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To Continue.... - Livin' the Good Life

Feb. 9th, 2008

03:40 pm - To Continue....

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Imagine with me for a moment an animal in labor. How about a cat? Now, the first thing that cat wants to do is find a place to labor all by herself. She will find a dark closet or a remote corner of the garage or barn, away from people. Safe from other animals. Then she will most likely lie there on her side and purr during her early labor. She'll appear to be asleep. Very relaxed. Or she may pace around. Finally, she responds, without fanfare, to the urge to push her babies out one by one. It all appears rather effortless and peaceful. Quiet. She'll lick and care for her babies all by herself and make herself available for nursing. This is nature's perfect way. And, most of the time, the whole process goes off without a hitch.

Now, imagine with me a woman in labor today in a modern hospital. When she walks in, the first thing that happens is that she gets a "cervical exam" to see if she's really in labor. An intrusive and uncomfortable experience for her. She is in an unfamiliar place, with unfamiliar people, that is anything but dark and private. She will then have a needle poked in her wrist and strapped to her so she can have a glucose drip, since she is not allowed to drink water, and they don't want her to become dehydrated. She has a strap placed around her belly that will electronically monitor her baby's heartbeat. Now that she is all hooked up with wires, she can't get up to go to the bathroom, so she has a catheter inserted. Strangers will come in and out of the room to check her progress regularly, with that same invasive and uncomfortable procedure. They prefer that she lies on her back so they can get a good reading on the monitor. This position causes her great discomfort and adds to her pain. And because she can't move around at will to find the most comfortable positions to labor in, she has additional pain. This causes tension, which in turn causes more pain. Her tension makes her contractions erratic and not very effective. This means that her labor will dawdle along. The doctor calls in to see how the mom is progressing, and they say "very slowly". It's Saturday, and the doc has a golf date that he doesn't want to miss that afternoon. He orders a pitocin drip through the mom's IV to speed things up. This drip causes much stronger contractions that are excruciatingly painful. The mother asks for some pain medication to deal with these unnaturally intense contractions. She gets an epidural, an injection inserted next to the spinal canal of the low back. This takes the edge off the pain, as the mom is now numb from the waist down. But, now her contractions slow down due to the medication. The doc orders more pitocin to speed things up. The contractions get stronger than ever. Though she can barely feel her incredibly strong contractions now, her BABY SURE CAN! These contractions are stressing this poor little guy out. TOO STRONG! The fetal moniter picks up signals of distress from the baby. Baby's not handling it well! Call the doctor! The doctor orders the nurses to prepare the operating room for a C-section. The surgery takes about 20 minutes. Looks like doc will make his golf game after all. While he rushes off, the mother is shakily dealing with the after-effects of major surgery. She can't nurse the baby immediately, like she had planned, because the baby is whisked away to intensive care to be monitored for the stress he underwent due to the pitocin. The baby is sleepy and unresponsive due to the effects of the epidural his mother received in labor. This requires even more vigilant monitoring. In the meantime, they prick the baby's heel to draw blood for "mandatory" tests, vaccinate the baby for Hepititus B, put blinding drops in his eyes to ward off his mother's potential venereal disease, scrubbed thoroughly (and often roughly), swaddled and put in a warmer for observation. Back in labor and recovery, mom wants her baby, but feels helpless to do anything about it. Separated at birth. A sad and unnecessary state of affairs. In the animal world, if you take a baby from it's mother at birth, there is a good chance that the mother will reject her baby when reunited. In nature, separation just doesn't happen if the baby is going to survive. And THIS is the reason that I said in my last post that hospitals are UNSAFE places to have babies. Ever heard the word "iatrogenic"? It means "caused by medical treatment". The labor and delivery wards are full of unwitting victims of iatrogenic disasters. Give me a nice, dark closet ANY DAY.

Comments:

From:(Anonymous)
Date:February 17th, 2008 10:04 pm (UTC)

Homebirth

(Link)
Darlene,

Thanks for your blog posts and comments regarding homebirth. I enjoy reading your blog and your natural approach to family living. I admire the way you live your life with intention and awareness. I whole-heartedly agree that the ACOG statement regarding increased rates of C-section are incomplete and do no take into account simple fear of litigation.

However, I believe that the fear of litigation needs to be examined. The reason it is there is because of bad outcomes, fetal deaths and maternal morbidities that have occurred because of situations that could have potentially been prevented. I believe that it is a question of risk that people are willing to take; in my roles both as physician and mother, I am unwilling to accept the very small risk that something may happen in a home birth that could have been prevented in the hospital. The risk of getting an unnecessary C-section is less frightening to me than fetal death resulting from cord prolapse and an inability to get the baby out as fast as possible.

Other routine interventions in the hospital such as heel pricks, erythromycin eye ointment, Vitamin K and fetal heart rate monitoring are put into place to avoid very rare deaths that can occur without these interventions. I agree that these are rare, but I am not comfortable knowing that there are children with disabilities that could have been prevented if their hypothyroidism (for example) had been diagnosed at birth.

Unfortunately, the medical system has burnt many bridges along the way with the medicalization of childbirth. Huge mistakes have been made by strapping women to beds with epidurals and catheters without any support or encouragement given to natural childbirth. I am happy to say that in Vancouver, labouring women can eat up until very active labour, IVs are not routinely started, continuous fetal monitoring is discouraged (except in high risk circumstances), lying in bed and lack of movement is strongly discouraged, epidurals are rarely offered without a request first from the mother and I have never seen pitocin initiated to expedite delivery in order for the obstetrician to arrive at a golf game on time. I have been taught in medical school that babies are to be placed right away on mom's chest and breastfeeding is encouraged as soon as possible. Mom/baby separation is not to occur unless medical intervention (due to baby apnea, etc.) is needed. Lastly, obstetricians in BC get paid less for a C-section than a vaginal delivery.

I guess I believe that in the end, we all want a healthy baby and a healthy mom. No one wants undue stress on mom or baby. I may be naive, but my hope as a physician who delivers babies is that we can come together as midwives, physicians and birth advocates to create a safe and supportive environment that respects and encourages labouring women that this is a low risk, natural event.

I would also like the nice, dark closet. If something scary starts to happen, I also would like to know that there are surgical options available so I know I did everything possible to bring my baby (or my patient's baby) safely into this world without dire complications. And, I look forward not only to the training I will receive on my elective with midwives but also to the day where we can say a 6% c-section rate is too high.

Sincerely,
Anne (mamma to Eden)

(Reply) (Thread)
From:(Anonymous)
Date:February 17th, 2008 10:05 pm (UTC)

Homebirth

(Link)
Darlene,

Thanks for your blog posts and comments regarding homebirth. I enjoy reading your blog and your natural approach to family living. I admire the way you live your life with intention and awareness. I whole-heartedly agree that the ACOG statement regarding increased rates of C-section are incomplete and do no take into account simple fear of litigation.

However, I believe that the fear of litigation needs to be examined. The reason it is there is because of bad outcomes, fetal deaths and maternal morbidities that have occurred because of situations that could have potentially been prevented. I believe that it is a question of risk that people are willing to take; in my roles both as physician and mother, I am unwilling to accept the very small risk that something may happen in a home birth that could have been prevented in the hospital. The risk of getting an unnecessary C-section is less frightening to me than fetal death resulting from cord prolapse and an inability to get the baby out as fast as possible.

Other routine interventions in the hospital such as heel pricks, erythromycin eye ointment, Vitamin K and fetal heart rate monitoring are put into place to avoid very rare deaths that can occur without these interventions. I agree that these are rare, but I am not comfortable knowing that there are children with disabilities that could have been prevented if their hypothyroidism (for example) had been diagnosed at birth.

Unfortunately, the medical system has burnt many bridges along the way with the medicalization of childbirth. Huge mistakes have been made by strapping women to beds with epidurals and catheters without any support or encouragement given to natural childbirth. I am happy to say that in Vancouver, labouring women can eat up until very active labour, IVs are not routinely started, continuous fetal monitoring is discouraged (except in high risk circumstances), lying in bed and lack of movement is strongly discouraged, epidurals are rarely offered without a request first from the mother and I have never seen pitocin initiated to expedite delivery in order for the obstetrician to arrive at a golf game on time. I have been taught in medical school that babies are to be placed right away on mom's chest and breastfeeding is encouraged as soon as possible. Mom/baby separation is not to occur unless medical intervention (due to baby apnea, etc.) is needed. Lastly, obstetricians in BC get paid less for a C-section than a vaginal delivery.

I guess I believe that in the end, we all want a healthy baby and a healthy mom. No one wants undue stress on mom or baby. I may be naive, but my hope as a physician who delivers babies is that we can come together as midwives, physicians and birth advocates to create a safe and supportive environment that respects and encourages labouring women that this is a low risk, natural event.

I would also like the nice, dark closet. If something scary starts to happen, I also would like to know that there are surgical options available so I know I did everything possible to bring my baby (or my patient's baby) safely into this world without dire complications. And, I look forward not only to the training I will receive on my elective with midwives but also to the day where we can say a 6% c-section rate is too high.

Sincerely,
Anne (mamma to Eden)

PS Eden and I spend hours listening to your Only My Mama cd - often the only thing that will make her stop crying (apart from nursing)!

(Reply) (Thread)
From:(Anonymous)
Date:February 18th, 2008 05:18 am (UTC)

Hospital Birth

(Link)
Anne's response encourages me to reply to this entry as well because the experience you write about is one that I have never encountered in my work in the field as pediatric nurse or heard of as mother, prenatal class teacher and La Leche League leader here or in Germany. Obviously the hospitals in your area or in the States, if it can be generalized, have a lot to learn. I have meant to respond to your statement of Jan.21 in which you suggest that a hospital birth in almost any country in the world in 2008 is unsafe. I know that at least in Germany, France, Switzerland and Austria, as well as Anne mentioned here in Canada, the birthing centers of hospitals are made as appealing and comfortable as possible, including meeting the staff before hand, regular furniture, colors on the walls, as little medical intervention as possible, encouragement to go for walks, sit in the gardens, have loved ones near, sit in the tub... and, in Germany, Austria and Switzerland at least, the professionals attending the births are always trained midwives. When there are no complications a doctor won't even be called in. This includes the babies first checkup as well. Parents also have the right to refuse certain preventative interventions if they object. The steps that have been taken in the last 30 years or so to have a natural birth experience in the hospital have been huge and many nervous or anxious mothers, not even to mentions mom's at risk (previous c-section, diabetes, preeclampsia ...) appreciate this combination of natural birthing but quick intervention if need be--and sometimes there is--because it helps them to be more relaxed and hence have an easier and quicker birth. (While I was very active in the home-birth movement, here in Vancouver, I was witness to one death and one child severely disabled due to complications during home-birth, with very experienced midwives, that could have been prevented in a hospital. It does happen.)
I also believe that, no matter what our views on issues are, one will find books and statistics to support them. So the best we can do is to inform ourselves as thoroughly as we can and then make the decisions that feel right inside, trusting our intuition. For me a hospital birth for my first child and a home birth for my second was the absolute right decision. With the choices we have now here in Vancouver I'd probably have chosen a "hospital" birth even the second time. But that's me and when I'm asked I tell young parents to educate themselves as much as they can and then make the decision that feels right to them.
Maybe putting some energy into reforming the hospital birth routine in your area would be a good cause for your passion and abilities?
With Love and Respect, Willow
(Reply) (Thread)
[User Picture]
From:lestermom
Date:February 18th, 2008 05:05 pm (UTC)
(Link)
Thanks Anne and Willow! Sounds like Canada and many other countries are way ahead of the US! Thanks for sharing all your information. As a childbirth teacher seeing the outcomes of birth in our area, and discussing with other Bradley teachers all over the country, and reading PUSHED, I stand by my view that homebirth was the best and safest option for me and a large percentage of moms, and I will continue to support it 100%. Saying that, many moms are not comfortable with homebirth, so I teach them to navigate the local hospitals. The results have not been encouraging, to say the least. Here's to Canada, Germany and the other countries who are ahead of us!
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