You will remember giving birth for the rest of your life. It is a sacred event that should be a loving and happy experience. There are many factors that will determine the outcome of your birth, including your health, genetics, any previous births, where you choose to give birth and who your care provider is.
Although the location of your birth and the provider you choose are just two pieces of the puzzle they can drastically affect your birth. They are also things that you can have control over.
If you are planning a hospital birth, how are you choosing your hospital? Health insurance coverage, cost and location may be top contributing factors in your decision. Some explanations I’ve heard for why a hospital was chosen include: “it was brand new, was pretty with modern décor,” “my mother gave birth to me in this hospital so I want to give birth here too,” “my friend said it was a good choice and delivered here.” This is actually a big decision and should be given careful consideration. Before jumping in with a doctor or hospital you may want to also consider some of the following points:
1. What is the cesarean section rate of the hospital or care provider?
The World Health Organization proposes a cesarean section rate that does not exceed 15%. The following article provides more details on this: World Health Organization 15% cesarean rate recommendation.
Nearly one-fourth of birthing women in the U.S. have a cesarean. The rate has steadily risen in recent years. In 2013 Florida had the 4th highest cesarean section rate in the nation at 37.7%. A hospital’s culture of managing labor and birth can lead to cesarean rates that are much higher or much lower than average.
The following are the rates for the local Tampa Bay hospitals for July 2012 – June 2013:
Morton Plant Mease Clearwater – 28.5%
Lakeland Regional Medical Center – 32.6%
St Pete General Hospital – 33.3%
Florida Hospital Tarpon Springs – 33.7%
Tampa General Hospital – 34.9%
St Joseph’s North Lutz – 37.4%
Medical Center of Trinity – 37.7%
Mease Countryside Clearwater – 38.4%
Bayfront Baby Place St Petersburg – 38.6%
Brandon Regional Hospital – 39.3%
Florida Hospital Tampa – 42.1%
St Joesph’s Women’s Tampa – 44.6%
Taken from the Agency for Health Care administration July 2012 – June 2013 and Cesareanrates.com
A cesarean section rate of 44.6%, as is the case with St. Joseph’s Women’s, is very high and could indicate over medicalization and interventions are resulting in unnecessary cesareans. This should be taken into account when making your decision.
2. Does the hospital support the kind of birth you are hoping to have: unmedicated vaginal birth, VBAC (vaginal birth after cesarean) or cesarean birth?
If you are hoping to have a VBAC you might want to find out the VBAC success rate of the hospital or care provider first. If you are high risk or your baby has possible complications you should choose a hospital that specializes in neonatal-intensive care and high-risk maternity care.
3. Is the hospital Baby-Friendly?
“The Baby-Friendly Hospital Initiative (BFHI) is a global program that was launched by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) in 1991 to encourage and recognize hospitals and birthing centers that offer optimal level of care for infant feeding and mother/baby bonding. It recognizes and awards birthing facilities who successfully implement the Ten Steps to Successful Breastfeeding (i) and the International Code of Marketing of Breast-milk Substitutes (ii). The BFHI assists hospitals in giving all mothers the information, confidence, and skills necessary to successfully initiate and continue breastfeeding their babies or feeding formula safely, and gives special recognition to hospitals that have done so.
Becoming a Baby-Friendly facility is a comprehensive, detailed and thorough journey toward excellence in providing evidence-based maternity care with the goal of achieving optimal infant feeding outcomes and mother/baby bonding. It compels facilities to examine, challenge and modify longstanding policies and procedures. It requires training and skill building among all levels of staff. It entails implementing audit processes to assure quality in all aspects of maternity care operations.” – quoted from babyfriendlyusa.org.
Some of the factors that make a hospital Baby-Friendly include:
- Help mothers initiate breastfeeding within one hour of birth.
- Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
- Give infants no food or drink other than breast-milk, unless medically indicated.
- Practice rooming in – allow mothers and infants to remain together 24 hours a day.
- Encourage breastfeeding on demand.
- Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospitals or birth center.
In Tampa Bay the following hospitals are designated Baby Friendly: Tampa General Hospital, Morton Plant Hospital in Clearwater and Mease Countryside Hospital in Safety Harbor.
4. Are there birthing tubs available?
More and more women are choosing to labor or give birth in a birthing tub because of the relaxation and comfort it provides. Some hospitals have a small number of birthing tubs available and allow mothers to labor in them. This is a nice option for women who do not wish to have pain medication.
5. Do they limit the number of people that may be with you during labor and birth? Can the baby’s siblings be present? Is there an age restriction?
You may wish to have your partner, your mother, other children, a friend or your doula with you during labor and birth. Some hospitals allow only a certain number of people in your room.
For example, a friend of mine gave birth to her son at a hospital and found out they would not allow her young daughter in the room. This was a disappointment. (Her daughter did manage to peek through the door with daddy holding her outside the room, but it wasn’t what they would have preferred.)
6. Are there any situations (such as needing a cesarean) that would require you to be separated from your partner or doula during labor or birth?
Most hospitals allow your partner to be present with you in the operating room during a cesarean. Quite a few in Tampa do not allow a doula to be present. Having a supportive birth partner or doula offers many benefits to a woman even during a cesarean. Once your baby is born oftentimes your partner will stay with the baby while the nurses do newborn procedures. You will still be undergoing surgery and it can be comforting to have a doula with you to help ease anxiety or fears.
7. What are the usual policies and practices regarding:
- IVs (intravenous lines) in labor
- continuous or intermittent electronic fetal monitoring
- freedom to be active and move about in labor
- eating and drinking in labor
- positions for birth
- treatment if labor is progressing slowly
- routine episiotomy
Many hospitals have similar policies regarding the above points listed, but some of them do vary and it is worth checking into. For example, a few Tampa Bay hospitals allow women to ingest clear liquids such as water, broth, popsicles and more during labor to keep them energized and sustained. While one particular hospital in Tampa allows nothing but ice chips. When you are working hard to bring your baby into this world having the extra sustenance can make a huge difference.
8. Is your potential care provider supportive of your desires and goals for the birth of your baby?
Each mother, baby and birth is different. Likewise, each have different needs or concerns whether you are hoping to have a VBAC (vaginal birth after a cesarean), a gentle cesarean, avoiding a primary cesarean, avoiding an epidural, or some other procedure. With this in mind, think about what your personal goals are. Does your care provider really, truly support those wishes? Does he or she have a track record of supporting women in similar scenarios? Ask him or her directly. You can also ask in local moms groups or search online for client feedback.
9. Lastly, how does your care provider treat you?
A good relationship with a care provider should feel like working with a partner who is interested in you and sincerely wants to help you. You should be respected and treated like an individual, not just a body moving through an assembly line. You have the right to ask questions, be informed and give consent or refusal before any procedure is done. Working with a provider that you feel comfortable with and who provides you with honest care is your right. They are working for you and not the other way around. Find somebody that treats you well! Trust your instincts.