As I've been thinking more about why I appreciated my birth centered births, I realized that it had a lot to do with how the care was centered around me, not the staff. So, I've thought about what that means and what might improve that for hospitals...so here's my modest thoughts on that issue.
1)Options. Women need to given information on the options and choices available to them before they even enter the hospital, and it should be provided to them by their chosen providers. It is unfair to expect women to have to go out and find their own information, especially if they don't even know that there are options. For instance, intermittent monitoring is a option for women...do they know that? Most don't. A hep-lock or no iv at all is an option for women who don't have an epidural at the time. Even if they plan on getting one eventually, they should at least have that option to begin with. If you are able to move, why not take full advantage of that. But it should be something that is discussed before they arrive at the hospital.
2) Informed consent for procedures. This should also be given before a woman arrives at the hospital.
3) Admissions. We've got to fix this for laboring women. For those who are induced or come in for a scheduled c-section, it is not a big deal. For a woman in labor, though, having to answer the questions is difficult. It's not impossible, but to really be centered around a woman and her care, we should find away to get the information we need without distracting a woman from her task. At the birth center I went to, this was not even done, because they had my records on hand with them from my pre-natal appointments.
5) If procedures are needing to be done(like iv, breaking the water, admissions questions), other personnel should be on hand to simply provide labor support or emotional support.
6) Interventions should be minimized unless requested or needed.
7) Please take that BP cuff off between blood pressures(unless the mother would rather it stay on).
8) We need to take a look at how we do c-sections. Why not allow the support person in earlier? Why do we have to tie down a woman's arms? Why not allow her to see the baby right after it is taken out? Why not let the mom and baby stay together as long as the baby is ok? More emotional support is needed during the mothers stay at the hospital.
9) Nurses need be trained in labor support. I use these skills even with those who have epidurals. For instance, did you know that the uncomfortable pressure at the end of labor can be helped by sitting up in bed? Or if the epidural only works on one side, you can use counter pressure to alleviate some of that pain. Wet washcloths are great for moms who are pushing for a long time. These are things that nurses aren't taught. And of course, this knowledge would be a huge benefit to those who are choosing not to get an epidural.
10) The room layout should be made with a laboring woman in mind, as well as the nurse and doctor. The beds should be made for the convenience of the laboring woman, not the doctor.