Saturday, December 11, 2010

Third World Green Daddy Part 5: Hospital Preparations

As I've mentioned in a prior post, my wife and I decided months ago to have our child in our town's public hospital as opposed to one of the crappy private clinics and hospitals here. After an unpleasant experience at a private hospital, I was worried that on the day of my son's birth I wouldn't be able to accompany my wife. It seemed that the standard policy in many places was to have the family of the delivering mother wait while she bore alone, a la 1950s USA.

We thought that in order for me to accompany my wife during childbirth, we'd have to have Samuel at our house. We asked our general doctor about it, and he said he liked the idea. But he was worried about safety and ethics. Namely, if he attended our birth and he saw that something were going wrong, he'd have to take us to the emergency room, after which he might be sanctioned in his practice as a doctor for not having provided adequate conditions for our childbirth.

With our doctor out of the running, we were even considering having a friend of ours assist with the birth at our house. She is an old, somewhat out-of-practice midwife living in a semi-rural slum of our town. We know her because she keeps up the 17th century church we attend. But obviously we'd be in trouble if something went wrong during the birth, because she has no fetal monitors or anything.

In the course of our regular prenatal controls, we went to the town's public hospital, just a few blocks from our house. We were attended by a lovely young gynecologist that allowed me into the consultation room, and answered our questions about the childbearing setup at the hospital. During that and subsequent visits, we've gotten a full idea of how the hospital runs things. Basically mothers in labor enter through the emergency room, from whence they are immediately spirited to a hospital bed in the maternity ward. They begin labor there, and when they've advanced to a certain stage, they go to another place called the labor room, where they and other mothers are looked after by a team of nurses and doctors, with all the essential monitoring equipment. When the baby is ready to come out, the mother is taken to the delivery room, which has an adjacent operating room in case anything goes wrong.

We didn't come easily by this information. For a long time no one could tell us exactly in what places and moments I might be with my wife, and when not. Both doctors and nurses said that everything depended on the judgment of the doctor on call at the moment of our delivery. Often I wasn't allowed to join my wife in her regular checkups and doctor visits at the hospital, which didn't bode well for my attending the birth. Hence we remained in a tense limbo, not knowing if I'd be able to be with my wife during our delivery, and not knowing where to get concrete, sure answers. The last thing we wanted was to add even more chaos to the birth process, with me arguing and getting pushed around by hospital staff on the big day!

Luckily my wife's co-worker used to be a secretary at the hospital, so she put us in touch with the hospital administration. It seems that one family member is always allowed to accompany the mother until the labor room, which is to say right up until the final moments of childbirth. Beyond that, we would have to set things up specially. Apparently the hospital had had trouble with fathers who were allowed into the birth room and then caused problems, either by getting in the way of the medical staff, or even fainting! Furthermore, because it's a teaching hospital, things can get crowded when you add another person to the mix of interns, pediatricians, OB-gyns, nurses, and other students in the birthing room. Granted, the convenience of doctors and other workers shouldn't be the prime consideration, but I could understand to some extent the reticence of the hospital to let fathers into the birth process. Anyway, once I found out that I could be with my wife until more or less the final moments, I was happy. My main concern was and is helping my wife to have a healthy, relaxed childbirth. I'm by no means the crucial person in the process, so insofar as my presence is a help, I want to be there, but if I'm in the way at any point, I'd be most useful by making myself scarce.

Yesterday I finally had my interview with the hospital administration. They asked me a few general questions and basically tried to ascertain whether I was comfortable around childbirth and babies, so that I wouldn't freak out or faint in the delivery room. Then they took me and my wife to meet the head obstetrician, who was also very nice. He explained in depth the process I've detailed above of different rooms in different moments of childbirth, and reiterated that I'd be welcome in the delivery room unless there were some unforeseen emergency or difficulty in the birth. After that we talked with a nurse that is the hospital's point person for incorporating fathers into the childbirth process. She was really gracious, giving us a list of things to bring, and setting up a date for my wife and me to make the rounds of the maternity ward this Monday, to prep us for how things work. The nurse also charged me with buying a few full-body disposable surgical scrubs--one set for Monday, one for the day of Samuel's birth, and another to change into before entering the final birth room. The hospital of course has scrubs for patients and family, but she was worried they wouldn't fit me!

In the end my take is that the hospital administration is trying to promote fathers' participation in childbirth, but many of the doctors aren't quite on board. Though my wife and I felt like rock stars yesterday with the attention the administration gave us, we weren't actually getting any special, exclusive treatment. Our friend told us who to get in touch with at the hospital to set up my attending the birth, but she didn't pull any levers or get us any undue privilege. In theory the attention we're getting, and the possibility of fathers' being present at the childbirth, is available to any patient. But we wouldn't have known about these rights and opportunities if it weren't for our friend's telling us. The administration's campaign to involve fathers seems not to arrive to the level of patients. Many doctors and nurses claim that either the father or the mother is usually reluctant to have the father present during childbirth, but I believe it's mainly that people don't know that it's an option. Doctors either don't tell them about it or even dissuade them from it, out of laziness, reluctance to change, or desire for convenience on the doctor's part.

The hospital has a concentrated campaign to push breastfeeding and mothers' spending time with their babies right after birth to establish a bond, and I imagine their designation of the special nurse in charge of father involvement is an extension of this more progressive, holistic approach to childbirth. It's probably like the US in the 1970s and 1980s, when hospitals started treating birth in a more human manner, cutting down on drugs, allowing and encouraging fathers to help out, pushing breastfeeding. It's exciting to be part of this change.

As in many aspects of life in our small town, certain practices and possibilities are lacking when compared to Bogota or Chicago, but that just means that there are lots of things yet to be done! Our efforts to introduce new ways of doing things (or in this case our participation in changes that are already underway) can really make a difference, and are greatly appreciated by our fellow townspeople. The special nurse as well as the hospital administrator seemed thrilled that we were interested and involved in our upcoming childbirth (as opposed to just swooping in on the day of and demanding treatment). They even asked if they could take promotional photos of us on Monday during our maternity ward tour. I told them that if they wanted they could present us as an international delegation coming specifically to their hospital to have our child. They asked if I was going to film the birth. We hadn't been planning on filming anything, but if it helps the hospital out, we're willing to consider it. They also informed us that we were free to request that no interns be present. Some people are annoyed or embarrassed to have a bunch of young doctors in training looking at them and prodding them. But my wife argues that if we don't allow interns to attend and learn, where will our future doctors come from?

With our hospital visit this coming Monday, we'll have everything in order for our baby's birth. I'm hoping Samuel holds out not just for our tour on Monday, but also for me to pick up my mother, who arrives in Bogota on Tuesday. If the big guy can wait until Thursday or so, that will be great. But we'll take him whenever he comes.

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