There’s a lot of decisions mothers make after those two lines appear on that pregnancy test. Who’s going to be their doctor? When do they tell their boss? Where are they going to make their baby registry? (And what do they need to put on that registry? What’s this NoseFrida that everyone’s talking about?) It’s all fun and exciting … and sometimes stressful. New mamas log a lot of hours sorting through people’s recommendations, comparing pros and cons, and reading an endless number of online articles debating the finer details of the latest stroller.
After nine months, the big day will be here. When a laboring mother arrives at the hospital, medical staff have a pretty set routine for how to help her have her baby. Some decisions are so routine that she won’t even be asked, like wearing a hospital gown. But every mother-baby pair is unique so choices that fit one mother might not fit another. Each mother should feel empowered about her birth and that includes making educated decisions that directly affect her and her baby.
Below we’ve listed 20 choices that mothers can make at their hospital birth. Some are dependent on which state she lives in. Others are only options in the right circumstances. But all are worth consideration beforehand because when a mother is in labor, she needs all the mental energy to focus on labor, not debating the pros and cons of a medical intervention.
20 Choices You Didn’t Know You Had At Your Hospital Birth
20 What To Wear: You Can Bring Your Own Birthing Gown
Some midwives believe that once you put on a hospital gown, you’ve had your first intervention. It establishes a mindset that you are a patient and there is someone else in charge. (Also, it wasn’t created as a fashion statement, that’s for sure.) Although a hospital gown will typically be handed to you without question, you don’t have to wear it. Simply tell the nurse that you have brought your own gown or you prefer to wear what you have on. You can purchase a specialized birthing gown (or sew your own) to bring with you on the big day. Or you can birth in something you brought from home, such as a nursing tank top or even a bathing suit if you’re having a water birth.
19 OB-GYN Or Midwife?
OB-GYNs (which stands for obstetrician-gynecologist) are the standard choice for hospital births in the U.S. today. They handle both low- and high-risk pregnancies and deliveries and are qualified to perform surgeries such as C-sections.
In other parts of the world, midwives are the typical go-to for a low-risk pregnancy and they are gaining popularity here in the States. Midwives deliver in hospitals (although you can also find them at birthing centers and home births too) and tend to give a more personal experience to the care they provide. As a profession, midwives are also more supportive of a low-intervention pregnancy and a natural delivery.
Think about what is important to you and choose a care provider that best fits your wants and needs. Just because you’ve had the same OB-GYN for years doesn’t mean you can’t switch over to a midwife for your pregnancy.
18 You Have A Say In Your Visitor Policy
Having a baby is an exciting time, not just for you but likely your family and friends too. But sometimes they get a little too excited, like invite-themselves-to-the-hospital excited. You might be the kind of person who thrives on social contact. Great! Open-door policy. Show up to the hospital the day of to see that delicious newborn. But if you want privacy to make this a more personal moment for your just-grown family, you have a say in that as well, regardless of what the hospital posts as its visiting hours.
Some mothers limit visitors to specific times or people and others decline visitors at the hospital all together. When communicated clearly and politely, you can sidestep hurting anyone’s feelings while putting your own family’s best interests first. If you have limits on your visitor policy, consider adding that to your written birth plan as well as reminding your labor nurse. And if you really want to fly under the radar from an overly enthusiastic mother-in-law, remember no one has to know that you went to the hospital at all. Sometimes labors happen too quickly to alert the family about what is happening so you can make that your story if you so desire.
17 IVs, Saline Locks, Heparin Locks, And What Your Choices Are
A saline or heparin lock is a catheter inserted into your vein, usually in your hand. (The difference between the two is the fluid, either saline or heparin, used to keep the line from clotting.) Hospitals will typically insert a saline or heparin lock upon admission so it can be quickly hooked up to an IV later, either to administer medications or fluids. Other hospitals will insert the lock and hook you to an IV from the start.
Some mothers decline the IV because it restricts movement. You’re tethered to a pole so it’s more complicated to walk around during labor. Others skip the lock as it can be uncomfortable and inhibits their use of water for pain management. (It can’t get wet so it makes using a hot shower more difficult.) While most hospitals have either a lock or IV as a requirement, you can discuss this with your doctor or midwife ahead of time and say that you will be declining either one unless there is an emergency. You’ll probably have to repeat that desire to your labor nurse upon arrival as well. Look into the pros and cons of all your choices – IV, heparin or saline lock, or none at all – then make sure your care provider and hospital are on board with what you have chosen.
16 Fetal Monitoring: Continuous Or Intermittent?
When you arrive at the hospital they will check the baby’s heartbeat to make sure your baby is doing well. Some hospitals will hook you up to an electronic fetal monitoring device, which wraps around your belly with one measuring the baby’s heartbeat and another measuring your contractions. If that monitoring is continuous, meaning it stays on for the duration of your labor, then you will be restricted to staying in or near your bed.
Because of that limitation and its effect on handling labor pain, mothers can request for intermittent fetal monitoring. A 15-minute check-in with the monitor every hour or so can reassure mother and medical staff that the baby is doing well while also giving the mother freedom to move around during labor for the rest of the time. Ask your care provider about his or her flexibility in relation to fetal monitoring and make sure to speak up if you have an opinion about it.
Also ask if the hospital has mobile electronic fetal monitoring, which can be waterproof or water-resistant and can allow you to labor in upright, active positions around the room and even in the shower.
15 Declining Or Limiting Cervical Checks
Regularly checking to see how far dilated you are is the standard at most hospitals. Your cervix will be manually checked once you get settled into your labor room and then pretty consistently throughout your labor. But you don’t have to follow that routine if you don’t want to. Some mothers choose to limit or skip cervical checks for a number of reasons, including the increased risk of infection with each check.
Also, labor doesn’t work on a clearly defined set of numbers. It’s not dilated X centimeters in X amount of time to have a baby. You could hang out at a three all afternoon and then shoot forward in your labor to pushing in under an hour. Think about what you feel comfortable with and if you don’t want to get hung up on the numbers, tell everyone that you decline cervical checks unless you say otherwise.
14 Pitocin: How Much, If At All?
Pitocin is the synthetic version of oxytocin, which is the hormone that your body produces to make your uterus contract. It’s given through an IV and used to induce labor as well as speed labor along. The nurse will gradually increase the amount of Pitocin until contractions come at regular intervals, are getting stronger, and are resulting in cervical dilation.
When labor stalls, Pitocin can really get things moving along. But with the increase of Pitocin also comes an increase in the intensity and length of your contractions. They are also likely to be closer together too, giving you less time to recover between each one. That makes a labor free of pain medication more difficult. Some mothers choose to bump Pitocin further down the list of options for inducing or speeding up a labor instead. Also, it’s not all or nothing. Pitocin can be given in smaller and less frequent doses or as a one-time dose as well.
These options are something that can be included in your birth plan and should be discussed with your care provider ahead of time. Ask how they typically handle situations such as stalled labor and make sure you’re comfortable with their approach.
13 Rupture Of Membranes: Artificial or Natural?
Some women have their water break in early labor or even before the first contraction, but most women arrive at the hospital with their bag of water still intact. Likely it will break sometime during labor. (Although your baby could be born still in the amniotic sac. It’s called an “en-caul birth” and it’s very rare but definitely super cool to see!)
When a doctor or midwife breaks your water artificially, they will use a small flat plastic hook called an amni-hook that is inserted in your cervix. It’s not typically any more uncomfortable than any other internal examination. Once your water breaks, it can progress dilation and speed up contractions. And if internal fetal monitoring is necessary, your water has to be broken in order to do so.
However, there are pros and cons to whether you have your water broken artificially or wait for it to naturally rupture. If your water is artificially broken, it can increase your chance of a C-section, prolapsed cord, and risk of infection. However, it might be necessary if your baby is under duress. Discuss with your care provider ahead of time what reasons they would want to break your water and decide which scenarios you are comfortable with. If you prefer to have your water break naturally, be sure to include that in your birth plan.
12 Whether Pain Medication Is Verbally Offered To You
Part of your labor nurse’s job is to help you manage your pain and conventionally that means offering you various pain medications, including an epidural. However, if you have already decided that you want to have a natural birth, you don’t need someone offering you pain medicine at your weakest moment. And you can include that request in your birth plan. Consider including phrasing such as “Pain medication only available at the request of the mother.” Stock your mental toolbox with natural pain-relieving tricks, such as massage and a hot shower. You can have an epidural or pain medication at any time, regardless of your original intent.
11 Requesting A Different Labor Nurse
Remember when you first found out you were pregnant and started your search for your doctor or midwife? Asking friends, checking hospital stats, maybe you even interviewed a few people before choosing who was going to be there for this life-changing event. But in reality, it’s your labor nurse who you spend the most of your labor with while your doctor or midwife checks in on you and arrives in time to make the big catch. And that labor nurse is randomly assigned to you at check-in. No pre-interview there.
Most likely it will be just fine. They’re all experienced at guiding women through their labors. But sometimes things just don’t click. Maybe it’s a personality conflict. Maybe you were going for a natural birth and your labor nurse keeps offering you meds. Whatever it is, if your labor nurse is making your labor harder, not easier, you can request someone else. Ask for the charge nurse and explain to her that you would like a different labor nurse. Although staffing availability might mean you have to wait, it’s important that you know you have that option. A stressful laboring environment can result in a longer and more painful labor and you don’t have time for that!
10 Don’t Tell Me How To Push!
It’s probably ingrained in your head. All those birthing scenes in Hollywood movies with doctors and husbands chanting “Push! Push! Push!” Well, that’s one way to do it. But it certainly isn’t the only way and it’s not the recommended way.
If you’ve had an effective epidural, you won’t feel the contractions to know when you should push and you will need someone telling you when you are contracting. But if you are birthing without pain medication, then you can just listen to your body -- push with your body – and that’s something only you can feel and know. If this is of interest to you, add in your birthing plan that you do not want any coached pushing. When the big moment comes, let your body take over and only push when you feel the urge.
9 Ensuring You And Your Baby Have Your Magic Hour
Right after your baby is born can be a very busy time. But it doesn’t have to be. Standard hospital procedures include cleaning, weighing, and measuring your baby but none of that has to be done immediately after birth. If you want to hold that precious new life that you brought into this world, by all means, do so! The research will back you up on the benefits as well, both for you and baby. The World Health Organization “strongly” recommends: “Newborns without complications should be kept in skin-to-skin contact with their mothers during the first hour after birth to prevent hypothermia and promote breastfeeding.”
Tell your care provider that you will be holding your baby skin to skin immediately after birth and will delay any measurements for the first hour or two. If you’re looking for the right wording to include this in your birth plan, consider this: “We decline separation of mother and baby immediately after birth, unless medically necessary.”
8 Standard Eye Drops And The Alternatives
Standard procedures include giving your newborn an antibiotic ointment shortly after birth. It’s to prevent an eye infection, most commonly contracted if the mother has chlamydia or gonorrhea but it can be contracted because of exposure to other bacteria as well. Some states, such as Missouri, mandate this eye treatment, but others states give you the right to decline. Weigh the risks and benefits beforehand and make sure everyone is on board with what you have decided.
It doesn’t have to be an all or nothing decision. If you choose to have the eye ointment applied, you may decide to delay it until after the first feeding. There is some evidence that the eye treatment can impede a newborn’s ability to see and latch onto the breast. Some mothers opt to use breastmilk to prevent eye infections instead.
7 Delayed Cord Clamping
Typically the umbilical cord is cut right after birth – either immediately or a few minutes after. The cord is clamped near the baby’s abdomen and again a few inches along the cord and the cord is cut in between, hence the term “clamping.” The term “delaying cord clamping” means doing this procedure later, although how long after varies by either waiting one to three minutes after birth or waiting until the cord has stopped pulsating.
Initially, immediate cord clamping was introduced in the ‘60s to reduce postpartum maternal hemorrhage. But even though research has shown this to be unnecessary, the practice continues. Studies have found that delayed cord clamping can have many benefits for newborns, both neurologically and physically. But doing so also runs a higher risk for jaundice so that’s something to consider when making your decision. Consider the benefits and risks and then talk to your care provider about when you want to the umbilical cord to be cut. That way on The Big Day you can focus on the magic of reaching that milestone moment, instead of worrying if you made the right choice.
6 You Can Wait On That Bath: Delayed Bathing Of Your Newborn
Hospitals will have their own procedure schedule following your baby’s birth and the first bath will be on that list. Years ago, a newborn was scrubbed down as soon as possible. But now medical experts and health organizations are recommending delaying that first bath for a number of reasons. One of those reasons is to keep the vernix on, which is that waxy white substance some babies are born with. It protects the baby from pathogens, moisturizes the baby’s skin, and even promotes mother and baby to bond during breastfeeding because of its unique new-baby smell! It’s all-around fantastic stuff that only newborn babies have. You don’t want to wipe off such a super gem! Bathing too soon can also upset the baby’s ability to maintain body temperature. And bathing too early means taking a newborn from her mother during those very important first few hours.
However, not all hospitals are quite on board with recommendations for delayed bathing. The World Health Organization recommends waiting at least 24 hours. Most of the vernix is absorbed within the first day but it isn’t fully absorbed until day five or six. Check with your hospital about its procedures and be sure to request your baby’s first bath happens when you decide.
5 Vitamin K: Injection, Oral Dose, Maternal Supplementation, Or Skip It All Together
Although rare, some babies can have low levels of Vitamin K, which can lead to serious bleeding disorder. The result can include brain damage or even death and it can occur days or months after birth with little warning. To prevent this, hospitals routinely give all newborns a Vitamin K injection.
However, the Vitamin K injection at birth is not the only option. An oral dose can be given to your baby. The first dose is administered at birth and a second dose usually three to five days later. A third dose is given in the fourth week to breast-fed infants. (Formula-fed babies do not need the third dose as there is Vitamin K in the formula.)
There are other options as well. Some mothers choose to take a Vitamin K supplement themselves, which can be passed on to their babies through breast milk. Other parents are concerned about preservatives in the injection and request a preservative-free brand. And some families skip it all together. Consider your specific circumstances and concerns and then thoroughly discuss your options with your doctor or midwife.
4 If You Choose To Make The Snip
Although circumcision rates have declined in recent years, the majority of boy babies in the U.S. still undergo the procedure. Regardless of your reasons why, if you choose to make the snip, your decision-making does not end there. Not all doctors use pain medicine during circumcision and if reducing the trauma of the procedure is important to you, it’s best to research your options and talk to your pediatrician ahead of time. Studies have shown that anesthetic pain relief can decrease crying time and lower their heart rates (which increase when experiencing pain), although there is no method known that completely eliminates the pain.
Other choices you have are whether or not you are present for the procedure. Typically, hospitals do it with parents in the room as it can be hard to watch. And, although it is usually done in the hospital before you are sent home, a pediatrician can also do it in office at a later date.
3 Can Delay Or Pass On The Hep B Vaccination
The first dose of the Hepatitis B vaccine is given shortly after birth. (The other two doses are given at one month and six months.) If you’re following the CDC vaccination schedule, your newborn will receive the shot before you leave the hospital. However, you do have the choice to wait on the vaccine if you so choose. Your pediatrician can administer the first dose at your first appointment. Or if you choose to do an alternate vaccine schedule, you can have your child receive it at a later time. Think it over beforehand because you will be asked about this before you leave the hospital.
2 Your Placenta: You Can Keep It!
More women are choosing to use their placentas after birth. Some choose to consume it through a practice called placentophagy. Usually, the placenta is dried and then encapsulated so the mother can take a “placenta pill” daily throughout the postpartum time. Others blend it in a smoothie or even cook it in a frying pan. Some cultures and religions plant the placenta and mothers adopt this practice in a number of ways, including burying it in a garden and planting a tree or flowering bush in its place.
Whatever you choose to do is fine. But you should check with your hospital ahead of time to see how accommodating if at all, they are to you taking your placenta with you if that is something you are interested in. Some staff members may be unfamiliar with the policy and some hospitals might forbid it. A few states, including Oregon, Hawaii, and Texas, have laws in place protecting a mother’s right to take her placenta home from the hospital. If it’s important to you, go for it. Just be prepared to make the appropriate accommodations and have a plan for how it will be stored and transported to your home.
1 What’s In A Name?
It’s a pretty big decision. It’s their name for the rest of their life after all. So if you’re still on the fence even while holding that beautiful newborn in your arms, it’s okay. You are allowed to leave the hospital without naming your baby. It’s not common so the first hospital employee you talk to about it might not know the procedure. Usually the name “Baby Girl” or “Baby Boy” goes on the certificate and you have a certain timeframe to update it. Specifics vary by state so if your belly is growing bigger and you are no closer to knowing what name to choose, you’ll want to ask the hospital about the procedures where you live.