Everything You Need to Know.
When most women find out that they are pregnant for the first time, they run to their closest book store and buy a flurry of how-to’s, what-to’s, and you-can-do-it-to’s – that is, if they can stop feeling nauseous long enough to make it to their car. I indulged in the same mommy-to-be right of passage, but it was only in retrospect that I realized I missed a very critical piece of advice.
You must carefully choose the hospital where your child will be born.
Perhaps many mommy manuals are lacking this key piece of information because of several factors that pre-determine where you will have your baby. Depending on your location, there may not be multiple hospitals within driving distance from which to choose. Perhaps you have been seeing the same gynecologist for some time, and it would only be natural that you would want to stay with that practice. Because many OB/GYNS only have privileges at one hospital, you are locked into delivering there if you choose to keep that physician. This is precisely the situation that I found myself in. I spent my time – admittedly not enough time – choosing the obstetrician, and I neglected to research the hospital where she delivered.
But as I learned during my miserable pregnancy – mommy beware – not all hospitals have been created equal.
My first experience with the hospital where I delivered my daughter came during my frequent visits to the emergency room for rehydration during my pregnancy. Now to be fair to that hospital and to any other, quite frankly, I couldn’t judge the quality of the entire facility on the care I received in the emergency room. Generally I was sent there by my OB on weekends or evenings, making my experiences more traumatic, and yes, entertaining, then they really needed to be.
I also spent time there prior to my labor and delivery to take a child birth/child care class. My husband and I were both very pleased with the quality of the class as well as the teachers. Although we went on to choose a different hospital for the delivery of our second child, I would recommend to anyone in my area to utilize the classes available at this local hospital.
But here is what our colorful, yet survivable ER visits, and our exciting and educational class didn’t tell us – not only is it true that not all maternity wards come with all the bells and whistles, but it is also true that they don’t all come with the standard package. It wasn’t until the delivery of our daughter that we found that out.
When I arrived at the hospital for the birth of my daughter, I was only 32 weeks and 2 days pregnant. My admission to the maternity ward was a whirlwind of phone calls to family, nurses scrambling to administer steroid shots, and visits from neonatologists to prepare me for what I might expect when my daughter emerged. There was no discussion of her impending long term care, the nursery facilities available, or the option of transfer to another facility. It never dawned on me that that would be necessary, and if the medical professionals surrounding me considered it for a moment, they surely didn’t take another moment to bother sharing it with me.
Despite expectations and fears, my daughter was born screaming, breathing, and kicking (she still does all three regularly). She needed only a small amount of fluid cleared from her underdeveloped lungs and a short time on oxygen to survive in this world that was not ready for her. But what any neonatologist will tell you is that every 24 hours, you can expect something new. And something new always came. There were EEG’s for possible brain bleeds, DNA analysis to rule out genetic defects. They eventually brought in a pediatric cardiologist – didn’t have one in house – who explained to us the heart defects she had discovered in my newborn’s tiny chest. There were wires, monitors, incubators, temperature gauges – all to make sure that this little four pound wonder didn’t stop breathing (which she did often), or lose her heart beat (thank God, not once), or suffer from hypothermia (closest she got – 95 degrees one scary night).
And all of this without a NICU.
I had the severe misfortune of delivering a pre-term child in a hospital that was not well -equipped to handle such a case, that did not have staff experienced in caring for such a child, and that did not know what to do with this woman – suddenly no longer pregnant, yet not leaving with a child in her arms. They showed me to a small room used only for overflow patients and said that I could spend my time there during the day. I was there every day for the 7:00 a.m. feeding and didn’t leave until after my husband had given the 7:00 p.m. feeding after work and we had been allowed our one hour of holding her outside of the isolette. I spent as much time as I could inside the nursery, holding her when allowed, staring at her when not, and talking to the nurses who were open to such chatter. But no one in that nursery was prepared to have a teary-eyed first time mother lingering each day. That just didn’t happen there.
One morning I arrived to find “my room” taken. No one told me. No one posted a sign. I just opened the door as I had every day for two weeks to find another woman sleeping in the bed. Where would I pump milk for my child? Where would I put down the bag filled with insurance paperwork for this child who shouldn’t be running up bills, lesson plans for the classes I had abandoned, and unwritten thank you cards from the shower my family had just barely thrown in time?
Soon the nurses started to ask why my daughter was still there. Didn’t the doctors think she could leave soon? One made a joke of telling my little baby that the kindergarten bus didn’t stop there to pick kids up – she’d have to leave eventually. It all depended on which doctor you asked – on three separate occasions we were told we could take her home – all to be turned away with an empty carrier and told to come back again tomorrow.
At no point during my daughter’s three week admission did anyone from the hospital offer to have the chaplain come speak to me, or perhaps someone from the social worker’s office – after all, they were just down the hall. The hospital seemed in all ways unsure of how to handle this strange thing – a three week old child and her mother hanging out on the maternity ward.
In the end there were one or two incredible nurses who got me through the experience, and the lessons that I learned about hospitals and maternity care were invaluable when choosing the OB to deliver my next child. I spent at least as much time researching the hospital choices with the new practice as I did researching the practice itself. And this is what I learned is important when choosing the hospital where you will deliver your child:
1. Does the hospital have a NICU?
A NICU, or Neonatal Intensive Care Unit, is a specialized nursery that exists to care for only sick or premature newborns. There are four levels of neonatal care, and by visiting your hospitals website, you will see their nursery described according to that level. Level I is basic care for healthy newborns, Level II describes the ability to care for infants with moderate and quickly resolved health concerns, Level III provides care for those children born extremely early or so ill that they may require surgical care, and finally, Level IV is the most advanced NICU care usually found in large, academic hospitals.
2. Does the hospital legislate surgical policies for religious reasons?
Some hospitals will not allow certain procedures to be performed in their facilities due to religious doctrine. For example, some hospitals associated with Catholicism will not allow tubal ligations to be performed.
3. Does the hospital allow VBACs (vaginal birth after Cesarean)?
With the increasingly litigious nature of obstetrics, some hospitals have chosen to not allow certain medical procedures that may have a higher rate of malpractice lawsuits such as VBACs. If this is the type of delivery that you are planning, you should check with your hospital first.
4. Does the hospital have a perinatal facility?
Perinatal wards provide care for women who need to be hospitalized during their pregnancy. For many of these women, their stay in the hospital will not end until after the delivery of their child. For this reason, it may be important to choose a hospital with both a perinatal care facility as well as delivery options that meet your needs.
5. Is there a lactation consult on staff? Many hospitals utilize lactation consultants that visit the hospital only on certain days of the week. Due to the typically short length of post-partum hospitalization, it is possible in such a hospital to miss the opportunity to meet with a lactation consultant to discuss your breastfeeding concerns.
6. Who is allowed to be with you during labor and delivery? All hospitals control the amount of people in the room with you during delivery to some extent, but some hospitals are far more strict in this respect. If it is important to you to have your new baby’s older siblings present for his or her birth, be sure to clarify that that is a possibility beforehand.
7. What policies are in place regarding the room facilities? While some hospitals allow their mommies to both labor and deliver in the same room, others will ask that you move to a separate room for the actual delivery of your child. This can be very disruptive both to you and your labor support team. Also, many hospitals are now offering private postpartum rooms, but they do not all guarantee that a private room will be available. Finally, if it is important to you that your husband and/or your baby be allowed to stay in the room with you over night, be sure to ask your hospital about that possibility prior to your arrival.
8. What is the hospital’s visitation policy? Some maternity wards do not allow young children to visit their mothers and new siblings. Be sure to check for specific age restrictions in your hospital’s visitation policy.
9. Does the hospital have rules regarding fetal monitoring? Again, due to the increase in obstetrics lawsuits, some hospitals are now requiring fetal monitoring throughout the duration of labor and delivery, thus inhibiting your movement.
10. How many women share one labor nurse? Your delivering doctor may not arrive to your labor and delivery suite until shortly before your little one makes his debut to the world. Your nurse will be your one constant during this journey, and it will become very important to you very quickly if you find that you are sharing her with many other laboring moms-to-be.
11. Last, but certainly not least – does the hospital employ a round-the-clock anesthesiologist for their maternity center? When you hit six centimeters and want the epidural ten minutes ago, you’ll be happy you asked.
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