What's the big deal about hospital gowns? Does it matter what you wear when you give birth? I believe the answer is an emphatic YES (and NO.... more about that later).
Well, what is the first thing that comes to your mind when you see a hospital gown? Generally, illness or trauma. Hospitals are not generally places that healthy people go to hang out. In fact, the only healthy people that walk themselves into a hospital for treatment are pregnant women! But is pregnancy an illness, or a condition to be treated?
NO. It's a normal bodily function for a female, and usually pregnancy and birth are healthy, uneventful processes for women and their babies. But the first thing that a woman is asked to do when she walks into a hospital is to put on a hospital gown. Why might this be a problem, or the beginning of one? I might even consider it the first intervention, albeit a psychological one.
Clothing can be a powerful statement about who we are. Most women take quite a bit of time picking out their wardrobe, and the way that we dress generally reflects quite a lot about our personality. Uniforms are for...making people more uniform! Reducing the expression of their individuality and personalities. Even changing the way that they think about themselves. Consider that the infamous "Zimbardo Prison Experiment" which demonstrated the power of environment over the mentality of the participants, included changing the uniform, schedule, and food of the participants (sounds like a hospital, doesn't it?). In just 6 days the participants, and the scientists overseeing the experiment, had essentially forgotten who they really were.
Think about it. Who wears uniforms? Some schools require uniforms. Prisoners wear uniforms. Often emplyees wear uniforms to make it clear who they are working for. Their dress then reflects the company that they are employed by, not their own preferences. Each branch of the military has it's own uniform, which is strictly enforced. Hospital patients wear uniforms, usually because regular clothes may get in the way of some treatments that need to be given.
Basically, choosing our own clothing allows us to express our individuality and personality, and uniforms do the exact opposite- they force us to conform to an ideal or image created by someone else.
Why is this especially important during birth? Because despite what we think of when we see a hospital gown, pregnancy and birth are NOT illnesses. Because you, as the mother, are the expert in giving birth to your baby, and you have the right to express your own opinions and ideas on how you should do this. I'm not saying that hospitals give out gowns to force conformity on birthing women, but the psychological effect of a healthy woman putting on the uniform of a sick person cannot be overstated!
I arrived at the hospital with a client in labor. She had carefully picked out a beautiful loose dress to wear while giving birth, and on the hospital tour she had been assured her that she would be able to wear her own clothing if she chose. However, as soon as we arrived, she was told to put on the hospital gown. Her expression, which was confident and powerful, changed to one of doubt and frustration. She expressed her desire to wear her dress, but the nurse and her mother both insisted that the gown would be "easier". (easier for whom?) I reminded her quietly that she had chosen that dress for a reason, and she could still wear it if she chose. She informed the nurse that she would not be wearing the gown, and continued in her labor, powerfully giving birth to her baby 10 hours later, despite back labor and a posterior baby. (Like many women who exercise this right, she had actually removed the dress by the end anyway, and had no clothes on! Which is why I say that it doesn't really matter what you wear in the end...)
The first step in maintaining your identity and purpose in labor just might be opting out of that hospital gown, the uniform of a sick person who needs to be treated and monitored.
Many women choose to wear a sports bra and/or loose skirt during labor, or a tunic or dress. Just choose something comfortable that makes you feel good. Many women end up with no clothes on towards the end of labor, and this is absolutely normal.
If you are planning on getting an epidural or are planning a cesarean, or just think that you would prefer not to make an issue of the hospital gown, there are quite a few companies now making "designer" hospital gowns for mothers in labor. This might be a good compromise, as the hospital is likely to find them interesting but still familiar, and you can still choose a gown that expresses your personality. A drawback here is that they generally aren't cheap, and often run 50$ and up, for a gown that you likely won't be in for long! Here are some places to look-
Lil-Miss Designer Hospital Gowns
MommyMoxie on Etsy
What do you think, will you ditch the hospital gown next time?
Food is powerful. Throughout history healthy cultures have used special foods or diets during pre-conception and pregnancy to promote fertility, healthy pregnancies, and easier childbirth. Some of these have been studied by modern science, and some really haven't, but in general they have a long track record of benefits and almost no associated risks, so why not try a few? You and your baby may benefit greatly.
Keep in mind that none of these foods or supplements are meant to induce labor. Your baby will come when he or she is ready! But a well-nourished uterus is efficient and strong, and this may help to promote a faster, easier birth for both of you.
There has been a lot of talk about postpartum belly binding, or wrapping, lately, and I have certainly been a part of that! See my post here on Bengkung, or Indonesian-style post-partum wrapping for supporting the body after the baby is born. But what about before your baby exits the womb? Can wrapping also benefit pregnant mothers? I think that it can, and here's why.
Please keep in mind that I am not an expert, just someone who loves to learn about pregnancy and birth, and especially how different cultures developed healthy birth practices. Don't do anything that you aren't comfortable with or that makes you uneasy!
Okay, I'm going to try not to ramble too much here. I had another post planned, but this topic of water consumption in pregnancy has been bugging me the past few days. Probably because it seems that every time a pregnant women has a pregnancy issue, I hear the same refrain from well-meaning doulas, midwives, doctors, and family members. And it's not evidence-based. It's just not. At worse, it's downright DISEMPOWERING.
"DRINK MORE WATER". Tired? Drink more water. Stressed out? You're dehydrated. Braxton Hicks? How much water are you drinking? Hungry? You're not really hungry, you're thirsty. Low amniotic fluid? OMG You need GALLONS of water immediately!
Even though doulas are usually very careful about NOT giving medical advice to women, even those that are their clients, I worry about this mantra, because, like anything in life, there IS too much of a good thing. Even with water consumption. Here are some of my thoughts.
I googled "how much water should I drink when pregnant?", and here are some of the answers that I found.
So we've seen anything from 64 ounces of fluid, to 96 ounces of water a day recommended in pregnancy. Most of these recommendations seem to be jumping off of the "8-8ounce glasses a day", plus extra for the pregnancy. But where did that initial recommendation come from anyway? It must have been based on some evidence, right?
Not so much, as it turns out.
Turns out, as revealed in an editorial in the British Medical Journal in 2011, this myth of 64 ounces of water a day was likely created by the bottled-water industry and has been debunked now for several years. The idea of drinking a prescribed amount of water every day may go back as far as the 1940's, but was never based on any science...just a guess by a nutritionist.
This researcher believes that "water AND a well-balanced diet" is the key to health. Baked potatoes, oatmeal, soups, and dairy all contain water AND nutrients that help our cells to maintain a proper balance of fluids and minerals, including salt. He adds, "There's no evidence you need to drink more water than what thirst dictates."
Drink When You Are Thirsty. Yes, Even if You're Pregnant
I believe these two things. One: our bodies are smart. Two: science usually backs this up. Turns out, this subject of water consumption is NO different. Studies show that our bodies are actually very good at keeping our fluid levels balanced, IF WE ARE LISTENING TO IT. Our schedules are often very busy, but pregnant women should especially pay attention to if they are hungry or thirsty, because yes, dehydration can cause contractions and even preterm labor if it gets very serious. Stomach viruses during pregnancy or food poisoning can be dangerous for this reason, but this is not the problem for most pregnant women.
However, drinking liters of water, as I often see advised, is also not without risk. Drinking excess water, without food or minerals (and salt) lowers your metabolic rate, and may make your kidneys work harder to get rid of the excess fluid. Did you know that it is possible to die of overhydration? And ironically, the symptoms of "water intoxication" are very similar to the symptoms of dehydration. From Wikipedia, some of the first symptoms of overhydration are " headache, personality changes, changes in behavior, confusion, irritability, and drowsiness". As it progresses, excessive urination and unquenchable thirst also manifest. I've actually seen pregnant women complain of these symptoms, and STILL be advised by well-meaning friends to "drink MORE water". This can be dangerous advice. I don't pretend to know if any mothers or babies have been harmed directly by the advice to drink gallons of water (yes I've seen that amount suggested, even by care providers), but it is wise to realize that there are risks associated with drinking too much water, and even if no physical harm results, I believe that there women are being given a confusing message.
"Your body is amazing and it knows just how to give birth and somehow a person will come out of your vagina if you just LISTEN to it.....but it doesn't know how to do something as basic as maintain a balance of fluid...so DRINK MORE WATER. Because you're always a step away from dehydration, you know."
Isn't that a little confusing? It doesn't have to be that way. I'm putting the myth of excessive water consumption for pregnant women to rest.
YOUR BODY IS SMART. Listen to it. Eat when you're hungry, drink when you're thirsty. Eat and drink whole foods, including dairy, eggs, fruits, veggies, soups, etc. If you are having lots of braxton-hicks contractions towards the end of pregnancy, try and Epsom salt bath instead of ingesting loads of water. Epsom salts are magnesium, which many of us are deficient in and is not found in purified water, and may help your muscles (and uterus!) relax so that you can have relief.
I also recommend This article by Matt Stone on why you shouldn't aim for colorless pee!
What About Low Amniotic Fluid?
Even though this post is getting long, I felt like I had to address this topic. If a late-term ultrasound diagnoses "low amniotic fluid", many women will feel pressured by their care providers to induce labor, even if there are no other indications of a problem. A study of opinion on obstetricians found that 95% felt that "isolated" diagnosis of low amniotic fluid was an indication for induction (reference here).
In this instance, again, well-meaning friends and doulas might suggest that a mother drink liters or a gallon of water and test again. While it's true that studies have shown that maternal hydration affects the amniotic fluid level, there is a problem with this approach.
First of all, the diagnosis of low fluid is not NOT particularly reliable. It's actually very difficult to measure the volume of fluid around a baby inside the uterus. If you can imagine looking down at a bathtub with a person in it, and from that angle only trying to determine how much fluid was around him....it's kind of like that.
Secondly, studies have shown that the mother's fluid intake affects the amniotic fluid level....but there isn't a consensus on what "normal" fluid levels really are. And most studies have shown that babies do just fine even if NOT induced, even if the fluid is low (but no other risk factors are present). It makes sense that fluid levels would increase. What happens when we drink tons of water? We have to pee! This is what the baby also has to do when confronted with excessive fluid. However, is there evidence that this inflation of fluid is more beneficial than whatever the level was before? That information is not clear.
Also, it's known that fluid levels decrease naturally as birth becomes imminent. Fluid levels tend to decrease in the 14 days or so before birth, as the baby swallows more fluid, and urine output decreases.
This study showed that in the 11% of women diagnosed with isolated low fluid, there were no differences in outcomes for babies that were allowed to continue gestating vs. babies who were induced. The group of women that were induced had a higher risk of cesarean, and lower-birthweight babies, but no increased risk for those babies was found.
Okay, so here is what we have established.
The diagnosis of low fluid is not reliable, and there is no easy way to see how much fluid is really inside the uterus.
Mother's fluid intake does affect the amniotic fluid, but fluid levels are dynamic and always changing, so taking one measurement doesn't necessarily indicate a problem for the baby.
Fluid levels decrease naturally towards the end of pregnancy.
No study of isolated low fluid at the end of pregnancy has established a clear risk to waiting for labor to start naturally, and induction of labor may increase risks for the mother.
So, given all of this information, it is up to the mother to decide if she would like to aggressively "treat" the low fluid levels with lots of hydration. She should not feel pressured to give in to an induction, since there is no evidence that this has any benefit for the baby. In contrast, several studies showed an increase in cesarean section for mothers that were induced. It's possible that drinking a lot of fluid will increase the "measurement" of fluid around the baby by ultrasound, but since this is NOT a reliable indication of fluid levels, it's really all about how the pregnant mother feels about what is going on. She shouldn't be scared into drinking a bunch of water OR induction for a diagnosis of low fluid because the evidence simply isn't there that these interventions are beneficial.
For more details on oligohydramnios (low amniotic fluid) see this excellent article on Science and Sensibility.
I wrote down these tips up for the upcoming Birth Expo (March 1st at the Herman Key Center in downtown Charlottesville, 10am-2pm), but I thought that I would share them here also.
Many women experience labor slowing down when they get to the hospital. There are many reasons why this happens, but one of the main ones is that all mammals need to feel safe and secure for the birth process to progress normally. Making use of some of these strategies may help the mother to maintain oxytocin levels that will keep labor going- even after a change of scenery.
We've all heard stories about women who had "easy" labors. (Okay I'm going to say that labor is almost never "easy", everything is relative, right?) Maybe they were only at the hospital a few hours before the baby was born, or say that they didn't have a lot of pain with contractions, or even that they didn't know they were in labor and had the baby at home or in the car accidentally! Why is it that for some women, labor seems to be faster and easier than it is for others? Of course there is no one reason why women's experiences vary so greatly, because each individual woman and baby is unique. But there are a few factors that studies have shown to help reduce the duration of labor, even in first-time mothers. Some of these factors include exercising regularly throughout pregnancy, waiting for the onset of natural labor, staying mobile and avoiding an epidural, and having continuous labor support such as a doula present for labor and birth. Let's look at why each of these factors may help your birth to be "easier" than it may have been otherwise.
Sometimes we focus so much on the pregnancy and birth, that we forget about what happens after the baby is born! As with other aspects of pregnancy and birth, it's important to remember that most of these routine interventions have their place....but only when indicated. There isn't much evidence that supports their routine use in ALL babies as is "standard of care" in most US hospitals. You can examine the evidence for yourself and see if you would like these interventions to be a part of your baby's first few hours or days. You might want to add newborn procedure preferences to your birth plan, and I also recommend having a person with you at your birth who is clear on what you want and don't want done to your baby. It's easy for the new mother to get caught up in the moment when meeting her new baby, and rightly so! But she may not notice some of these procedures taking place, because they are sometimes very quick!
In Part 1 we looked at the evidence against some common pregnancy interventions, and in Part 2 we examined common practices during labor, including continuous fetal monitoring and cervical checks. There are two more interventions that the evidence strongly recommends against, yet they are, in my experience, recommended or nearly forced on a majority of women who are birthing in the hospital. However, that doesn't mean that you can't examine the evidence and make your own decision about if you would like them to be a part of your care.
I look at birth from the perspective that our bodies are wonderfully made, and if we really believe that and work with the birth process and nourish our bodies properly, they will function optimally, most of the time!