Birth Plan Limitations
It is often said that medicine is an art and not a science. This is no more obvious than during labor and delivery. There may be many ways to ensure a good outcome, which means a healthy baby and a healthy mom, but there will be countless differences of opinion along the way as to how to best accomplish this.
For these reasons, it is important that you know what your doctor's ideas are about labor and delivery, and that he or she knows your expectations. You need to ask straight out about possible areas of conflict with either the doctor or the hospital you have picked for your delivery. Will your doctor follow your wishes? Does the hospital have rules limiting choices?
There are many established practices in obstetrics. Sometimes doctors are following standard practices, and sometimes hospitals may impose certain procedures on doctors and nurses.
Hospitals tend to have specific rules and regulations. One may be to take a patient's vital signs every four hours – including blood pressure, temperature, pulse, and respiration. If you have ever been in the hospital, you know how impossible it is to sleep because of these types of policies. In some hospitals, the doctor can write an order for vital signs to be taken every 8 hours at night for stable patients.
Hospital or departmental policy may dictate how long a woman can be watched who may not be in labor. It may limit visitors. It will define who can actually do specific procedures.
If you have picked a doctor who you feel understands what you want during labor and delivery, he or she probably does deliveries at a hospital that will allow the things you and he or she have discussed. If not, the doctor should tell you in advance, allowing you to switch doctors and/or hospitals.
Consider these parts of labor and delivery:
- Hospital admission. If you want to stay home during early labor, is your doctor comfortable with that? What if you are not sure that you are in labor and want to be evaluated at the hospital? How long will they watch you?
- Early labor in the hospital. How will you be monitored? Will you be allowed to walk, get in a tub of water, and in general, have freedom of movement? Is an intravenous line mandatory, or can you get a heparin lock, which can be used for intravenous fluids or medicines if necessary?
- Established labor. What are your choices for pain medicine, if you want it? Is there an anesthesiologist there to give you an epidural?
- Trouble with labor. How does your doctor handle
- failure to progress?
- Does your doctor use Pitocin (oxytocin)? Pitocin is medication that makes the uterus contract. What are the hospital's protocols for the use of Pitocin? These might dictate how much can be used and how fast. These also might dictate where you have to be while you are given Pitocin and how you are monitored.
- Later stages of labor. Are you still allowed to move around? What will your doctor do if there is any abnormality noted – an abnormality of the baby's heartbeat, for example?
- Delivery. In what positions and places can you push? When does your doctor consider intervention, like a vacuum extraction? When does he or she consider C-sections? Does your doctor always do an episiotomy, or usually? When the baby is out, do the nurses give him or her to you immediately? Is the baby left to breast feed immediately?
- The baby. Who will be checking the baby and when? Will your baby be allowed to room in with you?
- Complications. If any complication occurs, what are the steps usually taken? If a C-section becomes necessary, can your husband or partner still witness the birth? Under what circumstances will you be rapidly anesthetized and the baby taken out, as opposed to a slightly slower, but definite, move to do a C-section?
- If the baby needs special care. If your baby is born very early, or has a congenital abnormality or other problem, is there a NICU there, and what level is it? If there isn't one, or it isn't level III, are you prepared for the fact that your baby could be moved to another hospital if medically necessary.
- After the birth. Are there lactation specialists available to help you get started breast feeding? Is rooming in encouraged? If you have had a difficult delivery and medically need rest and/or medication, who will feed the baby?
You may look at all of these things differently if you expect a normal pregnancy and safe delivery, as opposed to a difficult pregnancy and specific concerns about your health or your baby's health. You may also look at things very differently during subsequent pregnancies.
The best thing is to ask as many questions up front as possible, both of your doctor and the hospital. Even if you have been to the hospital, if you didn't ask some of these questions, you may want to take another tour. A labor and delivery nurse will usually be able to tell you everything you want to know.