SPECIAL DELIVERY : THE BIRTH PROCESS HAS BECOME A FAMILY AFFAIR : Labor-Delivery-Recovery Rooms Give Growing Family Its Own Space

When Marjorie M. Pyle had her second baby, in 1964, her husband couldn’t even hold their new son until they had paid the hospital bill and gotten into the car to drive home. He had only been allowed to see his newborn through the nursery room window.

When they got home, she said, their 9-year-old son shunned her because she had gone off for five days and he hadn’t been able to see her. “He felt very left out” even though he had known a baby was coming.

In fact, in the 1960s, new mothers in the hospital were “not to unwrap or touch the baby.” It was not unusual for the baby to go into a pillowcase before being handed over to mother for a visit, said Pyle, a registered nurse and coordinator of childbirth education at Los Alamitos Medical Center in Los Alamitos. “Only nursery room nurses could touch the baby.”

Things have changed, and not just for the mothers. Fathers and other family members have won their rights and their way into hospital delivery rooms and nurseries. In 1988, Pyle’s sons would be allowed to cut their own baby’s umbilical cord, physician willing.

Insistence by pregnant women and their families and competition for the obstetrics dollar have brought about changes in general practices and attitudes on maternity floors. In Orange County hospitals, mothers and fathers, even grandparents and siblings, may participate in the birth process, making it truly a family affair.

The latest change is the coming of the LDR room, or the more advanced LDRP room. A woman goes through labor, delivery and recovery in one bed in the same private room, with members of her family present. (In an LDRP room, a woman remains in the same room through postpartum care.)

“No question, it’s the biggest change” in Orange County now, said Dr. Tom Garite, chief of obstetrics at UC Irvine Medical Center in Orange, which has two LDR rooms now and is converting several of its traditional labor rooms into LDR rooms. The new rooms will be finished this year.

To understand the room and its concept, it helps to look at what has been and still is common practice at some county hospitals.

In a conventional, problem-free delivery, the woman who enters the hospital in the early stages of labor is put into a semi-private labor room along with her coach, who is usually the baby’s father. When birth is imminent, the coach comes along as the woman is wheeled into the delivery room, where she is transferred onto a birthing bed.

Shortly after the baby is born, the mother is wheeled again, this time to a recovery room, where she is moved onto a new bed. The baby is whisked off to the nursery, often with the father in attendance, to be checked over by the nursery staff.

After one to two hours in recovery, the mother is transferred once more, this time to her postpartum room, where she’ll stay until she’s discharged from the hospital. There, in her fourth bed and room, she and the coach can relax with the baby and be joined by the rest of the immediate family.

“To be moved around like that (is) very disruptive,” said Sharon Clancy, director of marketing for Los Alamitos Medical Center. “Getting up and moving when you’re in pain is not the greatest thing to do.”

Enter the LDR rooms, which are mushrooming in availability in Orange County.

The concept evolved from homelike birthing rooms, commonly called alternative birthing centers, which have been available in most hospitals for 10 years. An alternative birthing center provides a comfortable setting for women with low-risk pregnancies who want just a brief hospital stay. These rooms generally have been used by women who had considered giving birth at home but who opted for the safety of a hospital.

LDR and LDRP rooms are different because they are equipped to handle low-risk and high-risk mothers, although no Caesarean section births.

Garite of UCI Medical Center said the metamorphosis in obstetrical care has occurred in three steps.

The first stage 15 to 20 years ago “was a dehumanizing of the birth process” that isolated fathers and siblings from mother and newborn, he said.

Then there “was a big wide swing (brought about by) the pressure of alternative life-style folks” who wanted a more sensitive birthing process. Those “outcries to humanize the birth process” led to the popularity of home births and alternative birthing centers within hospitals and to the participation of fathers and families in the birth process, Garite said.

The LDR and LDRP rooms are the latest step, providing a marriage of the home birthing idea with “all the benefits of the medical world,” Garite said. The concept “is a maturing of physicians and nurses to what the patients really want. It forces people to be a little more sensitive to the needs of the family.”

LDR and LDRP rooms are designed to look like home, with decorative bedspreads, wooden furniture and framed prints on the wall that conveniently hide medical equipment when it’s not needed.

The LDR and LDRP rooms are also private rooms, often larger than the usual hospital postpartum room, and are meant to accommodate not only the woman and her coach, but other family members for any part of the delivery process.

For example, the Los Alamitos Medical Center plans to provide sleeping chairs in its new LDRP rooms so fathers and siblings can stay for long visits. Saddleback Community Hospital in Laguna Hills, which will open a new Women’s Hospital equipped with 21 LDRP rooms in May, will provide window seats that can be used as beds in “the large family zone” of its rooms, according to a spokesperson.

LDR rooms also are designed to room the baby immediately after birth, with equipment on hand for the nursing staff to medically assess the newborn right there. If it’s an LDRP room, the baby will stay there with mother unless a medical problem develops or unless the mother requests the nurse to take the baby to a nursery so she can rest.

Both approaches mean a hospital generally can plan on smaller nursery areas for normal, healthy babies, because those newborns will be with their mothers most of the time.

“It’s their baby, not our baby,” said Susan McInerney, director of community relations at St. Jude Hospital in Yorba Linda. “In 15 years, maternity has gone from the dark ages to more of a family experience.”

The LDR approach also makes it easier for a mother and other family members to bond more quickly with the newborn, a process considered important to a baby’s emotional well-being.

Although the LDR concept is “not designed to change medical practice”--physicians can give the same care as in a traditional setting--the rooms are a big change for nursing care, said Kathy Cline, program manager of perinatal services at Hoag Hospital in Newport Beach, which will add nine LDR rooms in May.

In a conventional delivery process, the woman might deal with as many nurses as she did different beds: one nurse for labor and delivery, another in recovery and then the nurses who are on duty for the rest of her postpartum stay. Her baby would be attended by a nursery room nurse.

LDR and LDRP rooms operate on the idea of one nurse providing continuous care of one patient and her baby.

Besides saving the nurse the physical task of moving a woman from bed to bed, eliminating the transfers is also cost effective for the hospital, according to Alison Driessen, administrative coordinator of marketing and nursing at Fountain Valley Regional Hospital and Medical Center.

It can cost a hospital $30 to $90 to transfer a patient, she said, when the nurse’s time, linens, time spent remaking and cleaning a bed and the cost of keeping several rooms heated and lighted are accounted for.

But why doesn’t every hospital jump on the LDRP bandwagon? Cline said LDRP rooms “are mainly for hospitals that are starting from scratch.”

Space is one consideration. “I don’t know a hospital that doesn’t have a space problem,” St. Jude’s McInerney said.

The number of babies delivered each year by a hospital also plays a role. Based on an average maternity stay, the LDRP room can handle a maximum of 100 births a year, a hospital spokesperson said.

St. Joseph Hospital in Orange delivers the most babies of any hospital in Orange County and “we can’t do LDRP” at this time because of that volume, said Tess Payne, registered nurse and director of obstetrics education. “Logistically it’s not feasible here.”

St. Joseph, which delivered 5,855 babies in 1987, offers one alternative birthing center room and has started construction of three LDR rooms. Within the next four years, Payne said, plans call for a complete renovation of the obstetrics department, including 16 LDR rooms.

Marga Reizuch, a registered nurse and supervisor of obstetrics at Los Alamitos, said that some hospitals use the LDR room as a steppingstone to the LDRP concept, but most hospitals said the LDR rooms also are becoming more available because hospitals need to stay competitive.

In hospitals that offer LDR rooms and the traditional method for delivering a baby, the fees to the family are the same.

“It’s really popular, so a hospital would be cutting its throat” to charge more for LDR rooms, according to McInerney at St. Jude.

Nurse Pyle has seen many changes on maternity floors since her son was born in 1964. The bottom line to her, she said, is family involvement.

“We believe the family is really important. We’re not just delivering a baby; we’re creating a family.”