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?
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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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We'll be sharing some fun links and pictures, and you'll be the first to hear about new classes!

Link Party: Postpartum Recovery

A great article about some culture's "lying-in" practices for new mothers, comparing them with in the U.S. model of a "functional" postpartum period.

Why Are America's Postpartum Practices So Rough On New Mothers?

Book Review: "Mother's Milk: Breastfeeding Controversy in American Culture" by Bernice Hausman

Synopsis: (via Amazon.com)

    Mother's Milk examines why nursing a baby is an ideologically charged experience in contemporary culture. Drawing upon medical studies, feminist scholarship, anthropological literature, and an intimate knowledge of breastfeeding itself, Bernice Hausman demonstrates what is at stake in mothers' infant feeding choices--economically, socially, and in terms of women's rights. Breastfeeding controversies, she argues, reveal social tensions around the meaning of women's bodies, the authority of science, and the value of maternity in American culture. A provocative and multi-faceted work, Mother's Milk will be of interest to anyone concerned with the politics of women's embodiment.

Review:
    The author described the conflicting attitudes of breastfeeding advocates and feminist critics very well, highlighting how this poses a problem for everyday women and leads to "Mommy Wars", something very topical in today's media. According to Hausman, the only vocal breastfeeding advocate group is La Leche League, whose continuing ephasis on "immersion mothering" and not working outside the house is off-putting and unrealistic for many families. Conversely, feminist critics, who so readily discuss pregnancy and birth and fight for better treatment of laboring mothers, do not support breastfeeding, as it serves to encourage domesticity and exacerbate the gender differences between parents. When these two groups fight against each other, there is no one fighting for the everyday nursing mother (especially one who works outside the home). The author (eventually) made an excellent point about bridging the gap between breastfeeding advocates and feminist critics by encouraging "Health Advocacy" instead of breastfeeding advocacy. This perspective will help to keep the health benefits of breastfeeding part of the discussion, encourage practical advice, and reduce the judgement of women who choose not to breastfeed. Hausman quotes from Penny Van Esterik's Beyond the Breast-Bottle Controversy, and I think this nicely sums up the goals most breastfeeding advocates and educators: 

"The trajectory goal becomes not to have every woman breastfeed her infant, but to create conditions in individuals, households, communities, and nations so that every woman could. The first step is to create conditions that make breastfeeding possible, successful, and valued in a given society."

    Hausman touched on many different points regarding how women make the decision to breastfeed or not, including physician authority, popular texts for pregnant women, formula marketing, mass understanding of evolutionary theory, and race and class. Her overall theme seemed to be that women do not make this decision "in a vacuum", that the constant collision of culture, medical expertise, and personal beliefs make this decision so much more complicated that "what should I feed my child?" I appreciated her respect for women who choose to formula-feed, stating that they choose to not breastfeed not because they are uneducated or ignorant, but because they have taken into consideration their own circumstances and decided it's better for themselves, their baby, and their family to formula-feed. Hausman also made a nice attempt to deconstruct the bottle-feeding paradigm that women see every day. Her analysis of pregnancy books and formula marketing was eye-opening and a concrete example of how culture affects breastfeeding choices.

    While the author's overall point was well-taken, I found her tone and writing style very difficult to read, especially in the early chapters. It took until the end of the over 200-page book to understand her overall message; her initial thesis was written in such abstract terms, it took a complete deconstruction of the sentence to understand her point -- and even then, it did not seem to match her overall argument once I had finished the book. She claimed the book was for mothers (as well as for doctors, educators, advocates, etc.), but I would be surprised if most mothers would find her style accessible. The book seemed aimed more for educators and advocates than for breastfeeding mothers. As she states herself, mothers need practical advice and real social support from doctors, other mothers, and the workforce; mothers do not need ideology. As this book is mainly focused on discussions of culture and the ideological meaning of women's bodies, it seems as the book itself is an example of what would be unhelpful to an everyday nursing mother.

Hausman clearly did her research on feminist theory and breastfeeding benefits; however she seems to only site a few sources. She also has a clear bias towards La Leche League, and implies that they are the only breastfeeding advocates out there. It would have been nice to see an analysis of other advocates' texts as well. Also, while the author made a good attempt at an overall flow of the book (chapter one discussed public media, chapter two physicians, chapter three texts for parents, etc.), there were times when her discussions seemed random and not fitting to the chapter as a whole (for example, the discussion of the sexuality of motherhood and breastfeeding in the chapter about physicians, authority, and scientific motherhood seemed, while interesting on its own, a bit out of place).

Overall, this book was helpful to me as an educator and breastfeeding advocate, but it would not serve to help a nursing mother feed her baby or even help her to make an informed decision about feeding, as the book is so dense and difficult to digest.

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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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Happy World Breastfeeding Week!

World Breastfeeding Week - August 1 through August 8

Head on over to our Resources page for some of our favorite breastfeeding books and pages.

Postpartum Survival Kit

Lately whenever a friend or co-worker has a baby, I like to give her a "Postpartum Survival Kit" -- a collection of useful items that are super helpful to mom, but things that many do not remember needing.

I like to include ...

For Mom's Body:

• Overnight Maxi Pads -- the ones from the hospital can be really uncomfortable (and dare I say, cheap?). If it's touching your vulva the day after you push out a baby, splurge on some "fancy" ones. (Also, those first few days when your bleeding is a little unpredictable, put an extra pad across the back of your underwear at night. This will keep the leaking to a minimum.)
• Hemorrhoid pads (Tuck's are a popular brand) with Witch Hazel. I especially like to give these ask gifts, if only to relieve the new mom from having to ask the guy at the drug store where they are.
• Nipple Cream (I like the Lansinoh brand, but any 100% lanolin cream works. Note: Lanolin comes from sheep wool, so if you are vegan or prefer to stay away from processed animal products, there are non-lanolin nipple butters on the market, such as those from Earth Mama Angel Baby).
• ***Note. Nipple cream will not solve the problem of sore or cracked nipples, only make them feel better while you fix the issue, which is usually a bad latch***
• Puppy Pads. Seriously. I doubt you will find a pregnancy book that will include this one, but here it is. Again, in the first few days your vaginal bleeding may be a bit unpredictable, and you would hate to sit down in your new cream-colored nursing glider and leave a blood stain. Puppy pads are absorbent and have a plastic bottom layer, so the fluid won't leak through.
• Other One-Offs
• Breast pads. Some moms need a lot of these, some need none. I like to include a few, simply so mom doesn't have to go buy and whole big box, unless she finds she needs to wear them consistently.
• Microwave Sterilizing Bags. I know, boiling water is SO HARD, but I personally loved these. So I like to include one bag, so mom can use it for those first few items without bothering with the stove. (**Note. You don't have to sterilize pump parts and other baby things after every use, unless your baby is premature or his immune system is compromised).

For Mom's Mind:

• Her favorite magazine. There is a lot of sitting when you are nursing a newborn, so here's a chance to catch up with Martha Stewart (or People Magazine, I don't judge).
• A gift card for iPhone apps or music (this is great for Dads/partners too!) Angry Birds helped R's dad survive those early days (er ... months) of evening grumpies, where all we could do was sit and rock him.
• "What Mothers Do Especially When It Looks Like Nothing" by Naomi Stadlen. A great book about the realities of mothering a newborn, complete with negative feelings about oneself and one's baby. Very real and very moving.

For the Breastfeeding Mom and Baby

• If mom has registered for or already has a nursing pillow, a Nursing Pillow Cover. These get milky and smelly, so it's good to have an extra one handy.
• The name and phone number of a local Lactation Consultant. Most common breastfeeding issues can be fixed easily with a little help. Encourage mom not to wait, but to call someone right away (remind her it's probably covered by insurance!)
• The name and phone number of the local La Leche League leader, as well as their meeting schedule. All moms need support, but breastfeeding moms also need support from other breastfeeding moms. Seeing other moms nursing their babies and being able to ask them questions about their experiences is invaluable. 
• Occasionally I have a friend who wants to breastfeed but has not done any preparation (classes, reading, research). I will sometimes include a breastfeeding cheat sheet -- pictures of positions, latch "rules", common problems and what to do about them -- just so she has a jumping off point, as well as a handy reference for those moments when she doesn't know what to do.

What was the item you found most helpful in the early days of motherhood?

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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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"Bundle of Joy" and other phrases that should go away

I have a love/hate relationship with media coverage of celebrity pregnancy/birth. On the one hand, I LOVE babies. I mean, I just love love love babies. I love pregnant bellies, I love hearing about pregnancy, I love seeing baby pictures, I love hearing about birth. However, as someone who spent most of her college years picking apart mass media (and as someone who had a rather difficult postpartum period), I absolutely cringe when I read an article about a new celebrity mom. Without fail it will include phrases such as "bundle of joy", "the proud parents", "angel", "Mom and Baby are doing great!", and "already in love with the baby".

This post is coming in the midst of the Kim Kardashian birth media circus -- according to different sources, she gave birth to a baby girl on Saturday, anywhere from 3 to 5 weeks "early"; she possibly suffered from preeclampsia; no one knows the name of this baby; the parents have not yet released any details to the media. Now I respect their decisions to not release photos or any other information -- she's THEIR baby and they'll do what feels right. The problem comes when we've been saturated with Kim K gossip for ... well, YEARS ... and suddenly are cut off. We are in Kimye withdrawal and are scrounging for any piece of information, even if it's assumptions and conjecture.

So here's the point I want to make, which can come up with ANY new mom. When the media says "she's in love with the baby already", that is ALSO assumption and conjecture. We do not know ANYTHING about how mom is feeling about the baby or her birth. And we are unlikely to see a real picture of it at all. The media calls them "proud parents", but we don't know if they're proud; People.com says "Mom and baby are doing great". Why? Because that's what you say. E! News calls the baby a "bundle of joy"; she may be a bundle of fear, anxiety, and complications for all we know.

Yes, there's usually joy when a baby is born, but what if there's not? We are saturated with the coverage of the lives of celebrities, to the point where we see that coverage as "real" and what "should" happen for everyone. When all we see or hear about is happy moms and content babies, many of us develop unrealistic expectations of what new motherhood looks like. Then, when we are at home suffering from Postpartum Depression or taking care of a colicy baby, we may wonder what is wrong us ... instead of wondering what is wrong with US Weekly.

So new moms: put down tabloids and turn off the reality TV for an hour and find a local new moms group. You may still find that woman who sees here baby as a "bundle of joy", but you're probably also going to find that mom who's having trouble and wants to throw her baby out the window.



Next week ... why are we mentioning C-sections in an article about Kate Middleton's nursery plans? Oh, I forgot, because surgery is no big deal. (NOT!)

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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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