TRANSCRIPT EPISODE 4 – All About Pregnancy & Birth With Dr. Nicole C. Rankins

Transcript episode #4: 
choosing the right hospital to give birth

Transcript

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00:01          In this episode of the Podcast, I'm going to cover what you need to know when choosing a hospital to give birth.

00:14         Welcome to the All About Pregnancy and Birth podcast. I'm Dr Nicole Calloway Rankins, a board certified Ob Gyn physician and certified integrative health coach. Every week I break down topics, share birth stories or interview experts to help you have your very best pregnancy and birth. Quick note, the information is for educational purposes only and is not a substitute for medical advice. See the full disclaimer at www.ncrcoaching.com/disclaimer.

00:44           Well, hey there. I am so glad to have you here today. I have delivered babies at different hospitals during my career and one thing I'm learning is that the hospital where you deliver has a big influence on your experience giving birth. Now another big factor is your doctor and I talked about that in last week's episode, so definitely go back and listen to episode three if you haven't. It's on how to make sure you have the right doctor. Now getting back to the hospital, your doctor actually isn't there for most of your labor. Your Dr. may come in maybe at the beginning two or three times during your labor and then not again until it's time for you to deliver. It's really the hospital staff, specifically your labor nurse who is with you during most of your labor, so the culture of the hospital plays a significant role in your labor and delivery experience.

01:47             You want to be certain you are in a place that supports you and your vision for your birth, so keep listening to learn how to choose the hospital where you give birth. Now, before I get into the episode, let me tell you about this giveaway I am sponsoring. To celebrate the launch of the podcast, I'm giving away three spots in my online childbirth education class, The Birth Preparation Course. The Birth Preparation Course is a comprehensive course that will leave you feeling knowledgeable about your options in the process of birth, prepared to deal with any possibilities that may arise. You'll feel confident in yourself and your choices for your birth and empowered to advocate for the birth experience that you desire. There are over eight hours of content in The Birth Preparation Course and that content covers everything from getting in the right mindset for your birth to the details of labor to have to make your birth wishes to the postpartum period and everything in between.

02:53             All of the material is online so you can go through the course on your own time and at your pace. There's also a private community just for course members and that community is run by an experienced Doula. In the course community, you can get support from other pregnant women and I of course am in the course community as well doing a regular Q and A sessions. You get lifetime access to The Birth Preparation Course, so enroll once and you have access for all of your pregnancies. Now The Birth Preparation Course is easily valued at $400, but all you have to do to enter and get a free spot is go to www.ncrcoaching.com/giveaway. That link is in the show notes. Now, the last day to enter the giveaway is Friday, January 25th, 2019. That is just a few days away from when this episode airs, so don't miss out. Enter the giveaway today.

03:56             All right, let's go ahead and get to the show. So the first thing you want to do when you are choosing a hospital to give birth is you want to check with your insurance company. That is just part of the reality of the way healthcare is paid for. So you want to be sure that you check with your insurance company to make sure that the hospital where you want to give birth is covered by your insurance. You may be surprised to hear that your insurance only covers deliveries at certain hospitals in your area. I have seen it happen a few times that a woman doesn't realize this until she's well into her pregnancy, that her insurance actually doesn't cover labor and delivery at the hospital where she wants to go. So be sure to check with your insurance early to see what hospitals are covered.

04:51             After you check with your insurance, you also want to check with your doctor. You want to make sure that she practices at a hospital that's covered by your insurance plan and you also want to be sure that she practices at the hospital where you prefer to give birth. Doctors are not licensed necessarily, or credentialed to practice in all hospitals in the area, so they may only work at one or two hospitals. And if you're in a big group practice, you may find that although the big group, you know it may be a group of like 10 or 12 or even more Ob Gyn's together. You may find that that group says that they deliver at multiple hospitals in the area, but it's actually a handful of physicians in the group who deliver at each hospital. So what may be the case that if you go to say x, y, z women's center, and they say that they deliver at all four hospitals in the area, your Dr. may only at one of those hospitals. So you just want to clarify that your doctor practices at the hospital where you want to give birth and then also that she practices at a hospital that's covered by your insurance plan.

06:13             Now, next thing to consider is if you want an unmedicated or what's called a natural birth. I think all birth is natural, so I say unmedicated if you mean birth without medication as opposed to natural. So if you want an unmedicated birth, you definitely want to do your homework about the hospital where you give birth. You should be in a place that's comfortable supporting women who want an unmedicated birth. Now what you're going to do is you just need to ask a few questions. You can ask your doctor, you can check hospital websites, you can even call up to the hospital labor and delivery unit and ask to speak with a charge nurse. That's the nurse who's in charge for the shift or speak to a manager on labor and delivery. And what you want to ask is just a few basic questions. You want to ask, what do you do at your hospital to support women who want an unmedicated birth. And some things that you want to hear, you want to hear that you're able to move around. It's really important to be able to move around. If you want an unmedicated birth, you want to hear that they have options for intermittent monitoring where you don't need to be attached to the monitor all the time, if you meet certain criteria for that. You want to hear that perhaps they have wireless monitoring so you're not connected to anything. Everything is wireless for monitoring your baby in your contractions. Also, you want to know if there are options for tubs or showers because hydrotherapy is a great pain relief during labor.

07:57             Now even if they say they have tubs and showers, you want to specifically ask what is the availability of those tubs and showers for use during labor, because even if hospitals have tubs or showers, very often they are not in every single labor room. So they may tell you, oh, if that's something you're interested in, then definitely call ahead of time so we can try and get a room for you. So ask what the availability is for tubs and showers. That's really important. Some other things you want to ask are what equipment do you have to help support women who want an unmedicated birth? Do you have birthing balls? Do you have birthing bars? Those are bars that go across the bed. They connect to the bed and they can help facilitate squatting positions in labor or do they have birthing stools? They also help facilitate upright positions in labor.

08:57             You can also ask what percentage of women who give birth at that hospital receive an epidural? On average, about 70 percent of women will have an epidural and labor. That's going to vary by hospital, but you can get an idea if they say like a lot less than 70 percent. Then they are clearly comfortable with having women who want an unmedicated birth or if they say like 99 percent, then you know that they're clearly not as comfortable with having women who want an unmedicated birth. Now it's possible that the answers to those questions won't be supportive of unmedicated birth. Like that example I gave, if they say that 99 percent of women receive epidurals then that hospital doesn't have a lot of experience taking care of women who want an unmedicated birth. So in that case you can do a couple things.

09:50             You can consider looking for another hospital that's more supportive even if even if it's a little further from your home. I've had women drive 45 minutes, an hour, sometimes even a little bit longer to come to the hospital where I work. We're very supportive of unmedicated birth and if you can't go to another hospital, then you just need to be prepared to have your own strong support system for your unmedicated birth. Now that may include reading books on natural childbirth. Ina May Gaskins has a popular book I really like, Birthing From Within. You may take classes that are geared specifically towards unmedicated birth and you could either do that online or in person like the Bradley method, hypnobirthing or lamaze. You may want to bring your own equipment. Maybe you need to bring your own birthing ball. That's just an exercise ball, so it's not anything that's terribly complicated and you may consider hiring a doula or finding a Doula. Sometimes you can find a student Doula or there are discounted doula services available, so you may consider hiring a doula.

11:01             You may also in lieu of a Doula, get your partner or a trusted family member or friend to be a strong support person for you. If the hospital where you plan to give birth doesn't have a lot of support for women who want an unmedicated birth. Now, on the flip side, what if you want an epidural? If you plan to get an epidural, just ask about the availability of the anesthesia provider. In many hospitals, an anesthesiologist is not in the hospital, 24/7. That means if it's the middle of the night, you'll have to wait for someone to come in from home to place your epidural. Also, depending on the type of hospital, the anesthesiologist may have other responsibilities such as caring for trauma patients or caring for patients in the intensive care unit, and sick patients who need care will always take precedence over an epidural placement.

12:07             An epidural is considered an elective procedure and not something that has to be done, so if there are other sick patients who need care, you may have to wait. Now, this is one of the reasons why I strongly advocate that all women, regardless of how you plan to manage pain in the longterm, all women should know some techniques for coping with labor pain, whether it's breathing techniques, whether it's movement, your partner, or a doula doing massage. You need to know these things because there will be a period of time that you have to manage pain without an epidural. Now, the availability of the anesthesia provider is not a deal breaker in terms of crossing a hospital off your list. You just want to have a realistic idea of what to expect at that hospital.

13:06             Next thing to consider is if you are thinking about having a VBAC. VBAC is vaginal birth after Cesarean and we actually say TOLAC... t o l a c, trial of labor after Cesarean, and then it's considered a VBAC once the TOLAC is successful. So if you're interested in a TOLAC, that is not supported at all hospitals, so if that is something you're considering, if you want to try for vaginal birth after having had a previous Cesarean, you want to ask about this early in your pregnancy so you can plan accordingly. And not only do you want to check with the hospital, you also want to check with your doctor because unfortunately some doctors don't do tolac or VBAC either. You may have to travel some distance to find a hospital that supports Tolac or you may have to move to another provider.

14:18              All right, next up is do you want to get your tubes tied? Do you want a sterilization procedure after your birth? You should know that most Catholic hospitals only permit sterilization in rare circumstances, so if you're planning on getting your tubes tied, be sure that you're going to a hospital where the procedure is done. Now, if your only option in your area is a Catholic hospital, you may be able to petition for an exemption. That's not very likely, but you can talk to your doctor and try and see if they will make an exemption for your unique circumstances. Now another thing to consider is does the hospital support rooming in, meaning keeping your baby in the room and also does the hospital have a nursery? As far as the issue of the hospital supporting your baby rooming in, your baby should be with you during your hospital stay. So by rooming in, I mean that your baby stays in your room with you.

15:28             The majority of all exams and procedures that your baby needs can be done right in your room, including any exams. By the pediatrician. With my first baby, she was a Nicu baby so we didn't have this issue, but with my second daughter, she was a full term baby. I was pretty insistent that she stay in the room with me all the time, so she was with me except for just a couple minutes for a short test that she had to do. Now on the flip side, you may want to know if the hospital has a nursery. Sometimes birth can be a tiring and long process and it's nice to have the option to send your baby to the nursery so you can get some rest. And many hospitals these days are actually closing newborn nurseries or they only have teeny tiny nurseries where two or three babies can stay.

16:27             Now, neither one of these is necessarily a deal breaker. If your hospital doesn't routinely do rooming in, then you just need to be prepared to advocate for that during your hospitalization that your baby will be staying in the room with you. And if there's no nursery option available at the hospital, then you may need to have family or friends lined up just in case to help watch your baby in the hospital, if you need some time to get some rest.

16:59             Now, the last thing I want to talk about is, is the hospital teaching hospital? Now, teaching hospital is one where there are medical students and resident physicians. Medical students are in school getting their medical degree, either an MD or a DO degree and resident physicians are doctors in training. They've graduated from medical school and now they're learning to be an Ob Gyn. Now I get it. It can be a little unsettling to have learners in your birth, but the truth is it can also be very rewarding. Medical students are often so enthusiastic about being part of a birth and it also may you feel good to know that you've played a part to help future doctors in training. Now, please understand that even if you're at a hospital with a medical students and resident physicians, there is always an attending physician, a supervising physician available who is licensed, who is certified to practice independently. That person has to be in the hospital 24/7. They are always there with medical students and residents. So rest assured that they're not just kind of practicing all willy nilly by themselves. Now, to help you understand how medical students and residents may be involved in your birth, I have created a free downloadable sheet of questions that you can ask your doctor so you have a clear understanding of what their role is in your birth. To grab that downloadable tip sheet, just go to www.ncrcoaching.com/med-students, that's www.ncrcoaching.com/med-students, and that link will be in the show notes.

19:00             Now, once you've done your homework and you've settled on a hospital, please, please, please take a tour of the facility. That way you will know what the facilities look like. You'll know exactly where to go when it's time, and you can ask any questions that you have lingering in person. The vast majority of hospitals, I dare to say all hospitals, offer free tours of labor and delivery as well as the postpartum area. That's where you go after you have your baby.

19:35             All right, so that's it for information to help you choose the hospital where you give birth. I would love to hear what your experience has been with choosing a hospital to have your baby send me a DM on instagram. I'm on instagram at Dr. Nicole Rankins. Now be sure to subscribe to the podcast in Itunes or wherever you listen to podcasts, and if you feel so inclined, I would really appreciate you leaving an honest review on itunes. It helps other women find the show. And last but not least, don't forget about the giveaway. Enter to win a spot in The Birth Preparation Course. Go to www.ncrcoaching.com/giveaway. That link is in the show notes. Each spot in the course is an over $400 value. The last day to enter is Friday, January 25th, 2019. That is just a few days away from when this episode airs, so don't miss out on this opportunity.

20:42             Now, one of the things I want to do on this podcast is share women's birth stories. I believe that women learn from hearing the stories of other women. And next week I'm going to start off by sharing two very special birth stories, my own birth stories. Now, one of my birth stories is a little bit traumatic and there's also some regret in one of my birth stories, but it's important for me to be honest about who I am in my experiences with pregnancy and birth, so I will get into all of it next week. Until then, I wish you a healthy and happy pregnancy and birth.

21:39             Today's episode is brought to you by Women's Wellness Coaching by Dr. Nicole Calloway Rankins. Head to www.ncrcoaching.com to check out my free one hour mini course on how to make your birth plan as well as my comprehensive online childbirth education class, The Birth Preparation Course with over eight hours of content, and a private course community. The Birth Preparation Course will leave you knowledgeable, prepared, competent, and empowered going into your birth. Head to www.ncrcoaching.com to learn more.

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