Aromatherapy. Pressure-point massage. Water therapy in Jacuzzi-style tubs, with an option to dim the lights and play music. It might sound like a plush spa, but these services are for pain relief and distraction, not pampering.
Welcome to the modern hospital maternity unit, where these choices and others — including acupuncture and hypnosis, or “hypnobirthing” — are becoming part of the standard tool kit for women in labor.
Such amenities can weigh heavily when a pregnant patient is choosing where to deliver her baby, according to interviews with doctors, nurses, and midwives at hospitals around the Boston area, and maternity services have had to evolve to keep up with women’s expectations.
In addition to touring a hospital and considering its quality measures — such as caesarean-section rates — many pregnant women are looking for a maternity team that will accommodate their vision of a highly personalized birth.
“They’re really shopping for the perks and fringes and how receptive you are to exactly what they are thinking about for their patient experience,” said Dr. Edwin Huang, chairman of obstetrics and gynecology at Mount Auburn Hospital in Cambridge. “I’m not sure if a patient cares that you have 20 different options; they just care that you have the one that they want.”
Mount Auburn and other community hospitals are seeing more and more women touring their maternity units from outside of the hospital’s primary service area, Huang and others said. They are fielding some very direct questions about their approach to labor and birth. In the view of many administrators, they are being carefully interviewed.
Community hospitals have been especially aggressive in marketing personalized services, to compete with each other and with Boston’s major medical centers. The downtown teaching hospitals highlight their expertise and ability to care for women with high-risk pregnancies who could have difficult deliveries, but they continue to draw low-risk patients from the suburbs attracted to their reputation and advanced technology — a phenomenon that contributes to soaring health care costs.
Community hospitals say they are trying to offer something different to keep pregnant women closer to home: a small-hospital culture with amenities that cater to individual patients.
“Within the boundaries of safe care, I think we need to be flexible and offer patients more possibilities,” Huang said.
Thanks to hundreds of smartphone applications and dozens of social networking sites catering to expectant moms, pregnant women today have access to more prenatal information than any previous generation. Caregivers say patients know what options are available at their hospitals and elsewhere.
“The world today is a closed, tight-knit network and it’s easy to find out what others are doing outside of your small community,” said Donna Sherrill, director of maternal child health at Winchester Hospital. “Patients are educated. They have done their homework and their research through Web searches, reading books, talking to colleagues, and they are clear, for the most part, on what they would and would not like when they come to deliver their babies.”
Women giving birth also tend to be older than they used to be. In Massachusetts, 53 percent of first-time mothers give birth over age 30, according to the state Department of Public Health. The extra years tend to bring more experience and confidence, with patients educated on their options and not afraid to ask questions, providers say.
“Many of our patients who are highly educated women are also used to directing in their daily lives,” said Deborah Carlson, a nurse midwife at South Shore Hospital in Weymouth. They’re not afraid to direct at the hospital, either, she said, adding, “Some of them may not have many more kids, so she wants to maximize the birth experience.”
For first-time mom Nikki Clapper, 35, of Somerville, it was important that she feel in control of her labor and childbirth. Clapper gave birth to son Cairo on April 23 at Mount Auburn. A book editor with a penchant for research, she wanted to make sure the hospital staff would respect her wishes for an unmedicated birth with as few medical interventions as possible.
“I did not envision walking into a hospital, having someone put a tube in my back, not being able to walk around, and having someone passively give me, my baby, and husband over to a series of assembly-line events,” said Clapper, referring to an epidural, the most common form of anesthesia for childbirth.
Maternity care trends have been shaped by women’s evolving beliefs and expectations. In the first half of the 20th century, most women gave birth at home, with no medication. Hospital births became standard in the 1950s, with doctor-administered pain relief, until the late 1960s and ’70s, when many women demanded a more natural birth process. Then in the 1990s, local providers say the epidural reigned supreme, and drug-assisted inductions and C-sections became more common.
Both doctors and midwives say that over the past decade, they’ve seen the pendulum swing back once again, with an increase in women desiring an unmedicated hospital birth.
The epidural, however, is still the most popular request by women in labor, with about 61 percent asking for this spinal anesthesia in 2008, the most recent year for which national data are available, according to the US Centers for Disease Control and Prevention.
Women are not turning their backs on medical technology and pain relief, but not every patient wants pain medication or spinal anesthesia right away, or she may want to attempt a natural birth. Even those patients who definitely want an epidural still want help getting through the early stages of labor. And they expect far more than a breathing coach and some ice chips.
Most notably, most community hospitals have installed in-room Jacuzzi bath tubs in many, if not all, of their labor and delivery rooms over the past 5 to 10 years. A few, including South Shore Hospital, offer much larger hydrotherapy tubs that can be moved into different rooms. At Winchester Hospital, patients can lie in a large Jacuzzi-style tub in its own room, complete with lilac-colored walls, a light dimmer switch, and a sound system for playing music they bring from home.
For women hoping to go the natural route, many hospitals offer services that, until recently, were provided only by midwives performing home births. They include hypnobirthing, which requires pregnant women to be prepared with several courses on hypnotic relaxation and breathing techniques before labor. And Mount Auburn is preparing to offer water births — where women deliver the baby in the water — in 2013.
While midwives and most maternity nurses are now trained in pressure-point massage techniques, Winchester Hospital has an on-call massage therapist affiliated with its Community Health Institute. In Concord, Emerson Hospital offers aromatherapy in its private rooms.
While not having a eucalyptus-scented hospital room isn’t likely to be a deal breaker, such amenities contribute to a hospital’s overall atmosphere and help patients judge whether they will be treated as an individual or pushed into a prescribed order of events.
That feeling was crucial for Clapper. “I don’t have a conventional viewpoint that causes me to say, Oh, this is how American women get pregnant and give birth,” she said. “I don’t take for granted that there’s one way for dealing with those things.”