patchfire toured the notorious Northside Hospital in Atlanta, and wrote about it in birth_is_normal.
Here's her post (note: she told me that the tour guide actually used the term "lovely gown". I should be amused).
Her description sounds a lot like Women and Infants' Hospital in Providence, which I'll be touring.
Birth Rant below. You've been duly warned.
On the W&I website, there's a Virtual Tour of Women and Infants' OB services, and it pretty much reads like a verbatim account of patchfire's real-life tour of Northside. It's pretty, all right--whirlpool baths--45 minute limit, and don't you dare even think about actually *gasp* giving birth in there, or asking if your partner can join you in the bath. That would be Bad, Bad, Bad.
Of course, even this much was an untouchable dream for me at W & I, because I was in a real delivery room on a metal table with stirrups for various
"Follow the sign to the Maternity Admitting parking area. You may park in this lot until you are admitted to Triage. Triage staff will let you know when your car should be moved to the Visitors parking lot."
Um, that parking lot is in a high-crime area, so you might need security to take you (mom's partner, who should be with mom) there at night. It's across the street, IIRC--a very busy street. It may take a few minutes to figure out where security is. My advice? Just park in the visitors' lot and walk, if it's daytime. If it's gonna be night, have someone else drop you off. THEN let 'em figure out how they'll get rid of you. Because they have to; it'd screw up the ritual if you weren't gone while they "prepped" mom (read: IV, Johnny, possibly an enema. I don't think they do shaves anymore, say thankya).
Meanwhile, labouring mom is back in Triage (Triage! Like in M*A*S*H! I keep picturing helicopters full of obstetricians landing all over the lobby) being introduced to her IV and her lovely backless hospital johnny. Because of course she can't wear her own clothes. ZOMG, WHAT IF SOMETHING WERE TO HAPPEN?! And don't even ask about wearing NO clothes. Where is your sense of ladylike propriety, woman?
After Triage, mom will of course be taken to the labor room in a wheelchair, because she's ill, after all.
"Hospital policy requires that your baby be monitored electronically for 20 minutes each hour to establish a baseline heart rate for your baby."
The late Dr. Edward Hon, who invented the Electronic Fetal Monitor, disagreed. He said that the monitor was invented for high-risk births and recommended against using it for normal births, and that most women in labor would be better off at home anyway. He said this in 1987, not 1897, btw. Many, many, many stats show that women whose labors are monitored with the EFM end up with unnecessary Caesareans.
Dr. Hon also said this: "Most obstetricians don't understand the monitor. They're dropping the knife with each drop in the fetal heart rate. The Cesarean section is considered as a rescue mission of the baby by the white knight, but actually you've assaulted the mother." This from the inventor, yet the docs keep using it and the Caesarean rate stays steady. Again, WHY? It's more than just CYA. It's because it's the way it's DONE. EFMs also keeps a woman on her back. The only position worse for labour is standing on her head, and I'll argue that even that doesn't put pressure on the her body's essential vessels.
Manual monitoring with a fetoscope works pretty well, actually, and doesn't make the docs go running for the OR with every scratch of the pen. *sigh* At least they "let" the woman walk around (which renders the whole wheelchair scene from Triage a bit of a contradiction, no?). Unless, of course, she's getting an epidural, in which case she'll be paralysed from the waist down and won't be able to do anything but lie--you guessed it--flat on her back.
"Every labor room has cable TV. Mom may have ice chips, popsicles, broth, and jello while in labor depending on her condition, but no solid foods."
Well, that's good. Because now mom is pretty much NPO, so when they do that C-section(because mom has no energy left for pushing due to there being no fuel for her exhausted, depleted cells and maybe she's throwing ketones because her body thinks she's starving it) she won't asperate any nasty food particles. And whee, Cable for her not to watch because she's too busy being prepped for surgery. Maybe after they pull the baby out (and they pull HARD, I've seen it), if she's not in too much pain from the staples, she can watch A Baby Story on Lifetime, which will show lots of normal births, just like hers!
"The baby warming unit pictured here maintains your baby's temperature."
I pretty much thought mom's warm skin and a few blankets would take care of that. Not high-tech enough, I guess. A mother's embrace, peh. Practically obsolete. How keeping the baby away from mom seconds after being born will help him/her not be cold is beyond me. Maybe screaming a lot will help heat the little tyke up faster.
"Shortly after birth, the baby will have two sets of its footprints taken. One set is for identification purposes and the second set is a keepsake for the new family."
Seems to me that this could be done HOURS after birth, if the bracelets are snug enough on baby's ankle and mom's wrist. And um. If mom keeps baby with her? S/he's not likely to be snatched out of her arms. Jeebus.
Watch the "Birthing" Video (if it doesn't work, save the link and open with whatever player that will), which was on RI TV.
Note women flat on their backs, mostly (except for cute couple kissage just at the start. Dad must have made it back safely from the parking lot).
Note nurse tell mom that contractions are pretty close together. Y'know, just in case mom wasn't aware of that little factoid. Note nurse further tell mom that it's going to be "quite a while." Encouragement is good in labour.
Note required IV, "just in case". In case what? Note interview with nurses talking about women screaming and hairpulling and generally projecting that normal birth is an excruciating hell.
Note the nurse saying "push with everything you've got".
For a normal birth, YOU DON'T NEED TO PUSH WITH EVERYTHING YOU'VE GOT!!!!! It's not necessary and in fact isn't a good idea at all. If there's no urge to push right away, it's Normal. There's a period of reduced uterine activity for a reason. It's what Sheila Kitzinger calls the "rest and be thankful" stage (which can last from a few minutes to two or three hours, although most women who birth in US hospitals are totally unaware it exists. This is because US hospitals, pretty much all of them [and every single one where I've either attended births or given birth myself] start telling women to pushpushpushpushpush the second the required (and usually unnecessary) vaginal exam reveals her cervix is ten centimetres dilated. If a baby is in distress, okay, early pushing might prevent a caesarean (cynical me thinks not), but for a normal birth, it's just wearing out the mother for no good reason. Not to mention that waiting to push until her body tells her to do it is better for the baby because it doesn't adversely affect the fetal heartrate like coached pushing can. In the studies I've seen, APGARS are better for these babies, there's less likelihood of forceps or vacuum deliveries, mom's perineum is more likely to be intact, and on and on and on. This is even true with epidural births, according to this study (although I can tell you from study and experience that the urge to push is likely to be virtually nonexistent with epidurals, so the woman most likely has to actively push anyway, with her feet held up and knees pulled back by other people, of course, because the epidural has paralysed her legs). If a woman's body is able to do what it innately knows how to do, it's better for everyone, period (except maybe not for the doctor, who has to wait longer and maybe not get his/her quicker and more expensive C-section).
I'm also going to tour the Alternative Birthing Center, which I've never been to. IIRC, it's RI's only ABC. It offers early discharge, 6 to 12 hours after "delivery" (I don't exactly know who's doing the delivering. Dominos?). I don't know enough about the ABC to comment, so I'll tell y'all when I have. I hope it's nice. It's certainly pretty, from the pics. It's gotta be better than the hospital itself.
Then there's the NICU, or Special Care Nursery, which is essential to an OB floor, and NICU nurses amaze me at how they can put IVs into tiny veins and help preemie hearts keep beating. Hospitals that practise Kangaroo care probably save a lot of lives, I don't know if W&I does. *adds to Question List*
Preemies and genetic problems aside, though, I wonder how many little patients in the NICU would have avoided their stay there if mom hadn't been, oh, induced too early and her membranes ruptured when the baby's head was too high, causing a prolapsed cord (I've seen this happen--scary, scary scary and the doctor's fault completely. The baby was okay, after a very, very stat C-section). Or maybe he or she was exposed to infections made in the hospital like MRSA and other nosocomial infections. (Probably not coincidentally, every single study shows that of the babies who are infected, a large--upwards of 80%-- of them are males). MRSA infection is found mostly on the skin, most often in open wounds. Let's see...which gender (in the US) is more likely to sustain an open wound just after birth? Yep, it's the boys. One of those things that makes me go "hmm", and then have to supress the sudden urge to hit my head against a brick wall. A nosocomial infection caused by an iatrogenic procedure. I thought hospitals were supposed to make sick people well, not well people sick.
LITTLE THINGS NOT MENTIONED IN THE VIDEO:
IVs (shown, not talked about), mandatory in most baby factories, but not all hospitals.
Artificial Rupture of Membranes (if cervical dilation doesn't happen according to the hospital's set timetable). If it still doesn't happen in a timely fashion, mom gets Pitocin to speed things along, and make the contractions stronger and painful in a way that's different from natural ones, and raise the risk of hypertonic uterus which can lead to uterine rupture. There's another lovely new drug called Cytotec that's used instead of Pitocin sometimes that's even worse. And then if all else fails, bingo! Major surgery for something called "failure to progress". Nice that they make it a failure of the woman.
Women and Infants is a terrible place to have a normal birth. I know because mr_t00by was born there. I know I'm going to have a hard time revisiting, which is one of the many reasons I hope songdog and mr_t00by will be with me. And asking (polite) questions.
Bleh. This wasn't going to be MY rant about U.S. birth culture; I was just linking and giving a "what she said" to patchfire's post. Brought back some bad memories, I guess. Ick.
On a positive note about this hospital, they've got one heck of a women's oncology unit.
But yeah. What she said. *sigh*
I guess my Big Update and Sox-beat-Yankees celebration and my unexpected but not unwelcome opinion of Johnny Damon will have to wait. Eep.