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How the hospital environment hinders physiological birth

by lizzi (follow)
Helping plant the seeds of positive birth. www.sproutbirthing.com.au
Birth (105)     
I’ve been writing on the topic of homebirth a bit lately (after not being comfortable writing about it for so long, because I’ve never had one). And a friend asked an extremely relevant and interesting question. It was something along the lines of: Are you opposed to going to hospital because of the building itself or the treatment received there? I jumped straight up and said it was because of the treatment received there…but the wheels of thought were put in motion. Do I have issues with the hospital building itself? Turns out the answer is yes. I have some huge issues with the physical environment found in hospitals. And here’s why.

There are certain conditions that are considered “optimal” for labour and birth to progress in an efficient and safe manner. These are things which increase the production of natural oxytocin and decrease the adrenalin gremlins such as: feelings of safety, calmness, warmth, privacy, darkness. You can read more about this in Dr Sarah Buckley’s work Pain in labour: Your hormones are your helpers. Knowing how physiological labour works is a really important step towards learning how to optimise your chances of achieving it safely.

Often we find that the standard care provided by hospitals does not optimise the chances of a physiological birth. The policies and protocols are restrictive, fear based, non-woman centred and generally involve large amounts of intervention. It’s quite rare to find hospital based care providers who can support a woman in a fully physiological or instinctive pregnancy and birth simply because the system, and society in general, does not support this.

The bed is always front and centre in a birthing room. This can cause a variety of hurdles to achieving a physiological birth. Image courtesy of Wikimedia Commons.

But what about the actual hospital building. What role does it play in the decreased possibility of a physiological birth within its walls? A common story I hear from women is that labour stalled once they got to the hospital and while many care providers will tell you this is simply because the woman’s body needed “help” to labour and birth effectively, I propose that the physical hospital building plays a HUGE role in this.

When you arrive at hospital your partner will pull up at the front door and leave you, alone, while he goes and parks the car. Then, unless it is the middle of the night, you will walk through a busy, brightly lit, noisy, very impersonal reception area. Often you will pass at least one person who feels the need to make a comment or talk to you about your labour. In the first hospital I birthed at I was required to walk past accident and emergency and then go up a lift to the 6th floor. It is exceptionally difficult to “let go” and go into “labourland” when you are worried that some random person is watching you as you groan and grunt through contractions.

Then you get to the pregnancy assessment unit – and you need to stand in the reception area there and tell your story to a receptionist. During my second pregnancy I watched a couple stand there for at least 15 minutes, while the woman was obviously in labour, and have to try and explain that the woman is in labour. Firstly – even I could tell she was in labour and should have been assisted to get to a private room IMMEDIATELY. Secondly - It’s really hard to feel safe, private and unwatched while a bunch of random strangers are watching you groan and breathe and maybe swear through contractions.

Once you get through the “assessment” process (which can contribute to feeling unsafe, watched and cold in itself) and make it to your labour room you are faced with other building features that are not conducive to optimal labouring. Both times I thought I’d won the jackpot when told I had been allocated a large room. Both times I felt seriously exposed. There is also the fact that the rooms don’t lock. I had absolutely no control over who could come into my room. The midwife I was allocated asked me if I wanted to “strip off". Who in their right mind would want to strip off in a huge room that any random person could walk into at any moment? Sounds like a great way to increase stress (and is also a good indication that I was NOT in active labour and shouldn’t have even been admitted…but I digress). I’d also like to note that the bathroom in my birthing room didn’t even have a door – just a curtain. As someone who simply CANNOT go to the toilet without the door being locked I found this really distressing and also quite disrespectful. In hindsight the lack of privacy and dignity offered to birthing women at this hospital is astounding and should be reported as very unsafe!

The “labour aids” that hospitals have available, such as balls, mats, beanbags and tubs are usually pushed away into a corner and you need to know they are there and ask for them in order to access them. The bed, on the other hand, is front and centre. So when I felt like I was quite tired from being upright I asked to lie on the bed…Not knowing, in my labouring state, that I had the option of getting mats and beanbags and using those to get comfy and rest. I found hopping on the bed instantly isolated me from my support people and turned me from a “labouring woman” into a “patient”. It also caused a few physical complications due to me lying on my back.

Being able to see the clock will not help you achieve a physiological birth. Image courtesy of Wikimedia Commons.

As an added bonus I could see the clock from the bed. Awesome! I’ll never understand why on earth they feel the need to put a great big clock up on the wall, in full view of the labouring woman. Seriously. It adds stress and reminds women that they have a schedule to keep. And if you don’t labour according to the schedule you’ll be subject to interventions and likely a caesarean. Realistically, I had enough people wandering in, uninvited and unwanted, reminding me that I wasn’t labouring quickly enough for them. I didn’t need the giant clock on the wall reminding me of that every single freaking time I looked forward.

Then there’s all the machines. This one could go either way. If you really like the idea of a medically managed birth then all the equipment might make you feel safe. Personally I found that it just reminded me that the hospital consider me an emergency waiting to happen. Knowing that the midwife was taking her cues from the machine rather than from me and my baby was off putting and upsetting and left me wondering why on earth I had bothered to get into the midwifery group program in the first place. If I wanted impersonal, obstetric style, technology based care I would have just opted for the “standard” care offered.

All the machines are not terribly helpful at making a woman feel like a physiological birth is achievable. Image courtesy of Wikimedia Commons.

And once baby is out the need to get the oxytocin flowing is even more imperative. Oxytocin is what helps the uterus expel the placenta and clamp down to stop the bleeding. It’s pretty hard to get oxytocin flowing with mum sitting on a bed, in the middle of a large, cold room that is brightly lit so that everyone can “watch” her and bub. I know many people who talk about how hard it is to get the environment in hospital adequate, let alone optimal, for a safe physiological third stage.

So next time you are wondering about why a woman might prefer to birth at home – where she will not have to labour in front of random strangers, worry about a nurse she’s never met walking in on her undressing, pushing or pooping and where she knows exactly what she has available to help her labour and where to find it – please give consideration to these points. Hospitals are a great place to be if you have made an informed decision to have a medically managed birth, but if your preference is for a physiological birth then you might like to give further consideration to how the hospital environment can hinder that.

Yes. Home is where we know where the beer (and other vital labour aids!) are kept. Image found on facebook.

As always – information is power! Know your options and take responsibility for your choices.

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Thank you for this article.

You put words on how many of us felt in hospital labour environment

It also reminded me of the origin of the word hospital and the patriarchal energy signature it still carries from ancient times.

Your article also reminded me of the berth/birth process in maritime law - birthing/berthing through the waters of the mother/vessel and the doctors role was and is to hand over the baby as a commodity.

Maybe we are remembering the truth on this matter subconsciously that in the sacred texts women are the breeders for the system- no more than cattle/cows.

It would also explain the value of the live baby and the non value of the mother once her role is complete.

As for the pain- well, we all know how we are still programmed to believe birthing is painful, but go into the supposedly non civilized world and no mention of this pain. Of course the TRE release exercises are amazing - again all natural in the natural world. But you try shaking off that birth trauma in Ireland and the midwife will remind you to stop it or she will call police.

I could write an entire book on my experience of birthing in 2 Dublin Hospitals. Many of us knew to keep clear of the MMM hospital in Drogheda where the emphasis was on suffering and especially if the mother is unhusbanded - like in animal husbandry. The RC mindset is to get the baby safe and to hell with the vessel mother.

Yes I remember the clock too and the red lights at night- certainly not conducive to relaxation.

Yes I felt like a patient/ill and not some mother having a natural experience . It was far from natural.

Also the forcing of women in labour to keep walking and walking up and down that hall until you drop was awful. it was like a Hitler camp and I felt I was being punished for something.

I have been sharing birth experiences with others of my generation recently and most of us had similar feelings.

One sister felt like a beached whale when she was thrown onto the table for suction birth.

I felt like a side of beef being thrown onto that table for delivery and no one explaining anything. That was so stressful. So i collapsed after birthing, but no one really cared or bothered.

3 weeks and unable to walk is not what i would have called a helpful birth.

- To this day I cannot go near that hospital in Dublin.Rotunda- time to talk openly and hope it brings change for our younger sisters.

Dr Janov writes about the humanity being trained out of doctors etc and I can see that in hindsight. The doctors are not tuned to the birthing wombman . A s women we expect them to be though.

Anyway, enough of my ramblings for the moment. More Patch Adams required on this planet
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