April 19, 2017
In ancient times, some women would hire people to scream for them during childbirth, so everyone in their town would know they were toiling appropriately in labor.
After childbirth’s move out of the home and into hospitals, expectations shifted and women used modern medicines to be completely pain-free during labor — and in some cases were knocked out completely.
“Birth culture and expectations fluctuate throughout history,” said Amber Price, vice president of women’s and children’s services at HCA Virginia’s Henrico Doctors’ Hospital.
“When the epidural came along, women thought they could have the best of both worlds: They could be alert and a decision-maker, yet be pain-free during their labor.”
But even the epidural has its downsides. Many dislike that it increases intervention, making it harder for some women to push. And it lowers blood pressure, which results in an increase in caesarean sections.
The trend in birth culture today could be characterized by choice for those who can afford it.
Women can choose low-intervention births; a scheduled C-section followed immediately by skin-to-skin contact with their baby; or an epidural — and Price has made an effort to make all those options a reality for women at Henrico Doctors’ Hospital.
The hospital in western Henrico County is in the midst of a $40 million renovation and expansion to create what it has deemed the Women’s Hospital, a tower of the facility devoted to women’s health where labor and delivery, mother-baby and antepartum rooms are clustered, as well as operating rooms for gynecologic surgeries.
“(Patients) want to be part of a care plan where they can have choices about how they receive their care and do so in a way that centers around the family-centered care model that I think women are really appreciating today,” said CEO Will Wagnon, who recruited Price to the hospital from VCU Health about two years ago.
The Women’s Hospital opened in December, and work is underway on the final phase to move in the neonatal intensive care unit, which should be completed by October. At that point, all women’s services will be located in one part of the hospital.
Price said the renovation allows Henrico Doctors’ Hospital to build the facility around the various choices available to patients and allow them to select the birth experience that’s right for them.
“I take great satisfaction in making sure the basket is full and you only pick out of the basket what you’re looking for,” she said.
The Women’s Hospital construction began in September 2015. It includes renovating 72,000 square feet and adding a 12,000-square-foot lobby, so patients can come straight through the door and into the 16-room labor and delivery unit.
Each labor and delivery room has new features, such as lights that allow patients to choose the color of the room they like best, or even gradually filter through various colors. Price calls it light therapy and said it can help improve patients’ moods while they are in labor.
Every room also has its own tub deep enough for a pregnant woman and her entire belly to become immersed in water. It is not for water births but rather facilitates hydrotherapy.
More than 60 percent of the women seeking low-intervention or natural childbirth use the tub or shower at some point during their labor, Price said.
“It’s instant pain relief,” she said. “It relieves the pressure, because you’re weightless underwater. And it also feels really private.
“People can’t get at you when you’re underwater, so there’s that extra layer of feeling like you’re truly alone.”
The renovations also include updating the 27-room antepartum unit for women who have complications during their pregnancies or for those recovering from gynecologic surgeries.
A community room was added to the unit with doors wide enough for a bed to fit through. That was particularly designed for women who have to stay in the hospital for weeks due to pregnancy complications and gives them a chance to speak with others in similar situations.
The antepartum unit is connected to the 29-bed mother-baby, or postpartum, unit, for women to recover after delivery. The rooms were fitted with king-size beds to create a more home-like atmosphere.
“Birth is essentially a normal life event, and you don’t need to be in a typical hospital bed unless there’s a risk,” Price said.
The flow of the mother-baby unit was changed as well. Previously, babies were kept in the nursery, which is still an option if mothers prefer that, but now the default is to keep the babies in the mother’s room.
“That really helps increase breast-feeding rates and helps mom feel like she has a toolbox when she goes home, that she understands how to take care of her baby well,” Price said.
Henrico Doctors’ is not designated as a “baby-friendly hospital,” which is a program started by the World Health Organization and the United Nations Children’s Fund to boost breast-feeding rates. The designation requires hospitals to give infants no food other than breast milk unless medically indicated.
Price said Henrico Doctors’ goal is to maintain as much choice for the mother as possible, which means allowing her to feed her baby formula if that is her preference.
Price said Henrico Doctors’ Hospital expects to deliver about 4,000 babies this year.
“We also know that 19 percent of women in our community are looking for completely low-intervention labor,” Price said.
Low-intervention labor means women desire little to no medical intervention. It typically involves being able to walk around and move during labor, and many women use midwives rather than physicians when choosing this birth option.
Overall, Henrico Doctors’ has a 35 percent C-section rate, compared with a national average of 32 percent. Price said that is because Henrico Doctors’ is considered a high-risk hospital, so many of its patients are more likely to need surgical intervention.
But of the women who seek low-intervention births at the hospital, she said, the C-section rate is only 8 percent.
Price described the hospital’s labor and delivery unit as neutral, meaning no particular physician practice presides and a woman can choose to have either a midwife help her during labor or a physician.
“Any patient who wants to use a midwife can use one here. You don’t have to leave your doctor,” she said.
The renovations allowed the hospital to build its facility around the variety of care options it gives women in labor, Price said.
Before the renovation, for example, the hospital had one submersible tub that laboring women would need to leave their rooms to use. That meant it was not heavily utilized.
“That’s the cool thing about getting to start from scratch — you get to sit around a table and say, ‘Well if I were this patient, what would I need?’” Price said.
The last thing Carter Brown was expecting were twins.
Though they didn’t run in her family, she and her husband warmed to the idea as her pregnancy progressed. But then, even more unexpectedly, Brown’s water broke at 33 weeks and a day.
It turned out to be good luck that she went into labor early — one of her sons, Kobe, had his umbilical cord wrapped around his neck. Had the water of his brother, Camden, not broken, Kobe’s circulation may have become impaired.
“Camden saved Kobe’s life. That’s the story,” Brown said.
She and her husband chose Henrico Doctors’ Hospital because their preferred doctor practices there, but Brown said she was particularly glad they chose it because after her sons were born March 10, they needed to stay in the hospital’s neonatal intensive care unit, or NICU, for several weeks.
“It’s a horrible time, honestly,” Brown said of keeping her sons in the NICU. “These little guys are born and you think about how it will be when they get here and taking them home, and people don’t think that they’ll have them and won’t take them home.
“So it’s even that much more important to have a place where you can feel really comforted with leaving them, even though it’s really emotional. It’s never been a question that this was the best place to go.”
Right now, Henrico Doctors’ NICU has 10 rooms with two babies kept in each room. Once construction is done, the NICU will be centrally located in the Women’s Hospital with 40 private rooms.
“The parents will be able to take a shower, store their clothes, have a refrigerator in their room — for those who don’t want to leave their babies’ sides,” Price said.
Private rooms in the NICU also make it easier for mothers to have skin-to-skin contact with their babies, which some may not have gotten to experience after labor because their children were rushed into intensive care.
Skin-to-skin contact helps to regulate the baby’s temperature after birth and also facilitates healing in the mother, thanks to the endorphins that are released.
“The worst part is when you have this vision for your birth and none of it goes the way you expected,” said Price, who also is a certified nurse midwife. “But then to be given the opportunity as soon as your baby is stable, that’s a healing thing.
“I believe that if women get the birth experience they’re looking for, then that translates into empowerment and solid mothering.”
This article originally appeared in the Richmond Times-Dispatch