Giving birth in a hospital: Traditional labor? - Sonoma West Publishers : Weekly Discoveries

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Giving birth in a hospital: Traditional labor?

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Posted: Wednesday, March 23, 2011 12:00 am

The following article is the third in a series examining birthing options in Sonoma County.

By far, the most popular place to give birth in Sonoma County is at a hospital. For residents living in north or west county, this means a trip to Santa Rosa to check in at the labor and delivery ward of Sutter Medical Center, Santa Rosa Memorial Hospital, or Kaiser Foundation Hospital.

In some ways, the birth options available to women at these three hospitals are similar. None of the hospitals offer tubs for a woman to labor in, an option she might choose at home or at the Women’s Health and Birth Center. Giving birth in water — again possible at home, or at the birth center — is also out of the question.

Yet all three hospitals have amenities available to aid women who plan to give birth naturally, that is, without pain medication or medical intervention. All three hospitals offer in-room showers and encourage women to utilize them for pain management. Monitoring by telemetry is available, so that a woman may move around in labor, helping labor progress without augmentation. All three hospitals also support breastfeeding and offer lactation consultations.

The similarities don’t end there. These hospitals support the use of doulas — professionals who provide emotional and physical support to a woman throughout labor and, if necessary, advocates on her behalf — and birth plans, and promise to respect a woman’s wishes unless her safety or the safety of her child demands otherwise.

While hospital birth often conjures images of a brusque physician overseeing a woman in lithotomy position (read: stirrups), staying in bed is not usually a requirement. Neither is the physician: giving birth in a hospital does not necessarily mean being attended by an OB/GYN. Certified nurse midwives oversee some hospital births, although the extent of their involvement varies by hospital. Some certified nurse midwives are simply part of a labor team, while others oversee labor from start to finish or even offer continual support for the duration of labor.

Hospitals, of course, offer medical services that can’t be found at the birth center or at home. Staff can provide epidurals and intravenous pain management, and they are capable of performing planned or emergency Cesarean sections. They can take on higher risk births, and surgeons and pediatricians can be found within the walls of each of the hospitals.

Given all these similarities, there are still substantial differences to consider. The hospitals are compared below, in alphabetical order:

Kaiser Foundation Hospital, Santa Rosa

At Kaiser Foundation Hospital, which is available to Kaiser Permanente members, the labor and delivery team includes nurses, certified nurse midwives, and physicians. Staff operates on a shift schedule, so patients are attended by whomever is on duty and do not choose which doctor or midwife oversees their delivery.

“The midwives and nurse practitioners and doctors help the women form their birth plan. We try to meet their experience with what their birth plan is. Some people bring doulas in,” said Nance Jones, RN. “We do skin-to-skin after delivery and with Cesarean sections, too.”

The average length of stay is 24 to 48 hours, and most families remain at the hospital for approximately a day and a half. Staff does sometimes send mothers back home to labor there a bit longer — especially first time mothers who jump the gun and don’t realize they still have a ways to go.

“At home is the best place to be in early labor, but still getting here in plenty of time,” Jones said. “We are huge proponents of families coming here to deliver their babies in a hospital. We try and make the birth the way they want it.”

Kaiser is rated as a level two facility for infant care: an intermediate care nursery. High-risk infants who require a Neonatal Intensive Care Unit (NICU) are transferred to San Francisco, Walnut Creek, or Oakland.

“We have 24 hour in-house pediatricians, and 24 hour in-house obstetricians and anesthesiologists,” Jones said.

Kaiser also allows women who have previously undergone a Cesarean to try a VBAC, or Vaginal Birth After Cesaran.

“There’s a commitment to do that here. It’s something where we want to be sure we have close observation, but we do have a commitment to trying VBAC,” Jones said.

Visiting hours are 9 a.m. to 8 p.m., but fathers don’t count as visitors and are welcome to spend all day and night.

Santa Rosa Memorial Hospital

Of the three hospitals, Santa Rosa Memorial Hospital has the fewest births — about half as many as Kaiser or Sutter. Some women find the smaller scale appealing.

“We technically have five private rooms and five shared rooms, but we don’t double up. We spill into post-partum rather than have families share the same room,” said Sharon McKenzie, perinatal nurse manager.

There are other intimate touches. For instance, Memorial’s level two NICU offers Skype for far-away grandparents to see babies. (The UCSF-run unit also carries telemedicine capabilities.) Care is consolidated, with the mom and baby rooms just down the hall from labor and delivery. VBACs are also an option.

“Our physicians have been very strong about supporting VBACs. Of the people who are good candidates, we have a 70 to 80 percent success rate,” said certified nurse midwife Suzi Saunders, who delivers babies at Memorial and works out of Women’s OB/GYN Medical Group.

“We made a decision to support VBACs because it supports human dignity and justice,” added McKenzie.

Staff members noted that the hospital believes strongly in mother-baby bonding and family involvement.

“When we have C-section patients, we have immediate bonding time if possible, and get them breastfeeding right away,” said Saunders. “At other hospitals, you go six to eight hours.”

“We try to involve the family as much as possible,” McKenzie said. “The nursing staff wants those moms and babies together because that’s the nice part. That’s the part that feeds your soul.”

Memorial also has pediatrician hospitalists who are on call 24/7. Visiting hours end at 8 p.m., but fathers and siblings are not considered visitors.

Sutter Medical Center

Sutter boasts the lowest C-section rate in the county, as well as the county’s only level three Neonatal Intensive Care Unit. However, Sutter is unable to oversee VBACs and refers women who desire them to other hospitals.

“Our philosophy is to help a woman have the birth she wants. For some women, that’s access to an epidural as soon as possible. For some, that means having access to a doctor who supports natural childbirth,” said Natasha Kahl, MD, director of high-risk obstetrics.

Kahl noted that staff actively works to prevent unnecessary Cesarean sections. “The primary goal is to keep that initial Cesarean section rate down,” Kahl said.

Certified nurse midwives, family practitioners, and OB/GYNs deliver babies at Sutter.

“We have a number of family practitioners that deliver here as well. That’s a very strong community tradition here in Santa Rosa,” Dr. Kahl said.

In addition to a CCS Accredited Level III NICU and perinatal transport team, Sutter has a house on the hospital property where families with NICU babies can stay in order to avoid long commutes. Sutter does not have defined visiting hours for either the NICU or the traditional maternity ward.

At Sutter, certified nurse midwife Paloma Engel — who gave birth to her two children at home, and used to work as a homebirth midwife — brings homebirth practices to a hospital setting. Rather than arriving when the baby’s crowning, she “labor-sits” with the woman, offering support as needed.

“Since most of my patients want to give birth naturally, they need support. I like to labor-sit with my parents (the laboring woman and her partner), which means being there for hours and hours, not just showing up to catch the baby,” Engel said.

She noted that she encourages women to move around as needed during labor.

“A lot of people ask ‘Do I have to deliver in the bed?’ The answer is no.”

While she noted that it’s important to investigate all options — and there are important questions to ask a health care provider before choosing — some comparisons are less relevant than others.

“It really doesn’t matter what colors the walls are when you’re having a baby. The world gets very small,” Engel said.

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