Hospital delivery room rules can be complicated. Luckily, you might have a lot more control over them than you think! Navigating a hospital birth is easier when you know what rules are actually choices, so let’s dig in. (The bonus video is at the end of post)
I was appalled when I learned that some hospitals âdonât allowâ laboring people out of the bed! Now thatâs a next level delivery room rule.
As a labor and delivery nurse, I know not everyone wants an unmedicated birth experience. The labor tub, lunges, and birth ball in the shower arenât for everyone, but I think we can all agree that a labor bed is notoriously very uncomfortable. Also, there are major benefits to moving around and having some fun with positions that feel good even before that sweet relief of epidural (for most, that means youâre in the bed for the duration of labor). So when is a delivery room rule an actual requirement, a suggestion, or a safety concern?
Glad you asked!
Also, I canât emphasize enough how important KNOWLEDGE is to your birth experience. It shapes your perspective, expectations, helps you start forming or listening harder to your intuition. Itâs my biggest piece of advice when helping nervous parents prepare for their birth experience. Hereâs my fave childbirth class, and I know youâll love it, too!
Letâs clear up the confusion and talk about Rules in Labor.
(As a labor nurse, Iâve been dissecting this topic since feeling out of control in my choices during my first birth experience in the hospital at which I work. I think hospital delivery room rules is a topic that you need to know before being admitted to the hospital, too.)
Types of Delivery Room Rules
In an effort to simplify the very complex levels of hierarchy, policies and standard procedures (not to mention care provider preferences), I categorize delivery room rules into two groups: Body Rules and Facility Rules
Body Rules are the rules you have about your body, whether spoken or unspoken. Body rules also include how you intend to listen and work with your body.
For Example: This might look like asking to use a birth ball at the bedside or simply the expectation that you can pee when you want and how you want while in your labor room. To Note: In order to understand the options in your facility, it helps to take a tour during pregnancy so that you understand the tools and resources available for helping you imagine a birth experience that you dig (portable or intermittent fetal monitoring, birth balls, peanut balls, private bathrooms, showers/tubs, nutrition options, the list goes on).
Body rules usually have options that donât always sound like options.
For example: âYou canât get out of bed once youâre on the monitor.â
This is an example of a body rule, a rule about how you can use your body, that actually does have options but isnât presented in a way that leads to open discussion. It sure sounds like a hard and fast rule⊠but is it?
A couple follow-up questions might be:
- âHow long do I have to be on the monitor?â
- âDo you have monitors that move with me or can I have intermittant monitoring with a doppler?â
- âThis bed isnât working for me. What happens when I want to get up and walk around the room or go to the bathroom?â
That should give you some more information and help inform your next move.
Facility Rules are the rules that the facility has to ensure safety inside the walls of the hospital or birthing center. This might be due to resources available (human and tangible), the need to care for so many people at one time, or the goal to do no harm to their staff or patients.
Facility rules donât have much flexibility, if any, and can vary greatly by facility. Sometimes these are readily shared publicly, but often theyâre not and impossible to know all of them prior to being admitted. Luckily, many of them that potentially affect your birth in a big way can be discussed early in labor or prior to labor to help you decide where to go for your care!
Facility rules could include breech birth at an out-of-hospital birthing center, the number of people that can accompany a patient into the OR for a cesarean, or smoking or vaping inside the facility. These are solid rules that the staff work hard to follow and encourage for the safety of the patient, staff, and others
You might also like the video: What Does Informed Consent in Labor Look and Sound Like? Click here
Pregnant people are not fragile
Sometimes there are rules in hospital L&D that exist for safety but are complete crap. I donât want to leave you feeling like birth rules are black and white, because theyâre 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 Iâd love to have this discussion in the comments.
Questions that Iâd want to ask:
- âWhat are my options?â Â
- âWhy is this medically necessary, and what information is an OB obtaining about my cervix that a midwife canât relay âŠ. furthermore, what information is totally necessary that can only be obtained by touching my cervix during pregnancy?âÂ
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 theyâre policies or individual staff choices, are in place for said patient safety. Itâs 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 itâs now difficult to determine whatâs 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 thatâs pretty solid (âNo, the windows donât open. Sorry, I canât add a chair in here, fire marshall rules. Alcohol in the postpartum room is actually against the law. Thatâs a solid facility and community ruleâ â and yes Iâve had that discussion more than once) Iâm 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 canât wait for staff-patient ratios to improve so that I can be more one-on-one! Choice discussion takes longer, but that doesnât mean staff or facilities should choose whatâs best for a birthing person. Pregnant people are not fragile and can totally make their own decisions for whatâs best for them, their body and baby.
Navigating the Rules
For example: you canât get out of bed once youâre on the monitor.
To determine if this is a body rule or facility rule, you might ask: âWhat are my options?â
The above phrase didnât sound like there are any options, but if you ask that open ended question, you might get something like, âWell, if you want to go to the bathroom, you would have to take the monitor wires with you.â
Then itâs 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, âIâll have to ask the doctor,â generally thatâs a clue that itâs a choice. Possibly a clue that this isnât 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, âIâm glad you asked! There are some options that we can discuss and I want your doctor/midwife to be included, because Iâm new to the topic.â
Or different example:
âGreat question! It sounds like eating in labor is important to you, and I can definitely hear that. The reason your doctor/midwifeâs order states clear liquids, is because itâs 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 isnât really ever empty and the risk for aspiration is incredibly low, so thatâs a decision that you have to make for yourself.
(see what I did there đ thatâs 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 doesnât give much choice. BUT, you always have a choice. Maybe you need more information, or maybe your nurse or provider doesnât understand it as a choice, or maybe it doesnât seem like a choice because itâs 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 personâs choice.
Donât 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 â Comment Below!
