$Unique_ID{PAR00441} $Pretitle{} $Title{Pregnancy: The Third Trimester: Planning and Preparation} $Subtitle{} $Author{ Editors of Consumer Guide Ellis, Jeffrey W Ellis, Maria} $Subject{Third Trimester Planning Preparation Hospital Out-of-Hospital Birth home birthing center hospitals father labor delivery delivering medical technological maternity newborn care complication complications birthing room rooms LDR LDR's labor delivery recovery nursery nurseries Packing Suitcase} $Log{ Most hospitals offer a variety of alternatives for childbirth*0054601.tif A hospital delivery can be personalized to your family needs*0054701.tif Having the father attend both labor and delivery has become the rule*0054801.tif Home births have increased as parents try to make childbirth more personal*0055301.tif} Miracle of Birth The Third Trimester: Planning and Preparation Choosing Hospital or Out-of-Hospital Birth An important decision that you will need to make is where you will give birth to your baby. Most women choose to give birth in a hospital; others decide to give birth at home or in a freestanding birthing center. To make this decision, you will need to investigate your options before your due date draws near. You may find yourself facing conflicting opinions regarding the safety or desirability of hospital versus out-of-hospital birth. There are few general rules; each pregnancy and each couple is unique. Therefore, before you make your decision, you need to make every effort to gather information on the options available to you and the risks and benefits of each birth setting. You also need to discuss with your doctor the specific circumstances and requirements of your pregnancy. Out-of-hospital birth is an option only for the woman who is in good health, whose pregnancy is normal, and who did not experience complications in any previous pregnancies. Hospital Birth In the past, hospitals were generally inflexible in their rules regarding childbirth. A common complaint was that the birth process was treated as a disease. The family was often left out of the childbirth process; even the father was not allowed to be with his partner during labor or delivery. These often demoralizing procedures led consumers to demand a more humanized experience during labor and delivery. Starting in the early 1970s, hospitals began to reevaluate their policies in response to these consumer demands. Policies were changed to reflect an awareness of the emotional aspects of labor and delivery and the effects of childbirth on both parents. Today, most hospitals offer a variety of alternatives for childbirth. Having the father attend both labor and delivery has become the rule rather than the exception. These changes have allowed parents-to-be to experience childbirth in a more personalized way without having to give up the medical and technological benefits of a hospital setting. If you prefer to give birth in a hospital, or if the circumstances of your pregnancy require that you give birth in a hospital, your next decision is which hospital to use. If there is only one hospital in your area, your choice is limited. In most large towns and all large cities, there will be several hospitals from which to choose. Not all hospitals offer the same types of maternity and newborn care. Some hospitals (small, community-based hospitals, for example) can often provide care only to women with essentially normal pregnancies who are expected to deliver babies with no serious complications; they may not have the equipment or staff to adequately cover complicated births. Other hospitals, especially those associated with large medical centers or medical schools, specialize in the care of complicated pregnancies, in which either the mother or the newborn will require more intensive care or specialized facilities. When deciding between these types of facilities, you will need to take into account your own medical history, any history of serious complications in previous pregnancies, and any complications in your current pregnancy. Your doctor will have privileges to use at least one hospital; some doctors use two or more. It's a good idea to tour each hospital that your doctor uses. It may also be useful to tour other hospitals for comparison purposes. You may find that you prefer a hospital that your doctor does not use. If so, you may wish to change to another doctor who is on staff at that hospital. If your community has more than one hospital, you might be surprised at how different they are from one another in their facilities, policies, and philosophies of care. Most hospitals offer tours of their maternity facilities and can usually schedule them at a time that is convenient for both you and your partner. What do you look for when you tour a hospital? First of all, simply observe the atmosphere. Take a look at what provisions are made for the mother's comfort. Many hospitals now have attractive private rooms and bathroom facilities. Some hospitals have very comfortable labor beds, while others may have very narrow, hard labor beds. Some provide nice touches, like a rocking chair, a couch where your husband can rest, television and radio, and beanbag cushions for getting into comfortable positions. Others make few, if any, provisions for the comfort of the mother or father. Many hospitals have now converted traditional labor rooms into "birthing rooms" or LDR's (for labor, delivery, and recovery). In these attractively decorated rooms, the mother can labor, deliver, and recover without moving to separate rooms. In some hospitals, the birthing room is the only room that the mother will be in throughout her entire hospital stay. In others, she labors and gives birth in the birthing room, and then goes to a regular hospital room for one, two, or three days before going home. In still other facilities, she labors in one room, delivers in another room, goes to a third room to recover, and then is moved to yet another room for the rest of her hospital stay. While you are on the hospital tour, be sure to check the nursery. What does it look like? Are the mothers encouraged to keep their babies with them in their rooms, or do the babies spend most of their time in the nursery? Does the nursery have cozy touches, like rocking chairs and wall decorations? Do the nurses seem friendly and warm? What about the person leading the tour? Is she friendly and willing to answer your questions, or is she simply herding you through as quickly as possible? Unfortunately, some hospitals will be so busy that they will not take you on a tour of the actual facilities but rather will present a slide show or have you discuss policies and procedures with a member of the staff. Be sure to ask specific questions about the procedures of the hospital. Where do you go when you are in labor? Does your husband need to stop at an admitting desk before he brings you to the maternity floor? Can you preregister now instead of rushing through it when you are in labor? What type of insurance forms should you bring? Remember, it is a lot easier to ask these questions now than it will be when you are in labor. Questions about hospital procedures and policies need to be asked carefully. For example, if you ask "What usually happens to the baby after he or she is born?" you will probably learn more than if you ask "What is the hospital's procedure for routine newborn care?" Some hospitals may not have specific policies, but they will have customs, and these are what you will want to know. You might ask for a step-by-step description of what happens after a woman in labor arrives. Do most women have a nurse assigned to them, or do the nurses take care of more than one laboring woman at a time? Is it customary for women to receive pain medications, or do most women use little or no pain medication? If a woman desires a natural or unmedicated childbirth, is she actively encouraged and supported in this by the staff? What types of pain medication and anesthesia are available? Is there an anesthesiologist (a doctor who specializes in administering anesthesia) in the hospital at all times or is he called in only when needed? Is a pediatrician in the hospital at all times, or is he called in only when needed? Do most women receive intravenous fluids and continuous electronic fetal monitoring (see Labor and Delivery)? How long is the usual hospital stay? You may want to find out if there's a "short stay" program that allows mothers and babies to go home within a few hours after birth. Finally, during your hospital tour, clarify the costs of labor and delivery rooms, nursery charges, and so forth. You might be surprised at how hospitals, even those in the same town or area, may vary in their charges. You will also want to check your insurance policy to determine how much you may need to pay out of your own pocket. Out-of-Hospital Birth Out-of-hospital birth is an option only for the healthy woman who is experiencing a normal pregnancy and who has never experienced complications in any previous pregnancies. A woman who is experiencing a complicated pregnancy or who may require a cesarean section will need to labor and deliver in a hospital that is equipped to handle these situations. If you are considering an out-of-hospital birth, it is extremely important to keep in mind that emergencies can develop rapidly and often without warning during labor and delivery. Most out-of-hospital settings will not have the medications and equipment that may be necessary in an emergency. If out-of-hospital birth is an option for you, you will need to find out what services are available in your community. Many cities now have birthing centers. These are freestanding facilities that are staffed by medical professionals. Birthing centers offer an alternative to hospital birth for the healthy pregnant woman who is not at increased risk of experiencing a complicated birth (many of these centers will not accept women who have a greater likelihood of needing a cesarean section or other type of sophisticated medical intervention). These centers attempt to offer "the best of both worlds" by providing family-centered care in a homelike setting but with the security and safety provided by a professional staff, up-to-date monitoring equipment, and prearranged emergency backup. These centers can deal with normal pregnancies, and they may have the equipment necessary to detect complications that may develop. They may not, however, have the equipment or staff necessary to deal with such complications. A pregnant woman who experiences an unexpected complication will be transferred immediately to a hospital that is equipped to handle the problem. Before you consider using a birthing center, make certain that it is licensed by the state. You should also check with your insurance company to be sure that your policy covers childbirth in a freestanding birthing center. Another alternative to traditional hospitals is home birth. During the last two decades, the number of home births in the United States has greatly increased, as parents have attempted to make childbirth a more personal and family-oriented experience. The delivery is performed by either a doctor or a midwife and generally takes place in the family's bedroom. Medical intervention is often not necessary for a healthy woman who is experiencing a normal labor. During a home birth, a woman who does develop an unexpected complication must be transferred to a hospital immediately. This disadvantage of out-of-hospital birth should be carefully considered by all women planning birth outside the hospital. When inquiring about out-of-hospital birth services, find out what drugs and equipment are generally used. Are intravenous fluids, pain medications, or fetal monitors used? What emergency equipment is on hand for every birth? You will also need to know what hospital is used in case a transfer becomes necessary. Who makes the transfer arrangements? Is an ambulance readily available? How far away is the backup hospital? Out-of-hospital birth offers parents certain advantages and experiences that they may not have with a traditional hospital birth. They have more control over birth procedures and there are few routines that need to be followed. Contact with the baby after birth is limited only by the parents' wishes. When considering these advantages, however, you must weigh them carefully against the risks to both mother and baby if an emergency should occur. Packing Your Suitcase The following are some items that you may want to take with you to the hospital when you go into labor. Pack your bags at least two weeks before your due date so that you do not have to rush around at the last minute. For the mother during labor: - Massage oil (not lotion) or powder (cornstarch is best) - Toothbrush and toothpaste - Lip balm - Rolling pin, tennis balls, or other massage aids - Hot-water bottle or plastic ice pack for comfort - Juice, ice pops, or sour-candy suckers - Music tapes and a battery-operated tape machine - Cotton socks - Hair clips or rubber bands - Breath spray For the father: - Food/snacks - Breath mints or toothbrush - Camera and film - Watch with a second hand for timing contractions - Pencil and paper For the baby: - Warm hat (maybe provided by the hospital) - Stretch suit or T-shirt, receiving blanket, warm blanket and booties (depending on weather), and four or five diapers for taking baby home - Car seat For the mother after birth: - Nursing bras (two or three) - Nursing pads - Breast cream or lotion - Personal hygiene items, cosmetics, and a shower cap - Phone numbers of people to call with the good news - Reading and writing materials, birth announcements, stamps, address book - Comfortable clothes to wear home (stick with adjustable or loose-fitting clothing so that it's sure to fit)