When I unexpectedly found out I was pregnant with my first baby, I thought I knew enough about pregnancy, birth, labor, etc. from the little bit of coverage in my human anatomy college courses.
How much would I really need to know?
I figured my doctor would be able to answer all of my questions and take care of me.
Although there is truth to this – your doctor should be able to answer all of your questions and take care of you, what questions should you ask? And what does “take care of you” look like?
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I know my body, pregnancy, labor and birth ended up being vastly different from all of my friends, all of my family, and all of the women I took birth education classes with. Each one of us had a unique pregnancy and a unique birthing experience because we are all unique women. This is why I believe it is so important to educate yourself.
This task can seem daunting because there is SO much information out there. But I promise you the time spent researching, reading books, participating in a birthing class, and becoming a proactive part of your pregnancy and birth is priceless.
[Related post: Labor Induction Methods and Natural Alternatives]
One strategy taught to us in our birthing class that you can apply to each of the following hospital policies when making the best decisions for your family, is to always use your B.R.A.I.N.
B: what are the benefits?
R: what are the risks?
A: are there any alternatives?
I: use your intuition.
N: instead of ‘no’ you can say, ‘not now’ and revisit later
I’ve compiled a list of 8 standard hospital policies for labor and delivery that you can say ‘no’ or ‘not now’ to for an empowered birth.
Let me clarify… can and should are two very different words.
Only you are able to make the best decisions for yourself and your baby. The point of this article is not to convince you to say no to every policy, but to help educate you on why these policies exist, their pros and cons, and give you the background knowledge needed so that you can have an empowered birth by making the decisions that work best for your unique pregnancy.
Ultimately, positive communication and healthy relationship between you and your provider of choice are crucial for an empowered birth and labor.
Also please note, I am not a medical professional, and you should always have open and honest conversations with your provider of choice when making important medical decisions.
Here’s an overview of the standard hospital policies for labor and delivery that we will cover in this article:
- Continuous fetal monitoring
- Cervical exams (vaginal exams)
- Induction
- Blood draws and IV
- No food or drink
- Pushing on your back
- Testing and checkups at night
- Erythromycin drops, vitamin K shot, and Hep B vaccine for baby
- Questions for informed consent
1. Continuous Fetal Monitoring
Fetal monitoring is done to measure the baby’s heart rate in-utero. Some hospitals still set you up with a continuous (permanent, so to speak) heart rate monitor around your belly that is attached to a computer and printer. This monitor also measures the timing and intensity of your contractions.
Women who opt for an epidural see the most benefit out of having continuous fetal monitoring for two reasons: they cannot always feel their contractions for proper timing, and an epidural is a powerful drug that can affect the baby, so constantly checking the baby’s heart rate is important to ensure the drug has not had any dangerous effect on them. Since most women who receive an epidural spend most of their time laboring in bed, being strapped to the monitor is not as interfering.
If you are low-risk and without complications (such as preeclampsia or gestational diabetes) and you have a healthy baby, there is no real need to keep a fetal heart rate monitor on at all times.
Instead, you could opt for intermittent fetal monitoring where they hook you up to the belly strap and computer every hour or so. Another option is to request an intermittent Doppler be used instead (the tool they used to check the baby’s heart rate at your prenatal check-up visits). The Doppler will not measure your contractions but will ensure that the baby’s heart rate is within a safe and healthy range. This is what was used during most of my labor.
One additional pro to the Doppler is that it can be used in the water – so if you are laboring in the tub or the shower there is no need to stop every time they need to check in on the baby.
2. Cervical exams (vaginal exams)
This is NOT a requirement at any point during your pregnancy or labor, but it is unfortunately presented to women in such a way that they believe it is.
When providers do a cervical exam, they are looking for a few different measurements. They are looking for any dilation (how open the cervix is), any effacement (how thin the cervix is), the presentation of the baby (are they facing your spine or your belly button), and the station of the baby (how high up towards your head or far down towards your feet pelvis are they in your pelvis). This is all great information to know but does little to predict anything at all. Also, the accuracy of this information is essentially an educated guess on the part of the provider.
There have been instances where an OB or Midwife will measure a woman, then a labor nurse will measure her a few minutes later and each individual arrives at vastly different measurements. There is a huge human component to cervical exams.
Another drawback to cervical exams is the mental game they bring. For example, some women will measure 3cm dilated at their 37-week checkup and can be told they will go into labor any day. As the days pass, then the weeks pass with still no baby, the mental burden and unrealistic expectation put on them from that cervical exam can wreak havoc on an already anxious, impatient and nervous mama. Some women can be 3cm dilated for over a month before going into labor and this is also perfectly normal.
On the other hand, a practitioner might do a cervical exam on a woman 19 hours into labor and find she is only 6cm dilated. This can be extremely disheartening and discouraging to a woman who has been laboring for half a day.
Discouragement is the last thing your mind and body need during labor. News like this has been known to stall labor or is sometimes enough to persuade a mother to opt for an unnecessary C-section because she believes her body is no longer capable (not true).
Just as we mentioned every woman has a unique pregnancy and unique needs, every woman also has a unique labor. It is very possible to go from that discouraging 5cm to fully dilated and pushing in less than an hour.
Other arguments against cervical exams include a premature rupture of the bag of waters, an increased risk of infection, and additional discomfort for the mom.
I personally chose to have no cervical exams during my entire pregnancy and labor, until about 20 hours into active labor. At that point, I did ask for a check (honestly, I was hoping for that mental game to give me a little encouragement with a high number). It ultimately had absolutely no effect on how much longer it took for my body to push that baby out.
[Related post: Coping Techniques for an Unmedicated Birth]
3. Induction
Some of the most commonly used induction forms are Pitocin, prostaglandins gel, foley catheter, amniotomy, and a membrane sweep. I go into further detail about each of these in this post.
Induction can be used to initiate labor, or to jumpstart labor that has stalled. The most commonly used forms of induction are synthetic hormones such as Pitocin that mimics the natural hormone oxytocin. Oxytocin is a hormone produced by the body to trigger the onset of labor, contract the uterus, and dilate/efface the cervix.
The most common reason for scheduled inductions is in the case of late-term pregnancies. My baby girl was born 15 days after my “due date”. I emphasize “due date” because the date given by my doctor at my initial pregnancy confirmation appointment is really just a “guess date”.
There is no possible way any medical professional can accurately predict down to the day when my baby will be fully ready to be born and my body ready to give birth. However, scheduled inductions are encouraged by most OB’s if you go about 7+ days past your due date.
Knowing that this guess date could be off by weeks even, I felt no need to schedule an induction simply because I was still pregnant past my due date. Should there have been any concerns regarding the amount of amniotic fluid, the health of the placenta, or issues with her heart rate and breathing rates, that is a different story. However, everything looked great in ultrasounds and on a non-stress test done at 12 days post “due date”, so my husband and I said ‘no’ to an induction.
Practitioners (especially OB’s) have a bad habit of having induction conversations in the form of statements rather than questions.
Instead of saying, “You are about a week past your due date, would you like to schedule a non-stress test and ultrasound to check on the health of your placenta and baby to ensure that there are no potential complications with being pregnant an extra week or two?” they tend to say something like “You are a week past your due date so we need to get you induced. I called the hospital and scheduled your induction for 10pm tomorrow night.”
You ALWAYS have autonomy over your own body and your baby’s body. Your doctor or midwife cannot force you to get an induction – ever. Instead, ask if you can have an educated and respectful discussion with them about the situation, and remember to always use your B.R.A.I.N. You can also skip ahead to a list of questions to ask for informed consent.
4. Blood Draws and IV
Ohh the joys of triage. Triage is where the first standard procedures begin when checking into the hospital. Triage is typically a small section of the maternity ward with multiple beds separated by curtains where you will have your blood drawn, a fetal heartrate monitor put on, an IV inserted (either with a saline lock or a full IV with a portable pole on wheels), and a cervical exam performed (if you decided to consent to cervical exams, remember you can say no, even in triage!).
I chose not to have my blood drawn, not to have an IV saline lock inserted, and to have no cervical exam performed in triage. I did let them put on a fetal heart rate monitor for about 30 minutes and those were some of the worst 30 minutes of my labor.
Because I showed up to the hospital in active labor (be sure to read our post on the stages of labor), and they had me sitting/laying on my back for the heart rate monitor, I was unable to use many of my labor coping techniques. I ended up vomiting and enduring more contraction pain during those 30 minutes than at nearly any other point of my 23.5 hour labor.
Looking back, I would have changed two things about my triage experience. First, I would have gotten the blood draw. I ended up needing a blood transfusion post-birth and the blood draw in triage would have expedited the transfusion process. Second, I would have gotten off of my back and used my labor-coping techniques despite having the monitor strapped on.
The hospital was pretty adamant about getting the IV saline lock (I got some eye rolls and snarky comments), but I am glad I said no. A needle in my arm, wrist, or hand during labor would have been a massive annoyance. Labor hormones send all of your senses into overdrive, and things that may not normally bother you can become unbearable… and needles already bothered me.
*Hey, mama… Have you downloaded our free guide yet? “The Ultimate Guide to Natural Pregnancy Remedies” It’s jam-packed with awesome tips and advice to help you tackle those pesky pregnancy discomforts using natural remedies.*
5. No food or drink
The hospital policy of not being “allowed” to have any food or drink during labor was originally created back in the mid-20th century when twilight birthing was standard practice.
Twilight births were when women were put to sleep under anesthesia for the entire birthing process, and then awoken once the baby was birthed with essentially no memory of the event.
When any human undergoes complete anesthesia with food or drink in their system, there is a chance for something called aspiration, which is when this food or drink is inhaled into your lungs causing swelling (and potentially death).
However, twilight births are NOT a standard practice today. In fact, according to a study done by Anesthesia & Analgesia, only about 8% of women go completely under anesthesia for birth. Considering the potential risk of aspiration under complete anesthesia is this is the primary reason hospitals don’t allow food or drink during labor, I find this hospital policy extremely overgeneralized and unapplicable for the vast majority of women.
For most women, the energy required to undergo labor and birth is about equivalent to the energy required when running a marathon.
Can you image how much better your body could complete this job if you fueled it properly? For women planning on an unmedicated labor, there is no reason you cannot consume high-energy snacks and drinks throughout. For those who get an epidural, you can still provide your body with some sugar and energy through clear fluids with no concern.
Some great snacks you can bring to the hospital with you or enjoy at home in early labor include honey sticks, granola, crackers or rice cakes with peanut butter, breakfast bars or granola bars, fresh fruit, seeds and nuts, dried fruit, or anything else that you enjoy. When the time actually comes, you may find certain food items make you nauseous or your appetite has disappeared (this is especially common during active labor and transition) but it’s always smart to have a small variety packed in your hospital bag.
6. Pushing on Your Back
Have you ever noticed how nearly every movie that has a woman in labor shows her pushing and screaming on her back with her legs propped up in stirrups? Even with an epidural you do not have to labor or push on your back! In fact there are SO many benefits to moving during labor… yes, even with an epidural! Be sure to check out our article on labor positions and the benefits of moving during labor.
7. Testing and checkups at night
Your first night after giving birth is already overwhelming – between the exhausting marathon your body just endured, to the miraculous baby in your arms, to learning how to breastfeed, to the complete lack of sleep. The last thing you need to add to all of the emotions and chaos is unnecessary tests and checkups in the middle of the night.
If you happen to get any nice stretches of sleep (2 or 3 hours is a nice stretch that first night), you really don’t want a nurse busting through your door and interrupting everyone’s rest.
Some hospitals will want to come take your and your baby’s temperature, heart rate, blood pressure, ect. on a set schedule – a schedule that works for the nurses and not necessarily for your precious sleep.
You are allowed to make it clear you do not want any uninvited interruptions from the hospital staff during the night. In fact, set clear boundaries and include a specific time frame where you expect no visitors, for example, from 10pm to 6am.
This is a great piece of information to include on your birth plan (if you don’t have a birth plan, be sure to check out our article on how to write one, what to include on your birth plan, and snag your free template!)
8. Erythromycin Drops, Vitamin K Shot, and Hep B Vaccine for Baby
Each of these three shots/drops will be automatically administered to your newborn within the first hour or so of their birth without parental consent as they are one of those standard hospital policies.
These are not bad for your baby, but I firmly believe you should be making the decisions for your child, not the hospital.
Do some research on the pros and cons for each of these and be sure to clarify on your birth plan which you want, and which you don’t want. Again, I am not a medical professional, and you should always have open and honest conversations with your provider of choice when making important medical decisions.
Erythromycin drops are put in the baby’s eyes to help prevent bacterial infection (newborn pink eye) from their exit through the vaginal canal. The primary cause of this newborn bacterial infection of the eye (ophthalmia neonatorum) are sexually transmitted diseases – chlamydia and gonorrhea. If these bacteria are not present in the vaginal canal, they cannot be passed to the baby during vaginal birth.
Many countries including Australia, Denmark, Belgium, Norway, Sweden, Great Britain, and the Netherlands no longer recommend any form of preventative drops such as erythromycin drops for newborns. They instead recommend screening the mother during pregnancy for chlamydia and gonorrhea and counseling parents to ensure any newborn with pink eye is brought in for immediate medical attention. Take this into consideration when deciding whether or not to consent to erythromycin drops for your newborn.
The Vitamin K shot is administered to newborns to protect them from VKDB (vitamin K deficiency bleeding). Vitamin K is necessary for the body to form blood clots. Without blood clots, the body has no way of managing and stopping internal or external bleeds on its own. Mothers do not pass high quantities of vitamin K to their babies during pregnancy, and newborn babies do not create a lot of vitamin K on their own the first few months of life. This is why vitamin K shots are administered as part of standard hospital policy.
The chance of refusing the shot for your baby and then having any sort of bleeding issues is rare. Vitamin K deficiency bleeding, affects between 4 to 7 out of 100,000 infants who do not receive the vitamin K shot. However, for those 4 to 7 affected infants, the bleeding normally occurs in the brain or intestines and can be deadly.
My husband and I decided to get the vitamin K shot for our baby, but we requested a preservative-free version of the shot. Be sure to talk with your provider and hospital in advance if this is something you might be interested in requesting as well.
The Hep B vaccine does pretty much exactly what is sounds like – it protects the baby from Hepatitis B. Hepatitis B is spread through contact with infected bodily fluids such as blood and semen. It can also be passed from an infected mother to the baby through the birth canal, but not through any contact with feces, snot, saliva, sweat, tears, urine, or vomit.
The hospitals that give this Hep B vaccine within 24 hours of the baby’s birth are doing so as a precaution because there is no cure for Hep B, only a vaccine to prevent it (however you cannot be fully protected from it until all of the vaccines have been administered, a total of 3 doses over the course of the first 6 months).
So, if Hepatitis B is only transmitted through sexual contact (and the birth canal), why do hospitals give newborns a Hep B vaccine if the mother has tested negative for the virus? This standard policy was implemented in 1991 by the ACIP (Advisory committee on Immunization Practices) with the end goal of eliminating the Hepatitis B virus in the US. The idea was if every baby born is vaccinated against the virus, then eventually it can be eradicated. Meaning we are not giving the vaccine because the typical baby is at risk of contracting it, but because we are attempting a virus eradication.
You’ll have to weigh the pros of administering the vaccine to your child to help contribute to the goal of trying to vaccinate society and eradicate this sexually transmitted virus, and the cons/side effects of newborn vaccinations.
Keep in mind with any of these three newborn policies, you can always say ‘not now’. Your pediatrician will gladly administer erythromycin drops, a vitamin k shot, or the Hep B vaccine later on in your baby’s or child’s life should you decide to postpone at the hospital.
No matter what decisions you decide to make for your unique pregnancy, labor, birth, and baby, always remember that you have ultimate authority over your body and your baby’s body. You are allowed to say ‘no’ or ‘not now’ to your doctor or midwife, and you should always be actively involved in every decision.
Throughout your pregnancy, make sure you are able to have open, honest, and respectful conversations with your provider, and don’t be afraid to ask questions.
If you do not feel that your provider respects your autonomy or they are unable/unwilling to answer your questions, perhaps you need to find a different provider.
Below are some great questions for informed consent to ask your provider as unexpected difficult situations arise.
- Is mom or baby in any immediate danger?
- Give me more information about this procedure or drug and why it is the best course of action for me and/or my baby.
- What do we expect to happen after doing this procedure/taking this drug? Is it simply a routine policy or are there specific benefits for my unique situation?
- Are there any alternatives?
- Is there anything I should know about the side effects and liabilities?
- How do the benefits compare to the risks in my unique situation?
- What happens if I say no? Are there any dire consequences now or in the future? What are they?
- Can I wait a little longer before making a decision?
- Can my partner and I have a few minutes alone to discuss the procedure/drug?
- Are there any consecutive procedures or drugs that will also be needed if we decide to proceed?
- Is there anything else we can try first?
You probably shouldn’t expect your birth to go perfectly according to plan, but you should expect to be in control of the decisions made throughout the process. Find yourself a provider whose approach aligns most closely with your birth wishes, who is willing to discuss options with you throughout, and who respects your autonomy.
You deserve an empowered and unique birth.
Jess
