How to Have a Great Hospital Birth

Adriana Lozada: Hello, mighty parents and parents to be. I’m Adriana Lozada and you’re listening to Birthful, and today I’m here, just like every other week, talking to you one on one for about 10 minutes on a topic that I want to dive deeper into. This week, it’s going to be how to prepare to have a great hospital birth. And I know that sometimes the way we talk about the hospital system here on the show, it seems like, “Can you really have a great hospital birth?” And you can, but we do focus on these difficulties within the medical system because it is a broken system. As a quick reminder, the U.S. spends more on childbirth than any other country and has the worst outcomes of any high resource nation, particularly for Black and Indigenous families. 

And it’s not just about the outcomes. The Giving Voice to Mothers study from 2019, which focused on inequities and mistreatments during pregnancy and childbirth in the U.S., reported that one in six people experience mistreatment during childbirth, and the rate of mistreatment is even higher for women of color. From this study, the top four types of reported mistreatments were one, being shouted at or scolded; two, ignoring women, refusing their requests for help, or failing to respond to a request for help in a reasonable amount of time; three, the violation of physical privacy; and four, threatening to withhold treatment or forcing people to accept treatment that they didn’t want. 

So, yeah, that’s far from great, but that does not mean that you can’t have a wonderful birth experience in a hospital. It does mean, though, that you have to work for it. As a doula, most of the births I support are at hospitals, and for the most part, my clients have lovely birth experiences. So, I want to share with you today some ways you can prepare to do the same, with the key word being prepare. You are an active participant in this process. It is not something that just happens to you. 

So, first up is informing yourself about the actual birth process. Birth is a physiological event, so the more you know about how to support that physiology, the more flowing your experience is gonna be, and if birth is flowing, then there’s less of a need for interventions. Fewer interventions also mean more connected and enjoyable experiences, which is exactly what you want. So, you need to learn how to support your birth physiology, both during pregnancy and during birth. To do this, sign up for a physiology-based childbirth education class, which will inform you about the process, as well as how to best support it within a hospital setting, and when encountering specific interventions, such as an induction. Then this will also help you define what you want your birth to look like and how you want to feel during the experience, which will help you gain clarity on your birth choices. If you have no clue as to what that could be, then start bingeing on Birthful episodes, particularly the birth stories. 

So, after you learn about birth physiology and figure out what type of birth you want to have, the next step is to find a care provider that truly supports your birth wishes and practices family-centered care or shared decision making. This means that they will take the time to build a relationship with you and answer your questions, so that you can make the informed choices that are right for you and your family. 

If your provider simply tells you what needs to be done without willing to have a conversation around those choices, or practices fear-based perinatal care, then you will most likely not have a great experience, so make sure you guys are a good match. 

Now, you also need to give birth in a place where you feel safe and supported to support that physiology, so it’s important that you figure out how to feel that way in a hospital setting. And knowing what to expect from the moment you drive up until you leave can go a long way towards creating realistic expectations. This means that while you’re pregnant, you need to call up and ask all the questions and have a consumer mindset as you search for these answers. Ask how they support the type of birth that you want to have. 

And so, for example, do they encourage movement and not being on continuous fetal monitoring? Do they have birthing balls, and peanut balls, and how often do they use them? Will you be able to get into the shower or the tub? Do they encourage movement? What’s their policy around eating and drinking during labor? How about pushing decisions? What about doulas? Do they encourage the use of doulas? All of these things are important tools to support a physiologic birth and restrictive policies will make it harder to have one. 

Now, you probably see my next point coming a mile away, which is that you should have a doula. A doula is a super important piece of having a great hospital birth. And this is not just a nice thing on your wishlist. There is ample research that shows that people who use doulas are less likely to have a cesarean birth, less likely to need Pitocin, less likely to use any pain medication, and more likely to rate their childbirth experience positively. Hello, that’s exactly the definition of having a great experience. So, even the American College of Obstetricians and Gynecologists recognizes that having a doula is “associated with improved outcomes for women in labor.” 

And not only that. Having a doula is also beneficial for your baby as research shows better Apgar scores, which are widely used to report the health status of the baby immediately after birth. So, yeah, having a doula should be a top item on your baby registry. 

Now, you also want to write a birth plan that includes how you want to be treated during birth and if you want to be heard and respected, ask for it. For example, you can put in your birth plan that all care providers need to get consent from you before doing a vaginal check. Now, the day of, if you are low risk and nothing is indicating the contrary, stay at home as long as possible. This is a recommendation that I’ve heard from many care providers, and the reason is because people usually go in too early, which increases the chances of interventions. Your goal is to get there in active labor, and this will let you move quicker through triage and not to be in this limbo of are you staying or are you being sent home. This is true even if your water breaks. The timing will depend on your care provider and your circumstances, but your water breaking in and by itself is not a reason to rush into the hospital. That’s a movie thing. However, if you feel that you are too anxious at home and will feel safer at the hospital, go to the hospital. Again, whatever makes you feel safe and secure will support this physiology. 

Once you’re at the hospital, triage is the place to bust out your birth plan and also ask if you can be matched with a nurse that loves supporting the type of birth that you want to have. And if at any point you end up with a nurse that’s not a good fit, have your support person go talk to the nurse manager to get someone who is a better fit. Believe me, everyone will be happier. Now, once you’re in your laboring room, it’s time to make it yours. Dim the lights, change the temperature, set up your music, put up affirmations or pictures. Again, whatever makes you feel safe and supported so that oxytocin can flow. Even wearing your own clothes can make you feel more comfortable and less of a patient, so do that. 

And whenever your nurse asks if there’s anything they can bring you, take them up on the offer. They can get you water, birth balls, peanut balls, a bin with ice water and wash cloths, even drinks and snacks. Remember that they are on your team, so approach them as such. 

Now, I’ve been saying that you need to feel safe and supported, and so it shouldn’t be a surprise that it’s important for you to protect the energy in the room. To help with this, you can put a sign on your door that shares what type of mood you’re going for. So, for example, if you’re going for calm and quiet, you can ask people to use soft tones and wait until a contraction ends before talking to you. In general, see how you can bring more pleasure and joy into your birth instead of anxiety and fear. And if at any point you find yourself feeling overwhelmed, you can always retreat into the bathroom, or as I like to call it, your birth cave. 

Also, remember that birth is unpredictable, so you need to stay flexible. To help with this, see if you can focus on how you want to feel during the experience rather than a checklist of things you want to happen. For example, if you’re set on not having a cesarean and circumstances lead you there, you’ll likely be disappointed. But if instead you’re focused on feeling supported, seen, respected, grounded, reassured, joyful, whatever it is you want to feel in a way that is not outcome focused, then there will be room for feeling that way even if the details of your birth are far from what you had in mind. This isn’t to say that you should dismiss negative feelings if things are not going as you wanted. Rather, see if you can embrace a both/and attitude, as in yes, this sucks, and how can we still make it a good experience? 

For this, it’s helpful to have a plan of how to interact with your care providers. Use the BRAIN acronym to navigate new choices, and if you’re not familiar with that acronym, the B is for benefits, R is for risks, A for alternatives, I for your intuition or if you need more information, the N is for what happens next or what if you choose to do nothing. Know your rights as a patient and also know that during birth, unless there’s a true medical emergency, there is plenty of time to get answers to your questions so that you can give consent, make the choices, and feel like an active participant in your experience instead of being bulldozed by it. 

Bottom line is that to have a wonderful hospital experience, you need to feel safe, supported, heard, and even loved. When you feel that way, that’s when oxytocin flows. Oxytocin is what brings on your contractions. Contractions get your baby earthside. Having a goal of healthy mom and healthy baby is great, but it’s far from enough. That’s like the minimum. You deserve to have a healthy baby, be healthy yourself, and also have a wonderful experience as you welcome your child into the world. 

You can connect with Birthful on Instagram @BirthfulPodcast, and to learn more about Birthful and my birth and postpartum preparation classes, go to Birthful.com. 

Lozada: Birthful was created by me, Adriana Lozada, and is a production of Lantigua Williams & Co. The show’s senior producer is Paulina Velasco. Jen Chien is executive editor. Cedric Wilson is our lead producer. Kojin Tashiro mixed this episode. Thank you for listening to and sharing Birthful. Be sure to subscribe on Apple Podcasts, Amazon Music, Spotify, and everywhere you listen, and come back next week for more ways to inform your intuition. 

CITATION: 

Lozada, Adriana, host. “How to Have a Great Hospital Birth.” Birthful, Lantigua Williams & Co., April 21, 2021. Birthful.com.