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THIS is How We Birth in America?

admin April 24, 2012

I am incredibly annoyed and frustrated as I write this.  I’m writing it because it has to be said.  It’s something I’ve thought for a long time, but it’s two events that occurred in a single day that pushed me to do this now.

First, I read a beautiful planned-HBAC story that ended with surprise breech twins with cord prolapse.  That last part is important.  Those twins were delivered vaginally, by the way.

Second, someone I know was induced just past her due date so that family could be in town for the birth (no medical reason).  This also resulted in cord prolapse, followed by an emergency c-section.

Both stories ended with healthy baby(ies).

Get Some Real Medical Care

A few of the comments on that beautiful HBAC story (seriously, go read it if you haven’t clicked over) are really nasty.  “Go get some real medical care…that midwife was negligent.  You’re lucky this ended okay, stop encouraging women to birth outside of hospitals.”

Really?

Let’s go through the series of events in each situation (as far as I know them).  In the planned home birth, there was a concern of early labor, the midwife advising the woman to head to the hospital because this was outside her scope of care. The babies were born vaginally before intervention could reach them, even with the cord prolapse situation.  I’m pretty sure the midwife — by staying on top of the situation and referring the woman when needed — did exactly what she should have done.

In the planned hospital birth, an induction was scheduled for personal preference, not for any medical reason.  As far as I know, there were no risks/benefits to inducing discussed — it was just a matter of choice, like choosing which shirt to wear that day.  Pitocin was administered, then water broken, but because the baby (likely) hadn’t dropped yet, cord prolapse resulted.  And then an emergency c-section.  The doctor failed to inform the patient of the risks, and by intervening when not medically necessary, potentially caused the prolapse to occur.

Which mother needs to “get real medical care,” again?

I absolutely can’t stand that because it was a “professional” OB in a hospital setting, this situation was completely excused and ignored.  “Oh, it’s just one of those things,” or worse, “He saved the baby!”  Yeah, only after he caused the problem to begin with!

Yet when a midwife is conscientious with her clients, keeps on top of their situations, and refers care if and when a problem arises, “She’s terrible and has no training and could have killed the baby, you’re just lucky!”  No.  She behaved professionally and appropriately.

Just let this seep in for a moment.  In a medical setting, anything is acceptable and excusable to many.  Inductions and c-sections and all of these other interventions are discussed casually, even jovially by some.  This is how we birth in America.  We birth with interventions, and if something with those interventions goes wrong, “They did the best they could; it was just one of those things.”

But God forbid you step outside the mainstream and plan to birth in a birth center or at home.  Even if things went well, but there were some tense moments, “It was bad.  This is why women should not have home births.”  We’re brainwashed to think that more intervention is better!

Is The Hospital Less Risky?

One of the primary arguments for birthing in a hospital is that it is less risky.  “If something goes wrong, then they can intervene immediately.  Sometimes things go from okay to really bad very quickly and there’s no time to call for help.”  This is true — except, of course, if something goes wrong while you are alone in your room and the nurses are too busy to come and check on you (or you don’t realize it and call them).

Whereas a midwife is typically by your side and checking you frequently.  The delay in getting care in a hospital because of the busy-ness of the nursing staff and the need to page a doctor may be about the same as the quick ride to the hospital, for those who live close.  But does that mean that you should be in the hospital for anything that might have risk?  Does it mean that the very tiny “what if” should guide your over all decisions?

But a hospital birth is not without risk.

In 1900, the maternal death rate was 850 out of 100,000.  By 1950, that rate had fallen to 83 in 100,000.  In 1987, it was 6.6 out of 100,000.  And in 2007 (last year I could find data for), it was…12.7 out of 100,000.  That’s right — the numbers are going in the wrong direction!  Maternal deaths have doubled in the last 20 years.  And this is as the rate of interventions, c-sections, and so on have risen too.  The hospital isn’t so safe for low-risk women.

That’s just the death rate.  Women have a 33% chance of ending up with a c-section, which is much higher in some areas.  There are hospitals with 50 – 80% c-section rate!  There is no justification for having a rate that high, ever.  WHO recommends no higher than 10%.  In 1970, the U.S. rate was just 5%.

There’s also the use of other unnecessary interventions: induction (Pitocin, Cervadil — both of which can be dangerous), forceps, vacuum extraction, epidurals, narcotic pain relief, etc.  Then there is the way they force women to labor — often on their backs or at least in bed, which is not the optimal position for most.  Women are forced to push on their backs, which increases the chances of lengthy pushing and need for forceps because the pelvic opening is 30% smaller and their bottoms are “up,” requiring baby to come out “uphill.”

And of course the newborn procedures…early cord clamping and cutting, vitamin K, eye ointment, Hep B, separation from mom, barriers to breastfeeding (in some hospitals), and so on.

These are not, for the most part, evidence-based practices.  Why would women who are low-risk and want respect for their birth process go to a hospital, where there is greater likelihood of unnecessary interventions, where the maternal death rate has doubled in the last 20 years, where their wishes may be entirely ignored?

THIS is How We Birth in America

All That Matters is a Healthy Baby…or Does It?

Several days after these two events, I read a story about a mom who was trying for a VBAC at a hospital.  She was separated from her husband, coerced into the OR, and gassed without her knowledge (they told her it was an oxygen mask), and given a c-section without consent.

The best possible reason for this is that the baby took a turn for the worse. It happened fast, and they decided to go ahead with the c-section to save her baby.  They had poor bedside manner and neglected to tell her what was going on (even after the fact).

The worst possible reason is that they simply didn’t like that she was a VBAC mom and thought surgery would be easier and faster.  They had no respect for her autonomy as a person or respect for her to make her own decisions.  They tricked and lied to her in order to get her into the OR and gave her an unnecessary c-section against her will because that’s what they felt like doing.  The doctor and staff treated her as if she were a stupid woman, a mere vessel to deliver the baby, who had no rights.

It doesn’t matter which it is.  We don’t know and can’t spend forever speculating.  (By the way, no lawyer would take her case because there was “no evidence of permanent physical damage” to her or the baby.  The fact alone that her rights were completely destroyed does not matter.)

What matters more is the reaction this situation got.  “Stupid woman…that doctor obviously saved her baby…she deserved it.  She’s making this up.  Doctor knows best.  She should value a healthy baby over her own experience.”

What?

Where is the outrage over the way this woman was treated?  Where is the respect for her rights…or even her, as a person?  The majority of people sided with the doctor, and several even insulted her by insinuating that she didn’t care about her baby.

That is the most ridiculous thing I have ever heard.

“It’s not about the experience.  All that matters is having a healthy baby.”  Does it?  Really?  Then why are women suffering from Post-Traumatic Stress Disorder after giving birth?  That should not happen.  Giving birth should be an incredible, overwhelming, potentially difficult, but ultimately rewarding experience.  It’s like nothing else.

And it’s something that happens to both moms and babies.  We cannot ignore the mother’s role in the birth.  She is integral.  She is transformed from “me” to “mommy” that day.  Her body goes through so many changes for a 9-month period, and still more in the final days, as she prepares to birth.

Her body, during labor and birth, is literally beyond her control in many ways.  She can cope by turning inward and working with the process, rather than against it.  This produces a more relaxed mother, and an easier labor, which is better for the baby.  This experience cannot be separated into being about “her” OR “baby” because the two are intertwined and that cannot be changed…until the moment birth occurs.  Then they are, for the first time, physically separate — yet still emotionally intertwined.

It is one of the biggest experiences of a woman’s life, whether she’s done it once or twenty times.  To discount that is crazy.

Not to mention that the argument “You don’t care about your baby, you just want your good experience!” is insane on its face.  If complications arise and the baby suffers permanent damage or death, there is no good experience.  You will never hear a mother say, “Well, my baby died during birth, but at least I had a good experience!”  Never.

There is no mother out there who would choose her own natural birthing experience over her baby’s safety.  Even the most hard-core natural birthers, if told, “Your baby will die if you don’t have an immediate c-section” (and the reasons are valid, not “because it’s been more than 40 weeks” or something) will have the c-section and be glad for it.  I would.

Respect for the Birth Process and Women

We such a problem right now.  We don’t respect women and the birth process.  And unlike some, I don’t believe that’s because it’s women.

Consider this:

A woman enters the emergency room complaining of abdominal pain.  She is whisked back to an examining room and told “It might be appendicitis.”  She is then offered an oxygen mask because she’s having trouble breathing due to the pain.  She accepts it.  Only, it isn’t an oxygen mask.  She is put under general anesthesia.  There have been no tests performed, no determination that it is, in fact, appendicitis.  When she wakes up, she’s in recovery and is missing her appendix.  No one comes to tell her what happened or why she had surgery.  

There would be outrage.  How dare they give her surgery without her permission?  Without testing?  With no medical evidence?  I’m sure she could sue — she was missing an organ that may or may not have needed to be removed, and she could suffer infections or other complications of this unnecessary surgery.  The woman would be thought autonomous and worthy of respect in this situation.

Do the same thing during birth, and the woman has no role other than as a vessel for the baby’s safe delivery — however it might occur.  I think it is actually a total disrespect for pregnancy, birth, and children that underlies this, rather the simple fact that it is a woman.

(I don’t think men are any more respected during the birth process — in some areas they’re still not encouraged to come into delivery rooms.  When my daughter was born, the doctor barely looked at him and certainly didn’t ask if he wanted to participate in any way.  And in the story above, the husband was separated from his wife, barred from the OR, and lied to about the surgery too.)

Why is this?  And why do we stand for it?

Ironically, the woman in that story was told via commenters, “If you didn’t want interventions, you should have had a home birth.”  This, by the very people who decry home birth as “unsafe” and only for those who “don’t care about their babies!”  Talk about doublespeak!

For the last 60 or so years, women have been moving increasingly into hospitals and submitting to “managed birth.”  But we need to remember that in the 1950s, science was relatively crude.  We believed that formula was superior to breastmilk.  Also that babies ought to spend most of their time lying in bed and not being held, lest they get “spoiled.”  We believed in a clinical, hands-off approach to most things with birth and parenting.  This is thanks to psychologists who tried to tell people the “right” way to raise children.

We’ve started to realize, since then, that responding to a baby’s cues and needs does not spoil them.  Infants cannot be spoiled.  We know that breastmilk is nutritionally superior to formula.  But some of these clinical, hands-off methods remain, such as with birth: doctor knows best.  Lie back and take it, dearie.

Stand Strong

People don’t realize what they’re saying.  Honestly, they don’t.  They don’t know the history of the movement or how we arrived where we are today.  If questioned deeply they would probably get extremely offended because they were challenged and had no logic to stand on.

(Someone, please, tell me where the logic is that allows abortion because “a woman has a right to choose” but disallows choices during birth; or why doctors are somehow special, god-like humans that never make mistakes or at least are always more right than patients?)

We have to stand up, though, and keep pushing back against the status quo.  Wanting to be a full participant in your child’s birth (whether mother or father), be respected as a person, have the right to make decisions for yourself and your child, and be treated gently during the birth process is something that all women (and men) deserve.  All women deserve a choice in how and where they would like to birth.  And once that child’s born — the parents make the decisions.  End of story.  (Barring, as we all know, abuse or neglect.)

We need respect for birth and respect for families.  I could go on another rant about the lack of respect for families, but I won’t — now.

Support midwives, support the right to choose, and support birth.

What do you think about the state of birth in America?

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