbirth friendly. They don't even have birth balls, even though they just re-did the entire women's floor. Ugh. The nurses don't see as gentle there, kind of harsh.

Hosp2 - Great hospital for birthing. Had my son there. Nurses are very nice and helpful. I don't think I've had a bad one yet, except for the first nurse at my own birth and that was about monitoring, and she wasn't my actual nurse, thank god. She wasn't bad, just... not who I would have wanted.

Hosp3 - Hospital is SMALL, only 3 or 4 birthing rooms, and understaffed. Very nice and patient staff though.

Quote:

Originally Posted by earthgirl How difficult is it for your clients to have the baby stay with them for 'work ups'.

Hosp1 - A mandatory nursery trip for doctor to see baby. I haven't seen one client get past this yet. (boooo!)

Hosp2 - They do everything in the room. No problem.

Hosp3 - Only had 2 births there, both went to nursery, but for actual reasons, so I'm not sure about just regular old after birth procedures.

Quote:

Originally Posted by earthgirl How much time do you spend educating them about things that occur after the baby is born?

Not that much, usually just a small section during a prenatal, or if something comes up in particular that I know a hospital does or doesn't do.

Quote:

Originally Posted by earthgirl How much birth trauma do you witness?

I really haven't seen any birth trauma yet. Of course there are births that I think are over managed, but nothing traumatic, yet. Hope I don't have to see anything like that.

[DoulaCindy]

I didn't say anything about the "traumatic" birth question. Not sure I've seen one that really qualifies for that label, but.....I've had some clients that had some traumatic labor experiences with the doctor early on. One was horrible and had ME crying! Didn't let the mom see that though, but Dr. did.

My client totally freaked out every time they had to do an internal. She could close up so tight that the doctors could not examine her. She became emotionally distressed. During an exam during an office visit, one (female) dr. got aggravated about it. One dr. asked her if she'd ever been sexually abused, to which she said no and was highly offended. After watching her reactions, I questioned that too. Wonder if maybe she wasn't suppressing a childhood memory or something.

Anyway, it took lots of planning and preparing her for the internals. (she had PROM and was in the hospital for 2 days). I had to work hard to keep her calm but we got a system going. But once the doctor got irritated for her tightening up and yelled at her. She also questioned him wanting to put in a pressure catheter which made it worse. He told her it was time for HIM to take over! She was crying, he was fuming, the husband was speechless. I tried to smooth things over though I really wanted to chew him out!! He did come in later and appologize and then caught me outside the room and appologized again. I just don't get how anyone could have gotten upset with her when she was distressed! So, that was my traumatic experience as a doula! It took a lot of time and patience but she eventually had a vaginal birth. And get this.....SHE appologized to the doctor!

[Garden Doula]

Well, what is trauma? To me, anything unnecessary that is not part of the families (mothers) birth plan that they are forced or scared into accepting is a form of trauma.

There are so many hospitals around here. I am new, so I haven't had a chance to experience all of them yet.

This video is realy hard for me to watch. My DD1 was born in the hospital. She had a horrible birth. She was away from me so much. And she had such a terrible first year. Horrible. And she still has lots of thing about her... nervousness, trouble sleeping, anxieties... I don't like to imagine how her first moments and days at that horrible hospital shaped how she is. So I'm having trouble watching it and responding coherantly and ojectively.

[earthgirl]

I'm sorry... I meant to say after birth trauma. Have you witnessed rough handling of the infant, nurses ignoring baby cues to finish their assessments, or refusal to let them be done on Mom.

[WaterMoon]

Wow that video made me feel sick. It is really sad to watch videos like these.
I have not witnessed any birth trauma, or ruff handling of babies. But with 2 c-sections that I attended I was not allowed in the OR, and didn't see what they did to the baby after it was born. With one of the sections I attended they did the eval with the daddy right at the babys side and was really gentle with him. After they were done, they gave baby back to mom, unwrapped, and let them lay skin to skin with a heater blowing under the blanket. I thought that was really cool.
I do try to educate everyone about infant after care so that they know what could go on before it happens and are able to make an effective "Baby Plan". Which I think is just as important as a birth plan.