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Posts Tagged ‘hospital birth’

There are people who really believe that having a baby is inherently dangerous. Maybe more dangerous than extreme sports.

Not just people watching A Baby Story on TV, where women are routinely whisked away in a panic for surgery. Not just people regularly watching women on soap operas faint, only to find out they are pregnant. Not just the drama made for television and the movies, teaching us visually that clearly most women just aren’t up to the job of birth- it’s way too hard, too painful, too scary.

According to some medical providers pregnancy and labor (but especially labor) are accidents waiting to happen. And for these practitioners, the idea of a woman giving birth outside of a hospital setting is selfish and extremely dangerous. For all who believe birth is inherently dangerous, I bring you Birth – an Extreme Sport.

Welcome to the Birth Arena.

First in the line-up is Mary Averagemom. A generally low risk pregnancy, Mary’s fundal measurements were on target with her estimated due date throughout her pregnancy. Her practitioner began discussing induction at her 35 week appointment, to prepare her for this eventuality. He also offered to schedule an elective c-section at the same appointment.

When Mary made an appointment, at about 5 months along, specifically to discuss her written birth plan, her provider reviewed all the items and agreed to all of the options, as long as there were “no complications during labor” and “assuming hospital policy allows it.” This included intermittent EFM (15 min on, 45 min off), no IV, no induction/Pitocin, no epidural, eating & drinking during labor, husband and doula present, squatting for the pushing phase and baby presented to Mary skin to skin at birth.

Hospital policy did deny food during labor, but Mary was told the other requests listed were the doctor’s prerogative. So begins this Extreme Birth– because shouldn’t these be Mary’s prerogative?

Throughout her time in the hospital, even with the support of her husband and doula, Mary was bombarded with pressure from staff (nurses and OB) to consent to protocols. Mary refused the unnecessary IV line 4 times before being told she could not decline. Although she had discussed intermittent use of the EFM for monitoring well in advance of labor, (and agreed to 15 minutes of monitoring per hour) she was regularly scolded for detaching the belt and getting out of bed to change position. (The staff did not respond to Mary’s call button at the agreed removal time- another example of ignoring her limited consent.) Pitocin was brought up multiple times (at least 4) although Mary was clear she would not consent to Pitocin during early labor.

When it came time to push, Mary was told not to push(!) because the doctor was delivering another baby down the hall. When pushing did not go according to the count, Mary was scolded and told her wasn’t trying hard enough. (This all followed an argument about the use of the squat-bar on the bed -part of the original birth plan, which the doctor had affirmed agreement to at 8:30 am that morning. It’s extreme that a doctor would attempt to argue with a woman in labor, ready to push, and expect a discussion. Words don’t come easily during pushing and I believe he expected Mary would be unable to defend herself at all and simply yield to his preference- which eventually she did.)

Following “delivery”, minor tears were sewn while baby nursed. Nursing staff refused to speak to Mary after she’d been so difficult. (Doctor also left the room without a word.)

This is extreme treatment. Ignoring consent. Condescension. Mary’s discovery that her doctor had no intention of honoring her birth plan- finding this out during labor!Extreme measures that disregard the definition of CARE for women.

Care- to be concerned or attentive; have thought or regard; with the opposite being indifference. But this “care” was indifferent, and the fact that this is the standard of care, means the standard is indifferent to women.

Contestant number 2:

She’s mom to a young toddler, pregnant with baby number 2, and views birth as a physiologic process designed by God. She’d like to birth in an environment where she is respected, her choices are honored, and no one is trying to rush things along. She’d also like the option of having child #1 present to witness the birth of her younger sibling. Meet Hannah Homebirth.

During her first birth in a hospital, she experienced care like Mary’s. She wants to avoid a repeat of that routine treatment and has chosen a homebirth midwife for prenatal care and to attend the birth.

Hannah read several books about birth during this pregnancy: Henci Goer’s The Thinking Woman’s Guide to Better Birth, Pam England’s Birthing from Within, Ina May Gaskin’s Ina May’s Guide to Childbirth.

She discussed with her midwife reasons a transfer to a hospital might be needed. Which hospital, admissions through ER, the potential reception by staff. Hannah and her husband have discussed reasons to birth at home, concerns, risks with each other & their midwife.

The time for labor came on naturally, 40+ weeks. Hannah drank some water & ate a granola bar. Contractions just begun, a walk around the block brought Hannah into active labor. Doula & midwife arrived to find a relaxed, focused beginning labor. Hannah headed to the birth ball and asked her husband to fill the tub.

The water- the heat and buoyancy- relieved a lot of pressure. Contractions became closer, stronger. Hannah requested no vaginal exam & although the midwife legally had to offer and document findings, the exam was presented as an option. She refused each time, feeling no pressure.

Encouraging words spoken through labor- “You’re doing a great job!” “The baby is doing great” (after intermittent Doppler check.)

Pop! Water bag spontaneously broke at 9:15 pm. (Light on.) A quick check revealed no meconium in the fluid. (Lights back out. Candles flicker.) Relief of darkness & relief at clear fluid.

Time to push. On hands and knees, semi-upright, Hannah roars her baby out slowly. No one else present makes a sound. Once her head is out (and midwife checks for cord), 2 pushes bring her fully into the world. To Hannah’s breast, a beautiful baby girl! 9:45 pm.

Perhaps these are the extremes: from indifference to genuine love. But it’s an extreme worth looking into. I don’t want my birth to be part of someone’s routine. I want my birth to be part of someone’s passion.

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When I was pregnant the first time, I didn’t even know women still had babies at home anywhere hospitals existed. It just didn’t occur to me. I’m not sure if knowing other women made that choice would have had any impact on my decision to go to a hospital. Maybe. But probably not.

I followed the rules. I was an inside the box kind of woman. I thought going to a hospital was the safest thing to do. I didn’t spend much time selecting my OB. It didn’t occur to me that I could interview and select for myself, not just get whoever was available. I didn’t realize that I wasn’t automatically an OB patient at my GYN’s office. No one ever expressed it any other way, so I went along.

I just didn’t know what I didn’t know.

I wanted a natural birth in a hospital setting. I wanted to move around. I asked in advance about using the hospital’s “special” squat bar during the pushing phase. I got “ok’s” for almost everything I asked for. I didn’t think what I was asking was too big a deal: no IV, limited fetal monitoring, freedom to move within the room, choice of pushing position, my husband and doula present. But apparently that’s not the standard at the hospital I chose.

So even though most things were “ok” no one was comfortable with my choices. The nurses got angry when I removed the EFM belt to get comfortable. I refused the IV 4 separate times before they decided I needed antibiotics- intravenously. I was offered an epidural at least 4 times. Finally the nurse had had enough and stopped coming into the room.

When I reached transition (and was vomiting into a small bedpan) she poked her head in, saw me vomit- and left my husband holding the plastic pan! (He still talks about this.)

And when I began to push before the doctor arrived, I was admonished. Then, I was criticized for not pushing right, for not pushing to a count, for not trying hard enough. At one point, the nurse said “Do you want to have this baby or not?” as I was not pushing, while waiting for a contraction.

At that moment, I angrily thought “No! If I could choose, I’d stop right now, walk out of here and never come back!”

It wasn’t until later that I realized the staff was unprepared for someone like me. They had procedures and protocols in place to do their daily work and I didn’t fit into the mold of their day. They had little or no experience with childbirth with no Pitocin and no epidural. They didn’t know what to do when I got out of bed and used the toilet, because the other women in labor couldn’t walk around because they didn’t feel their legs!

So I think, looking back, that I frightened them. Maybe I made them wonder why, when I pushed back against their idea of normal. (It probably didn’t help that my baby crowned at 3pm, just at the shift change for nursing staff.) I was different, unusual for this hospital. Even though the hospital tour touted the advances in equipment- like the squat bar, no one actually used this stuff. The doctors didn’t like it, so it was there mainly as part of the sales pitch.

When I look back, I realize that the staff wasn’t able to support me- not because they didn’t want to, because they didn’t know how. These were not evil hospital workers, intent on intervention at every turn. These were people, doing their jobs to standard, the way they were taught. They believed the IV was important, and that’s why they insisted on it. They were not trying to step on my rights as a patient, but they didn’t really understand why I was asserting myself. It was foreign to them.

They probably didn’t know (and maybe still don’t) that you can’t push when it doesn’t feel like pushing. And you can’t not-push during a pushing contraction. It might have been the very first time they saw a woman in labor without drugs. So how could they know what I really needed, when they had never seen this before?

I knew I had to try something new for my next time. I needed to find a care provider who would understand and respect my choices, and I needed to find a care provider that trusted my body as much as I did. That was the beginning of my transition out of hospital birth.

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I love books about babies and pregnancy and childbirth. I love reading what others have to say. I love it when my mind opens to new information and I stand back and think to myself- Well, that’s a new way to look at it.

I spent so much of my first pregnancy devouring as much as I could and still feeling like I was missing out on something important. I felt talked down to at times. I felt pressured to “do the right thing” which amounted to whatever that author thought was best for me- for everyone, I guess.

I was already a stressed out, type-A personality, perfectionist, trying to do everything right. So why didn’t it feel right to be told what to do? I didn’t even like it much when it was my doctor. And it wasn’t the authority thing- I was a rule follower. Totally inside the box, I thought…

I recently came across a new book on homebirth. I had a hospital birth and a homebirth, so I like books that talk about differences, that give different sides to the whole birth story. I definitely preferred homebirth- but it turns out I’m a bit more “outside the box” than I thought 5 years ago.

When I went to Amazon to read some more and check the reviews, I was surprised by the number of negative comments about this particular book. The readers talked about the level of judgment in the author’s tone: that instead of being a positive “why homebirth is great” it was a judgmental “why hospitals stink” kind of book. I was disappointed and moved on to something else.

Then a bit later in the day, I saw a comment on Facebook where a woman said “there’s no such thing as a natural hospital birth.” Her opinion was that hospitals don’t do anything naturally, so there’s nothing natural about hospital birth- period. And it sounded like she might think there is a “right way” to birth, too.

Does it do any good to bash women over the head with opinions and judgment, when they make different choices?

I consider myself a homebirth advocate. I think it’s great. But it might not be for everyone. For example, if you want an epidural, you generally can’t get one of those at your house. To me, birthing naturally means going with the flow of your heart and soul and body. And if you feel safest in a hospital, you probably won’t find homebirth peaceful, because you’ll be all worried about the “what if’s.”

And if being in a hospital doesn’t bring you comfort, it’s time to consider alternatives like homebirth or an independent birth center. And just like the judgment of “hospitals are not natural” it doesn’t do any good to hear judgments like “you’re putting your baby’s life at stake” by choosing homebirth if that is what fits you best.

Truly, the most recent data shows homebirth to be as safe as hospital birth for low-risk mothers and babies under midwifery care. So I’m going to say that the other way too- hospital birth is as safe as homebirth for low-risk mothers and babies, especially under midwifery care.

And although the same study shows hospitals are likely to perform various interventions more frequently, I don’t think that was really ever questioned. It’s one of the criteria women use to make the choice of where to birth. Some women may actually want an intervention (like epidurals).

Here is my point: women who advocate choice in birth ought to applaud all women who consciously choose their birth place. Yes, it is often a default- not choosing, but for some women, hospital is their actual choice.

This whole argument about the “right way” got me thinking about how women are consistently told what to think when they’re pregnant. Like somehow people think that our brains are no longer capable of choosing for ourselves; we somehow lack the capacity for sound decision-making because of what? Hormones?

And educating women about fully informed consent, informed refusal, and consciously choosing options for birth can only happen when women can hear it. Judgment closes minds, creates defensive posture internally and shuts us down.

But helping a woman open to her own voice, validating the truth inside her- no matter what that looks like, respecting her as a wise and powerful woman, empowers her to be everything she is here to be; to choose the best way for her as an individual.

Most simply, I think of it like this: Although my experience giving birth at a hospital was a very negative experience, it gave me so much strength later on. I learned so much about myself because of that one choice. Who am I to assume that the opportunity for your personal growth in pregnancy and childbirth lies only in one specific direction?

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