Hospital Birth

The extent and magnificence of the medical discoveries made during the last hundred years is beyond both praise and gratitude. But now ​that many of

the troubles and dangers have been overcome, we must move on – not only to save more lives, but actually to bring happiness to replace the agony of fear. For although the consciousness of a woman’s discomfort can now be dispelled, it is only at a price, for with it goes the awareness of birth and the joyful sensations and emotions that should accompany it. Now we must bring a fuller life, truer to natural law, to women. – Dr. Grantly Dick-Read, M.D

In South Africa’s private health care system, the majority of babies are born in hospital.

The birth method can be one of many. The most common at the moment in South Africa is Caesarean                                                 Sections, which are at a staggering 70%!

The second most common is induction of labour.  (See induction post under Birth Interventions)                                                           Inductions is most often the start of many birth interventions, and the one cascades into the next.

Many of these result in Caesarean Sections which also contributes to the high incidence of Caesareans.



Your Risk Factor

Sometimes the hospital is the best place to give birth. If you have a pre-existing condition such as a 

heart condition a hospital birth may be best for you.

If you develop a disorder such as pre-eclampsia you’ll need to be in the hospital for your baby’s birth. You can help make sure that you do not develop such disorders by being vigilant in your self-care and nutrition prenataly.

It may be safer to be at the hospital for twins and most likely for higher order multiples. Some doctors feel that breech babies should always be born in hospitals.

Research your doctor’s and your hospital’s policies carefully – some may not even be willing to allow you a “trial of labor.” That means you have no chance of a vaginal delivery for your twins or breech baby.

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Even if you find yourself in one of the above situations you can still have an empowering hospital birth. Preparing throughout pregnancy and getting to know your body will help. Take steps to put yourself in control – no matter what kind of birth it needs to be for you and your baby.

If you are “low-risk” for obstetrical complications (meaning you’ve had a healthy pregnancy and there are no indications that anything could happen at your birth) a hospital birth may be the riskiest for you.

Studies have shown that home birth or birth center birth can be safer than hospital birth. This is usually because in the hospital you are put through routines and procedures that may hamper the normal birthing process.

Birth is “managed” as opposed to letting women do what they instinctively need to do. You may also receive interventions that cause more problems.



What You May Face

Hospitals are governed by rules. They are business organisations that must operate within certain guidelines and policies. You will be part of that and expected to conform to their defined protocols. Find out beforehand what your hospital birth will allow and will not allow.

You will probably have an IV placed right away and be set in bed and hooked up to a fetal monitor belt. The belt is strapped around your abdomen and leaves you with no choice but to stay in bed.



Depending on your hospital you may be able to opt for a heplock instead of an IV. After an initial time period on the fetal monitor you may be able to have intermittent monitoring with a Doppler as you would have a birth center or home birth.

If your labor is not moving along as quickly as the hospital would like, or you are not having a “textbook” labor you may be started on synthetic oxytocin (Syntocinon).

Realise that contractions induced by synthetic oxytocin are much harder on you and on your baby than natural contractions. You might also be offered or required to accept synthetic oxytocin to get your labor going if you haven’t started labor when you care provider wants you to.

You should be wary of any types of induction techniques. Agents to ripen your cervix and artificial rupture of membranes are interventions that are more likely to happen at the hospital.



Artificial rupture of membranes (“breaking your water”) could be done without your consent, so be clear about your wishes for your membranes to stay intact unless you agree to have them ruptured.

You may see many different care providers during your labor and hospital birth. Shift changes could bring new nurses and new midwives. You may not see your doctor until your baby is about to be born.

During a hospital birth your chances of episiotomy and surgical delivery increase. There are conflicting studies on episiotomy but most agree that they are completely unnecessary. Evidence is showing that natural tears heal as well as episiotomy if not better.



When Baby Arrives

The hardest thing to deal with at some hospitals is baby care procedures. Many hospitals today are becoming more aware of what is best for babies and for mothers. They will place your baby right up on your chest and allow you plenty of time to bond.



Others will only place your baby on your chest for a few seconds and then whisk him away, or worse, they will hardly let you have a glimpse of your baby.

Your baby’s cord will probably be clamped and cut right away, your baby subjected to all newborn procedures, and then he’ll be bundled and finally brought back to you.

You may not want this for your baby. You may want your baby to be given right to you and all procedures delayed until after you have had time to bond. You must be your baby’s advocate!



If the hospital has any hint that something may possibly be wrong with your baby she may be taken away for a full infant workup, which is painful for her. Medication will also be started right away, even if it later turns out there is no problem.

Hospitals feel it better to be safe than sorry. This can be a good approach, but it’s highly disruptive for your healthy newborn.

There will be varying levels of support for breastfeeding. Again it depends on your hospital. There are also varying levels of tolerance for your other children and the rest of your family.

Your hospital will want you and your baby to stay for at least 24 hours and most likely 48 hours before you go home. Commonly, you will be in hospital for the day of birth plus 2 days. The hospital may want the baby to be in the nursery for at least a few hours for “observation” or they may even want your baby in the nursery more.

Again, you will have to advocate for your child. If you want to leave before the hospital’s and doctor’s set time period you’ll have to sign that you are doing so against medical advice.



Choose What is Right for You

A hospital birth may give you peace of mind, and it may be the right choice for you. Be sure you decide what is important for you in your birth experience, and then find out how likely that will be at your hospital. One way you can increase your chances of a great hospital birth is to hire a doula.

Careful research and planning are essential to a good hospital birth, as well as communication with your care provider (this is really true for anywhere you plan to birth!)

Choose a birth preparation course so you’ll be totally prepared for your hospital birth.



Active Birth in a Hospital Setting 

The knowledge of how to give birth without outside intervention lies deep within each woman. Successful childbirth depends on an acceptance of the process.” Suzanne Arms

Active birth means being able to give birth to your baby without any interventions. You can stay mobile and you can choose the position you want to give birth in. It is your homebirth away from home.

Sadly in South Africa today, with our terribly high levels of intervention and unacceptable Caesar rates, you can’t just enter a maternity unit and hope for the best. Our private hospitals in South Africa have certain routines and protocols that they follow once a mother is admitted to the hospital.

You will have to be very assertive in making your wishes clear beforehand and ensure that you are consulted every time they want to intervene with your birthing progress. If you are attended by a private obstretician, you will have to ensure that he is “active birth friendly” before you embark on you journey. Ask for stats, listen to the words they use. Remember, it is never to late to change your care provider.

We do have active birth units in South Africa. Please see our post on Birth Units under Birth Choices. These units are much more conducive to active labour and most use midwives to conduct the care.



Interventions in hospital can be any of the following:

• Ask to dress in a hospital gown

• Restricted to one room only

• Not allowed to eat and drink when you want to

• Having intra-venous therapy

• Augmentation of labour by given you drugs to speed up contractions

• Induction of labour by giving you drugs to start labour

• Continuous foetal monitoring

• Pubic shaves

• Enema

• Restricted to the bed in a semi-supine position

• Epidural

• Pain medication that restricts your ability to move around (Analgesics, e.g. Pethidine)

• Not allowed to shower or have a bath

• Artificial rupture of membranes

• Being moved from room to another to give birth

• Episiotomy

• Forceps delivery of baby

• Vantouse or vacuum delivery of baby

• Give birth in semi-supine or lithotomy position (legs in strirrups)

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Steps to make an active birth possible in a hospital setting:

 

• Decide early that this is what you want and stick with it

• Prepare your birth plan and discuss this with your doctor and midwife

• Visit the hospital before and discuss your birth plan with them

• Believe in yourself and your body’s ability to birth your baby -Trust yourself

• Read, read and read about active births as much as possible

• Prepare your body by eating healthy and exercising regularly

• Stay at home as long as possible before going to the hospital when your contractions start

• Hire a doula – she will assist you in ensuring that your wishes are carried out within reason and support you

• See you contractions as bringing your birth of your baby closer every time

• Try out all kinds of positions for labour

• Ignore people who ask you why you want an active natural birth

• Get support from your partner – he needs to be comfortable with your decisions and must be your voice when you are active in labour

• Only surround yourself with positive people who believe you can do it

• Know that you are strong

• Choose a supportive doctor

• Choose a facility that will allow you to birth naturally

• Learn about natural pain reliving method

• Insist in giving birth in the position you want to

• Consider a home birth