As a person who has dedicated much of her life to fighting for equality and social justice, I knew that the journey is not without its obstacles. Over the years, I’ve messed up more than once. My mistakes have taught me that my biases can fool me and that I must never stop examining and reexamining my own privilege. Putting yourself out there as an ally is a vulnerable position because you invite accusations of hypocrisy. I’ve been called out on many occasions and had to defend myself or apologize. Even though it is work, I welcome the opportunity for personal growth, a precursor to societal transformation, toward an end to oppression.
When I first started my work as a doula, my goal was to serve all families without discrimination or judgment. Despite my best intentions, I had to be honest with myself that I lacked the experience and training to feel confident in serving LGBT (lesbian, gay, bisexual and transgender) families. Since then, I have taken these steps:
1.) Inclusivity. I re-wrote my intake forms so that instead of asking information on the baby’s “mom” and “dad,” I now have space for information on up to four parents. This allows families to define their own roles, separate from gender, as well as include information on biological and adoptive parents.
2.) Continuing education. I found a wonderful resource in The National LGBT Health Education Center. Their on-demand webinars taught me so much about health disparities, pathways to parenting and ways to be more welcoming in my practice.
3.) Visibility. I have a listing on the resource directory, Trans Birth, “created to connect Trans* and gender non-conforming people and their families to midwives, OB/GYNs, and doulas who provide welcoming care to our communities.”
This is just a start. In the coming year, I plan to create a local resource list of welcoming providers in my community. Do you provide welcoming healthcare services in West Michigan or have a favorite resource you’d like to share? Please contact me!
In preparation for an upcoming birth, I toured Spectrum Health, Butterworth Campus, in Grand Rapids. My notes are below. While most of my clients are in the Muskegon area, if a mom has preterm labor or a baby is known to have health problems during pregnancy, the mom will most likely be referred to Spectrum, since there isn’t a NICU, or neonatal intensive care unit, in Muskegon. Also, Muskegon moms planning a VBAC (vaginal birth after a cesarean) will be referred to Spectrum as they are the nearest facility with 24-hour anesthesia available, which is required at hospitals where VBACs are done.
Notes from Spectrum Health, Butterworth Tour on 4-14-15 with Bonnie Brack, RN
The tour met on floor “A” in the center tower. We were told to have visitors park in ramp 7 and patients in ramp 6.
The postpartum rooms are on floors 6, 7, and 8 and we didn’t get to see them. They are private rooms with their own bath and shower.
Women in labor present to triage, which has the same equipment as on the L&D floors. I later asked if moms who presented further along in their labor had to spend time in triage and she said some women circumvent triage if it is apparent they are close to delivery. Couples can also take advantage of valet parking. At 9 PM, the doors lock. If locked, wait for a guard because they’ll be right back. Visitors must wear a badge. In most cases, women move from triage, to the delivery floor, to a postpartum floor.
We went to the 2nd floor. The 4 former triage rooms are now used to prep moms having cesareans. The LDR (labor, delivery, recover) rooms are where the moms stay for up to 2-hr. postpartum. The babies can room-in with them. The nurse pointed out that the thermostat in the room can be adjusted, as well as the blinds and the lights. She also emphasized 4 options: a wooden rocker, birthing balls, a squatting bar and a mirror. When asked, she explained that they have different sized balls (or add or decrease the air to get them the right size), but they do not have space for a peanut ball. I also asked about out-of-bed options for second stage, such as a birthing stool. They used to have a birthing rocker, but no one knows what happened to it. There is a whirlpool/Jacuzzi bathtub in each room, but water births are not allowed. From the way she made it sound, all women push in bed. There is no CD player available or MP3 hook-up in the rooms. There is a couch the folds out into a bed. TV channels 3, 8, and 13 are informational stations. Linens, towels, washcloths, gowns and catheter kits are all kept in the cupboards. Moms are only allowed ice chips in labor. Up to 5 people are allowed in a room, in addition to staff. In addition, each floor has its own waiting room.
Most circumcisions are done by the OB, the day after birth. It’s whoever is doing rounds from the practice you are with.
Dial ‘9’ for outgoing calls. She suggested bringing a cell phone and charger to the birth.
Nurse said there were no “walking” epidurals and all women with epidurals are catheterized multiple times during labor to empty the bladder.
There is a 1:1 nurse to patient ratio, except maybe 2:1 for patients in early labor. All patients receive continuous electronic fetal monitoring.
There are 2 c-section rooms on the 2nd floor and another on the 3rd floor. In an emergency, they can prep a patient in their LDR room. Only 1 person is allowed in the room with the mom. They still try to do modified skin-to-skin. The doctor makes the first cut on the cord and the support person can make the second, if desired.
When I asked if there was a space where visitors could store food, she said there was a clean utility room with a fridge, but didn’t know if it could be used to store food.
Questions and Answers from NOCH Hospital Tour with Laura on 2-24-14
Classes and Other Support Services
Does the hospital offer classes in childbirth education? Newborn care? Breastfeeding? Postpartum adjustment?
Laura teaches childbirth preparation. She is trained through Prepared Childbirth Educators. She teaches a 3 class (2 ½ hours per class – 7 ½ hours total) series and an all day (9 AM – 4 PM) Saturday class. They have a breastfeeding support group that meets 2x/mo. They also have infant/child CPR, Postpartum adjustment group, a refresher class, and a sibling class. They do not have any IBCLCs, but Laurie McCabe is their certified breastfeeding counselor who teaches their breastfeeding preparation and breastfeeding and beyond classes.
Care During labor and birth – Organization of Care
Is there a birth center in the hospital? How does care in the birth center differ from “regular” hospital labor and delivery care?
There is a separate area within the hospital that is for labor and delivery. It was private and when I was there at least, very quiet. The nurses do work 12-hr shifts, so you may have the same nurse for your entire stay (depending on how long you are there). They also strive for one-on-one care, when possible, so moms get a lot of personalized attention.
Would I labor and give birth in one room, or would I be required to move just before the birth? Would I stay in the same room after I give birth?
Women deliver and recover in the same room. There is an operating room on the unit just for c-sections.
Care during labor and birth – companions
Do you have any policies that limit the number of people who may be with me during labor and birth? Can the baby’s siblings be present? Is there an age restriction?
I didn’t ask and it didn’t come up.
Do you have experience with trained labor support (doulas) during labor and birth? Do you encourage use of doula care?
Laura said they see a doula at a birth about every four months or so.
Care During Labor and Birth – interventions
Do you monitor the well-being of the baby during labor? Do you use occasional or continuous electronic fetal monitoring? Is a Doppler or fetoscope an option?
It’s up to the provider and really depends on how well the baby is doing. They do use the wireless, which can pick up the heartbeat at long distances (mom can walk the perimeter of the ward without a problem) and are waterproof.
What are your usual policies and practices about:
I didn’t ask and it didn’t come up.
- Freedom to be active and move about in labor
This is very much supported. They have three sizes of birth balls that Laura described using in a variety of ways. As mentioned before, moms are encouraged to walk, as well.
- Eating and drinking in labor
Laura said that it’s up to the provider, but they have juice, jello and other “clear fluids” on hand.
She described many different births using the stool, squat bar and hands and knees. Hands and knees and the stool seemed to be her favorite. She said she sees more intact perineums with the stool, too.
What is the usual care if a labor is progressing slowly?
If a mom comes in, she is monitored for two hours. If, during that time, there is no cervical change, they will send her home. Laura encouraged labor support people or moms themselves to call the hospital to inform staff of their progress. She said to just call straight to labor and delivery. She said that 4-1-1 is the rule: contractions four minutes apart, lasting 1 minute each, continuing for at least an hour, but it’s usually OK to wait a little longer.
What percent of the time do women giving birth here get an episiotomy?
She had stats, but didn’t want to give them out without asking permission first.
Care during labor and birth – help with pain
How would you recommend that I prepare for managing pain during labor and birth?
I didn’t ask this question, but they do have a high percentage of parents that attend their childbirth preparation classes.
What drug-free measures for pain relief are available in this hospital?
They have birth balls, as mentioned above. For comfort, they are cool with aromatherapy and have a CD player families can use. Their Jacuzzi can be used for pain relief, but there isn’t enough space to deliver in there. Some of the providers are pushing for a portable birth tubs, but it is still uncertain.
What would happen if I decided that I wanted an epidural?
I didn’t ask this question.
Are other pain medications an option?
I didn’t ask this question.
Care during labor and birth – complications
What percentage of women who give birth here have cesarean sections?
She had stats, but had to ask permission before disseminating. She did say their overall c-section rate was lower than the national average and primary c-section rate was only 19%.
Are there any situations (such as cesareans or other procedures, tests, treatments) that would require me to be separated from my partner and/or doula during labor or birth?
Only 1 person is allowed to be in with the mom during a cesarean.
Postpartum and newborn care
What newborn care is routinely provided or offered if a baby is healthy?
Hep B shot, Vit K shot and Erythromycin eye drops. Baby is weighed and measured.
Would my baby be separated from me immediately or shortly after birth? For what purpose and how long?
Early skin-to-skin is encouraged. Most procedures take but a few minutes to complete. The baby can stay with mom until she’s ready to hand him/her off and then he/she can go back to her quickly afterward.
Are there any policies regarding use of hospital nursery care by healthy newborns? Do you have a “rooming in” option, where my baby could stay in the room with me instead of being cared for in the nursery?
I didn’t ask this question.
Is there a newborn intensive care unit on site? Is there any situation in which my baby would need to be transferred to another facility?
There is no NICU on site.
What breastfeeding resources are available? Does the hospital have a lactation consultant on staff? How would I ensure that my breastfed baby would not be given bottles of water or formula? Do you pass out formula samples?
They have a certified breastfeeding counselor, Laurie McCabe, who serves all of their patients, but most staff nurses have some training. There are no IBCLCs on staff.
Could my partner stay with me throughout my stay after the baby is born? What accommodations are available?
The rooms have a pull out love seat that looks pretty comfortable.
Leaving the hospital
How long do women usually stay after a vaginal birth? Are shorter or longer stays acceptable to the staff?
I didn’t ask this question.
What follow-up care would you provide after I go home? Does the hospital have a nurse available for home visits? Do you provide information or give breastfeeding or emotional support over the phone?
About 45% or more of the moms who deliver there have a positive perinatal risk assessment screen. Laura attributes this to the very personalized care she gives and the multiple contacts which build trust with moms to be honest about their experience. They have a support group for postpartum adjustment and are dedicated to providing emotional support.