A Doula Reviews a Hospital - UWMC Northwest Hospital

Location & Logistics:

• From the main hospital entrance, continue straight and turn right at the Emergency Department. Follow that road as it snakes around the back of the hospital and it will lead you to a parking lot outside the "Totem Entrance". Park there! 
• Parking is free on weekends, you have to pay during the daytime M-F
• Entry to the Childbirth Center is through the Totem Entrance, straight down the hall and then take a right. There is ample signage and hand sanitizer on the way! Note the bathrooms immediately to the left when you walk in... those are good for doulas!!!  
• After Hours: Still use this entrance, but when the doors are locked, press the silver call button and smile for the camera! Security will answer and you just have to say "I'm a doula, I'm headed to the childbirth center" and they'll open the door for you. Occasionally you need to know the name or room number of whomever you are visiting but not often. 

Types of practitioners:

• OB/GYNs: Meridian Women's Health is the main OB/GYN practice and they are by far the most beloved OB practice of the majority of birth workers. They are compassionate and practice evidence-based medicine with a strong love for doulas. 
• CNMs: The CNM group at the hospital is pretty phenomenal as well. They are now in a position where they can take midwifery hospital transfers as well, so we kinda love them more. 
• Hospitalists and Family Practice Doctors: None. This might seem a bit odd, but this is a small hospital and the doctors and midwives here take care of their own. 

How do they treat Out-Of-Hospital transfers?

• Compassionately. This is not a hospital where a midwife will be shamed for transferring (even an intended HBAC) and the family will be treated with respect and given ample opportunity to continue laboring as they intended as long as it's safe..
• The CNMs can now take intrapartum transfers as well so this is a lovely option for families to be aware of when transferring. 

Cesarean rate through the years:

• They have recently dropped their cesarean rate significantly and I believe this is due to nurses who are most all trained or at least incredibly knowledgeable in optimal fetal positioning techniques, and OB/GYNs who have taken very relaxed stances on induction, cesareans for arrest of descent/dilation and the like. 
• More statistics like the image above can be found starting on page 70 Right Here.

NICU level

• Level II: They recently partnered with Seattle Children's to have pediatric ARNPs on site and they can care for babies above 34 weeks gestation, but for anything major, they will transfer to UWMC-Main or to Seattle Children's Hospital. 

Natural birth rating: I give it 4 out of 5 birth balls!!!

• They don't allow for water birth so they don't get a full 5, but everything else bodes very well for those intending to have an unmedicated and low-intervention birth. 

Policy on food for patients

• Low-Intervention Labor: No restrictions
• Pitocin: No restrictions
• Epidural: Clear Liquids (popsicles are encouraged)

Where is the nourishment?

• Each of the two hallways have a nourishment room that is open to patients with a variety of juices, jellos, snacks, fruits, popsicles and a small array of postpartum meals for patients who birth while the cafeteria is closed.
• The Cafeteria (Checker's Cafe) is right below the childbirth center. Take either the elevator or the stairs right across from the fish tank in the lobby down to the first floor and follow the hallway to the left. Checker's is open for Breakfast: 6:30 a.m.–9:30 a.m, Lunch: 11:00 a.m.–2:00 p.m. and Dinner: 4:00 p.m.–7:30 p.m.
• Starbucks on site (down closer to the main hospital) is open M-F, 6:00 a.m.-1:30 a.m. & Sat-Sun, 6:00 a.m.-7:30 p.m.

Labor Tub Options and Review

• I give this one 3 out of 5 duckies. Not all rooms have a tub, and those that do are super cramped. This is changing when the hospital's new birth wing opens in 2020. The rooms that do NOT have tubs do have a shower (a very small shower... I think boats have bigger showers) and there are two "tub rooms" in the middle of the right hallway that anyone can use with really nice tubs in them. There's not much in the room other than a tub and a shower chair, but they do the trick. While the tubs in each of the two rooms are identical, there are differences between the two rooms so take note... the first one on the left is smaller but is able to be dark. The second one at the end of the short hallway is larger and has a fetal monitoring cart in it, but it has high windows with no coverings. It's important when discussing taking your client to the tub rooms to let them know the difference and help decide which one they prefer. I personally like the first one that can be dark... the nurses will come in periodically with a doppler to monitor if you're in this room. 

Birth suite tips, and tools:

• I'm a well-known linen succubus and there are blanket warmers in each of the two hallways so just ask a nurse and they will grab you one. 
• They do have balls, peanut and round, in loads of sizes. There is also a cub and a birthing stool (not a Kaya for use in water, but a land-based sparkly blue one with handles) and squat bars are in the equipment room so you need to ask for them but they have them!!

Partner accommodations

• The partner-bed isn't too shabby... I think it's supposed to be a twin and while it is a bit narrow, I've slept on it happily many times and seen many partners snoring away on it. 
• Included with your stay is food for the laboring person and you can order a full meal "for them" every 2 hours... so if you don't mind eating at separate times... it's a thing that happens a LOT. 

Doula friendly nurses?

• Literally every single one.... they love us and we love them.

Medication Options and Restrictions available

• Nitrous: the nurses control this and anyone can use it. You just need to ask. It's amazing. 
• IV Narcotics: Fentanyl is available if the provider orders it
• Epidural: available though sometimes there is a wait because the anesthesiologist might be busy. There is usually only one anesthesiologist available and if someone is having a cesarean, you will have to wait. 
  • The epidural can be placed while you're in your room, though sometimes they limit the support to only one person so you'll have to ask people to step out. Those that stay will have to sit. No fainting!!!
  • More often than not at this hospital, I've seen epidurals not work well enough and the doctor is called back in to give the patient a bolus of medication. This must mean they default to a lower dose as I've also seen patients with a lot of mobility for their birth and most can still feel the urge to push!!

Cesarean 

• Due to the small size of the ORs, Doula support was limited until recently.  Thanks to some passionately pro-doula OBs, the push to include doulas in the OR has been practically fully accepted. You might need to ask for a second bunny-suit as the nurse might not bring it, but it's pretty common for doulas to be allowed in.
• As is standard, the doula and partner will sit outside the OR while the patient is prepped, draped and properly anesthetized. Then we get to go in!  
• Recently, I saw them use some fantastic plus-size specific tools for cesarean birth, including the use of the Alexis O Retractor and Negative Pressure Wound Therapy. This made me super happy. 
• The OBs at northwest also offer a clear drape for those who would like to see the birth of their baby, and they are happy to allow skin to skin immediately after birth with either the birthing parent or a second person in the room. 

Postpartum & Lactation:

• The hospital is great with immediate postpartum bonding for parents and baby... skin to skin is encouraged and the baby is left on the chest for the "Golden Hour" while the nurses cluck away teaching the parents about newborn cues and how to look for signs that the baby is ready to feed. 
• Lactation support is also top-notch and I give it 4 out of 5 drips. They have been a "Baby Friendly" hospital since 2017 and it shows in the compassion and care of the nurses as they educate and support breast/chest-feeding families. I do wish they had more of a follow-up system similar to Evergreen's Postpartum Care Center Appointment, but it's pretty good besides that!

Special Considerations

• VBAC: I legit wouldn't go anywhere else. Meridian Women's Health is fantastic for those considering a VBAC and again, their generous timeline for birth, nurses trained in Spinning Babies and evidence-based views on going postdate as a VBAC lead to an outstanding VBAC success rate. Personally as a doula here, I have a 95% vaginal birth rate with VBAC patients at this hospital. 
• Twin and high risk care providers: The OBs at Meridian Women's Health are phenomenal with twins at this facility. I've seen vertex and breech twins here, and they are gentle with their induction and generous with their timeline as long as all are healthy.
• Placenta release: Easy peasy. They don't send the placenta to pathology unless there is an infection or other reason for further examination, so most parents can take it home immediately or have a designated placenta person pick it up. 

---