Baby catching up: 31 weeks and the hospital tour.

[rivka]

I'm 31 weeks pregnant. My due date is nine weeks away.

I feel as though I've grown noticeably in the last week. My belly now starts with a hard ridge about two inches below my sternum, which is high enough that leaning forward in a chair leaves me gasping for breath. Tying my shoes has become an adventure.

It's much easier to tell how the baby is lying these days. Right now she's head-down with her feet wedged up under my right breast and her hands near my left hip. She consistently seems to hang out on the right side of my body. She's kicking a lot, which usually isn't painful (unless she gets her aim just right) but is certainly strong enough to arrest my attention.

My cold is awful, but pregnancy still feels pretty darn good. I don't mind the fatigue and the decreased mobility at all - I'm perceiving them as parts of a normal process, so they don't worry or frustrate me. Yet. Honestly? I thought pregnancy would be much worse than this - much more uncomfortable and, given my orthopedic history, possibly disabling. So I feel incredibly lucky to be almost at eight months and still doing well.

Since my last long baby post, we toured the hospital where we're going to deliver and had our fourth childbirth class. (I'll talk about the class in my next post.)

The hospital is a private community hospital affiliated with the University of Maryland (where I work) and run by the Sisters of Mercy, an order of Catholic nuns. It's a five-minute drive from our house - just across the street from the alt.polycon hotel, for those of you who were there. They've positioned themselves in the community as specialists in women's health, so they have a 5-star obstetrical service - including a Level IIIB NICU, which we will not need but which is the second-most-advanced level of neonatal care that there is.

The tour started with admissions procedures - where to park, which entrance to use at which hours, how to check in and get to labor and delivery, all presented in extreme detail. Key thing to remember: anyone visiting the L&D floor or the mother-baby unit must have a photo ID. (saoba, do you have one even though you don't drive?)

We visited an L&D room, which was surprisingly large and decorated in a late-80s motel style. There was plenty of room for several people to move around, and plenty of room to labor outside of bed. All the scary medical equipment was packed away in cupboards. The room had a birthing tub, which I had envisioned as being in the middle of the floor but turned out to be in the bathroom. That seems awkward - and crowded, if you're planning to have a water birth and have the midwife and doula and father all hanging out by the tub. Apparently only two of the L&D rooms have tubs, but they save them for midwife patients and it's usually not a problem to get access. They have birth balls and mirrors, but if you want music you need to bring a player from home.

Good things: every time the L&D nurse mentioned care providers, it was always "your doctor or midwife." (Obviously, midwife care is a big part of the service, which is not typical for a U.S. hospital.) She cautioned us to make sure we bring a robe and slippers, because "your doctor or midwife will probably want you up and walking the halls." (Many U.S. hospitals still encourage women to labor in bed.) They have a patient kitchen, including a fridge and microwave, and we're encouraged to bring snacks from home. (Many U.S. hospitals forbid women to eat or drink during labor, in case general anesthesia is needed for an emergency C-section.) They have sandwiches and so forth on hand 24 hours, in case you deliver after the hospital kitchen is closed. (My mother said she once delivered at 5pm, missed dinner, and wasn't given anything but Jell-O until sometime the following morning.)

You stay in L&D for about 2-3 hours after you deliver, while they make sure you're not going to bleed to death, and then they move you down to the mother-baby unit. The mother-baby unit has all private rooms, with a standard hospital bed and a recliner that converts to a cot. (UK readers: not a crib for the baby, but a narrow bed for the father.) Their standard arrangement is 24-hour rooming-in, although you're allowed to drop your baby off at the nursery for a few hours if you want to shower or get some uninterrupted sleep. When you first arrive on the unit they take the baby to the nursery for an exam and testing, but parents are allowed to go along if they like.

For an uncomplicated vaginal delivery, the standard hospital stay is 48 hours after delivery. Uncomplicated C-sections get a 3-4 day stay. The nurses are all very hyped on postpartum education, and encouraged us to see the hospital stay as a time to learn about baby care and get supervised experience with things like baths and cord care. Professional lactation consultants make rounds twice a day, and in the interim many of the nurses are trained in breastfeeding support. They don't give breastfed babies formula, sugar water, or pacifiers.

They have ridiculously elaborate security precautions. Immediately after the birth, the baby is tagged with an alarm bracelet and anklet. Mom and Dad get matching bracelets to show who belongs to the baby, and can't access the nursery without having their bracelets scanned and matched. Visitors have to leave a photo ID at the desk, and can only come up three at a time. If the baby is removed from the mother-baby unit, or even comes too close to an open elevator, an alarm sounds and security personnel descend immediately. Have they ever had someone attempt to steal a baby? No, but they say that you can't be too careful.

In general, I was very pleased. Our midwives had already said good things about Mercy, so I knew it wouldn't be awful there, but I am pleased to know how many of the things we would have requested are already standard practice there.

Comments

[riarambles.livejournal.com]

FWIW, from what I have seen, the hospital I work at (as an interpreter, so I only see a very specific subset of laboring mothers: those that speak Spanish and are in labor when I am on call) seems to keep all women on the fetal monitor the entire time they are in labor.

[rivka.livejournal.com]

I'm not surprised, but that's a Bad Thing for two reasons:

(1) It keeps women in bed, which can slow down labor and make contractions more painful.

(2) Continual use of a fetal monitor sometimes leads to a baby being identified as "in distress" when in fact nothing is really wrong - it's just a momentary blip in the heart rate. So sometimes the fetal monitor leads to unnecessary C-sections.

[riarambles.livejournal.com]

I'm actually aware of those two problems, which is why I was having my doubts about delivering there (if I were pregnant in some imaginary future). However, I was talking with a midwife today while I was there, and she said that they often do not require constant fetal monitoring, and that the few deliveries I've been there for have probably been high risk for one reason or another. So. I feel better about it now.