Thursday, August 13, 2009

The Hospital Experience

Yes, I'd say that, overall, I am happy with the care that Robert and I received at the hospital. I say this as somebody that originally wanted a midwife-attended homebirth, one fairly suspicious of the whole hospital methodology; a lot of publications imply (or say right out) that in order to have a 'natural' birth in a hospital setting, you have to fight hard for it. I did not find that to be true. There were a few things that were irksome, but they seemed mostly a matter of organization. So, the things that were good, in no particular order:

--The nurses are very pro-movement during labor; there's no tendency to try to keep the laboring woman on the bed. "Do whatever helps" seems to be their mantra. My nurse suggested walking around, squatting on a birth ball (they did seem rather inordinately proud of their birth balls, I wonder if they're new or something), kneeling, and going to hands and knees near the end, when I was almost fully dilated but still had a "lip" of cervix in the way.

--The jacuzzi tub. This is probably what made the difference between being able to get through the first stage of labor with no painkillers, and needing an epidural. I spent more than four straight hours in that tub. (And, they never run out of hot water...) The nurse came by periodically to check on me and on the baby (with a hand-held Doppler), but other than that just left me alone, which was what I needed. If I have my next baby at that hospital, it will be because of the tubs more than anything, probably.

--I was asked on arrival whether I thought I'd be wanting an epidural, and I said no. Nobody ever offered me one again. My nurse explained afterwards that she knew that I knew that I only had to ask should I change my mind, so why offer? There was simply no mention of painkillers until after Robert was born, when I needed some for the stitching.

--Nobody ever suggested speeding up the labor. This seems to be the biggest complaint against hospital procedure, that they push the Pitocin too much. I don't know if it's because I was progressing nicely every time we checked, or because my water hadn't broken, or if my timing was just particularly good: I arrived shortly before a mid-afternoon shift change, and delivered well before that shift was over. Robert was born somewhere around 8:00pm, so it could just be that we were being convenient. Or maybe this hospital just doesn't have a policy of pitting patients that haven't truly stalled. All I know is that I came in expecting to have to defend myself against the Evil Pit, and it never came up.

--Every procedure done prior to the birth was framed as an option, not a requirement. The nurse never said, "We're going to check your dilation now", it was always, "If you like, we can check to see how you're doing, but it's up to you". Once I got to transition, she went over with me what I wanted to happen immediately post-birth: place the baby on my belly, delay cord-clamping, all that. (Did I mention that my carefully crafted Birth Plan was still in the car, with the rest of The Bag?) Of course it all went out the window with the shoulder dystocia-- the cord was cut immediately and Robert rushed away-- but from talking with other women who've delivered at this hospital, I don't doubt that without that circumstance, it would have happened as discussed. I do like that they never took the baby from the room or out of my sight, even though he couldn't be with me immediately.

--My obstetrician was fine. The practice that I use has three OBs, which I think of as The Great, The Good, and The Bad; he is The Good. I do think that he was getting a bit frustrated or annoyed with me towards the end, since I basically screamed non-stop for the better part of an hour while trying to avoid the pain (and therefore not progressing)-- I remember thinking at one point, "who cares, dude, this is MY party"-- but Don said that he seemed chagrined once he saw what I had been dealing with. I have to take his word for it, I neither noticed nor cared. The doc did what he was there to do, left the touchy-feely part to the nurse, and did a meticulous job sewing me together again.

--The way the dystocia was handled. Had I not already known what it means for shoulders to get stuck (and what it can lead to), I might not have even noticed what was happening; they were so calm, focused, organized, and fast. Anti-drama. I can easily see how somebody in my situation could have missed it entirely, up until the rest of the baby was born and the pediatric team took over.

--The nursery nurses were amazing; they deserve their own post, or some brownies or something. Actually, all of the nurses-- labor & delivery, post-partum, and baby nurses-- were fantastic; they're kind of a local legend here. The baby nurses really seemed to understand just how special MY baby was*. Since Robert spent an extra two days in the hospital as well as the last day of my stay, I think I saw more of the nurses than one usually would, and they were so nice to me.

--Every nurse except one was able to help me with the breastfeeding, in addition to the hospital's lactation consultants that came by periodically. This was good since it did not seem to come naturally to either of us. I didn't get any bad advice from them, nor were any of them pushy or invasive, which I understand to be the main complaint against hospital nurses and LCs in regards to breastfeeding.

*I also think that they liked him because he was an anomaly; every other baby in the Special Care Nursery was premature-- tiny, red, and in need of a lot of care-- while he was this big, chubby, mellow guy that was clearly healthy and merely needed observation. He was literally twice the size of any of the other babies there, happily basking under his heat lamp, equally OK with breastfeeding or taking a bottle. They kept playing with his hair, styling it into a little baby-Hawk...

I'll outline what I didn't like about being in a hospital next time...

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