Hospital Tour Questions | Childbirth Classes in Western Mass

When I was pregnant with my son, I was the most prepared pregnant person. Ever. Even before I got pregnant, I was the most prepared non-pregnant person. Ever.

Consider the hospital tour. Most parents take their tour with a hospital's admission class or towards the end of their pregnancy, as a formality. I took mine before I was ever pregnant. And here's why.

In my own childbirth ed class there was a couple. They arrived at our second-to-last class looking very upset. They explained that they had been on their hospital tour the previous week. There they had learned that mom would have an IV placed as soon as she was admitted, would be on continuous Electronic Fetal Monitoring, would not be allowed to eat or drink, and would be confined to a bed the whole time. In our class we had learned many techniques for dealing with labor pain, and almost all of them required being up and moving around. The couple checked with their doctor, who had previously agreed to their preferences for a non-medicated birth, lots of moving around, and as few interventions as possible. "Oh, right, but yeah, we have to follow the hospital's rules," he said when they confronted him about all the restrictions.

This mom was 38 weeks pregnant, so it was pretty much too late to switch care providers. Now, I don't know if their doctor actually DID tell them they wouldn't be able to have an intervention-free birth at their hospital and they just didn't hear it, or if he actively misled them. I went home that night and was so upset for them. "Why did they wait so long to go on their tour?!?!" I cried at my husband. "Um ..." he answered, in his best I'm-trying-to-say-this-in-the-nicest-way-possible voice, "because you're the only one who goes on hospital tours for fun."

If this couple had gone on their tour even a few weeks earlier, they would have had more options: they could have tried to switch to another care provider with privileges at a different hospital; they could have spent time negotiating with their current care provider or another doctor at that hospital for more flexible rules; they could have met with the nurse manager or head nurse at the hospital to discuss the hospital policies (and see if there actually WAS a hospital policy about laboring in bed); or they could have taken time to adjust their expectations for a non-medicated birth and prepared themselves for laboring in bed. And if this couple had gone on their tour MONTHS earlier, they would have definitely had timed to switch care providers and plan their birth at a hospital where their wishes would be respected.

So go on your tour. Now. Even if you're not pregnant yet. Ask lots of questions, and really listen to their answers. Listen to the kind of information they volunteer, vs the information that you have to request (e.g. if they are super excited to talk about all the TV channels they get in the rooms but are confused when you ask about pushing positions, then they are probably used to moms spending a lot of "alone time" chilling in bed). If anything sounds like it conflicts with what your doctor has told you or has agreed to, ask for clarification -- it may be "policy" to give an IV to every patient, except when a doctor has specified other arrangements in writing. Then negotiate where you can -- you may need to make a special appointment with a nurse or a member of the hospital staff to sit down and go through things in detail. Finally, if you really get a bad feeling from the tour, look into changing hospitals -- but be prepared that changing hospitals will mostly likely mean changing care providers as well.

Don't know what to ask? I've put together a (very) long list of questions for your hospital tour (and for your care provider -- make sure their answers match!).

For a printable version, click HERE. 

Hospital / Birth Center Tour Questions

Name of Hospital / Birth Center:  

Address: 

Main Phone Number: 

Maternity Dept Extension:

Date of Tour: 

Tour Guide’s Name: 

Arriving at the Hospital in Labor

Can I pre-register or take home the paperwork I will need now, so admitting will be easier/faster?

Is there a Triage process before admission (observation on Fetal Monitor)?

How many people can be with me during Triage?

Do I need to be in Active Labor to be admitted? Is there a minimum I have to be dilated?

Labor and Delivery

Are there separate labor/delivery/recovery rooms, or just one room throughout stay? 

If separate, when does mom move from one room to another?

How many Labor rooms are there? ___ Delivery Rooms? ___ Postpartum Rooms? ____

Are they private? Shared?

How many people can I have with me during labor? During pushing?

How many people can I have with me during a Cesarean birth? Can my doula stay in the OR with us?

Can I wear my own clothes? Or is a hospital gown required?

If my partner/support person/doula is with me during labor/birth, does he/she have to wear anything special?

What is your Nurse-to-Patient ratio during Labor?

During Delivery?

During Postpartum?

What will the nurse do to help me during labor?

Can I eat and drink while in labor? Before/after epidural?

Is an IV required for everyone?

If IV is required, can a Hep-Lock be placed instead?

What kind of fetal monitoring is allowed/required? Continuous/Intermittent? Electronic Fetal Monitoring (EFM) or hand-held Doppler monitor?

Can I move around freely during labor? Walk in the halls? Or will I be confined to bed?

What things does the hospital have than can help with labor pain? Shower? Tub? Birth Ball?

Is there any reason these things would not be available to me when I arrive? (Restrictions? Complications? How many balls/showers/tubs are there for everyone?)

Will I be able to push in any position that feels good? Or will I be confined to bed?

What things does the hospital have than can help with pushing? Swat bar? Birthing stool?

Is there any reason these things would not be available to me when I arrive? (Restrictions? Complications? How many balls/showers/tubs are there for everyone?)

Newborn Care:

What immediate newborn procedures are required (Vitamin K, Eye Ointment, weighing)?

Can these be delayed, and for how long?

When/where are these done?

What other newborn tests or procedures are required before discharge (hearing tests, PKU test, regular weighing, bathing).

When/where are they done?

Do babies usually room-in or stay in the nursery?

Is there a NICU (Neonatal Intensive-Care Unit)?

What level (I, II, or III)?

If not, where is the nearest hospital with a NICU?

Is there a Lactation Consultant on staff? How are the nurses trained in breastfeeding?

What is your breastfeeding rate? At discharge? At 6 weeks? At 6 months?

Postpartum

How long is the average stay after an uncomplicated vaginal birth?

After a C-section?

Can partners/Dads stay over?

When can other children visit/stay over?

Other visitors?

Other Statistics/Information

Are most deliveries performed by OBs? Midwives?

What groups (OB offices, midwifery practices, etc.) have delivery privileges here?

What is your Cesarean rate?

Epidural rate?

Induction rate?

Augmentation/Pitocin (speed up labor) rate?

For a printable version, click HERE. 

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Like what you've read? Pregnant and looking for a class in Western/Central Massachusetts?
Check out our current class schedule here.

Questions? I'm never very far away from my email.

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Book Review: "Expecting Better" by Emily Oster

There is no lack of pregnancy books out there, so when I heard about one more book expounding on the "newest" recommendations for prenatal health, I was skeptical. When I saw the post on Slate.com that it was about debunking myths about eating sushi and drinking alcohol and coffee, I scoffed - doesn't EVERYONE know that it's ok to drink alcohol once in a while, a few cups of coffee won't hurt, and sushi won’t make you any sicker than it would for a non-pregnant person? Then my dear husband had to remind me, as he so often does, "Babe. No, they don't. No one else reads pregnancy books for fun like you do." He had a point. And when I went on to actually READ the post on Slate, I learned that the author, Emily Oster, is an economist, not a doctor or a childbirth educator, and the book was about the actual studies that lead to the common recommendations about food, drugs, and general health during pregnancy. I was intrigued -- I do so love evidence-based care.

I picked up Expecting Better from the library when it was released. Again, I was surprised to find my name at the top of the list for it -- weren't other people as excited as me to find out the methodology that went into studying the effects of deli meat on pregnant stomachs?! Apparently not. Their loss, because this book was wonderful.

The author takes the reader through the story of her own pregnancy -- from stopping birth control through delivery day -- and discusses the research behind many of the common recommendations she received. For example, when asking her doctor when she would expect to resume a normal menstrual cycle after stopping hormonal birth control, the doctor gave her “vague reassurance” that it would not take long. Ms. Oster, a planner like myself, found phrases like "a little while" and “everyone is different” to be inadequate answers. She used her training as an economist to pull the studies associated with this “data”, dissect them, interpret them, and (lucky for us) explain them in simple, easy-to-digest language. (Turns out, 60% of women have a normal period the first month off the pill, and nearly 100% of women will have resumed normal cycles by nine months).

The author does a great job breaking down statistical theories in an easy way. For those of us who have forgotten (or blocked out) our last high school or college statistics class, she explains concepts such as false-negative and false-positive, how researchers arrive at those numbers, and why they are important when calculating your own risks. She also explains some of the more complex reasoning behind certain medical recommendations. For example, she briefly explains the different classes of drug restrictions, including how the Class C classification is pretty un-helpful. This information is a particularly useful nugget for a mother to have in her arsenal, even after the birth. Imagine a doctor prescribes a nursing mom a drug and says "This is a Class C drug, so you have to wean immediately." Wouldn't it be nice to know before going to the doctor that a Class C means there have not been any well-controlled human studies for this drug, instead of thinking it means it will immediately harm your baby?

Ms. Oster walks a fine line between giving us the data we need and making any true recommendations herself. She makes a good effort to explain HOW one would go about making a decision with all the facts, and gives examples of the decision SHE made vs. the decision her friend made with the same data and the same risk factors. While her personal interpretations come out at times (for example during the discussion on home birth), she stay mostly neutral on "controversial" topics, such as breastfeeding and pain management. To her credit, she guides the reader through the problems with the study responsible for the standard (negative) recommendation about home birth from the American Congress of Obstetricians and Gynecologists, pointing out where the flaws are and how their published infant mortality rate may not be accurate. Overall, the author’s tone is one of respect – mothers CAN be trusted to make informed decisions as long as they have the correct information.

My one issue with the author’s interpretation of the data is regarding epidural use and breastfeeding. Though it hard to argue with her data analysis (since that’s her job), I feel like perhaps she did not extend her analysis far enough. She states convincingly that getting an epidural does not delay the onset of lactation or cause babies to be lethargic (there is some anecdotal evidence that babies born after epidurals do not latch as well, though according to Ms. Oster there is not enough randomized data to conclude this). However, her conclusion that “there is no affirmative evidence that nursing is impacted by the epidural” is simply not accurate – lactation does not automatically equal breastfeeding success. She goes on to describe that a major complication of getting an epidural is maternal fever, and that the standard care for an infant in that case is to be given antibiotics. In addition, the infant is usually SEPARATED from his or her mother and placed in the NICU for observation. The simple act of separating a baby from its mother directly impacts their ability to breastfeed. So while an epidural may not keep a mother’s milk from coming in, it may lead directly to a practice that damages the breastfeeding relationship – a huge factor for many moms contemplating their pain management.

Overall, this book is a great resource and one that should be on any educator’s bookshelf (not to mention in a gift-bag to your newly pregnant friend). The studies used are current and well-interpreted, and Ms. Oster’s writing style is friendly and accessible. In order to give informed consent, one first needs to be informed. This book is a great way to get your questions answered and begin the process of making well-informed decisions about your care.

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Like what you've read? Pregnant and looking for a class in Western/Central Massachusetts?
Check out our current class schedule here.

Questions? I'm never very far away from my email.

Follow Crafted Birth on Facebook for updates and birth-related resources.

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