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A lot of us are restricted to certain hospitals by our insurance. If we ever did get pg, we would have to birth at dh's hospital (he works in one) or they won't cover but 80%. They have sucky rules, no tubs, and no LDR's. I would rather birth at the hospital that's closer with the big tubs where you're allowed to eat while in labor. Insurance is a big reason people are stuck giving birth at a hospital with rules they don't agree with.


Although I don't think they'll let you eat IN the tubs at the cool hospital. ;o)


I delivered at NY Hospital on the UES 6 mos ago. They too have rules like no food, etc that I didn't necessarily like, but i went along with it - cause I believed they knew better than me. After a not too terrible 12 hours of labor, my girl's heart rate dropped, then dropped more, then very quickly dropped to a dangerous level. Within 45 seconds of reaching this dangerous level, I was on the table (sans anesthesia mind you) and 2 minutes later she was out and I had a morphine injection to take away the pain of no epi. I also threw up right away, but there was nothing in my tummy, so nothing of consequence to throw up. Bottom line - emergencies happen - better to be safe. I'm wishing you the best in the last stretch of your pregnancy!

Amy E.

I can see your point but I think this happens because there aren't a lot of options in the middle. I think some of the interventions and rules are not really based so much on solid, recent medical evidence but on tradition. Doctors do things like they have always been done. I find that a little annoying and would probably be one of those woman sneaking a banana or some gatorade into L&D.

I am personally not comfortable with a home birth becuase I know things can go wrong but I am also not cool with a hospital where I am not allowed to make informed choices either. I hate the whole "we know what is best for you young lady" attitude some doctors and hospitals have. Tell me the real deal and let me decide. I think doctors need to stop treating adult like children and allow us to make informed choices.

I also think (and have had this confirmed by friends in the profession) that a lot of the choices doctors and hospitals make are ruled by fear of litigation, not fear of actual negative outcome. That sucks but I guess it's hard to blame them for that. I would love to find some sort of middle ground but there doesn't seem to be one where I live. A birth center attached to a hospital maybe? A midwife with admitting privilages but will allow you to labor at home? A doctor who will act as backup for home or birthcenter birth? None of those options are available to me so I will probably be one of those woman breaking the rules.


Rules are rules, but some of them can be bent, if you ask. I had a 16 hr 'emergency'induced labor(h2o broke @ 34wks)...starting @ 530am. by 10 am I was HUNGRY. I asked, and she let me eat (a small ammount, but enough), even though the H. policy was not to. But that way everyone KNEW what iI had had, should there be any complications.... Just an Idea....


I am restricted by my insurance, as someone already mentioned, so I'll be giving birth in a hospital even though it's not my preference. I wish I could afford to pay out of pocket to have a home birth or use a birth center, but it's not an option.

My personal opinion is that the risk of death due to aspiration is worth taking a chance on. It's far less than one in a million. I'm lucky that my doctor will let me drink whatever I choose.


Well, for me there was a hospital 3 blocks away or a birth center 60 miles away. If I'd done the research I've done since, I would have had a homebirth, but as a nervous (uninformed) first time mom, I wasn't willing to go that far. Like most people, my hospital birth was fine, though not without unneeded intervention. I did eat. I did turn down much of the usual stuff, but when you're in a hospital, your choices are limited by their policies.

If I have another, it will be a homebirth. But if I lived much further from a hospital than I do, I might not feel comfotable making that choice.

Point is, there are not many viable choices out there. Most women are stuck, so they try to make the hospital experience as close to one they want as possible.


I gave birth at a high intervention hospital and managed to have the kind of birth I wanted because my doctor was all about low-intervention. I broke all the hospitals rules (I ate, I walked, I had a doula) with my doctor's knowledge and encouragement. I was very lucky.

Cat, Galloping

In reading this, it occurs to me that the truly stupid thing about the rules breaking is doing it secretly. Disagreeing with doctor, fine, lying to him/her, not so good. They may need certain pieces of information to make decisions about your care if things don't go exactly as planned.


I personally think for a lot of people, it's just the mentality of "they can't tell me what to do". I have two children and I have to say, it doesn't get any better. Every experience we have had (preschool, nurseries, etc) there have been a few parents who think the rules are stupid and just do what they want. I find it very aggravating.

Brooklyn Girl

Oh yeah...insurance. How quickly I seem to forget. In a city like New York, there is an embarrassment of hospitals wih slightly different philosophies, most of which accept the popular insurance plans. That said, there's a disturbing trend of doctors who don't take any form of insurance at all.

I'm with Cat--what disturbs me most is people who are actively working against their caregivers, sometimes in secret (the "sneaking" food during labor remark, for example).


My doctor told us, "Eat before you come to the hospital. You'll need your energy."

I was a first-time, low-risk mom though.

Sneaking food is a bad idea. If you're going to break the rules, be up-front about it. Take responsibility for yourself and your actions.


I'm of the opinion that women should be able to have low-intervention births in hospitals. I did. Even though I live in a big city, with lots of options (birthing centers, different hospitals, homebirth midwives) but I wanted to be at a hospital with a top-level NICU. I was paranoid after losing my first child, and wanted the best possible facilities immediately available in case something went wrong. But if nothing goes wrong, why intervene? If the birth process goes well, all the doctor/midwife really needs to do is just stand by, ready to leap into action if something happens. (I wrote an entry about my feelings on low-intervention births in hospitals on my blog last year, with a detailed description of my experience. It's at http://summertime.blog-city.com/in_which_i_talk_much_about_birth.htm if you're interested.)

Brooklyn Girl

Melani--You nailed it. That's absolutely the attitude I mean.

It's similar to what I encountered when I was teaching, when I'd have borderline failing students whose parents would take them out of school for vacation for a week. The kids, who were struggling to keep up anyway, would now be hopelessly behind and the parents refused to admit that the absences had anything to do with the problem.

Summer--Thanks for sharing your story. It's not that I think that women in hospitals shouldn't be able to have low intervention births, as much as I think it's a question of playing to your hospital's strengths. With the IV issue, for example, if I'm at a hospital where they recommend an IV upon admission, that suggests to me that the medical staff is most accustomed to giving meds via IV...so for me personally, I'd rather not be IV-less and have them looking for a vein at a critical moment.


I had home births personally and am now a L&D nurse in NYC.

I think for the most part, most people don't think much about the hospital policies before they walk in the door. We have a list of standard procedures and rarely does anyone bat an eyelash.

Most women choose their doctor, for whatever reason, and then just go to the hospital where he or she has privileges and passively do what they're told.

Birth centers are not an option in the NYC--three closed recently due to malpractice premium increases (due to the market, not actual cases) and the only one left is in the Bronx. Roosevelt has a fake one, in a hospital, and it's not so bad.

Home birth was dealt a blow a couple of years ago when the one OB who backed many of the CNM's retired. I think a bit of laziness was involved as newer CNM's tended to just approach him rather than cultivating their own relationships with other OB's.

Also, for some reason, CNM's in NY are against large fees to the backup OB. It might be an insurance thing. When I had a baby in Miami, my backup OB billed my insurance company $1500 for "backup" when the global midwifery fee for home birth was only $2500, and they paid it (they saved plenty on the hospital fee). He would have billed his usual fee if he had actually been called. $1500 for one prenatal visit--plenty of doctors would be happy to get that.

There isn't much of an underground network of unlicensed midwives who attend home births in NYC as there is in NJ and upstate NY, because there were enough legal providers that women preferred to use their insurance.

So, things that I do every day that I would not choose for myself because I believe the risks outweigh the benefits: IV/NPO, EFM, bedrest, epidural, almost every scheduled c/sec, the list goes on.

As for the commenter whose baby was dramatically saved: were the apgars 3's, indicating the baby was in distress, or 8's, indicating that it was yet another case of misdiagnosis?

Brooklyn Girl

Shamhat--Very interesting. Thanks for posting. What do you feel the risks of IV/NPO, EFM, and, epidural, in particular, are?

I thought there was an extant birthing center in NYC: the Brooklyn Birthing Center.


Well, learn something new every day!

A few months after Elizabeth Seton closed, we heard that Brooklyn got a new insurance bill. I know the Childbirth Center in Englewood, which closed right before Seton, went from $30,000/year to $300,000/year and closed, and I ran into a Brooklyn midwife who was looking around for job opportunities right about the time Columbia's Allen Pavilion revoked privileges for midwives, and lo and behold! I lost track of the story, assumed they closed, and they're STILL OPEN. Praise be to the Creator/ess of Your Choice!

Oh goodness, don't get me started on interventions, when women like Henci Goer and Nancy Wainer have written it all already. The Radical Midwives email list recently had a discussion in which they decided that the standard newborn hat was an "intervention"--mothers whose babies didn't get hats immediately kissed and caressed and smelled their babies little heads, while mothers whose babies were hatted rarely touched the head. Mothers virtually never removed the hats themselves. I personally make a point of never confiscating the baby to the nursery until the mother has seen the whole baby and not just the gunk-smeared eyes peeking out of the blanket, because I think it might make her more secure about recognizing the baby on a gut level when we finally release him or her all spit-shined, but that's all I have the power to do for my clients.

Experienced midwives always say that over time they have learned to do less, to touch nothing, to respect the process, to listen to the mother's intuition, and to think of everything they say and do as an "intervention' with potential risks and benefits.


And the bed! The damned bed! No choice but to lie down, like an ill person. Automatically slapped into modified lithotomy for Valsalva pushing and a 2nd degree tear.

The BMJ article found that American midwife-attended home births had the same perinatal infant mortality rate with a 3.6% c/sec rate. What they don't mention is that with freedom of position and non-directed pushing, midwifery clients generally have about 50% intact perineums, 30% first degree tears, and 20% second degree tears or episiotomies. "Recovery" from a really good birth is a shower, a big breakfast, and a nap.


Hey, interesting post & comments. Found you via Julie's big list.

I too have a instinctive trust of Western medicine... maybe because half my family are doctors or nurses, or maybe because I've never been seriously ill.

Self-centered rule-breakers also bug the freakin' crap out of me. I like rules - they usually make sense.

BUT, it seems to me that in many cases of hospital births, women are not treated with much respect, or are intimidated into action without consideration for anything beyond what's (a) fastest - especially in high traffic hospitals and (b) safest while rushing the birth along.

Sometimes people break the rules because they don't have a choice.

For the birth of my daugther, I wasn't comfortable with a home birth, but after learning about all of the potential interventions I wasn't entirely comfortable with the hospital, either!

A doula worked wonders for/with us. We were fortunate to have a straightforward birth, in a quiet hospital with a great staff. But it was the advice and aid of our doula that allowed me to labor at home until I was nearly in transition... so that by the time we got to the hostpital things moved fast. Had a monitor but no IV, was allowed to move, transition in the shower, etc.

All in all it was a good experience. But even from my hunky-dory perspective, I could tell that divergence from the norm would not be tolerated by the staff. And it scared me, more than a little. For this and other reasons, I'm considering a home birth if we have another... now I just have to figure if we can afford both another kid *and* a home birth! :)


I had a low-intervention hospital birth with a midwife. (If you like, you can read my birth story here: http://www.livejournal.com/users/rivka/246308.html .) In my case, I wanted a hospital birth because I have quite the abnormal pelvis due to a birth defect. I was told by the senior midwife in my midwife practice that I had a greater than 50% risk of needing a C-section, and she also thought the pelvic anomaly might lead to unusually painful labor as the baby's head butted up against my weird bones.

So I wanted to leave the option open for pain relief, and I wanted to be able to have a C-section quickly if necessary. But I didn't want my birth to be automatically high-intervention, either. I wanted to be able to have a low-tech granola birth right up until the moment that high-tech help was necessary. Fortunately, my midwives made that possible within the hospital setting - but it's not always that easy. With an OB, or at another hospital, I might have had no other choice than to have an IV and continuous electronic fetal monitoring. Ironically, I'm pretty sure that if I'd been forced into one position in bed I would've needed a C-section. My midwife did a lot with positioning to get the baby around my pelvic abnormality.

Amy E.

I should note that while i might break some of the rules I wouldn't lie about it....well at least not after the fact. I might not say, "Hey doc, I'm gonna go have some toast and orange juice right now." I would more likely have the toast and juice and then tell the nurse about it so she could note it on my chart.

I know the attitude you are talking about and I don't like it either. But I also think that if everyone just went about it with the attitude that doctor knows best and we should just do what they say and be okay with it then nothing would ever change. I trust doctors. I know they want the best outcome. And in a life threatening situation I would be very thankful for their expertise. My best friend is a doctor in a large teaching hospital so I also know for a fact that what is best for the patient is only one of many factors that go into hospital policy. If we don't stand up and advocate for ourselves then nothing will ever change.

And I think it is the more privilaged patient, who has access to information and choices that can be really key in making things change that then trickle down to some of the less privilaged patients. A patient on Medicaid may not have any choices about providers and hospitals and might be stuck with very few options. We kind of owe it to ourselves and them to question authority when appropriate.

All that said, I know the attitude you speak of. It seems especially prevelant in Manhattan and is one of the reasons I am glad to live in a more low key place now after 10 years in NY. Those women are not looking to make positive change. They are just looking to create the best situation for themselves even if it makes everyone's elses life more difficult. They don't have an overwhelming desire to change the rules they just think the rules shouldn't apply to them. It is ultimately a sense of entitlement without responsibility and it would bug me too.


Nothing really to add but wanted to add what a great post and even better responses. I’m seriously taking notes over here. I’m hoping to go Jenny’s route although instead of an actual doula my BF who is currently doing her maternity rotation for nursing school at the hospital I’m delivering at will be with my husband and I at the birth. I’m hoping that with her knowledge of the staff and other hospital polices that she can help us to have a birth that closely resembles the one I want. But let’s face life happens, while I’m willing to bend the rules I wouldn’t want to break them just because you never know what is going to happen.


Interesting post and comments, BG. As an ICU nurse, I understand the need for IVs and NPO (nothing by mouth) status but at the same time I'm hesitant to do that with healthy people, myself included.
Food (hah) for thought and something to think about, indeed.

Shamhat - if you would (and see this), what position would you recommend other than modified lith?


Concerning eating, I have had many girlfriends (both natural birthers and epis) tell me they vomitted quite a bit during labor. Ranging from a little bit of bile to full out dry heaves on the bathroom floor for hours. (the dry-heaver's OB eventually stepped in and reasoned with her to take meds.)

One begged her husband for orange juice, which she immediately vomitted all over herself and the bedding, nurse walks in and says "this is why you shouldn't drink or eat during labor."

Just my opinion but the labor and delivery department see groups of women each and every day giving birth, if a 25-year veteran says it is probably not a good idea to strap a feedbag to your mouth, they likely know what they are talking about.


It's quite common for women to vomit during labor, particularly women who don't have epidurals and experience their "transition." Many people can vaguely recall the experience of nausea being instantly and totally relieved by vomiting--it's not enjoyable but it immediately makes you feel better. Dry heaves often don't provide the same relief.

It's the women who have naturally longer labors who are miserable while NPO. They're still pregnant, they're still hungry, and they suffer from a loss of energy and often a drop in blood sugar. No, there's no sugar in the IV, it's just ringer's.

As for position during birth, the easiest on the perineum is probably hands and knees. That's also the "Gaskin maneuver" for shoulder dystocia, and thus a good position for a big baby. Lying on the side is also good, and can be achieved with an epidural as long as the birth attendant is willing to set that heavy top leg on his or her shoulder.

Standing is probably slightly better for the perineum than squatting. Lying on the back with the legs drawn up, well, it always amazes me when someone doesn't tear. The tissue looks tight even before crowning.

For teaching a woman to push, you can't beat sitting on the toilet, if she can walk to it. And all the coaching about where to grab the legs, elbows up, etc., geez, if these nurses have ever had children, don't they remember that it doesn't make a bit of difference where the elbows are?

Valsalva pushing, where the mother is told to hold her breath while bearing down, may very well be necessary for an epidural birth for all I know. But for someone who can feel the urge to push, well, she'll know what to do when the time comes. Physiological pushing often comes in short bursts, and they're extraordinarily effective relative to coached pushing.


I can't tell you how much I do not want to read these comments because I'm sure other people don't agree with you. So I won't read them.

I'm an RN and read at least one post weekly that just rips the medical community to shreds. I would never say we're perfect, but I will tell you this: it is nearly impossible to give a patient good, well-rounded care when they come into the hospital expecting the worst with a gigantic chip on their shoulder, ready to refuse and refute any and all suggestions or protocols.

I have told my patients' families (my patients are usually unconscious) several times: WE ARE ON THE SAME SIDE. Our methods may differ and there is always room for compromise, but WE ARE ON THE SAME SIDE. I didn't agree with some of the stuff my OB wanted me to do, but she didn't like some of my ideas. So we picked and choose with the understanding that BOTH of our goals was a healthy mom and healthy babies. Life is about compromise and healthcare is no different.

It is so frustrating to try to take care of someone who doesn't want to be there and doesn't want your help. I love my job and I love explaining what we're doing and helping people make informed decisions. But if someone comes into the hospital and then refuses all treatment (or picks and chooses based on ignorance), it makes me want to tear my hair out. Ask questions, ask more questions, and then ask them again. There's nothing wrong with that. Thank you for assuming that we're a team and we have your best interest in mind.

Also, it's really cool to see you talking about labor and delivery. You're having a baby!


Heather - if medical professionals really *always* knew what was best, you wouldn't still see some providers giving routine episiotomies, after multiple studies have shown they don't produce better outcomes.

Personally, I was happy to have the opportunity to drink clear liquids during labor. Yeah, eventually I threw up and switched to water or ice chips, but for the early parts of labor ginger ale and chicken broth helped keep my energy up. Throwing up isn't that big a deal.

That said, in the main I agree with Linda. If you're totally at odds with your provider, things aren't going to go well. We wound up with several departures from our birth plan, but I felt fine about it because I really trusted my midwife to give me the right advice and not intervene unnecessarily. So I wanted to delay cord cutting, but when she explained why she needed to cut the cord right away (meconium in the fluid when my water broke) I was unconflicted about it. It didn't become a battle, because I trusted her.


I had 2 very different experiences at the same hospital with my 2 kids. I was like you the first time. I was not going to let anything mess my healthy child. I got high intervention, long labor, c-section and a sick child at birth.

The 2nd time around, I went and learned more. I read reams of books from all different perspectives on birthing. I switched OBs. I decided to take Bradley classes and produced a birth plan. I took to that hospital. I also hired a doula. I ate peanut butter before leaving for the hospital to keep my energy up and my doula kept me hydrated. I had a quick labor and natural vaginal delivery of a bigger baby at the same hospital. I let them put the iv in about 5 minutes before he came. I did not want it while I was pushing.
Baby was still sick, but oh so much healthier and quicker recovery than the first.

I think it is like infertility. It pays to know what you are talking about going in.

That said, you are getting down to the wire to have a baby that you are so anxious to have. Do what is comfortable for you.
Best wishes for a great delivery and recovery.


I've been thinking about your post for a couple of days. I felt much like you do: I didn't like the paternalistic attitude some doctors took with me and other women I knew, but I hated the other side of the coin, where acceptance of any intervention or pain relief presumably meant I was a clueless cow and a pawn of the medical community.

We all know that there are too many c-sections and other interventions. Pain relief, while a great thing in my experience, does cause some women's labor to slow down. The idea of putting strict contraints on how long and in what position a woman can labor is wrong. We get that.

What really bothers me is that some individuals (midwives and otherwise) who advocate for natural births are just as condescending as doctors. This is particularly disappointing because most of them are women and I expect better from them.

Shamhat, who had a lot of great points, wrote "As for the commenter whose baby was dramatically saved: were the apgars 3's, indicating the baby was in distress, or 8's, indicating that it was yet another case of misdiagnosis?" That snarky comment is exactly what I mean. This woman felt her baby was saved by a c-section. We weren't in the delivery room with her. We don't know her history. If her child had been born disabled because of some birth trauma, would we all stand around clapping, saying "well, good for her. You know, she refused a c-section."

I wish I had been better informed before my son was born. I don't think it would have changed anything, and frankly I'm perfectly happy with my birth, but I do believe it would have given me more control in the delivery room. Unfortunately, I didn't really feel that either side spoke to me.

I'm not trying to start an argument here, I'm just saying that if childbirth educators and doctors want women to listen, they first need to show that they respect our intelligence and our ability to make decisions about our own care.

beaver girl

Hi BG! No matter what - i think everyone should at least be able try to get the birth experience they want. Here in Illinois, birth centers are illegal, so it's homebirth or hospital. Home is outside of my comfort zone but from what I understand, once you enter the hospital - they are the ones in charge because of liability.

From what my midwives tell me, they will advise and help "bend" some hospital rules that they don't think make sense, eg - eating or whatever.

But it's all about what's comfortable and right for you. I'm following you closely - I'm right behind you!


There is a common theme appearing in messages from persons writing from both sides of this issue. Education. I don't think the importance of being an informed participant in one's medical care can be stressed enough.

When women are fully informed as to the risks/benefits of a given policy or procedure, they make choices that they are comfortable with. When such choices are made with the cooperation of the healthcare provider, there is no reason for subterfuge. Too many times I've read stories where people were dissastified with their experiences because they felt they had no say in what happened to them, or didn't know the reasoning behind it. The key is becoming informed and finding a like-minded care provider.

Our culture doesn't encourage women to learn why lithotomy position may not be best for them. It tells us to lie on our backs because that's the way birth is done, and don't ask questions. Epidurals are either touted as a wonder solution or evil incarnate. I was happy about my choice to avoid one because I fully understood the pros and cons. A friend of mine was happy with her choice to have one for the very same reason. It's all about ready and abundant access to information and the ability to make choices that you and your care provider are satisfied with.


Ok, so apparently I made a "snarky' comment.

Is there a "non-snarky" way to ask the question?

Every woman who consents to a c/sec does it with the belief, at that time, that her baby's life is in danger. In my experience, most women recall their c/secs as being a response to "the baby's heartbeat," even when their medical records turn out to state ftp/cpd/etc.

However, since our c/sec rate is about double than the infant mortality rate in Mali, some of those women have apparently been misdiagnosed. As long we refuse to acknowledge that, then we will never solve the problem.

Apgar scores are one indication that a baby was in distress before birth, and one that many mothers can recall, even if they were behind a drape at the time of the birth.


I wish I could have eaten during labor. I had preeclampsia and a heavily medicated, induced, long labor. Even if they had let me eat, I was so sick to my stomach I couldn't stand the thought, and I was really weak by the time I gave birth. We have a picture of me eating a granola bar that my dad happened to have in his pocket about ten minutes after my daughter was born.

My story is sort of the opposite of Shamhat's scenario. They said they thought I'd need a C-section, but I unexpectedly went through transition super fast (ouch) and delivered vaginally. I don't know my daughter's Apgar scores; they didn't tell me. They then took her off to the NICU for a couple of hours, because she was so lethargic (probably from the drugs I was getting). She went home a few days later, but she had a rough first few weeks. In retrospect I am, frankly, amazed that I didn't have a C section, given all that happened. I guess what I'm saying is that it's not cut and dried, and decisions are made under less than ideal circumstances. An earlier C might have been better for my daughter, because she would have been exposed to less drugs, but not so good for me. Or maybe it would have been harder for her, because maybe labor is useful to the baby. I don't know. I was way too sick to be second guessing anyone. And, in the end, here we are, four years later, and it all worked out. She's fine and lovely and blooming.

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