Special Delivery : The latest alternative to assembly-line birthing: Labor to postpartum in one cheerful room--with the TV on
Twenty-five years ago when Patricia Fazio was in the final stages of labor with her second child, the nurses wouldn’t let her have the baby until she was moved to the delivery room. They clamped her legs together to transfer her but, recalled Fazio of Van Nuys, “I couldn’t wait. My daughter was born on the way.”
Fazio, 52, is part of a generation of women who endured the assembly-line method of giving birth, where expectant mothers were shuffled from labor room to delivery room to recovery to postpartum while their husbands paced the halls. Because childbirth was tantamount to surgery in those days, a mother was kept at the hospital for several days, isolated from the sterile nursery where her baby stayed until Dad took the family home.
In February, Fazio’s daughter, Teresa Priore, gave birth in a new, cheerily decorated labor-delivery-recovery-postpartum room at Northridge Hospital Medical Center. After Priore, 27, of Reseda, checked into the hospital, everything happened in that LDRP room, and in the same bed.
The nurse assigned to her--along with husband Chris--coached and pampered her through labor, and her doctor arrived for the delivery. Whatever medical equipment they needed was within easy reach, tucked away in the closet. The room and staff were equipped to handle anything short of a Cesarean-section, which, if necessary, would have been conducted in an operating room down the hall.
Afterward, the nurses weighed and tested little Alessandra Priore right there in mother’s room, cleaned the baby and departed, leaving her in a heated bassinet by Priore’s bedside. Mother and child were ready to go home the next day, although Priore opted to rest an extra night at the hospital.
“I liked her experience,” Fazio said of her daughter’s delivery, which she watched through semi-transparent curtains veiling the bed. “Everything went so fast. It was wonderful.”
“My mom told me what it was like back then,” Priore said, referring to her mother’s childbirth experiences. “I can’t imagine having to move from bed to bed and not having my husband with me.”
Priore is part of a new generation of mothers who are part of the third phase in giving birth since home deliveries of long ago--single-room maternity care and a focus on family involvement in childbirth.
The first phase is what Fazio experienced, a veritable assembly-line process. Then came “alternative birthing centers,” available only to a small percentage of women with low-risk pregnancies who could undergo natural childbirth. While families were allowed to be present at the births and infants could stay in the room after delivery, mothers were generally discharged within 12 to 24 hours.
LDRPs take family involvement in childbirth a step further by emphasizing bonding from the moment the baby is born. Many LDRPs have beds for fathers who want to stay and help care for their babies. Northridge Hospital stocks a refrigerator with juice and water for overnight guests.
LDRPs also give the mother more control of the situation. Aside from not having to endure room-to-room transfers, an expectant mother can have her mate, or entire family, with her during delivery. She can choose to have an anesthetic to relieve labor pains. She can take a shower in the middle of heavy labor to cool off. She can watch television.
Stacie Mulder’s fiance, 22-year-old twin sister, best friend and aunt comforted her during 19 hours of labor at Northridge. After Mulder’s son was born, her fiance, Sean Jones, 22, of Van Nuys, slept in her room on a bed that pulls out of a wall unit. “It was pretty comfy,” Jones said. “It was nice being in there with her so I could help her.”
Jones, an active-duty reservist with the Navy’s Seabees, was given a two-day leave from his military construction unit for his child’s birth.
Gloria Hill’s two children skipped school and waited just outside her LDRP during the birth of her third child. The hospital would have permitted Deanna, 15, and Sergio, 9, to watch the delivery but Hill, 36, of Mission Hills, didn’t want Sergio in the room, and a tense-looking Deanna couldn’t work up the nerve to go in. “I don’t want to see my mom in pain,” she said.
Minutes after their sister was born, Deanna and Sergio eagerly entered their mother’s room.
The single-room maternity-care concept doesn’t stop when a woman gives birth. One nurse continuously cares for a mother and child during a 12-hour shift. That nurse is responsible for teaching both parents how to care for their infant.
“Our emphasis is on the family unit,” said Janet Rejkowski, a registered nurse certified in inpatient obstetrics who runs Northridge Hospital’s New Arrivals maternity unit. “When they go home and have to deal with the baby at 3 a.m., then they’ll know what to expect.”
Northridge Hospital is the only San Fernando Valley medical center with LDRPs; it has 19.
Valley Presbyterian has two Family Birthing Centers, which are smaller than LDRPs. A mother cannot stay more than 24 hours in these facilities. Hospitals with LDRPs allow a longer stay, although usually mothers and newborns go home 24 hours after delivery.
Joining the national trend toward single-room maternity care is another Valley-area hospital, Glendale Adventist Medical Center, which plans to build 34 LDRPs by 1993.
In the meantime, Glendale Adventist, along with St. Joseph Medical Center in Burbank, offers LDR rooms, where a woman goes through labor, delivery and recovery before being transferred to the room where she’ll spend a night or two. Although the birthing process is less trying for the mother, the child starts life away from mom in a nursery.
Northridge has a small nursery in New Arrivals, but nurses encourage mothers to keep their babies with them and will offer to check in on mom and baby throughout the night.
Ultimately, however, the mother decides where her baby sleeps. Priore requested that her infant stay in the nursery at night because “my stitches gave me a lot of pain. I couldn’t get in and out of bed. During the day, she was with me and I had people around to help me.”
Most moms want their babies near them from the moment they’re born, maternity care specialists say.
“I loved having my baby with me,” Mulder said. “Even if he woke up, I wouldn’t have minded.”
“Research shows that most mothers rest better when the baby is with them,” said Ginny Reed, an RN who works for the Phillips & Fenwick consulting firm helping hospitals that want to update their maternity care programs. In response to this trend, a growing number of hospitals are building LDRPs.
Of the nation’s 4,300 hospitals with obstetrics programs, 20% have either LDRs or LDRPs, according to Debbie Bulger of Phillips & Fenwick. In 1989, a little more than 7% of births took place in LDRPs; the number is expected to nearly double this year. LDRs already account for a large share of births--36% in 1989, with an estimated 40% this year. Meanwhile, hospitals providing traditional birthing, where the mother is moved from room to room, dropped from 31% in 1989 to 23%.
“By the 21st Century, hospital maternity care programs will be almost completely LDRs and LDRPs,” Bulger said.
Although LDRPs are more cost-effective because of smaller staffs and fewer bed transfers and linen changes, many hospitals, such as St. Joseph, cannot build them due to space constraints.
The father of the single-room maternity care concept is Loel Fenwick, a South African doctor who was astounded at the state of obstetrics in the United States when he arrived in 1974. “Throughout the world, you would have a major battle trying to separate a newborn from the mother,” said Fenwick, an obstetrician who consults with U. S. hospitals wishing to improve their maternity care.
Yet in the United States, generations of mothers, some so anesthetized during delivery that they’d remain groggy for days afterward, were told that “a nurse had all this training and a pretty white uniform and cap and she could well care for your baby,” he said.
“I was amazed at the complexity of the hospital maternity process. Not only were women being moved four to five times, but they had an inordinate number of things done to them. The system designed for the highest-risk woman became the determinant of how deliveries would be.”
As a consequence, Fenwick said, “women were staying away from hospitals. They wanted to avoid loss of control, which is what had happened there.”
Anxious to stay competitive, hospitals in the 1970s and ‘80s established Alternate Birthing Centers for women opting for natural childbirth. The ABC room, with a low double bed, curtained windows, soft lighting and art on the walls, was designed to resemble a comfortable bedroom. But the ABCs posed a problem. Few pregnant women could use them because the rooms had limited medical equipment. An expectant mother with intense labor pains couldn’t even get an epidural injection for comfort. Doctors thought that the lighting was poor and tended to call the beds “back-breakers.”
Fenwick came up with the solution. In March, 1984, St. Mary’s Hospital in Minneapolis became the first to have a single-room delivery. Since then, hundreds of hospitals have raided their budgets to build LDRs and LDRPs.
LDRs and LDRPs are decorated like the ABCs. At Northridge Hospital, the rooms are done in shades of pink and feature whitewashed wood furniture, a television and a bathroom with shower. The only telltale sign that one is not in a hotel room is the fetal monitor on a night stand and a sink in the corner. The medical equipment is tucked away in a deep closet and the light is maneuvered on ceiling tracks from the closet to the center of the room. The blood-pressure gauge is hidden behind a wall panel.
“I love the room. I couldn’t be happier,” new mother Priore said of Northridge’s facility.
Coincidentally, new father Jones worked for the construction company that built the hospital’s LDRPs last year, and he hung the doors and wall units. “I said, ‘It’d be cool if I had a baby in one of these rooms.’ ”
While Northridge’s rooms are bright, St. Joseph, on the other side of the Valley, has done up its LDR suites in mauve and earth tones, with soft recessed lighting.
“You go from your bedroom to another bedroom,” said Cynthia Dunn, 31, who with her husband Jim drove all the way from Woodland Hills to Burbank to deliver her second baby.
“I feel comfortable at this hospital. It doesn’t feel like a sterile hospital facility,” Dunn said.
She gave birth to a boy on a recent Thursday afternoon while watching “CHiPs” on television. Her husband took pictures of the event.
In the LDR system, “the patients recover a lot faster because there’s not such a surgical aspect to their delivery,” said Lusanne Orme, head nurse in labor and delivery at St. Joseph. Some hospitals encourage expectant mothers to take showers and walk around during labor--whatever makes them feel comfortable.
Many doctors and nurses prefer working in LDRPs, they say.
“I think they’re marvelous,” said Dr. Louis J. Smith, a veteran obstetrician who has delivered babies in surgical delivery rooms, ABCs and, now, LDRs at St. Joseph. “They’re very convenient for the doctor and the mother. They’re equipped well enough to do any kind of normal vaginal delivery.”
“I hated the old system,” said Joy Chew, assistant head nurse at Northridge. “You were running down the hall and praying you would get the mother to the delivery room before she delivered. The LDRPs are just so much nicer.”