It's a little-known fact that while organizations of experts can issue recommendations, hospitals are not required to enact the exact same standard of care—meaning that each hospital can determine for itself what rules and policies it wishes to enforce. In larger cities, expectant moms can often call multiple hospitals to find out about visitation policies, for example, and get multiple answers. Hospitals may be for- or non-profit, run by a parent company or affiliated with a university, religious group or teaching program. A hospital may also shape its rules based on what insurance companies do and don't cover. Even local malpractice laws can affect the types and timing of medical interventions in the labor and delivery process.
Most pregnant women would be surprised to find out that even though the birth process has certainly changed from the days of “twilight sleep,” old beliefs and habits surrounding the labor process have been difficult for the medical profession to let go of, as per Supported Birth. Even when excellent, peer-reviewed research emerges and expert organizations adopt new policies, hospitals and doctors can be much slower in adapting to those recommendations, and the lack of national standardization in the US means that hospitals often change their rules in piecemeal fashion. Here are 20 New Hospital Rules Not All Moms Might Be Aware Of.
20 Thirsty For Ice Chip Change
In the 1950s, most hospitals moved towards a policy of disallowing any food or liquids to be given to pregnant women, as it was standard practice at the time to place them under anesthesia for the births of their babies, as per UT Southwestern Medical Center. Many hospitals are finally realizing that the policies set in place by physicians then are more than outdated now and will permit clear liquids. Other hospitals allow small snacks. The key word here is "allow"; pregnant women should carefully examine the hospital's rules when it comes to what laboring women can drink when deciding what hospital is right for them.
19 Newborn Nursery Nostalgia
Possibly one of the most polarizing reversals in hospital policy so far, the increasing number of hospitals that are eliminating their nurseries definitely has moms talking.
More and more hospitals are adopting what they call a “baby friendly” approach, installing bassinets in rooms to keep newborns close by.
Moms from a generation ago might remember being told their baby had to be taken to the nursery, but today's moms might find that they can't send the baby to the nursery even to get a nap in, according to Today. While research definitively shows the benefits of keeping mom and baby close together, many advocates are calling for a middle-ground solution.
18 VBAC To Back
One rule that varies from hospital to hospital is whether they allow a woman, who previously had a C-section, to labor and attempt to give birth naturally. This process of v-birth after C-section (VBAC), was forbidden by most hospitals for years because of very real risks that women could suffer a uterine rupture or hemorrhaging, but changes in how C-sections are performed coupled with additional research has indicated that many women can safely have a VBAC, as per Verywell Family. Not all hospitals have updated their VBAC rules to reflect the newer data, so it's important that expectant moms prepare ahead of time.
17 Mom Might Be Kept Stationary
Hospitals and doctors aren't always big fans of variations—predictability feels much safer. Because of this, many laboring women are placed in a hospital bed and fitted with continuous fetal monitoring and an IV for hydration, even if they've stated they intend to labor naturally without pain medication, as per The Swaddle. The IV and fetal monitor effectively act as a tether, preventing mom from walking or moving as she labors. Not all hospitals automatically hook mothers up; increasing numbers of labor and delivery wards are switching to intermittent fetal monitoring for low-risk mothers to encourage movement, but moms can't assume all hospitals have updated this rule.
16 Delivering More Doulas
Many hospitals are waking up to the fact that having a doula present during the labor and delivery process can have very real benefits both in the short- and long-term for mother and baby. As hospitals look to include doulas where once they might have shut the door, expectant mothers will find that rules and policies are not universal, according to Pro Doula.
While outside doula certification programs and training programs can provide demonstrable credentials, some hospitals are requiring additional credentialing or certification that is specific to that particular hospital.
Some hospitals still do not provide or recommend doulas, so many moms don't even know they can have one.
15 The Cord Conundrum
Not very long ago, it was common for the umbilical cord to be cut as soon as the doctor or nurse had a firm grip on the newly-emerged baby. The baby was either immediately given to mom or—more probably—whisked away for a battery of tests and exams. One hospital rule change that parents are seeing, in a growing number of hospitals, is a slow-down of the procedures that occur directly after birth. Delayed cord clamping is fast becoming the norm since ACOG issued new recommendations in 2016, as per ACOG. Hospitals are advised to wait at least 30-60 seconds to allow the cord to continue to pulse, but many moms in the know insist upon waiting until pulsating stops and the cord turns white.
These measures can assist in deterring many complications, the most common being jaundice.
14 Leaving Her Hungry For More
Labor is exhausting whether it's a two-hour or two-day process, and expecting moms are done with the ice-chips-or-nothing policies many hospitals have. General anesthesia that was commonly given to laboring women in the mid-20th century was the culprit for the rules that aim to reduce the risk of aspiration, but changes in modern methods of labor and delivery as well as medical advances have probably made this rule outdated, according to The Bump. Research indicates that laboring women should be allowed to eat or drink as needed. Only a few hospitals have been willing to adopt new rules based on this research, however.
13 We'll Leave The Lights Off
It certainly makes sense that if something is going wrong with labor, the doctor and nurses need to be able to see what's going on, but the days of starkly lit labor rooms and bright spotlights are falling away as hospitals begin to modify previous rules to increase comfort for low-risk mothers. Many laboring rooms now come with dim or adjustable lighting that a partner or doula can turn down for the laboring mother, as per Giving Birth With Confidence.
Research shows that laboring women prefer a darker room at the most intense part of labor when delivery is beginning. Reducing the mother's stress leads to better birth outcomes.
12 Mom's Choice Monitoring
The wires that attach the electronic fetal monitors (EFM) to the displays aren't very long. Most hospitals used to require continuous EFM even for low-risk mothers, and many hospitals still enforce this rule, according to Evidence Based Birth. Other medical facilities have changed their policies for low-risk patients and practice intermittent EFM. The laboring mom isn't tethered to a monitor, but a nurse or obstetrician will check in periodically to get a reading of the baby's heart rate. A small but growing number of hospitals are using hands-on listening using instruments like the fetal Doppler device, which allows the most freedom of movement for mothers.
11 Overstaying Her Welcome
In a study of over 70 countries and their hospital policies regarding length of stay, researchers found that US women on average are discharged far sooner than most other countries, as per Business Insider. The study only took into account mothers who gave birth naturally to a single baby, but it highlights widespread hospital policy for a low-risk, uncomplicated birth. Most women stay in the hospital a maximum of two days. Women who undergo C-sections stay an average of four days.
The most common reason cited for the short hospital stay is cost—insurance only covers so many days in the hospital before patients must pay out of pocket.
10 The Baby Trackers
It's far rarer these days, but hospitals and nurseries have mixed up newborns and sent the wrong baby home with families many times over the years. A bracelet placed on baby has long been the standard to reduce the risk, but the latest advances have involved incorporating the latest technology into hospital policy in identifying babies, according to the Huffington Post. Mother and baby are usually required to wear a bracelet with both names and numbers, as well as a QR or barcode. Some hospitals are using microchipped bracelets and a few have even adopted footprint scans. Avoiding mix-ups is another reason cited for getting rid of hospital nurseries.
9 Don't Care To Share
Hospitals have all kinds of medical interventions at arm's reach, but the downside is the lack of privacy. Many mothers utilize insurance at a hospital, but most insurance plans only cover a spot in the maternity ward—and that usually means a shared room with nothing but a fabric curtain separating one exhausted mother from another. Mothers who want their own room on the maternity ward often have to pony up serious cash, as per The Bump. What mom might not realize is that no matter how much she paid for her room, nurses will come and go constantly to check vitals for her and baby—those are hospital rules.
8 Laboring On The Clock
One of the biggest variables that expectant mothers encounter when they go into the hospital with active labor is the potential timeline of events and when the doctor or hospital staff will typically intervene in the labor process. Up until recently, the average length of time women were in active labor or the second “pushing” stage was based on data from the 1960s—but things have definitely changed over the years, according to Verywell Family.
Today's moms seem to have longer labor averages, but hospitals are often slow to modify existing rules as to how they time medical interventions like induction or a C-section.
7 The Skin-To-Skin Emphasis
Proponents of breastfeeding are excited that hospitals are getting on board with providing a positive environment for skin-to-skin contact after the baby is born, but some hospitals have embraced this policy without considering the unintended consequences resulting in damage to the newborn, as per Massachusetts Breastfeeding Coalition. While skin-to-skin contact between mother and baby significantly reduces stress and helps forge a strong bond, many mothers are exhausted from prolonged and difficult labor and may fall asleep, presenting a potentially risk for the newborn. Because hospital rules are still evolving on this issue, there is no national standard, even as nurseries are being eliminated in many hospitals.
6 How To Opt Out
While expecting parents often hear the term “informed consent,” few understand that it means that every procedure that is performed is supposed to be discussed with them, and that the hospital must receive consent from the patient unless it is an emergency situation, according to Babble. Hospitals all have their own rules and policies when it comes to how the mother is cared for and what tests the newborn is subjected to.
Patients can refuse any procedure or care if they want to, but they need to keep in mind that because birth plans are not binding in any way, they may need to have an advocate with them.
5 Formulating A New Policy
Recent research left experts stunned: women of color were up to nine times more likely to be offered formula than white mothers while in the hospital, as per Science Daily. One of the biggest factors influencing breastfeeding success in new mothers is whether formula is offered in the initial feedings, so hospitals have been moving away from accepting free formula samples from manufacturers. Unfortunately—as with many other hospital policy changes—this rule has become extreme in some hospitals, requiring the mother to sign a form consenting to giving her newborn formula or even requiring a prescription before allowing formula to be offered.
4 Alright, Everybody Out
Hospital rules about who can be present during labor and delivery have changed from excluding fathers completely to, in some cases, allowing the entire extended family in. Most hospitals, however, have rules allowing for three people, according to Verywell Family. Hospitals that have larger delivery rooms may allow more people, but they might have policies regarding the time of day. Women labor around the clock, but that doesn't stop hospitals from enforcing daytime and evening visitor rules.
Staff might also politely ask visitors to leave for certain procedures, like exams or administering epidurals. For C-sections, rules tend to be more restrictive, with hospitals citing safety.
3 Water, Water Everywhere
In nearly all the studies focusing on laboring in water and water births, the collective body of evidence so far indicates that it is a safe and effective way for women to labor and give birth, according to Evidence Based Birth. Some hospitals have begun offering facilities that allow an expectant mother to labor in water and then get out to give birth. Fewer hospitals allow women to complete the delivery in water, but they do exist. Some hospitals are still concerned with the liability aspect of water birth—and some insurance may not cover it—so pregnant moms need to call both their insurance and the hospital to determine the rules.
2 Laboring With A Breech Baby
Most babies turn on their own, and when labor begins their heads are pointed down. Only three to four percent of babies stay in the breech position when labor begins. In the US, it has become common practice to deny v-birth and schedule a C-section if the baby cannot be turned, as per The Journal Gazette. This has become so commonplace that most doctors are not learning about techniques that used to be taught to encourage the baby to turn. Despite recent new recommendations from ACOG that some breech presentations can be safely delivered, many hospitals still refuse to allow mothers to deliver any breech presentations naturally.
1 It's A Nice Place To Visit, But...
It's certainly reasonable that the number of visitors are often limited, especially considering that many women are recovering with their babies in shared rooms. While some hospital visitation policies are expansive, others are very specific about how many people can visit, who can visit, and what are the acceptable times, as per Dignity Health. Many hospitals may limit the amount of time young children may visit, which is important for families who might want to have the newborn's siblings come. The rooms can get crowded quickly with more than a couple people, and no matter how good mom feels, she needs her rest—visitors get the boot by the evening.