I’ve been debating about whether to share this post or not. I’m concerned that it may come across as unnecessarily negative, pessimistic, or even “combative” or “anti-hospital.” However, I do think it is honest and I’ve decided to share it. There is a fairly “normal” course of events for women having a natural birth in a hospital setting. In order to be truly prepared to give birth in the hospital, it is important to be prepared for “what to expect” there and to know how to deal with hospital procedures. All hospital procedures/routines can be refused, but this requires being informed, being strong, and really paying attention to what is happening. I hope this list of “what to expect” with help you talk with your medical care provider in advance about hospital routines and your own personal choices, as well as help prevent unpleasant surprises upon actually showing up in the birthing room. This list is modified from material found in the book Woman-Centered Pregnancy and Birth. I am not saying that is how your specific hospital operates, but that many American hospitals function in this manner.
- Expect to have at least some separation from the person who brought you to the hospital, whether this separation is due to filling out admission paperwork, parking the car, giving a urine sample, being examined in triage, etc.
- Expect to remove all your clothing and put on a hospital gown that ties in the back.
- Expect to have staff talk over you, not to you, and to have many different people walk into your room whenever they want without your permission and without introducing themselves.
- Expect to have your cervix examined by a nurse upon admission and approximately every hour thereafter. Sometimes you may have multiple vaginal exams per hour by more than one person.
- Expect to have an IV inserted into your arm, or at minimum a saline lock (sometimes called a Hep lock).
- Expect to be denied food and drink (at best, expect clear liquids or ice).
- Expect to give a urine sample and perhaps a blood sample.
- Expect to have an ID bracelet attached to your arm.
- Expect to have to sign a consent form for birth and for application of a fetal monitor that states that your doctor will be responsible for making the decisions about your care (not you).
- Expect to have a fetal heart rate monitor attached around your belly—two round discs on straps that will often stay with you continuously until you give birth (or, at best, for 15 minutes out of each hour of your labor).
- Expect to have your water manually broken at about 4 centimeters (or at least, strongly suggested that you allow it to be broken). After this point, expect to be encourage to have an electrode screwed into the baby’s scalp to measure the heartbeat and a tube places in your uterus to measure your contractions.
- Expect to be offered pain medications repeatedly.
- Expect to receive Pitocin at some point during your labor–“to speed things up.”
- Expect to be encouraged (or even ordered) to remain in your bed through much of labor, especially pushing.
- Expect to either have your legs put in stirrups or held at a 90 degree angle at the hips.
- Expect to be told you are not pushing correctly.
- Expect to hold your baby on your chest for a few minutes, before it is taken away to be dried, warmed, and checked over.
- Expect the baby to have antibiotic eye ointment put into its eyes (without telling you first).
- Expect to have your baby suctioned repeatedly.
- Expect to be given a shot of Pitocin to make your uterus contract and deliver the placenta.
- Expect not to be shown the placenta.
- Expect your baby to be given a vitamin K injection.
I think it is important to note that what you can expect is often different than what you deserve and that what you can expect often reduces or eliminates your chances of getting what you deserve. In my classes, I’ve made a conscious decision to present what women deserve in birth and though I also talk about what they can expect and how to work with that, I think sometimes they are left surprised that what they actually experience in the hospital. At minimum, what you deserve are Six Healthy Birth Practices (as articulated by Lamaze):
- Let Labor Begin on Its Own – Download PDF
- Walk, Move & Change Positions – Download PDF
- Have Continuous Support – Download PDF
- Avoid Unnecessary Interventions – Download PDF
- Get Upright & Follow Urges to Push – Download PDF
- Keep Your Baby With You – Download PDF
As an example of what I mean about what you can expect clashing with what you deserve, consider the second healthy birth practice “Walk, Move Around, and Change Positions”—monitoring and IVs directly conflict with the smooth implementation of a practice based on freedom of movement throughout labor.
So, how do you work with or around these routine expectations and your desire for a natural birth?
- Discuss in advance the type of nursing care you would like and request that your doctor put any modifications to the normal routines in your chart as “Doctor’s Orders” (if your doctor is unwilling to do so, seek a new medical care provider!)
- Labor at home until labor is very well-established.
- Go through the above list of “what to expect” and make a decision about how to handle each one on a case by case—you may choose to actively refuse something, you may be okay with accepting certain procedures or routines, and you can develop a coping plan for how specifically to work with any particular issue.
- Take independent childbirth classes and learn a variety of techniques and pain coping practices so that your “toolbox” for working with labor is well stocked.
- Hire a doula, or bring a knowledgeable, helpful, experienced friend with you. It can help to have a strong advocate with you (this may or may not be a role your husband or partner is willing to take on).
- Another tactic is to “never ask permission to do what you want, but to go ahead and do it unless the hospital staff actively stops you.” (An example of this is of getting up and walking around during labor)
- “Many people, if they can find no other way to get around a dangerous or unpleasant hospital policy, unobtrusively ignore it”—a good example of this is with regard to eating and drinking during labor. Restricting birthing women to ice chips or clear liquids is not evidence-based care. Bring light foods and drinks and quietly partake as you please.
- Leave the hospital early, rather than remaining the full length of stay post-birth. This can minimize separation from baby and other routines you may wish to avoid.
- For some additional ideas see my post, “Can I really expect to have a great birth?“
Finally, and most importantly, “birth is not a time in a woman’s life when she should have to FIGHT for anything,” so if you find that you feel you are preparing yourself for “hospital self-defense” I encourage you to explore your options in birth places and care providers, rather than preparing for a “battle” and hoping for the best. If you feel like you are going to have to fight for your rights in birth, STRONGLY consider the implications of birthing in that setting. Also, as The Pink Kit says, “hope is not a plan”—so if you find yourself saying “I hope I can get what I want” it is time to take another, serious look at your plans and choices for your baby’s birth.
Talk Birth 
Great post and sadly so true.
I agree that educating yourself is a big step away from this and having a doula can help too.
I had a birth the other night and mom was in triage FOREVER because it was a busy night. Only one birth partner at a time is allowed in triage. So I switched with Dad. Mom had to pee, so I unhooked her and she went to the bathroom. When she came back she started to get back into the bed, I asked if she preferred the birth ball. She said yes!
Little things like this make a big difference.
It’s good to know what to expect if you have to choose between a hospital birth and an unattended childbirth. I have had two prior c-sections and was turned down in my last pregnancy by every single midwife in my state for a home birth or birth center birth. I understand their position. They have to be able to serve the majority of home birth clients, and their right to practice here is precarious at best. A bad outcome, even if it had nothing to do with midwifery care, would probably put that midwife out of business, and seriously threaten the ability of others to practice. I finally found one physician willing to “allow me a trial of labor”. Unfortunately, that pregnancy ended in a miscarriage. It is so very, very wrong that the few short weeks I carried my baby were spent in a state of stress and panic over choosing a care provider that, ironically, I never even met for a prenatal appointment. And it is even more wrong that my only choices are accepting a hospital environment or going it alone.
Tracy, I totally agree! I was forced into an unassisted home birth for my first because the hospital refused to accomodate my wishes. I emailed over 30 midwives when I was 37 weeks preggo in the state of AZ and nobody would agree to attend my daughter’s birth at such late notice. Everything was just as I imagined and sooo perfect but a lot of women are jot comfortable with U/C and, in this country, our options shouldn’t be as limited as they are. Unacceptable in my opinion.
“Expect to receive Pitocin at some point during your labor–”to speed things up.”
“to speed things up” that was the direct quote when they put me on Pitocin when I came to the hospital in labor already. one thing lead to another and I “needed” a c-section. which they messed up doing. everyone was “OK” but I was so tramatized afterward…four years later I had a wonderful, loveing homebirth. best choice I ever made in my whole life.
Linked! Great posts!
http://icanwesternmd.blogspot.com/2009/09/beyond-birth-planhow-to-get-natural.html
Be sure to know all you can about Pitocin before you go in
One that really struck me was ‘expect not to be shown the placenta”. I didn’t know enough about what to expect for my first baby however I was able to communicate that I wanted a natural birth and generally they worked well with me in helping that happen. However the placeta was whisked away and I never got a chance to see it. That really bothered me – I felt like it had been a part of me for nine months it’d be nice to know what it looked like. That and so many other things on your list are things one just doesn’t think about and therefore doesn’t know to watch out for/request when in the hospital (almost got a shot of pitocin after delivery as well but thankfully had a great spouse and coach paying attention to the staff…I thought I only had to make it through labor and delivery then I would be clear – that just showed me.) Thanks for this list. I have a hospital birth (after having a home birth a couple of years ago) coming up and this is a great reminder of the things I need to spell out when I walk through the doors.
“What to expect” was exactly what I got with my first birth despite being encouraged to write a “birth plan”. I went to the hospital with faith in my doctor and nurses, faith in myself to get the job done and the promise of being treated well and and having my needs met . I went home cold, drained and sad. Nothing was done like I wished because no one was interesed in reading my “birth plan”. It was filled with silly things like being able to walk during labor and keeping the baby with me to nurse (they took him for the hearing test for 3 hours and fed him a bottle against my wishes). With my second we chose to go with a midwife/birth center. Thank you God! No medication of any kind was “needed”, my husband was able to support, the baby was wonderful and even nursed before the cord was cut, this is the way to build a family! We liked it so much we’ll be going back to have #3 in a couple of weeks. Hospitals are good to have for emergency situations but not for normal birth and most births are normal.
I had sooo much of the ‘expected’ forced upon me, especially after being told I needed to sleep because it would be at least 10-15 hours before my daughter decided to make an appearance…they gave me ambien to sleep, and less than 5 hours later, my daughter arrived. Next time, I am NOT taking medication unless it is MEDICALLY needed…I was quite disappointed especially after creating a well-thought out birth plan. I have found a fabulous midwife for my next childbirth experience and am looking forward to a more positive delivery for our second child, when the time comes.
I had myself really worked up in advance of first birth because I was paranoid about several of these things happening. What reassured me was my husband totally being on the same page with me. He actually drafted the birth plan based on one provided by our childbirth educator. It’s so true that you aren’t in a good place to be on the defense while you’re in labor, (and isn’t having your defenses up just as intrusive to your birth experience as continuous fetal monitoring?) and an assertive, informed birth companion is so crucial.
thank you thank you thank you! i have been looking for something like this to share with others.
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I have read dozens of birth stories which comprise these steps (falling like dominoes) … induction … fetal monitoring … pitocin … epidural … fetal distress … cesarean. I have also witnessed it with a client who birthed in a hospital. Yes, she had a birth plan, yes, she wanted a natural birth, yes, she had done her homework. Still, at the birth, the fear-mongering of the doctors and nurses got the better of her and she ended up cut.
I am SO grateful that my own son was born at home with midwives, especially since he was a frank breech, and if I had been in a hospital I would certainly have been cut.
One quote which I have seen puts it bluntly and suscinctly: IF YOU BUY THE HOSPITAL TICKET, YOU ARE ON THE HOSPITAL RIDE.
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I do believe it is important for moms to be educated and know what to expect from standard hospital procedures. I feel blessed to have given birth in a hospital that is very friendly to natural birth. My preferences were completely respected, and I did not have to deal with many of these problems. I had a beautiful, natural birth in a hospital setting.
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This is brilliant – thank you for posting! Sadly, very true. So many women are uninformed of what to expect at the hospital. Luckily, I did some research while pregnant and realized what a battle I had before me to birth naturally in the local hospital. I went up there three different times to try and sign waivers ahead of time and get them to work with me on what I was comfortable with hut it was a complete and royalty failure. They just looked at me like I had two heads 😦 so, I trusted my gut and stayes home and delivered my baby girl unassisted. Everything was absolutely perfect and I will never go to a hospital to birth any more children. So much needs to change with maternity care in America….
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Would you consider putting a picture somewhere in this post? I would love to Pin it to my childbirth education board! (http://pinterest.com/birthbyheart/) Great post.
Yes! Great idea. I wrote this before Pinterest was big. Now, I make sure to include a picture with almost every new post I make! So, I’ve updated the post now and it includes a picture 🙂
Thank you! It’s been pinned 🙂
You’re welcome–thank you!
I live in a progressive place, but my childbirth at the hospital was wonderful. But…I had a very detailed plan and a doula. basically none of the bullets applied to me:) As long as YOU know what you want, things can work out fine:)
Absolutely! Thanks for sharing. I wish more women had your experience. I do think in many places the outlook for woman-centered, natural hospital birth is improving–more slowly than I’d like, but improving! Unfortunately, most women who give birth in my town and in many parts of the state I live in experience almost every one of these bullet points. That was one of my main reasons for writing this post–because I was tired of feeling like I was lying to women and preparing them for a birth they were not really going to be able to have 😦
That was phenomenal. Absolutely correct, and, with education, correctable! On a side note, none of the links are current/ working. Thank you!
Thanks for the alert! They’ve been corrected! 🙂
Wow. Luckily I’ve never had those experiences. I’m 36weeks pregnant with my 4th child.I swear by midwives. I delivered in a traditional hospital setting with my 1st. The other 2were born in a birthing center attached to a hospital.I agree educating yourself is key. If you want an unmedicated birth do not take the hospital class. Find someone who specializes in unmedicated births .
I had two hospital births and very few of these happened to me or were offered to me luckily. I delivered with a midwive who knew my expectations well before I went into labor though and supported my choice.
That’s great! 🙂
Greetings! This is my first visit to your blog! We are a team of
volunteers and starting a new project in a community in the same niche.
Your blog provided us valuable information to work on.
You have done a marvellous job!
If you don’t educate yourself so you can have intelligent conversations with your medical staff, then yes, you probably can expect all the things listed above.
Otherwise, you should evaluate each OBGYN / L&D unit on its own merit and principles and select both a hospital and OB / L&D that is most in line with your own birthing philosophy. My hospital has pretty much told me: “It’s your labor. Tell us what you want.” I have talked since day one with my OB about my wishes and she scanned in a copy of my birth plan to my medical records in case for some reason I don’t have one with me when I go into labor. She’s even agreed to let my husband deliver the baby since he has experience in that area. They work well and closely with doulas / midwives in our area, and even though they may be behind in their knowledge and practice in natural birthing, they have not provided me with any reason not to move forward with my plans for a natural birth. My OB is currently getting her certification to practice natural, holistic medicine (food & vitamin therapy) alongside conventional- a move certainly in line with the wishes of most of on this site. None of our L&D are certified for natural childbirth techniques, however, they will support every type except a water birth (liability). By the way, I don’t live in a very progressive town where a person would think to expect more than the bullets listed above.
It’s fine to want a 100% natural childbirth, and we should certainly take classes on those- especially for our first- but we shouldn’t neglect the one offered by the hospital either. You never know what will happen that may require emergency services, no matter how well-educated your doula/midwife is, and it’s better to know what your options may or may not be in the event of a worst-case scenario.
One other interesting tidbit: when I asked the delivery nurses why they don’t have a class, or at least a segment on natural birthing techniques, they said it’s because 98% of the women ask for epidurals, so they didn’t see enough interest from their patients to justify the cost of the class or offering it regularly. That makes sense. That afternoon the anesthesiologist came in to talk about epidurals and said nearly everyone woman initially requested a natural childbirth, but ends up requesting an epidural- hence the nurses’ original statements. Further investigation with the nurses, anesthesiologist, OB, and even pediatricians, revealed that most women like the idea of natural birth, but few have actually prepared themselves for it by conducting their own research, talking to those who have experienced it, communicating their wishes regularly with their OB (or in some cases even with spouses), writing a birth plan, asking questions, taking classes, or any other measure. Then when the time comes, they arrive and simply request it as though they were requesting nachos at a ball game. They have no idea what to expect or (more importantly) how to cope with pain. So they ask for an epidural and go through the standard conventional practices because they don’t know what else to do.
The fault lies with the medical community only to an extent. If patients continue to go in uneducated and uncommunicative as is the case with many in my area, we can’t really expect our medical community to take us seriously when we ask for alternative methods to be used. The change has to happen on both ends.