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Posts Tagged ‘midwife’

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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I have a theory. You are the expert when it comes to your own body.

I’m not saying doctors (or midwives, nurses, etc.) are unimportant- in reality, the knowledge they wield is incredible. But their specialty is THE body, not YOUR body. And what they learn and study is great because there are things that every body has in common. Biology has made us each unique and yet the same. (It’s pretty incredible when you think about it.)

People who study THE body understand that normal is not exact- it’s a range. And sometimes even the range of normal can vary by individual. For example, blood pressure is considered normal generally when the systolic pressure (the first number- when the heart contracts) is between 140-90 and the diastolic pressure (when heart is relaxed) is between 90-60. So average normal readings would fall between 130/85 to 90/60. The upper ranges of each number are generally considered borderline for hypertension.

I’ve always had a generally lower average. I’ve had healthy readings as low as 70/35 with no signs of illness, dizziness, etc. Is it outside of normal? Yes, absolutely. Did my doctor want to review some other factors to make sure I was ok? Yes. But at the end of the day, she said it didn’t appear to be a problem and we left it alone. My readings are always at the low end of normal or just below. And this is why watching the other signs my body provides, and talking with my care provider about them is so important.

I’m the only one who knows if I feel dizzy (assuming I didn’t just fall down on the floor). I’m the only one who knows if I’ve suffered blurry vision, weakness, sleepiness- all signs of blood not getting to where it needs to go. So if I am paying attention, I can relay the additional information needed to fully understand the significance of test results. Without my input, my doctor might have unnecessarily prescribed medication.

On the other hand, people may experience the symptoms of hypotension and be within the low normal range. Knowing what feels right in your body is a big part of partnering with your care provider to receive the best care.

When you’re pregnant, there are some changes to your body you can’t miss. Who could NOT notice the belly that makes it impossible to button your favorite jeans? Paying attention to other aspects is just as important.

You are the expert of your specific body. Your midwife or doctor knows what is normal for the average body, and your individual input can have a significant impact on the care you receive. Be sure that you choose a care provider who is open to hearing what you have to say about any symptoms you are experiencing. (S)he should also ask you questions that might lead to this type of conversation to give you an opportunity to discuss anything unusual.

One last thing: Many first-timers might be thinking “How do I know what’s unusual? I’ve never been pregnant before.” And because this is true, you may find you have even more to talk about. Don’t be afraid to ask questions about what you’re experiencing. The books written about pregnancy are not meant to substitute for the personal care of your midwife or doctor.

If the book says it’s normal, but you feel abnormal, bring it up. This is what you’re paying for!

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