Pregnant people are not fragile

Sometimes there are rules in hospital L&D that exist for safety but are complete crap. I don’t want to leave you feeling like birth rules are black and white, because they’re not. Your gut will guide you in decision-making, despite my simplified facility rule vs body rule structure. Flexing this gut instinct, learning to listen to your intuition, will also serve you very well in parenthood (and hell, life! only you know you best!)

For example: in Arkansas, the law on the books states that any birthing person pursuing an out-of-hospital birth and choosing midwifery care must submit to a cervical exam by an OBGYN or Nurse Practitioner twice in their pregnancy. The exams are required to determine if the mother has any medical conditions that would make home birth dangerous. 

How absurd!

Um, what? This is a body rule and facility rule, it seems (facility meaning state-wide system). I have no idea how people get around this insanely perverse and medically unnecessary requirement, but I’d love to have this discussion in the comments.

Questions that I’d want to ask:

• “What are my options?”  
• “Why is this medically necessary, and what information is an OB obtaining about my cervix that a midwife can’t relay …. furthermore, what information is totally necessary that can only be obtained by touching my cervix during pregnancy?” 

I assure you, this is not a requirement for a healthy pregnancy, and this is not part of the prenatal course, even in the medical care model.

Many hospital practices, whether they’re policies or individual staff choices, are in place for said patient safety. It’s easier to keep a large number of people safe with rules and policies in place that keep safety a priority, and routines develop quickly. However, at some point, the process discussion seems to have faded into just the process sometimes, and it’s now difficult to determine what’s a choice in the whole process. 

As a nurse, more questions from birthing families makes my job take longer. When I teach that everything is a choice unless we come up against something that’s pretty solid (“No, the windows don’t open. Sorry, I can’t add a chair in here, fire marshall rules. Alcohol in the postpartum room is actually against the law. That’s a solid facility and community rule” – and yes I’ve had that discussion more than once) I’m in the room for longer and teaching far more about other options that I used to.

More time to care for people with questions is great! I can’t wait for staff-patient ratios to improve so that I can be more one-on-one! Choice discussion takes longer, but that doesn’t mean staff or facilities should choose what’s best for a birthing person. Pregnant people are not fragile and can totally make their own decisions for what’s best for them, their body and baby.

Navigating the Rules

For example: you can’t get out of bed once you’re on the monitor.

To determine if this is a body rule or facility rule, you might ask: “What are my options?”

The above phrase didn’t sound like there are any options, but if you ask that open ended question, you might get something like, “Well, if you want to go to the bathroom, you would have to take the monitor wires with you.”

Then it’s up to you to decide if the consequence is worth the action for your comfort, labor progress, safety, goals, etc.

If you get an answer such as, “I’ll have to ask the doctor,” generally that’s a clue that it’s a choice. Possibly a clue that this isn’t a choice that is common in this facility or with this professional but still your choice nonetheless.

If I were queen, that phrase would be changed to, “I’m glad you asked! There are some options that we can discuss and I want your doctor/midwife to be included, because I’m new to the topic.”

Or different example:

“Great question! It sounds like eating in labor is important to you, and I can definitely hear that. The reason your doctor/midwife’s order states clear liquids, is because it’s a facility policy that laboring people are offered clear liquids. This is a decision made with OBs and anesthesiologists at the table, since many of our patients get epidurals and cesareans. However, there was little evidence to support the safety of limiting intake during labor when recommendations changed in the 1940s.  There is current evidence that discusses that the stomach isn’t really ever empty and the risk for aspiration is incredibly low, so that’s a decision that you have to make for yourself. 

(see what I did there 😉 that’s not really how I talk, but I do encourage you to do your research or ask your provider to provide the latest research on important-to-you topics)

This is not a hard and strong rule to be applied in every situation. I have no idea what the language is of every labor nurse, in every unit, with every provider. I do know, however, that we often explain things in a way that doesn’t give much choice. BUT, you always have a choice. Maybe you need more information, or maybe your nurse or provider doesn’t understand it as a choice, or maybe it doesn’t seem like a choice because it’s so darn obvious (like a life or death resuscitation decision).  Not every choice is about life or death situations, however, and you as the birth person should ultimately be deciding and feel like what happens is a product of your choices with honest and transparent information provided to you by your care providers.

We, care providers, have to get more comfortable with the mindset of offering information in order to help you make these important decisions and choices.  Instead we make the mistake of telling you how it works in the hospital, guiding you into the path of least resistance, or sitting by while others take on that role. Even the easy choices that everyone in the room feels is obvious are still, in fact, the birthing person’s choice.

Don’t miss more on this topic in the video below! 

Share with me what hospital delivery room rules you were shocked about or where you found flexibility within routine and policy. I would LOVE to hear what you think – Comment Below!