Let’s face it, when it comes to birth, we’re mammals. And what do mammals need during labor and birth? An environment in which they feel safe and protected during a vulnerable time. And that means a place that’s familiar, peaceful, quiet, and dimly lit. A place where there are no disturbances or intrusions or interference with what bodily instincts are telling the laboring mammal to do. Yeah, that’s pretty much the exact opposite of what describes the typical hospital labor and birth unit.

In this post, I’ll be suggesting some things you can do about that not-so-small drawback of hospital birth, but before I do, if what I just wrote is giving you pause and there’s no reason not to, you might want to investigate having a home or birth center birth. Rather than figuring out how to adapt to an uncongenial hospital environment, why not bypass the problem altogether? If that solution appeals, but your concern is safety, here are some posts I’ve written that have more information on out-of-hospital birth safety. If it doesn’t, or there are reasons why hospital birth is the better option for you, well then, here you go:

Planning your birth

• Choose a hospital that:
  • Has soaking tubs or birthing pools available. There were many things study participants liked about laboring immersed in warm water (Cooper 2019), e.g., they felt relaxed, found it soothing, and were able to move freely, but here are some comments that speak to your back brain’s needs:

“I felt safe.”
“I felt protected.”
“I felt a sense of privacy.”

• • Has a bathroom with a shower connected to the labor room. Unfortunately, few hospitals offer the option of laboring in a deep tub or birthing pool, but between the white noise of rushing water and feeling warm water streaming over your body, laboring in the shower runs a close second. (FYI: I speak from personal experience.)
    Tip: Check whether shower stools are available, or you can bring a birth ball with you so that you don’t have to stand.

• Hire a doula. Some mammalian species have “aunties,” females who companion and watch over the laboring females, and in most human cultures, having female companions in addition to midwives is the norm. Doulas are the modern equivalent of this. (FYI: If you’re thinking the nurses will fill this role, it would be unusual if they did. The usual setup in hospitals is having nurses sitting at a central station watching screens displaying the data coming in from the monitoring equipment attached to laboring patients, almost all of whom have epidurals.)
• Prepare yourself to avoid or at least delay an epidural. Having a doula to accompany you is one strategy for avoiding or delaying an epidural; another is you and your intimate partner taking childbirth education classes that prepare you to cope with labor without one. Once you have an epidural, its requirements—continuous fetal monitoring, maternal blood pressure monitoring, an IV, a catheter in your back attached to a medication pump, a bladder catheter, possibly cuffs on your lower legs that squeeze and release to keep the blood circulating and prevent clots from forming, etc.—reinforce that you are undergoing a medical event. In addition, having an epidural eliminates mobility, and the ability to be up and walking or even just to change positions freely is a critical factor in feeling that things are normal and you’re okay.

Strategies for Labor

• Bring with you:
  • Your own clothes to wear. Nothing says “hospital patient” like wearing a hospital gown. Bring a few short-sleeved comfortable nightgowns or sleep shirts that are long enough for modesty and that you wouldn’t mind if they got stained. You may need more than one during labor, and you’ll want to change into something fresh after the birth. You can always change into a hospital gown if, for example, you decide to have an epidural, which will require staff needing easy access to your back. (FYI: I brought a couple of nursing nightgowns with me—nightgowns with openings for convenient breastfeeding covered by a panel of fabric. A nursing nightgown came in handy after the birth as well.)
  • Your pillow. Use the hospital pillows for helping with positioning and save yours for under your head. Don’t change to a fresh pillow case. Smell is the most primitive of the sensory inputs that can trigger emotions, and having the smell of home by your face to mask the typical hospital medicinal smells can subtly contribute to your feeling that you are in a safe, familiar place.
  • Noise canceling headphones or ear plugs or plan to listen to music. One of the more unsettling things about hospitals is the noise. Diminishing noise or screening it out will help you stay in your bubble.
  • Non-caffeinated beverages and an assortment of easily digestible finger foods. You need to keep hydrated, and you need calories. Having food and drink of your choice will also help you feel at home. (See my bullet below on declining a routine IV in favor of eating and drinking.)
  • A swimsuit for your intimate partner if your room will have a shower. That way, they can get in the shower with you, and staff (or your doula) can tend to you while you are in the shower without mutual embarrassment.
• Put a sign on your labor room door that says: “Please knock before entering and announce yourself.” It isn’t usual for medical staff to do either, and this is a way of claiming the labor room as your space rather than theirs.
• Stay out of bed. The bed is the most prominent feature of labor rooms, and the implication is that this is the proper place for labor. But you are much better off doing almost anything other than lying in bed, and as a bonus, research finds that mobility during the dilation phase reduces cesareans (Lawrence 2013), not to mention that staying active (slow dancing in your intimate partner’s arms is a great choice!) and being able to freely follow your instincts in finding positions of comfort during contractions reduces pain and may help you avoid wanting an epidural.
• Decline routine continuous fetal monitoring in favor of intermittently listening to the baby’s heart rate. You’re on solid ground in doing this. Routine continuous fetal monitoring hasn’t been shown to improve newborn outcomes and has been shown to increase cesareans and instrumental vaginal deliveries, and fetal monitoring guidelines reflect that fact:

“For a woman who is at term in spontaneous labor with a fetus in vertex presentation, labor management may be individualized (depending on maternal and fetal condition and risks) to include techniques such as intermittent auscultation.” — American College of Obstetricians & Gynecologists (2019)

“Implement intermittent monitoring policies for low-risk women.” — California Maternal Quality Care Collaborative (2022)

“1.2.9 Offer women with a low risk of complications, fetal heart rate monitoring with intermittent auscultation when in established first stage of labour. Do this as follows:

• • use either a Pinard stethoscope or doppler ultrasound” — National Institute for Health & Care Excellence (2022)

“Routine use of cardiotocography is not recommended.” — Queensland, Australia Government (2017)

 “Monitor pregnancies greater than 37 weeks 0 days’ gestation in healthy women in spontaneous labor without perinatal risk factors via intermittent auscultation.” — Dore (2020)

“During low-risk labour, the WHO recommends the intermittent assessment of the fetal heart rate.” — Pasquale (2024)

Tip: In case you do need continuous monitoring, my blog post on the topic includes ideas on how to minimize the probability of experiencing its harms.

• Decline a routine IV in favor of eating and drinking in labor. You’re on solid ground here too. Having an IV is uncomfortable and inhibits mobility, and deprivation of food and especially drink increases discomfort too. Like hospital gowns, a routine IV reinforces everything about birthing in the hospital that you don’t want reinforced during your labor. The argument for it goes like this: in case you need emergency general anesthesia, if you have something in your stomach and you vomit under anesthesia, you might inhale (aspirate) it into your lungs with potentially serious consequences. For that reason, we don’t let you eat during labor and only allow sips of water or ice chips, and we give you an IV so that you don’t get dehydrated. That argument, however, isn’t supported by the research, and enlightened obstetric guidelines recommend eating and drinking in labor:

“Allow and encourage women to drink water, juice, or isotonic drink liquids, and light meals or snacks during labor.” — Miller (2016)

“1.8.17 Inform the woman that she can drink during labour when she is thirsty, but there is no benefit to drinking more than normal. Isotonic drinks may be more beneficial than water.

1.8.18 Inform the woman that she can eat a light diet in established labour unless she has received opioids, or she develops risk factors that make a caesarean birth more likely.”  — National Institute for Health & Care Excellence (2023)

“Oral fluid and food intake during labor is recommended.” — Pasquale (2024)

There you have it. As a wrap up, you might want to read “Dotty and Her Dog: A Parable of Modern Labor Management,” in which I tell a tale about the consequences of overriding Mother Nature.

The thing is, a medicalized birth has its place when necessary—and even then, everything that can be done to preserve a calm, peaceful, supportive atmosphere should be done—but the potential harms when you or your baby’s status doesn’t merit it aren’t trivial. The subliminal effects of the trappings of the typical hospital birth can end up precipitating the very outcomes they are intended to prevent: delayed labor progress leading to increased surgical and instrumental deliveries and babies born in poor condition.

References

ACOG. ACOG Committee Opinion No. 766: Approaches to Limit Intervention During Labor and Birth. Obstet Gynecol 2019;133(2):e164-e73.

Cooper M, Warland J. What are the benefits? Are they concerned? Women’s experiences of water immersion for labor and birth. Midwifery 2019;79:102541.

Dore S, Ehman W. Society of Obstetricians & Gynecologists of Canada. No. 396-Fetal Health Surveillance: Intrapartum Consensus Guideline. J Obstet Gynaecol Can 2020;42(3):316-48 e9.

Lawrence A, Lewis L, Hofmeyr GJ, et al. Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev 2013;10:CD003934.

Miller S, Abalos E, Chamillard M, et al. Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide. Lancet 2016;388(10056):2176-92.

National Institute for Health & Care Excellence (NICE). Fetal monitoring in labour; 2022.

National Institute for Health & Care Excellence (NICE). Intrapartum care; 2023.

Pasquale J, Gialdini C, Chamillard M, et al. Clinical algorithms for the monitoring and management of spontaneous, uncomplicated labour and childbirth. BJOG 2024;131 Suppl 2:17-27.

Queensland Clinical Guidelines. Normal Birth. Queensland, AU; 2017.

Smith H, Peterson N, Lagrew D, et al. Toolkit to Support Vaginal Birth and Reduce Primary Cesareans: A Quality Improvement Toolkit. Stanford, CA: California Maternal Quality Care Collaborative; 2022.