midwifery/ alternative births Mother-Baby Resource Guide

midwifery/ alternative births Mother-Baby Resource Guide

INTRODUCTION St. Luke s Hospital & Health Network, its physicians, nurses and ancillary staff in the Department of Obstetrics and Gynecology liberally welcome all clinically-safe birthing practices representing client/patient wishes. In the preparation for childbirth and in acceptable labor, delivery and post-partum processes, St. Luke s Hospital & Health Network has long been benevolent regarding the incorporation of both certified nurse midwife and physician-attended alternative births at both our Allentown and Bethlehem Campuses. This Position Statement reflects the institution s considerable openness, as well as its firm boundaries, regarding the conduct of all persons involved in obstetric birthing experiences. BIRTH PREPARATION While not an absolute requirement, formal childbirth preparation classes (as offered through St. Luke s Childbirth Education Services and other locations) are strongly encouraged for all women planning for the delivery of a baby at St. Luke s. Additionally, the pre-birth visit (to be scheduled at the 34th week of pregnancy) and the pregnancy orientation class are similarly encouraged. The pre-birth visit includes an interview and information gathering session by a St. Luke s Hospital maternity nurse. The pregnancy orientation class provides information on maternity services and a tour of St. Luke s New Beginnings Family Birth Center, census permitting. Information about childbirth preparation classes, the pre-birth visit and the pregnancy orientation class can be obtained from your obstetric care provider or by calling (toll-free) St. Luke s Info Link at 1-877-610-6161 or the Just-In-Time Information Line at 1-800-260-8355. This time investment at the pre-birth visit and the pregnancy orientation class (one-hour sessions conducted prior to the actual labor and delivery date) simplifies and accelerates the admission process, reduces anticipatory anxiety and fear of the unknown and familiarizes future parents with individuals and patterns of care in a casual, non-clinical atmosphere. (For more information, visit Preparing for Your Baby in section E. ) MIDWIFERY/ALTERNATIVE BIRTHS A-1

BIRTH PLAN GUIDES AND BIRTH PLANS The Birth Plan Guide, a relatively formal birth preference check-off sheet, is contained in section G. These aid the pregnant woman in expressing her desires and preferences regarding the conduct of the birth experience, both in the form of check-off list and comments. While other informal and personal lists are acceptable, this formal standard is a more user-friendly method of communicating one s wishes and will be familiar to all concerned. Prior to its implementation, the Birth Plan must be considered in detail by your care provider and also signed by your provider if an agreement is met. It will be reviewed by the pre-birth visit nurse during your appointment at the hospital. If a 34-week visit is not scheduled, please mail the completed Birth Plan to the pre-birth visit nurse at one of the addresses below no later than 34 weeks gestation (six weeks before the due date ). St. Luke s Hospital Bethlehem Campus Attn: Toni Prelovsky, RN, MSN 801 Ostrum Street, Bethlehem, PA, 18015 St. Luke s Hospital Allentown Campus Attn: Ella Rios, RN, Nurse Manager Third Floor OB Department 1736 Hamilton Street, Allentown, PA, 18104 Birth Plans presented to Labor and Delivery personnel for the first time when being admitted for actual active labor and delivery are much less likely to receive full consideration. After review, Birth Plans become part of the patient s chart once they are signed off by the obstetric care provider and the obstetric nurse. It should be emphasized that, although liberal, requested behaviors, practices and procedures that are deemed either unsafe or incompatible with evidence-based and optimal clinical outcomes will not be signed off as acceptable and will be referred to the Department of OB/GYN. If there is a persistent attempt on the client/patient s part, or that of her support persons, to proceed with some action or inaction cited as unsafe or clinically unacceptable, the client/patient will be asked at any such time, to sign a waiver of proceeding Against Medical Advice by the hospital s staff. If a clearly indicated clinical intervention or procedure is recommended at the discretion of either the midwife or the attending physician, and the client/patient refuses in a manner that creates an unsafe environment or suboptimal clinical situation, the client/patient may be asked to sign a formal Refusal of Treatment document. Finally, if hospital personnel, the midwife or the attending physician deems any behavior to be grave, disruptive, a safety or security risk to the fetus, mother, any family, support person or hospital personnel, St. Luke s Hospital s Security Department may be immediately summoned and involved at the Labor and Delivery staff s discretion to enforce a safe environment. A-2 MIDWIFERY/ALTERNATIVE BIRTHS

MIDWIFERY BIRTHS, COLLABORATIVE AND RESIDENT PHYSICIANS Each midwife practicing at St. Luke s is associated with a collaborative physician who advocates for and backs up certified midwifery birthing experiences, consults and/or co-manages the client/patient in high-risk situations and aids the midwife in operative vaginal and Cesarean births. Occasionally the client/patient is completely referred to the collaborative physician for ongoing care, with the midwife continuing in a supportive role. It is expected that any client/patient who demonstrates a problem requiring collaboration with an attending physician as an antepartum outpatient will promptly be seen by that physician at the midwife s discretion and according to the Practice Guidelines for Nurse Midwifery. Further, it should be recognized that St. Luke s Hospital is a major teaching hospital with both Obstetric and Gynecologic residents and medical students. Part of their education needs to be in the form of the observation and care of alternative and midwifery births. While strong preferences against their participation will be entertained, there will be no guarantee that one or more of these individuals may be involved in inpatient care of any client/patient in a clinic or hospital setting. DOULAS Certified Doulas contracted educational and intrapartum support persons can be valuable to the laboring woman in multiple ways, and have been associated with improved obstetric outcomes. An excellent statement regarding their value: Women in general have (much) to gain from the presence of a female companion who is not just sympathetic, but is informed as well, and therefore in a much better position to provide the sense of firm reassurance which is so sorely needed at this time. O Driscoll and Meagher, the Active Management of Labor Assuming this positive behavior, compatible with the decorum noted above, Doulas are welcome within the Labor and Delivery areas at St. Luke s. Their planned use should be noted on the Birth Plan. Finding a Doula DONA International; www.dona.org; 888-788-3662 Association of Labor Assistants and Childbirth Educators; www.alace.org; 888-222-5223 Childbirth and Postpartum Professional Organization; www.cappa.net; 888-692-2772 Birthworks; www.birthworks.org; 888-862-4784 MIDWIFERY/ALTERNATIVE BIRTHS A-3

WATER BIRTHS Again, according to an individual s Birth Plan, and with the agreement of the obstetric provider, water births may be planned and accomplished at St. Luke s Hospital. For safety and sanitary purposes, these will only be done according to the Hospital s Practice Guidelines for Nurse Midwifery. This policy is titled Rules and Regulations specific to Warm Water Immersion for Labor & Delivery. The latter information is available to prospective families desiring a water birth. HOME BIRTHS All of St. Luke s related midwifery and alternative birthing will be done within the confines of St. Luke s Hospital s inpatient labor and delivery services, either in routine areas or those dedicated to nurse midwifery. St. Luke s Hospital does not maintain any relationship with either lay midwives or certified nurse midwives in any way relating to home births. The physicians at St. Luke s Hospital will not proactively support births intentionally planned to be done at home, or in the process of occurring at home by plan, whether the hospital had been notified in advance or not. USE OF STILL PHOTOGRAPHY AND VIDEOGRAPHY This remains a sensitive issue within hospitals at this time. The use of either still photography or video equipment will be allowed at St. Luke s births only under the following circumstances: All images will only be recorded from the top of the delivery bed. Images will not be recorded during the delivery. At all times, sensitivity and protection of the client/patient s privacy need to be an utmost concern. All equipment imaging will be abandoned at which time the midwife or attending physician asks that it be so, such as in the event of an emergency or any other high-risk clinical situations. NUMBER OF PERSONS ATTENDING A DELIVERY While families and support personnel are indeed welcome, and the labor and delivery areas are roomy, large numbers of observers and support personnel can be cumbersome and interfere with the best in clinical care, safety and outcomes. It will be at the discretion of the midwife or the attending physician to recommend the number of persons permitted in the labor and delivery suite. Similarly, it is expected that the family or support persons will promptly comply, and/or relieve one another as necessary. If you are planning a midwifery-attended birth or would like hospital personnel to consider something other than the matters cited in this position statement, feel free to discuss your concerns with your midwife or attending physician, or one of the nurse educators. A-4 MIDWIFERY/ALTERNATIVE BIRTHS