In the eyes of most consumers, “The HOSPITAL” is one unified system. However, it helps to understand several parts of the hospital structure as it relates to birth:
- The Marketing Department is focused on getting people to choose their hospital. The in-house marketing team works with outside advertising agencies and web content designers to create engaging marketing campaigns. It is important to note that they work with market data, and information provided by the in-house marketing team, but possibly do not get direct input from care providers, staff or patients. (This is the marketing company that created the iDecideHow campaign )
- OB/GYN Care Provider Groups contract independently with the hospital to provide obstetric services to hospital patients. As contractors, they control their own practices, set up their call schedules, and may have their own set of patient care protocols/policies. Additionally, within each care provider group, Individual practitioners have autonomy, which means that within a group, you find providers who treat pregnancy and birth in a variety of ways ranging from a normal physiological event to a medical emergency waiting to happen.
- Hospital Administration establishes hospital protocols and policies, hires and manages staff, including nursing staff, and contracts with providers. Hospital administration and staff have direct patient contact.
As you can see, these various parts may not always function as a smoothly integrated whole. To illustrate that fact, let’s look more closely at two examples from our area: Brookwood and St. Vincent’s.
When Brookwood built their new Labor and Birthing Suites, they installed a large specialty tub in one of the rooms. They also have a few large inflatable pools. Brookwood is the only Birmingham hospital that provides a specialty tub and inflatable pools. When they first built the new Women’s Center they brought in someone to train OBs on attending water births. As independent contractors, the OBs could choose whether to attend the hospital’s training. There were OBs who attended, and others who didn’t. The marketing department released the “iChooseB” advertising campaign for the new Women’s Center. The marketing materials told women that they could have a water birth, even though at the time there were only a handful of OBs willing to attend water births, others who “allowed” water labor, and still others who didn’t “allow” their patients to get in the tub at all. Water birth was only available for a short time. The hospital changed their policy regarding water birth. The revised policy continued to allow women to labor in the birthing tubs, but removed the option of water birth. So, the advertising campaign told women they had the option to give birth in the water, the hospital did not allow birth in the water, and OBs made their own decisions about whether or not they would offer the option of laboring in the water. Some OBs were fine with their patients laboring in the water, others had strict rules for who would qualify, and others who said “no”. In addition, a woman might be told she could labor in the water by her OB, but when she arrived at the hospital in labor, an OB who didn’t allow water labor was on call.
Meanwhile, the advertising campaign for water birth was still on the web site. This ad campaign wasn’t changed until Caroline Malatesta won her law suit against Brookwood for falsely advertising water birth and other natural birth amenities. Amenities that the hospital allowed (intermittent monitoring, freedom of movement during labor and birth, etc.) but that the hospital could not compel all the OBs to allow. And, while many nurses were comfortable with these practices, others were not as comfortable or as knowledgeable in how to support women who wanted these options.
Today Brookwood advertises amenities that are available at the hospital. Please be aware that your chosen OB, or the OB on call for your birth, may not encourage or “permit” you to utilize some or all of the amenities, nor is there a guarantee that all nursing staff will be comfortable and trained in supporting your low-intervention labor.
Another local example is St. Vincent’s Monogram Maternity iDecideHow campaign . Billboards and print ads stress the personalization of maternity services at St. Vincent’s, where “you get to decide” by meeting with a Monogram Maternity “birth designer” toward the end of your pregnancy (usually scheduled between 34-36 weeks) to create a customized birth plan that is shared with your OB. Advertising may lead consumers to conclude that everyone providing care at that hospital will follow their birth plan, and be on board with everything they and their birth designer put in the plan. But as with iChooseB, there is inconsistency between the various components. The ad campaign appears to promise something universal and consistent to all patients that is, in fact, highly variable. Yes, the hospital has provided some training for nurses on how to use the amenities many people want to use, but not all nurses are comfortable with these skills and tools. The hospital cannot make contracted obstetricians participate in Monogram Maternity, or dictate which amenities they support. As a matter of fact, not all OB Groups at St. Vincent’s participate in the Monogram Maternity program. Birmingham OB/Gyn is one example of a practice that does not participate in Monogram Maternity.
Where does this leave the “i” in “iDecideHow?” You may have an appointment with a "birth designer", put together a birth plan, and then discover in labor that your care provider (or the on-call provider) doesn’t allow everything—or anything—on your plan. The "birth designer" encourages you to discuss your birth plan with your care provider before labor, but the last month of pregnancy is a pretty stressful time to discover your OB is not on board with what you are planning. (Read too our blog post “Birth Plans, do they work?”)
Advertisers use a variety of techniques to appeal to consumers so that they will buy a product. Interestingly, in both examples we describe, there’s an obvious appeal to the patient as “primary decision maker” in their maternity care, represented by the "i". We hope that by walking you through these examples, that rather than being discouraged, we have encouraged you to truly exercise your autonomy (I Choose/I Decide). For a great discussion about assembling a team that recognizes YOUR right to make decisions about YOUR care, read our July blog “Birth Independence”.
Figure out what it is you want by attending in depth childbirth preparation classes doing your own research, talking to friends, etc. Then talk to your care provider to determine if their birth philosophy supports the kind of birth you are envisioning. Ask friends about nursing care in your hospital of choice. There is always someone who had a fabulous experience at each hospital in Birmingham. The question is, was that an exception? Or does it usually happen that way? Is the support for what you want consistent?
We encourage you to have these conversations early in pregnancy. The earlier you get the right support team for your birth, the better!