Saturday, April 26, 2008

Doubts

Sometimes I wonder how I ended up "here" writing about birth. I never set out to be any sort of an alternative birth activist. I do not consider myself a homebirth activist. I don't even think I am a natural birth activist. Mostly, I am just.... mom.

But, I am driven to share some of the horrors I've encountered in working L&D over the years. Why?

I do not want to create any unnecessary fear for expectant mothers. It is not my intention to fill a pregnant woman's mind with scary imagery. Also, new mothers have such a lot to worry and fret over already, it is not my intention to have anyone worrying over how their delivery went, in any sort of past tense. So, what are my motivations in sharing some of my worst moments working L&D?


Am I a fear monger? Am I writing all of this for no good reason? Surely, a pregnant woman would experience fear when reading through some of what I have shared here. Or she may detach and say to herself, "That could never happen to me...."


Or....
she might be prodded to ask a few more questions at her prenatals.... she may ask around and talk to other women who have been delivered by her OB and get an idea of how he "really" handles deliveries.... she might be motivated by what she hears to then seek out a Nurse Midwife for her hospital birth.... she might decide that securing a doula to advocate for her during labor is well worth the money.... she might even look into a birth center or home birth for her next time around....
who knows?


And I do not even know if that is what I would want?

I am having doubts. My first homebirth took place in London, England. Homebirth is certainly not the "norm" over there, but it is also considered a safe option for low risk women by the Royal College of Midwives, the Royal College of Obstetricians & Gynaecologists and the Nursing & Midwifery Council. My National Health Insurance covered it completely. In England, as in many European and Scandinavian countries, the Midwifery Model of Care prevails and most births are attended by licensed midwives. Doctors, obstetricians, care for only higher risk women. But, here in the USA, it is a very different system, of course. Midwives are marginalized from the mainstream healthcare system. Licensing and regulation varies from state to state. In some states there isn't any licensing for midwives at all- midwives attending birth in those states do so illegally!


As a result, I went from a country where I had a wonderful homebirth under the watchful eye of licensed, fully trained midwives, well-integrated into the mainstream system to a system where midwives are very much detached from mainstream birth.


And, I must admit that this caused me great doubts during my pregnancy. I was really wanting to run back to merry ole England to have my third baby! In fact, I went to see an obstetrician during my pregnancy at the same time as I saw my midwife and was considering a hospital birth up until my 32nd week of gestation. Why?


Well, if I am totally honest, its because I believe my baby and I were safer in our homebirth in London in comparision to the homebirth that I had here in Texas with a Documented Midwife. The midwifery training in the UK is quite extensive and broad compared to what is required by the Texas Department of Health for Documented Midwives. Also, at the time I delivered in London, the Midwives had the local "ambulance squad" on alert during my labor and delivery, in the event of a sudden complication developing that might require urgent transfer.


You see, I am not a frilly-fruity "trust birth" "birth is as safe as life gets" sort of person. I chose a homebirth based on an extensive review of the current research available to me. I considered the risks and my husband and I talked about the risk of a sudden, unexpected complication occurring quite often. I maintained an impeccable diet and exercise regimen during my pregnancy to be as physically fit for the birth as possible and to minimize any nutrition related complications as much as possible. In other words, I did not take the decision to birth at home lightly. To look modern medicine and its lifesaving technologies in the face and say, "No." that’s quite a decision. But, I made it. I did. Why?
I made the best choice I could at the time. I believe that every woman needs to consider their place of birth and choice of provider and all the various details involved very carefully.... that I do know with any doubts.
Because... the person standing at the foot of the bed when you deliver in the hospital has a lot of control, total control really, especially if you are numb from the waste down. I have witnessed that total control be abused.

I have stood beside a Medical Doctor as he manually removed the placenta post delivery as the the mother was writhing and screaming in agony. I have stood beside this same doctor as he did this countless times and I learned with each new time it occurred that this was his "routine." Anyone who works in obstetrics knows that this is not "routine" unless the mother is bleeding to death or the placenta is in danger of being retained beyond thirty minutes, or so. Immediately after delivery, this doctor would quietly reach inside the womb, his arm up almost the elbow and scrape the placenta away with his gloved hand. The mother would always be screaming as this is an acutely sensitive time for the uterus. I was a "new" nurse and too afraid to say anything. Later I talked to my charge nurse about him and was told that he hates women and this is his way of getting back at them. I was told to encourage his patients to get epidurals. I wish that I was making this stuff up. If you only knew how badly I wished that.

So.... back to why I chose homebirth.... it was the best place for me to have an unmedicated, normal, safe birth.

But, I truly do have doubts sometimes, because I truly believe that homebirth practitioners need to be integrated into the mainstream system for optimum safety. I long for the days when we can merge the modern, lifesaving technology a hospital offers with the care providers and the atmosphere for normal birth. Carpet and curtains don’t do it! We need to reinvent the mainstream healthcare system to respect mothers more. Mothers need to talk about their births and share their stories. Women, in the form of obstetricians, nurse midwives and doulas need to maintain normal, healthy birth standards to keep mother's and babies safer within hospital settings. If anything close to that began to happen in hospitals where I live, I would gladly return to L&D and work "with women" again!

7 comments:

pinky said...

You may be interested in the Med Teams initiative. That is a communication process that some hospitals, especially L&D units are doing. It helps establish rules of communication and ways that Nurses, Doctor, Midwifes, whoever works in the unit, can speak with each other about their concerns. I have found it helpful.

In my Hospital, if I am uncomfortable with a Doctors practice, I can speak to them or if they are unwilling to communicate with me, I can speak to the Cheif of OB. I can also speak to the Cheif of medicine.

I agree that we have a long way to go. But folks do have resources if they feel a Physcian is behaving badly. You can also call DPH or the Board of Reg for the Doctor. The biggest problem is, not reporting it at all.

Mary the Birth Goddess said...

Thanks Pinky! I would love to have you as my nurse if I ever had a hospital birth again!
Yes, the blatant physical abuse is reportable and should be reported. I have lost a lot of sleep over the things I saw as a new nurse and did not speak up about.
What's a lot more common and troubling are the things like decisions on C-sections where the OB talks the parents into something that clinically isn't necessary. That sort of stuff is happening day in and day out and is so frustrating. Mostly, I am getting fed up lately with the elective primary C-sections. I just do not think informed consent is happening prenatally.
And then, here we are postpartum working with this nearterm/37weeker who is a crappy breastfeeder, with mom naseated and in pain- and I think to myself, did she honestly believe scheduling a surgical birth would somehow be "smooth" sailing?

Mary the Birth Goddess said...

sorry for all the mis-spelled words in that comment!

Amy said...

I love your blog, and your honesty! It is a fine line to walk as we try to educate, but not create fear in which women will make choices from. Choices need to be made from good research, quality education, and careful consideration of risks and benefits for each woman's situation.

I had a couple in one of my childbirth classes take me aside after class one night and tell me that I was scaring the mother with some of the stories I use to illustrate various situations. The husband went on to say they basically only wanted to here the positive stories and that by my telling anything negative (true) I was only using scare tactics.

The bottom line was that they didn't want to hear the truth because the truth scared them, why? Because it went against the choices they had made and they were not willing to change because they had to believe that all hospital/OB births are the best.

Please note I never, ever condemn hospitals or OBs in my classes but I don't gloss over the truth of what can and often does happen. I also discuss homebirths too and midwives.

Anyway, don't ever stop educating women about their choices, it's so very important that we keep speaking the truth because if we don't we are doing women we serve a disservice.

Mary the Birth Goddess said...

Amy, you make some great points! Thanks for your comments, very thoughtful!

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