As a paramedic, we have a handy book of rules and protocols called Standard Operating Guidelines. It helps outline a pretty vast variety of emergencies we could be asked to respond to, and gives the guidelines we’re expected to follow in regards to our patient care. For some emergencies, there’s a phrase used in our SOGs for choosing our patient’s destination in which there are cases when we transport our patients “to the most appropriate facility” rather than the Emergency Room closest to where we first meet our patient. This phrase means that a woman having a heart attack should go straight to a facility with a catheterization lab like St. Elizabeth’s, or a man with the sudden onset of stroke symptoms might be transported to St. Louis University Hospital, or a toddler with a seizure might go to Children’s or Cardinal Glennon, or a woman in labor might be transported 10 minutes further than the hospital in Highland in order to bring her to a hospital with an OB department. The “what ifs” are endless so many times, we’re in the ambulance making a game-time decision in the Land of Shades of Gray to do what we believe is in the best interest of our patient, even if it means transporting them further than our local ER.
But, this post isn’t a soapbox on emergency prehospital care. This post is about encouraging women to choose the most appropriate facility to deliver their baby.
There are many women who deal with high-risk pregnancies that may require a Cesarean surgery as the safest means of delivery and those women ought to be searching out the best obstetrical surgeon for that job. Unfortunately there are babies who are carried through gestation who will need extra help when they meet the outside world, and those mamas should probably be basing their hospital for delivery on an incredible Neonatal ICU for the best care of the baby. There are obviously a lot of women who choose epidural pain relief, who will want skilled nurses who can monitor those types of intervention. But what about us mom who, while we recognize our choice for pain relief and realize the risk that any pregnancy could lead to a Cesarean, really just want to be supported in every possible way to have a natural, drug-free birth?
If you fall into the last category, it is your job as a consumer in the childbirth industry to choose your most appropriate facility. This is so much harder than it seems it should be, and I am aware of the difficulty because I’ve worn the shoes of a woman planning a birth at a specific hospital with a certain provider… and then I switched. It was emotional for me to “break-up” with a provider who I’m sure wouldn’t recognize my name on a list and most definitely wouldn’t recognize my face, but she was kind and took care of me for 37 weeks so I was somewhat attached. Luckily, I sat through The Bradley Method course (TBM) that taught me everything I needed to know about the options available through childbirth and gave me the confidence to know which of those options was right for my family. The TBM course encouraged consumerism, and the idea that if I thought I could be more supported at another facility, then I needed to at least consider changing my plan. And change we did. I’m sure Todd remembers what happened when we visited Greenville Regional Hospital and I met my midwife for the first time… I stood in that hallway with a group of strangers and bawled big, ugly tears of absolute joy and relief.
Let me make this clear: I’ve now had 25 couples come through my own TBM series as a certified instructor and they have had successful deliveries at a multitude of hospitals. These students have wonderful birth stories from Anderson, Alton, Gateway, and Belleville Memorial on our side of the river, and Missouri Baptist and Mercy in St. Louis. There are successful birth stories from Salem, Illinois and Evanston, Indiana. I tell my students that with the right tools, they are capable of having the natural birth they want at any hospital and then I do my darndest to prepare them with those tools. But they must also realize that depending on the hospital and provider they choose, and depending on the luck of the draw when it comes to the nurse assigned to them, they might have to strongly advocate for themselves during labor and delivery. Why did I switch providers at 37 weeks of my first pregnancy? Because I wanted the focus of my labor and delivery to be on handling the difficult but worthy task of delivering my baby naturally and I didn’t want to expect to spend an ounce of energy advocating for myself. Also, I wanted my husband to be focused on being my physical and emotional support, not given the duty of fighting for the birth we prepared for.
So with all these words like “fighting” and “advocating”, are you confused? Does it seem strange to you that for a woman who has been lucky enough to have a low-risk pregnancy and no signs of a baby who might need specialized care at birth to have to fight to not be given drugs, or tied to a bed with continuous fetal monitoring, or have her waters broken artificially, or given drugs to hopefully speed up labor? Those interventions are the normal; they are the expected and managed route of care that many OBs are familiar with and request the nurses to follow. This is my soapbox. This is my opportunity to tell you that you can choose the most appropriate facility for your plans of a natural birth and (***drumroll please***) not have to fight.
It’s hard. It’s hard to put someone on the spot with difficult questions like “What is your Cesarean rate?” or “How often do you induce labor when it isn’t a medical emergency?” or “Does this hospital see many natural deliveries?” But a doctor or nurse who isn’t afraid of those questions and is proud to answer them will be a sign that you might have found your winning destination when it comes your time to deliver your baby. And if your doctor is similar to my first OB, who had heard me rattle about natural childbirth for over 30 weeks of our relationship, gives a wink while saying “I’ll induce you at 39 weeks if you want”, I won’t blame you if you run. Then I won’t blame you if you cry your eyes out when you find a place that greets you with phrases like “This is your birth, and our job is to support you.”
I had two amazing births at Greenville Regional Hospital (GRH), each with a different midwife, and both in a birthing tub. And I’ve been blessed with multiple experiences to see others on their Birth Day at GRH. There are nurses who are so accustomed to natural birth that they look forward to preparing the tub for a waterbirth, speak only in hushed tones, willingly pull down the blinds for a dim atmosphere, find a birthing ball even if it only sits in the corner as an option, and support Dad continuously with offers of food, drink, or a more comfortable stool. There’s a midwife who just might be there for 5 hours or more of your labor, a constant source of assurance, stepping out only once to pee. And while it’s incredibly hard to watch a woman in pain, the midwife will be the first to offer words of encouragement and recommendations for a different position rather than grabbing a narcotic and a syringe. Once the bundle of joy has arrived and laying comfortably skin-to-skin on Mom, this midwife will sit back in the corner, patiently waiting for signs that the baby’s cord has pulsed the last of oxygen- and iron-rich blood to the baby and is ready to be cut. The nurses will nod in understanding while the parents describe which interventions they are and are not comfortable with their baby receiving, never questioning their preparedness and judgement. And the nurse is clear that once the parents are ready to hand over their precious baby, and no sooner, they will do the extracurriculars of weights and measurements. Because after a mom has finished the hardest task she’s ever been handed, and she finally gets to snuggle her baby on the outside, why should she have to have her baby weighed or bathed or footprinted on anyone else’s schedule?
This supportive birth environment exists. Dad remains the closest and most vital support to Mom, but all the hospital staff support Dad in his mission and respect the family’s birth plan. Do you have to go to Greenville Regional Hospital to experience this? Absolutely not. But if you want to plan on a similar birthing experience, you need to ask the tough questions of your provider and the hospital, and follow your instincts. Pregnancy is many months of planning and preparing, but will hopefully include more than which shade of Benjamin Moore matches the crib sheet and which stroller will work best at a parade. You won’t have a second chance to birth this baby, so please choose your most appropriate facility for the experience you (and the daddy) want.
(And if you want to read about another personal soapbox, check out Why I Choose A Midwife).
The Pleasant Farm 
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