Are Routines During Birth Good or Bad?

January 26, 2008 in Birth, Birth Care Provider, Birth Stories, Choose Wisely, Pregnancy

When I drive home there are 2 different ways to enter my neighborhood. I always go the same way regardless of the direction I am driving home. It is just my normal routine, which is normally fine. But when I am driving my husbands car, I should enter the other way, because he parks on the street in front of our house, and if I go my normal way, I have to turn around in my neighbors driveway to park there. Not a big deal, but I always moan when I get home in his car, because THEN I remembers I meant to go the other way. Habits are hard to change, but it is possible. For instance if I wrote a note and put it on my steering wheel reminding me to turn in the other entrance, that might help me remember. Even better if I had someone riding with me who reminded to go in the other entrance I would do it and would be grateful for the reminder.

During births in a hospital or birth center there are many routines that are part of almost every birth they see. They won’t think outside of that box unless prompted. Some hospitals and care providers*** are more open to doing things differently and will willingly do so if they are asked. Others are very set in their ways and it may be a fight to get them to do something outside of their normal routines. It is a good idea as an expectant parent to find out what their routines are and how open they are to doing things differently if requested.

Do some research to see what routines are typical during a birth and decide if this is what you want or if you want them only if medically indicated. Write it out in a birth plan and review it with your hospital and care provider. It may be a very interesting experience. You may get conflicting opinions and if your care provider is not on call during your birth you may find it hard to fight the normal routines of the hospital.

I have had a student Kate who was planning on birthing at my least favorite hospital in the area. I let her know my concerns about the hospital, but she talked with her OB who said ok to intermittent monitoring and no IV, so she felt good going into the birth. I warned them this is not a hospital that normally is flexible. But they felt reassured because their OB said ok. When their birthing time started and they went into the hospital, their OB was not on call and they didn’t have the energy to continue fighting the nurse who insisted the on call OB says they MUST have IV and CFM. They did end up having a fairly good birth experience, I think mostly because of shift change and they got a new nicer nurse, who helped mom refocus and relax, despite being stuck in bed with CFM. (Read Kate’s Story here). Please remember, the place you chose to give birth at can have as much if not more of an effect on your birth experience as your care provider.

I have a student G. who went on her hospitals tour and asked some good questions about CFM and IVs, the hospital said it was up to her OB. Then she shared her birth plan with her OB he said those things were hospital policy. So she felt there was some lack of consistency there. Then he was trying to scare* her out of other things she wanted with blatant lies. He insists ALL first time moms have to get episiotomies or they will rip from top to bottom. (Nice supportive images for a first time mom… ughh). She might need the vacuum to help get the baby out.  (This was just in passing, it wasn’t in her birth plan… just telling her she might need that.) She also doesn’t want pitocin automatically given after she has her baby, unless it is medically warranted (excessive bleeding for instance) He insisted that ALL first time moms would hemorrhage without pitocin. Well, the human race would not exist if that was true. My student chose to do some research on that as she didn’t believe him and found that is NOT true. It was after this visit that she decided she was finding a new care provider and not going back! She found a midwife and is planning a home birth. (Here is what happened during her birth!)

There are moments when certain interventions are warranted. But it should be on an individual basis rather than a routine for everyone. I imagine this OB mentioned above has never seen a normal birth, only medically managed ones. So he may not know what is possible. 

But at least he was honest, how many care providers say, oh yes, no problem we can do that, knowing it is rarely ever done. That is a wolf in sheep’s clothing and harder to protect yourself from. (For an idea of how to know this, read this post)

Some typical routines I will review over the next few weeks. 

Induction at 41 weeks (or some places 40 weeks)

Continuous Fetal Monitoring

IV

NPO

Cutting Cord Right after Birth

Pitocin after birth

Purple Pushing

So to conclude… hospitals and care providers tend to have their routines. See if those routines are what you want automatically for your birth. If not, see how flexible your care provider and birth location are to moving outside of the routines… write down what you want and be prepared to remind them of what you want during your birth. A humans’ habit is to slip into their typical routine. Such as me driving home, if I had someone say to me, turn in here I would do it, but without their reminder I most likely would travel my normal path. But some hospitals and care providers are NOT flexible and it is important for you to know that before your birth. Getting them to go away from their routine will be a fight and giving birth is not a time you want to be fighting.

*** I specifically use the word care provider (CP) because choosing a midwife does not guarantee a certain type of birth… it isn’t as easy as OB or Midwife. Each care provider is different, just as each birth location is different. There are wonderful flexible OBs who trust birth and Midwives who are very routine based and don’t trust birth. I tend to refer to hospitals instead of hospitals/birth centers because it is too long to write the whole thing. There are birth centers which are just as stuck in their routines as hospitals! It isn’t as easy as birth center or hospital either.

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