Advocating and communicating in a hospital setting

ADVOCACY & COMMUNICATION TIPS

 

Try not to over think your plan or your providers. Focus on laboring and supporting the laboring mother.


 

DURING PREGNANCY

• Prepare a birth preferences list or Birth Plan

◦ Based on your preferences & the evidence you choose to use

◦ keep it short

◦ bullet points

◦ by subject (labor, birth, postpartum, baby, contingency/emergency)

• Share your birth plan with ALL of the providers in your practice, repeatedly

◦ Be willing to share your own evidence and reasoning with your care providers

◦ Share at each visit, so each doctor or midwife will know you, and your desires, and be familiar with your plan & your needs.

• Talk about your birth preferences at every visit

◦ The more frequently you engage your care providers, the better you can work with them. Use their responses and their info to determine how to move forward, how to achieve your desires, and what they are willing to work with. You can also use this time to gauge how your provider feels & practices personally as an individual.

◦ If met with hesitation, ask open questions like : “How can I achieve this?” Or “How can we work together to bring me as close as possible to these preferences?”

• Ask your doctor to pair you with a nurse who is in line with your desires. For example, a nurse experienced in natural birth. You can also do this in labor.

• Learn the hospital AND the doctors in your practice

◦ Ask around to learn firsthand how doctors and nurses worked, their bedside manner, and get feedback from friends and acquaintances

◦ Ask nurses & doctors at the office of your care provider to find out how the doctor feels about certain standards of care, such as constant monitoring, natural birth, or eating during labor

◦ Ask at your childbirth education class or the hospital tour, or call the hospital, to find out the hospital's standard procedures, protocol on things like support in the OR, telemetry monitoring, or using the tub or shower, food & drink, etc.


DURING LABOR

• You can decide when to call in to your provider or hospital, to alert them to your labor or water breaking

◦ You don't have to call in right away unless something is wrong (waters that are not clear, bright red bleeding blood that is not associated with mucus plug, baby not moving)

◦ If you call, you may choose NOT to go to the hospital until you feel ready

◦ The staff may say “come in just to be checked” - use discretion to avoid either being sent home or admitted too early

• Have your birth plan handy, with your hospital bags (at least 2 copies)

• If you go to triage, or an admission exam, you may be monitored for 20 minutes & possibly checked for cervical dilation, to determine if you are in active labor**

. • When you are in your room, have a copy of your birth plan for your nurse, and one for your table.

• Take note of your doctor & nurses names on your board in your room

• Be prepared for a little bombardment

◦ removing your clothes

◦ obtaining electronic blood pressure readings**

◦ urine sample/blood draw

◦ being strapped to electronic monitors around your belly**

◦ being recommended an IV for fluids or antibiotics**

 

**These may not be based on evidence.

 

You do not have to consent to any of these, for various reasons. Please refer to evidencebasedbirth.com for up to date evidence on some of these subjects

 

• Once you are admitted to your room, have you birth plan ready for your nurse, and one for your table.


MOST COMMON PROTOCOLS OR PROCEDURES THAT REQUIRE SOME ADVOCACY IN LABOR

 

1. IV FLUIDS/how much**

2. EATING/DRINKING**

3. ANTIBIOTICS FOR UNKNOWN STREP B RESULTS**

4. ELECTRONIC FETAL MONITORING**

5. ARTIFICIAL RUPTURE OF MEMBRANES**(breaking water)

6. ELECTRONIC BLOOD PRESSURE MONITORING**

7. MOVING

8. TOUCHING WHILE MOM IS IN PAIN/CONTRACTING

9. PUSHING POSITIONS**

10.PUSHING TIME

11. TIME**

12.LABOR ASSESSMENTS

1. CONTRACTION PATTERN

2. RATE OF DILATION

13. BABY & MOM'S WELL BEING

14. FETAL HEART TONES

15. MOMS CARE -MEDICATIONS & PROCEDURES
EXAMPLE: MAGNESIUM FOR BLOOD PRESSURE, OR EPISIOTOMY TO PREVENT TEARING

 

** may not be based on evidence.

 

*RESOURCES

◦ evidencebasedbirth.com → topics

www.ncbi.nlm.nih.gov/pubmed

www.cochrane.org

*Disclaimer*

If you are a high risk patient, be sure to confirm with your doctor, any choices you determine are best for you, are also best for your specific condition, considering baby's safety and your own.