Six Tips for Gentle but Effective Hospital Negotiations

By: Jessica English, CD(DONA), LCCE

Is the hospital you've chosen totally supportive of the six Lamaze Healthy Birth Practices? Once you educate yourself on the elements of a healthy birth, there may be times you need to advocate for yourself and your baby. Hopefully you're able to choose a birthplace that largely supports your goals for birth, but if that's not possible, here are some suggestions that might make negotiating easier.

1. Talk it out beforehand, and get it in writing. If something is particularly important to you, talk it over with your midwife or doctor at an office visit. For example, if you know it's standard for women to get a routine IV in labor, explain your concerns to your provider ahead of time. If you can agree that you will not have a routine IV for a healthy, normal birth, ask your provider to write that in your chart and either put it in writing on a prescription pad, or sign your birth plan. That way, if your doctor or midwife isn't in the building when you arrive in labor, you'll have that piece of paper to back you up. Individual midwives or doctors usually have the power to override routine policies for their own patients.

2. You'll catch more flies with honey than vinegar. It's great when moms and dads are passionate about healthy birth. Unfortunately, sometimes that passion can leave them feeling confrontational. You don't need to start off with guns blazing. I suggest to my students that they are firm but very polite when working with the staff. Is continuous monitoring the policy at this hospital? You might say to the nurse, Our midwife OK'd intermittent monitoring. We'd be so grateful if you could help us with that. And if her answer is no, try again. This is so important to us. I know it's not the standard, but we really appreciate your understanding. We did OK it ahead of time. Nurses, midwives and doctors are just people. A gentle approach is usually received much better than angry demands, and you're more likely to get what you want. Be likeable.

3. Brainstorm. If you can get your nurse or provider working with you, they may start to take ownership of your ideas. Try asking for their help to brainstorm a problem. For example, a dad or other support person might say to the nurse between contractions, We really want the baby to stay skin-to-skin after birth. Can you help us think about how that might work? Can some of the routine things be done while the baby is on her chest? What if we waited to weigh and measure him? Or maybe continuous electronic monitoring is required because of a medical complication, and you've been asked to stay lying down in bed. Ask your nurse or provider to help you think through other options, such as laboring with continuous monitoring on the birth ball, on hands and knees or sitting upright. If they respond with reasons why something won't work, you can always throw out a phrase like, Let's try together. When people are part of the process they generally respond better than if you simply list your demands.

4. Bring a doula. An experienced doula has usually seen other families successfully negotiate in the hospital environment. She probably knows what's possible and may have some techniques for helping you get to yes.'  For example, hospitals in our area require 30-40 minutes of continuous monitoring when a woman first arrives, with intermittent monitoring as an option after that time. The mom is usually asked to lay on her side in the bed for this monitoring, which is hard for most women to do when they are in active labor. Sometimes the nurse will stay and hold the monitor device on her belly, so that she can still move with her contractions without losing the baby's heart tones on the monitor. Once one of my doula clients had a nurse who was not willing or maybe not able to stay. The nurse kept insisting that the mom lay on her side, and the mom kept insisting that she couldn't do that because it would make the contractions too intense. I asked if it might be possible for the dad to hold the device on her belly. The nurse happily agreed. She was able to leave and still get the monitoring she needed, the mom was able to continue standing and leaning with her contractions, and the dad was happy to help.

5. Don't stop at the first no. If you're asking for something outside routine hospital policy, the first answer you receive will probably be no. Expect that first no, and be pleasantly persistent, using all the techniques mentioned above. I know one woman whose nurse kept telling her there was no way she could have the special requests she'd made for her planned cesarean, such as having both her husband and her doula in the operating room and having her baby skin-to-skin on her chest while the doctor finished the surgery. The mother just kept nodding and smiling and saying, I understand, but this is what I want. How can we make it happen? Her negotiations were successful, and her doula and husband were both at her side when that beautiful baby was laid on her chest almost immediately after his cesarean birth. Had she accepted that first no, her birth experience would have been much different.

6. Remember, it's your body, your birth and your baby. If it comes down to the line, remember that no one can force you to do anything or accept any intervention that you do not want. Shared decision making requires your consent. I remember my client who was pushing on hands and knees with a nurse, only to have a midwife come in at the last minute and tell her to turn over on her back. She asked why, and the midwife replied, I don't deliver babies this way. Between strong pushes, the mom simply said, No. The midwife told her again to turn over, and again the woman said, No. The midwife successfully caught the baby while she stayed on her hands and knees. It was a beautiful birth! It can be intimidating to have professionals in scrubs and white coats telling you to do something, but if there is no clear safety reason for the request, it is always your right to say simply and clearly, No. After all, it is your body, your birth and your baby.

Jessica English, CD(DONA), LCCE, is the owner of Birth Kalamazoo, which offers birth and postpartum doula services, natural childbirth and breastfeeding classes, and in-home lactation consults. A DONA-certified birth doula and Lamaze-certified childbirth educator, she teaches an 8-week series of classes called The Best of Natural Birth. She is the editor of DONA International's eDoula newsletter. A longtime writer and business woman, she also works as a consultant for organizations and birth professionals.