More Thoughts on Labor & Delivery

This post is a follow up to the original post titled “Labor & Delivery”. I received a comment from one of my good friends, Temple, offering her thoughts from the point of view of a mother. She has provided some interesting and thought provoking information. I followed up her comment with some more information regarding the culture of childbirth in this country:

Temple wrote:

I love this post. While we've talked about this many times, it was great to see this topic carefully and fully laid out.

I would like to offer an expectant mother's viewpoint. Unlike a nurse, midwife or other ob practitioners the vast majority of 1st time mothers not only know nothing about giving birth, they know less than nothing about pregnancy itself - or the enormous changes their bodies, minds, and emotions will go through. I did a lot of research before I got pregnant and during my pregnancy - still reading or hearing about it is NOTHING like the real thing.

On your 1st baby appointment, you have to get up on a table and have your innermost self examined -sometimes with a vaginal probe (uncomfortable and incredibly embarrassing).

From that point on, you have to get used to at least three different people touching you (everywhere), inserting a needle in your arm, you've got to pee in a cup, and are expected to freely discuss every aspect of your personal life: from what you eat to how you have sex. It's invasive, uncomfortable to downright painful, and can cause feelings of helplessness and anxiety. I was lucky, my ob was/is wonderful as were most of her nurses. She had midwifes and doulas on her staff - who were great about talking and taking any and all questions. They made me feel safe and comfortable. But I am well aware that my experience is the exception, not the rule.

You finally get to baby-birthday - you're excited and terrified. I had no idea what to expect and I trusted the nurses. I had been very clear what I wanted, but no one explained to me what those choices would mean in labor and delivery. In fact, no one told me what to expect at all.

I HATED the iv in my hand, the monitoring band around my belly. I didn't want an epidural but when I asked about other methods of pain control I was told that there weren't any. I was VERY upset that I was not able to walk around or sit up and bear down when it came time to push. And I couldn't b/c I didn't have any feeling in my lower body. I felt that I had been punished for wanting my pain controlled. From my discussions with other mothers, the primary worry is about pain/pain management.

With my next child it was much different. I knew what my body could and could not do; I knew how to 'firmly' articulate what I wanted and how I wanted it. I had my daughter w/ very little medical intervention. I was able to feel her moving down my body and into the world - fabulous! Labor was 3 hours (start to finish) - 4 pushes. I firmly believe that less medical intervention had a direct link.

Exectant mothers like me are in a difficult spot. In reality, the ONLY way to give birth like you're discussing is to NOT do it in a hospital. But how many 1st time mothers would/could do that? Because, in the end, we want a healthy baby and fear of something going wrong is equally up there with fear of pain.

It sounds to me that you need to either be a midwife, a doula or both. Or maybe become a consultant for Doctors who are willing to truly offer an alternative birth experience. I just wish that I had known you (now) when I was pregnant (then). Don't give up - expectant mothers need you.

Peace & Love,


Amynonymous said...
I can understand that pregnancy and childbirth is an entirely new and scary time for not just first time mothers, but all mothers. Although I haven’t had children, I have seen the fear in mothers eyes and voices when they hear their babies heart rate is dropping. It’s true, they don’t know that their Pitocin augmentation could have caused this, or that position changes can help bring the babies heart rate back up. They only care about their baby; that they come into the world healthy and safe. Mothers truly will do anything for this. The problem with the U.S. maternity system is not with the mothers but with the culture of childbirth. When the country sees Rachel from “Friends” giving birth on her back in a hospital or Katherine Heigl scream through natural childbirth in “Knocked Up”, that is what they know. Women have had intensively medically managed births in hospitals for so long that it has become the norm, not only for patients but for providers. Women trust their providers to keep them safe and inform them about risks, benefits or alternatives. For example, I witnessed a wonderful physician tell a second time mom who had been laboring for 3 hours “let’s get you some Pitocin and get this baby out” and she said “whatever you think we should do”, in this situation, the mother trusts the doctor and trusts that a medication that is ordered is the best for her. The doctor should have asked whether the mother wanted Pitocin (because in this case there was no actual medical need), and explained the risks and benefits before asking the nurse to start it. The doctor had been on call for 55 hours, and wanted to deliver the baby so he could go home to his family. This is the norm. Mom comes in contracting, break her bag of water, labor a little more, start an epidural and Pitocin, up, up, up that Pitocin until Mom is ready to push, direct her through the pushing (count to 10 while she pushes), call the doc to catch the baby and your done. Unfortunately, physiological birth is not that streamlined and organized, and it’s hard for medical providers, who are used to controlling everything, to wait patiently through the stages of labor. Healthcare providers are not truly the problem however, many of the problems associated with medically managed births and the culture of childbirth in this country; the rigorous control, the rushing, the interventions, stems from the insurance system. The pay schedules, liability, and malpractice insurance, instituted medically managed birth and ensures that it stays that way.

In your situation, you were told there weren’t any alternatives to an epidural, and in this case I say shame on the person who wasn’t willing to inform you of alternatives. One of the nurses I followed on my rotation had a patient that was thinking about trying an unmedicated birth. The nurse explained to her that if that was the way she would like to do it that there were many ways to help labor progress and to manage the pain, and she would help her the whole way.

I have to disagree that the ONLY way to give birth the way I described was to NOT do it in a hospital. Even the hospital I rotated through, with its 95% epidural and Pitocin rates, had natural births. Specifically one “hippie” doctor helped a women give birth unmedicated while squatting on the floor in her hospital room. It's about finding the provider that will work with you.

Lastly, I will say that the resources for realistic information about birth, hospital or otherwise, is out there. There are plenty of wonderful websites, blogs and books that provide this type of information. Not the “What to Expect When You’re Expecting” variety but the information for women to research the risks, benefits and alternatives to the “normal” hospital birth. Yes I’m in nursing school, but a lot of the information that has shaped my opinions and view about childbirth were entirely outside of my nursing education.

I'd love to hear more thoughts on the subject.

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