Sometime in December I expect to push a human being out of my vagina.
Am I afraid?
I’m a little afraid of complications. Premature labour, pre-eclampsia, shoulder dystocia… those are all somewhat frightening things. I’m not at all afraid of the pain; I’m pretty sure I’ll be able to handle it.
I’m planning an unmedicated, low-intervention birth. But I’m not actually against any particular intervention, when used appropriately. I think too many labours are induced or augmented; Pitocin is an overused drug by far. That said, if I am convinced that a clear medical indication exists for the use of Pitocin, I will use it. The same is true with intravenous fluids, stripping my membranes, rupturing my membranes, epidural anesthesia, episiotomy, forceps, vacuum extraction, and cesarean section. I would consent to each of these, given the right circumstance, and none of these interventions scares me much.
What scares me is having any of this done without my consent. You may think that medical consent is absolute; a doctor/nurse/midwife would never touch a woman or administer treatment without her consent. But the stories are everywhere. A woman consents to a simple cervical exam in late pregnancy to see if and how much she’s dilated; the midwife strips her membranes (separates the membrane surrounding the amniotic fluid from the cervix) without even telling her. A woman consents to intravenous fluids because she’s told she’s dehydrated; the nurse “slips in” some Pitocin.
Even minor non-consensual acts can feel extremely violating to a woman. A nurse, without saying what she’s doing, grabs a woman’s leg and moves it. A lactation consultant walks in the room, and without introducing herself, grabs a woman’s breast. The experience of being in the hospital so often feels as if one is being disembodied, objectified.
And even when consent is given, it so often is poorly informed. Health-care providers intentionally frighten women to get them to acquiesce. Continuous electronic fetal monitoring has been shown to be of no benefit to maternal or perinatal mortality or morbidity, but a woman refusing it will often be asked “do you want your baby to die?” Small risks of non-intervention are inflated; larger ones of an intervention the doctor currently wants aren’t even mentioned. Women are told the pain of labour is going to get much worse, and the anesthesiologist is going to be busy in a few minutes, so if they ever want pain relief, they had better get it now. Emjaybee, a regular commenter here at feministe, had a traumatic birth that culminated in a nurse running away with her baby, without her or her husband’s consent.
There’s a term for this: birthrape. Some don’t like the term; they think it minimizes the experience of victims of sexual assault. But what else do you call fingers and instruments in a woman’s vagina, when the woman has explicitly said she doesn’t want them there? I’ve experienced sexual assault myself, and maybe that’s part of why this kind of bodily violation frightens me so.
What causes this and where do the solutions lie? Is it that obstetricians are sadists? I don’t think the answer is that simple. Most doctors want to do what’s best for their patients, although that’s not their only motivation. They also need to protect themselves in a non-sensical legal climate. In malpractice cases, scientific evidence is not the guiding philosophy. What’s important is the “standard of care.” That is, it doesn’t matter that continuous fetal monitoring doesn’t improve outcomes; what matters is that every other obstetrician in the country insists on using it.
And obstetricians are not immune to the messages our culture sends about women. Women don’t know what’s best for themselves; they can’t be trusted to make decisions for themselves and their fetuses. Even the Supreme Court thinks women can’t be trusted to make medical decisions for themselves that they won’t regret later.
Also contributing is the fetus-fetishism of our culture. Women are seen as birthing machines. Good mothers sacrifice themselves for their children. Nearly every intervention privileges the health of the baby over the health, or even life, of the mother. Remember the Angela Carder case, in which the hospital got a court order for a cesarean, which contributed to the deaths of both Ms. Carder and her fetus? This philosophy is often exacerbated by financial considerations: a dead mother doesn’t cost much to an insurance company, but a permanently disabled newborn may cost millions of dollars to support over its lifetime, and the doctor can be sued for that amount. This New Yorker article blames the Apgar score: a simple metric measuring the health of the baby at birth; no such metric measures the mother’s health.
The advice I’ve been given: stay away from the hospital. As the Navelgazing Midwife puts it, “when you buy the hospital ticket, you go for the hospital ride.” Believe me, I would love to have a homebirth. But that is simply not possible for me or a huge number of women. The only affordable health insurance available to me is through my work, and it doesn’t cover homebirth. In fact, it only covers birth in one particular hospital. “Well, then get a homebirth midwife out of pocket!” Even if I had a spare $3k lying around, which I most certainly do not, it wouldn’t go to a homebirth. It would go in the bank for emergencies, since I have no financial leeway right now. Or it would go to pay off some of my debt. Is respect and informed medical decision-making reserved for those women who are both medically low-risk and at the top of the economic ladder? Why shouldn’t women who have to birth in the hospital have their bodily autonomy respected?
I’m doing the best I can. I’m eating well and exercising to keep myself low-risk. I’m seeing a group of nurse-midwives, who have a primary cesarean rate of half the national average, as well as low episiotomy rates. I’ll be refusing cervical checks, so no one can strip or break my membranes. I’ll refuse an intravenous drip, so no one can sneak anything in. I shouldn’t have to make that kind of defensive decision. I should be able to trust my care providers. I’m educating myself about birth to an insane degree, and trying to pass on as much of it as I can to my husband, who is better at being charmingly assertive than I am. But I’m still scared. And I shouldn’t have to be.
My son is 20. One of the best things I did when I birthed him was to have no only my then husband (who was pretty much useless) present, but also my older sister, who’d had three children of her own. I knew she would be calm and collected. I had a birth plan. I knew that if my ex was told “she needs to have X done” he’d have no idea whether or not that was true, but that my sister would, and would fight like hell to ensure that the birth was as unmedically intervened as possible.
I’m 5’2″ and weighed 105 when I got pregnant. My son was 9 pounds, 8 ounces, and was 22 3/4 inches long. I was able to have a completely unmedicated birth….including no episiotomy (I tore, but that was because of something completely unforseen – I had a contraction after his head was safely delivered, and both his shoulders were born at the same time). Hard labor was over 24 hours. The two primary reasons I was able to pull this off were a sympathetic OB-GYN and my sister’s presence. I’d recommend having an experienced “birther” in the labor and delivery rooms with you if it’s at all possible. You’re going to feel both very busy and very vulnerable. It’s easy in that circumstance to get pushed into something you don’t want and don’t need. Having someone there who can fight for you helps a lot, not only if there *is* a problem, but to relieve your mind of worry about it while you do the work of bringing your child forth.
Congratulations on the upcoming event. May your birth experience be as wonderful as mine was. :-)
I have no helpful insight to share, just wanted to thank you for such an informative, moving, and well-written post.
Thank you. I find so few people are aware of the issues surrounding birth in this country.
I plan to have children (recurrent pregnancy loss is getting in the way..my next EDD is January 5th, but that one miscarried back in May), and I plan to have a homebirth. Of course, since homebirth midwives are illegal in my state (IL), I have to get one clandestinely and pay her out of pocket. What’s sick is that she probably charges less than waht a lot of people pay after insurance. (She’d be legal in almost any other state, went to the best midwifery school, yadda yadda yadda).
Good luck in your birth. I hope it’s gentle.
I’m due Feb. 1st and I totally sympathize with everything you have said here. Unnecessary interventions are one of the biggest fears for me when I give birth. Luckily I had some choice in which hospital I went to, so I chose the one which offers waterbirths, private rooms and a midwife unit. I’ve only seen midwives during the entire pregnancy, but so far there has only been one that I’ve seen that I would trust not to do something without first explaining to me exactly what is going to be done and why and then never without my consent. And probably seen about 5-6.
Do you have any resource suggestions for info about interventions and gentle births? I’ve looked, but books like the IMO supremely frustrating what to expect…don’t really offer that much that I would consider helpful.
Have you thought about having a doula? The hospital I’m going to offers their services, but I may just find my own as I would like to at least meet her first and I’m not sure how they are about that (if they are going to discuss it with me at a future prenatal appt. or if she is just going to show up when I get there to give birth).
N1Nj4G1rl, for books, try Henci Goer’s “Thinking Woman’s Guide to A Better Birth” and Barbara Harper’s “Gentle Birth Choices.” Surprisingly, the “Childbirth Choices” discussion board at babycenter.com is a wealth of information from very informed women, and they’ll answer questions about your specific situation.
$3000 feels like a lot of money, I know. sometimes midwives offer sliding fees. depending upon what your insurance covers, it could be more for a hospital birth w a cesarean.
The political climate of litigation fears is too high to nearly escape induction, routine monitoring, medications in labor, cesareans. Women who emerge with nary a heparin lock in a hospital are rare and very, very lucky.
Then there’s the aspect of how your baby is treated, handled, and how the normal physiology of labor and birth is not conducive to unhindered birth in the hospital – no matter how much we attempt to create it. It’s rarely found at home with most midwives.
This is your baby’s birth. His/her only birth. You’re making choices the best you can, but in the end, what choice do you have? What could you sell or barter with a homebirth midwife to get the birth you deserve? Have you talked with some midwives? Even checking out a few would be beneficial.
I know where you’re at. I opted for hospital birth because it was $10 with our insurance. I got a $10 birth…and even managed to avoid an epidural or cesarean! Still, I was left wounded with sutures from a third degree episiotomy deep in my rectum. My relationship wtih my partner was hit hard, my view as a woman was also diminished. What went wrong?
In the end, I could not let go to labor and still fight off the well-meaning interventionists. Their fear about birth was palpable. It affected me so much. I was afraid. Why didn’t I want a healthy baby?, they asked. How could they help me if I turned them down for simple procedures? Was I that set on a romantic birth to the point of risking my baby’s life?
The views are different. It’s not the same. We are living in a culture that even a ‘good’ hospital birth undermines our female power and the trust of birth. We walk away with mixed messages (“i can’t dilate on my own”; “my waters need to be broken in labor”, “my babies are too big to fit through my pelvis”….rather than looking it as the fault of the medical model and their fear of birth, we take it in. we allow the model to turn these myths back on ourselves.
then, when it comes time for menopause, breast cancer, etc., we’re still so wounded that of course our broken bodies need to have our uterus removed. of course we’ll take hormones made from pregnant horse urine. of course – because we’re broken and only the medical model can fix us. then there are risks…which we still internalize as our body’s fault.
we have lived too long with these ideas/myths…the misogyny of the medical model doesn’t trust our bodies….doesn’t trust the non-linear process of a woman’s complicated process. we are up against a world of pain as women.
http://www.youtube.com/watch?v=cqaXVGgbB7k
birth is normal. extraordinary, but ordinary. a miracle, but a common transition.
since when do 45% of first time moms need cesareans? since when do most first time moms need to be induced? the reasoning always comes back to a fault of the mother. there’s something wrong with the model we’re up against…and it’s not honoring our complexities and individual processes at all. we’re seen as antagonists against our babies.
I had 2 wonderful, drug-free, intervention free births. It is an amazing experience. Congrats!
Thank you for this. I have a double cervix and might have a bicornuate uterus (need an ultrasound to be sure), and at my last pelvic exam, the gynecologist said whenever I decide to have a baby, I will have to deliver via c-section. It totally freaked me out. Just the matter-of-fact way she said I have no choice about it, which is total bullshit.
It’s helpful to hear someone else’s fears and identify with that. Good luck with your birth! I’d love to hear more about it.
Dr. Confused,
I’m due in March, and we wanted a homebirth, but found out we were having twins; California midwives aren’t licensed to attend twin homebirths. I wrote a post about my experience thus far here.
I second the recommendation for a doula. If you’re concerned about how you’ll be treated in a hospital (and I think you’re right to be concerned), a doula can function not only as a labor coach but also as an advocate for your rights and your choices. Your partner may not be the best person to do this, as s/he will inevitably be very emotionally involved with your labor process.
N1Nj4G1rl,
I also like “Gentle Birth Choices” as well as “Ina May’s Guide To Childbirth.” I would also recommend to anyone considering less mainstream options in pregnancy/birthing/childrearing that they check out the discussion boards at http://mothering.com.
I was also going to suggest a doula, or at least a trusted relative who can help make decisions. Your partner is going to be much too consumed with worry about you and/or the baby to really be able to stand up to the hospital personnel, especially if something goes wrong and they’re shoving consent forms at him and telling him that you and the baby will die unless he signs. Both of you need to have an additional person who will be on your side (and I mean plural “your”).
Oh, and judging from my co-worker who goes on maternity leave next week, by the time you start your ninth month, the only thing on your mind will be, “Okay, when is this whole goddamned thing going to be over?!?!” ;-)
Wow, thank you so much for this post!
My son is 7 months old and I still feel so angry about his birth. I guess I shouldn’t write my whole birth story, but there were many unnecessary interventions and no one even bothered to show him to me or let me hold him once he was born.
For the longest time I thought I had lost my mind because I was so upset about it. I didn’t know other women felt the same way until I was about 5 months postpartum.
I attempted a home birth with a midwife with my daughter. The reason? I was a poor grad student with no insurance at all and a husband who thought dealing LSD was a valid career option. It was a home birth, or the tender mercies of New Orleans’ Charity hospital. It was kind of a no-brainer, and my midwife was amazing. I had no fear regarding birthing at home, because I was young, healthy and strong. After 24 hours of labor, I started passing meconium with each contraction, and the top of my cervix was horribly swollen while the bottom had dilated nicely, and the midwife decided to transport me. We’d decided on Mercy Hospital as the backup because it was the closest (figuring if we did have to transport we’d just…accrue bills we could never ever pay). We all got there, including my midwife, my husband (we had to wake him up!!) and my poor freaked out parents.The doctor who was on call was the worst jackass I think I’ve ever met. I had written out a list of procedures I refused to give my consent to (episiotomy, fetal monitoring, etc). He looked at the list and snorted that if I didn’t do exactly as he told me to do, I’d have a baby I was ‘less than happy with’. Less than happy.
That’s when my mother started to cry, and my midwife and I got ANGRY. She went into the delivery room with me and whispered, “I need you to push hard, because he wants to cut you”. He did too. He was dying to cut me open. I pushed my heart out, and my daughter came out before he’d even scrubbed in. Thank GOD. They suctioned the meconium out of her lungs and she was perfect. Of course, said asshole also did not give me my rhogam shot (I was going to go to a private doc within 3 days to get the shot) because he came in when I was half-asleep and told me it wasn’t necessary. It was, of course, and I was RH-sensitized with my son’s birth, leading to vast quantities of medical intervention for that pregnancy, and the closest of close calls. Both myself and my kids are fine today, but I cannot stress enough the importance of having an advocate there with you who will face down the doctors and make sure your wishes are carried out.
I don’t know what to tell you.
I too was most terrified of interventions. I was low-risk until diagnosed with GD (which, based on 3 months monitoring of blood glucose levels that NEVER went into diabetes territory and a child with a birth weight of 5lbs,13oz, I now question). Once I went “high-risk” the type of control I seemed to have left was stubborn refusal. My OB wants an induction (at 39 weeks?) After weeks of fighting, my plan was to let her schedule it and refuse to show up.
The day I went into labor, my water broke first. I told my husband that we WERE NOT going to the hospital or contacting the OB until I was contracting often and regularly too. Their 12 hour clock from waters breaking until delivery-must-be-done was not starting until I allowed it to start. I walked my neighborhood, first willing the contractions to start and then willing contractions to regularize. I curled in my bed with my pillow and focused on “opening”. When I felt myself start to going mentally “weird” with contractions, that’s when I decided it was time to go to the hospital. Less than 2 hours after that, the kid was born, small but otherwise healthy. (It was also only 7 hours since my water had broken.)
There is a great documentary by Desmond Morris called The Human Animal. I believe the episode on “The immortal gene” contains a section on childbirth in various cultures. From the unassisted childbirth in Central Africa, where the woman simply covers the newborn with grass to the more family like atmosphere in some Middle Eastern countries, to the more medicalized procedures in western countries, to the rather cold birth procedures in Russia where the babies are separated from the mother right after birth and contact is only allowed during feeding times. It also contains parts on waterbirth and other alternative birthing.
Thank you so much for this. I’m a number of years from wanting kids, but this articulate so many of my thoughts on the subject. I’m not a totally against some sorts of medical intervention, but I’m certainly not willing to give up my bodily rights for the convenience of my doctor. It’s my body and my baby and the medical personnel is there to help, not to take over.
I highly recommend Bradley classes for unmedicated childbirth. Having said that, the key phrase here is “unnecessary” interventions. In my case, at week 41 (yes, 41), we discovered that my daughter was breech. After attempting an external version (shove her to make her turn, didn’t work), I opted for a c-section (with the support of the wonderful midwives who had been seeing me).
Recovery from the section sucked, but it was the right choice (ahem, MY CHOICE). Interestingly, the doctors said that they wouldn’t MAKE ME have a c-section, but that they did Highly Recommend it in this situation.
And a postscript…it turned out that my little girl had the umbilical cord wrapped around her neck THREE times. If I had tried for a vaginal breech birth, I would have ended up, at best, having an emergency c-section.
Trust your instincts and your birth helpers. But remember that sometimes, intervention may actually be a good idea.
I still mourn not getting the birth experience that I wanted, even though I know we did the right thing.
Thanks for the ideas, I will definitely be checking out those books and websites!
Have someone you trust in there with you, after having talked with that person beforehand? Preferably someone who has the legal authority, should you pass out? I hate to say this, but a male partner would probably be listened to more.
I also heard something about adjusting some dial…that decrease the pain but won’t numb you over the experience? I read about a woman whose nurse chose to let her suffer until she chose the full numbing option.
Oh yeah, check your blood pressure. In the Old Days, ‘fattening’ a woman up for birth is a good idea…UNLESS she has high blood pressure. Pregnancy itself causes heighten blood pressure, if she is already high pressure, and she eats very rich food that leads to higher pressure, she’s going to have a very difficult birth. That happened to my mother, I was 8pounds+, and thank goodness for modern intervention (they used the clamps to pull me out, that might have affected my eyesight, jury is out), or she might have died.
If your blood pressure is high, some Chamomile Tea would lower it, though the jury, as usual, is out;
http://www.google.ca/search?hl=en&client=firefox-a&channel=s&rls=org.mozilla%3Aen-US%3Aofficial&hs=8RX&q=Chamomile+Tea+pregnancy&btnG=Search&meta=
The jury is always out, earlier, doctors advised women not to eat seafood due to the mercury, but then they turned back and say that something in fish is so important for fetal brain development, the risk of avoiding seafood outweights the risk of avoiding mercury! There are these, very small white fishes, sold frozen in packets at Chinese groceries, I don’t know the English name, but they are the length of a pinkie and 1-2 cm in width.
I will chime in and say I’ve had three hospital births and they *can* go very well. I had an awesome doctor who listened to me, who respected what I wanted, who let me try unmedicated labor when I wanted, but who listened the minute I changed my mind and decided I wanted pain relief. During my labor with my son, who we knew wasn’t going to survive long after birth, she sat in a rocking chair by my bed the whole time I was in hard labor because I was fairly drugged (upon my request, I was having a very difficult time) and had started to hallucinate. Each time the nurses were wonderful and supportive, I was given the baby immediately afterwards and left in peace with the baby until I was ready for a shower and food. I totally understand all the fears, because I had them too, and I would have them if I were to get pregnant again and have to go to a different doctor or a different hospital, but there are some decent doctors and great, supportive nurses out there. I really hope you have a great birth!
Having never been pregnant, all I can say is congratulations and good luck!! I was a december baby, back in 1979, and my mom was able to do a natural, unmedicated hospital birth. She still says it was one of the best experiences of her life. I say she must have had a lot of those postpartum hormones that make you forget the pain. :-)
Also, I have to say – Desmond Morris’s The Human Animal, which one commenter referenced above, is chock-full of unfounded assertions about evolutionary psychology. Take it with a salt lick.
I used to be a doula. I attended a birth where the mother didn’t speak english and the husband had to translate (she spoke chinese, I’m not sure if it was mandarin or another dialect). She agreed to an IV, so they hung the bag. Her husband and I helped with comfort measures and the nurse came in to change the bag. She never said more than “I need to change the bag” (it was empty). Turns out she gave her pitocin – without a word to any of us.
I told the mom “next time they come in, they’re going to want to break your bag of waters, you need to start deciding now if you want to allow it”. They came in and without a word broke her waters. Stupid resident didn’t even check position of the baby. Well guess what? The baby wasn’t full engaged so the cord started to prolapse. At least they didn’t do a c-section then, instead the resident shoved her hand up the mom’s cervix and held the cord back until the head came down. That wasn’t painful at all. (sarcasm tag)
They did all that with a doula present! I was somewhat hamstrung because I didn’t have medical POA so they could have thrown me out if I spoke up too much. I did pull the dad aside after the birth and told him that it should never have gone like that. They should never have given her pitocin without consent much less broke her water without consent (or checking the baby’s position).
That was the worst birth I saw.
I’m scared, too. And I’m not even pregnant!!!
Okay, I just read the birth rape link and I can’t stop being tense now. A long hard labour is bad, but let her birth at her own pace if she’s not dying!
This will probably alienate a bunch of women commenting here, but I will never understand the emphasis on the birth experience so many pregnant women have. I had an average medicalized hospital birth (induced a few days early because of high blood pressure, large fetal size, pelvic sprains, and general whiny discomfort on my part) and really – it was fine.
Really, the one thing I was thinking the whole time I was in labor – even after realizing after 5 hours of unmedicated labor I was going to ask for an epidural – was that it wasn’t as bad/momentous/as big a deal as I thought it was going to be. it wasn’t even the *most* painful experience I’ve had, the test for carpal tunnel (where the insert electrified needles into the nerves of your forearm) was much worse. I had built it up in my head as this huge huge huge thing that it didn’t live up to it either positively or negatively. Holding and interacting with my baby afterwards was much more affecting.
Although I was only in labor for six hours, and only had to push for like five minutes. So, take what I say with a grain of salt. It’s just that in the week leading up to giving birth I was sooooo terrified of a multitude of things, I wish I could go back in time and just give myself a hug. Honestly, I think part of the reason I asked for an epidural was that I was just so tired from a week of sleepless nights I couldn’t concentrate (also, my family members kept coming up and trying to talk to me, pissing me off and breaking me out of the pain-trance thing I had going).
I’ve met enough obstetricians that I’m convinced they all take a class called, “you’re always right, patients are idiots.” In fact, IME, they outrank cardiothorasic surgeons for God complexes.
My SIL is a L&D nurse and my wife and I have several children (Emergency C the first, planned C thereafter). The degree to which hospitals thing you agreed to their plan astonishes me. My wife and I knew that the hospital we went with had a very medical approach and made out peace with it, but I was aghast when at the anesthesia class, the attending anesthesiologist joked that “if you come in with a doula, a birth plan and a big rubber ball, you’re getting an emergency C section.” (And this wasn’t an old guy; this was a thirty-something lesbian or bisexual woman. And I’m not inferring orientation; she fielded a cell phone call from her partner during the presentation — in front of a room full of pregnant women who were there to hear her talk about anesthesia: rude! — that made it clear that she was partnered with a woman.) Net-net, I think if they all had immunity from liability, they would still pull the same stuff, because they are steeped in a culture that tells them that their way is the right way.
Okay, I can’t believe that this only just occurred to me, but is the hospital’s resistance to long labor because of health insurance? As in, the longer you go on, the more of the hospital’s resources you’re eating up and the less they make from what your insurance company pays them. That would also account for the assembly-line attitude of a lot of hospitals: as far as they’re concerned, you’re wasting their money with every “excess” hour that you’re there, because they only get a flat fee from the insurance company no matter how long you take.
Oh god I had a horrible time of it with my son. I had preecclampsia but they let me go 2 weeks over my due date then loaded me up full of drugs to keep my blood pressure down (and that also stop labor and milk production).
A c-section, being mistaken by the nurses for the heroin addict in the room next door (and then treated like the scum of the earth- the actual addict didn’t deserve that kind of treatment either) , and bloody nipples from trying to nurse a a hungry child with no milk followed.
Let’s just say that if I ever entertained ideas of having more than one child- the hospital experience killed it.
I strongly second the idea of having someone there whose been through childbirth themselves and is a tenacious advocate.
This does not have to be true. Like others I ended up at the hospital because of problems that would have made a home birth dangerous to myself and my children. The hospital had me fill out a written birth plan with my wishes clearly laid out and that plan was shown to the nurses during the process and was certainly understood ahead of time my by OB. It included not only my wishes concerning the birth itself but also what I expected would happen post birth. Any change in the plan was discussed and the decisions were ultimately mine. Despite my excellent diet, regular exercise, birthing class and great support neither birth went as expected. But both births were wonderful experiences and the fact that they were in the hospital made no difference to me or to the loved ones I had with me. My oldest is now 12 and my youngest 5 and there is so much to celebrate and so many challenges that the actual details of their births are quickly fading with the reality of their lives being of the utmost importance. Best of luck, it’s the beginning of a great adventure!
nthing the suggestion of a doula or a knowledgeble and assertive person you trust.
My first child was born in a hospital. she was 10 days late, they induced me and I ended up with every intervention – pitocin, internal monitor, epidural and ultimately c-section. I don’t dispute that one can have a good birth in the hospital but the statistics show (sorry, don’t have citations right to hand) that if you have good prenatal care and competent birth attendants homebirth is as safe or safer than hospital birth.
Kids 2 & 3 were born at home with midwives. I figured if I wasn’t at the hospital I wouldn’t have another section. Daughter #2′s birth was hard – but a 35 hour labor ending in a vaginal delivery is a MUCH easier recovery than a 36 hour labor ending in a c-section. My son’s birth was fast an intense and both home births were amazing and enpowering experiences. Being able to be at home or in a situation where you feel in control of your environment is huge when birthing. There are very few things in life that will make you realize how little control you have than giving birth so doing what you can to optimize your situation is crucial.
all that said, congratulations!
You’ll do great. I had a medical birth and a Bradley birth, and loved them both. It’s a very exciting time, and definitely unknown! After my natural birth experience, I wanted to get pregnant RIGHT THEN and do it again. (I didn’t)
I loved a book called I Wish Someone Had Told Me by Nina Barrett. Lots of it didn’t apply to me, but I really related to so much of it. You might enjoy it too.
Best of luck! I’m excited for you! Congratulations!
I have four kids. I’ve been pregnant five times. I’ve had everything from pure textbook to the middle of the night emergency D&C to being so bombed out of my skull I was hallucinating.
I’ve delivered with an episiotomy. I’ve been induced. I’ve delivered when i was the only person in the room (the baby got stuck).
At the end, there is one definition of a successful birth: a living mother takes a living baby home. The rest is details.
This will probably alienate a bunch of women commenting here, but I will never understand the emphasis on the birth experience so many pregnant women have. I had an average medicalized hospital birth (induced a few days early because of high blood pressure, large fetal size, pelvic sprains, and general whiny discomfort on my part) and really – it was fine.
Vanessa, I think you answered your own question! And it’s great if you did. What many of us feel is that, sadly, your experience is rare, and the way hospitals handle birth is the reason it’s rare. You’re lucky. I wasn’t. Neither have lots of women been (or we wouldn’t have a whole national organization to help us deal with it.)
Thanks for the shout out, Dr. C. You know, I’ve only been able to re-read that post once or twice; it’s still too painful to go back and feel those feelings again.
While trying not to be harassing, because, hey, listen, I KNOW how that feels–I was exactly in the same mindset as you re: homebirthing. Too much money. Too weird. Not enough failsafes. I didn’t want to mess up my rug or inconvenience my neighbors with the hollering. Etc. etc. etc.
And oh how I wish I could go back and change how I thought then.
And I don’t know if it’s fair to compare you and me; maybe you’ll be like Vanessa, instead. Maybe it’s wrong of me to even try to influence you at all. If it is, then ignore me, okay?
Knowing what I know now, I wouldn”t care about any of that stuff that made me go to the hospital last time. Even if his birth had been better than it was–I was hurt by birthing in the system, and I feel pessimistic enough about anyone else doing so that I want to beg you to try negotiating with a midwife for a homebirth, and if she can’t, getting her to give you a name of someone who might. To keep calling and trying and saying to hell with the money, I’m doing this once in a lifetime thing the way I want to do it. Because this kid’s birth will only happen once, and he or she won’t really care or remember it, but I will.
I don’t know; it’s probably stepping over the line, and if so, forgive me. Mothers have amazing strength no matter how they birth, and I know you will too. I would only say, whatever you do, be prepared to fight. Either fight your own fears and the indoctrination we’ve all had, or fight the system that will try to get between you and your birth. Adopt a warrior mindset, because you will need it, either way.
/steps off soapbox
fight for it, man. own the pregnancy. and best of luck.
Excellent post.
I plan to stay away from the hospital when/if I give birth. I have heard, read, and seen too many horror stories.
My sister was born at home after my mother had a traumatic experience giving birth to me at a hospital, where they took me directly out of her vagina and into a nursery for 12 hours and refused to give me back to my mom until “she rested.”
My nephew was born in the hospital. They did the “you’re dehydrated and need these fluids” routine with her and then added Pitocin and forced her into labor. Then they were drug pushers for pain meds until after five hours of the nurses asking “are you ready for an epidural yet?” she finally gave in and got one. They had one of those annoying monitors on her the whole time, so her movement was restricted. Then they decided she was “ready” before she actually was, and did an episiotomy without consent. And while my sister was sleeping, the nurses took her son away to the nursery and fed him formula, against my sister’s wishes.
I was there and saw the whole thing. It was pretty strong birth control incentive for me at the time.
I’d like to remind the people who had decent hospital births that they enjoyed a privilege that not everyone can enjoy. Circumstances differ, and not everyone has access to a hospital and/or medical professionals who listen to them and treat them respectfully.
This is coming from someone who will almost certainly have a hospital birth, because there’s no way I’m going through birth without some serious pain management. But I’ve had more than my fair share of experience with doctors over my lifetime, ranging from the incredible to the incredible assholes. Yes, it is possible to have the former, but remember that it’s by chance more than anything else.
You sound like you’ve done your homework, and that is the best way to prevent being taken advantage of. If you haven’t read Ina Mays Guide to Childbirth, I would recommend it. I felt so empowered after I read it, and I truly believe that it gave me the strength to advocate for myself.
I ran the gamut with my birthing experiences, except a c-section. I have written about them on my own blog (tag: birthing), if you like reading birth stories. (They certainly aren’t for everyone! :) )
I am pregnant, due in May, and this one will be born at home with a midwife. I am so grateful that we have the little bit of extra money to hire a midwife this time (about $1500- one quarter the cost of a hospital birth, and luckily we are due after tax time or we wouldn’t be able to afford it.). We were on Medicaid with my others, and I had NO options.
Oh, I haven’t been to Navelgazing Midwife’s blog in quite some time — I posted my daughter’s birth story there (and why I had and plan to again have a homebirth). Thanks for the reminder; I’m pregnant again (due March) and will be reading quite a lot.
The best advice I’ve seen on here:
1) Get an advocate, other than your husband. Be sure this person has time to know you and to know what you want and don’t want. You want someone who’s willing to be a complete pain in the ass!
2) Hold off on going to the hospital as long as humanly possible. I was so sad when my cousin (more like a sister) called to tell me that she was already at the hospital because “my water broke and they told me to come in.” As the previous poster said, if your water breaks, as long as the fluid is clear w/white flecks only (no green, no brown), stay home. Go walk. Clean the house. Do whatever you can to keep yourself busy (other than sex — nothing up there once the water breaks!) until labor has progressed far enough for you to not think straight. In my cousin’s case, it started with them pushing Pit on her because she just wasn’t contracting “enough”. From there, she “had” to have fetal monitoring, which in turn left her in bed as her only position. Ick. Yeah, I would have screamed for pain meds too if I’d been on my back in bed!
Anyway, best wishes to you. It seems that you’re someone who reads all you can put your hands on, and you’re well-informed. Trust your body, and it’ll work for you!
Well, yeah I will definitely agree with you with Amanda W, but I just wanted to let Dr. Confused know that it *is* possible. Hospital birth can be scary as hell, but it can also go fine. And I live in a rural area with very limited doctors and one choice of hospital- not everyone is lucky enough to find such a wonderful doctor, but it can happen. Vanessa, I actually could’ve written that myself. My thoughts exactly.
emjaybee – I actually had originally wanted the nice homebirth and didn’t get to have it. i understand and empathize with your awful experience – I actually had a hugely negative experience with a lactation consultant and with the first few weeks of breastfeeding, that probably contributed to some baby blues for me. So I understand how these things can affect you. (In fact, it may be making the birth itself seem inconsequential in comparison.)
So yeah, I guess you’re right.
I guess all I’m trying to say is what Angelia Sparrow did.
I think Angelia’s definition is very dismissive and condescending and is at the root of how OBs get away with this shit.
It’s like saying the definition of a successful tour in Iraq is coming home alive, and the assaults against you don’t matter really.
Mnemosyne – above you said that from what you see (based on one woman) women give up caring about anything but getting the baby out at the end. That’s really simplistic and dismissive as well. Yes, at the end of my pregnancies (in the middle of the 2 of the 3 hottest summers on record for Oklahoma, at the time) I wanted to be “not pregnant”, but uppermost in my private mind was protecting me and my baby from assault at the hands of medical “professionals”. Understand that what a woman (in particular) says in public often very poorly reflects what she is actually feeling/thinking. We’ve been conditioned to keep serious doubts to ourselves.
I don’t know, maybe. I certainly don’t want to be dismissive, and certainly feel that violations of choice are akin to rape in these situations (not to mention the insertion of instruments into a woman against her will).
But I think that pregnant women are under a lot of pressure to have the perfect natural birth, to be perfect breastfeeders, to bond instantly, or what have you, otherwise they’re failures. That’s what I felt, anyway.
I thought it would be awful to have an induction and hospital birth, but it was fine. I thought I was awful for failing to get my daughter to latch on and giving her formula. After a few weeks I realized it was fine (and incidentally, after that I was able to start breastfeeding and go on to breastfeed just fine for a year.)
And if I had remembered her name, I would certainly complain about the lactation consultant who came uninvited into my hospital room and bared my breast and squeezed my nipples in front of my entire family. And then who told me that my nipples were too flat and I should use a nipple shield even though it hurt. And that if I gave my baby formula she would get nipple confusion and never nurse properly. Boy was she wrong.
Meh, I think I’ll shut up about this now. I’m not sure how to say what I want to without seeming kind of like an asshole.
five and one half years ago i was VERY young. (not as young as some…younger than most) i was unmarried, abandoned by the father (charming man that he is), and the only thing i knew for sure was that in the end, this kid was coming out. luckily, i was in college, and still had decent insurance, but my doctors treated me like a child who didn’t know what was going on, and were a little rude at times about me being single. i read that docs often do one test that isn’t accruate, or even needed, and when i refused it they lectured me about not thinking about what was best for my baby. the nurses constantly reminded me that i had passed my target weight two months ago…and one had very long fake nails…ewwwwwww!
i went into early/false labor twice, apparently commuting to school didn’t agree w/ my wee one. they would keep me over night, pump me full of fluids and send me home, but not after jabbing me full of so many holes i was black and blue to the elbow. i had a bit of a plan…natural. no drugs, no needles (cuz i am soooo afraid of them), no cutting…i figured i would be fine…it would be simple…
i was told i had “group b strep”, which they told me was common, but to this day i have yet to find another woman who has even heard of it, but meant i would certainly have to have an IV b/c i would need large doses of antibiotics throughout my delivery or my baby would “be very sick”. (every “false” labor they also dosed me up “just in case”) each time they wouldn’t listen when i begged them to use certain veins…b/c i obviously don’t know that the ones in my wrist and crook of my arm w/ roll and blow…all b/c none of them was willing to use a butterfly in the back of my hand…six tries and four nurses later they finally gave in…
the final week, i knew it was time. one of my doctors didn’t agree…he said i needed at least two weeks…but when he did my exam…was surprised to find me dialting…and w/o asking stripped my membranes. i had no idea what he was doing…and never thought to think anything wrong w/ it until i was older and knew more mothers. but i was convinced that this time i would not go through all the trauma again w/o going home w/ a baby…
my contractions were on minute apart, lasting 45 seconds each. still, for some reason, after breaking my water, the doc and nurses decided that i needed pitocin, and conveniently already had an IV (b/c apparently my contractions weren’t fast enough?) now it was 30 sec apart, 30 sec each. i couldn’t catch my breath, so then i needed something to calm me down…whether i wanted it or not. good thing things were going to fast, b/c there was no time for them to force me into an epidural. it did nothing for the pain (and i still don’t know what it was) which i didn’t need, it wasn’t that bad pain…but i was hallucinating!
2 1/2 hours and we were finished…after i tore DEEPLY b/c my daughter’s head didn’t mold, came out perfectly round…ouch!!!
sorry to share such a long story…but i really feel that docs and nurses feel that they know more than we do. anyone can be vulnerable, i was incredibly so! it wasn’t a year or two ago that i figured out why i felt so off about the whole experience…thank-you for this great post b/c i lets me put a name to how i felt about my birth experience…
sorry again for such a ridiculously long post…ugh
Just wondering, you don’t think doctors and nurses know more about childbirth than you do?
Nurses go to school for 2-6 years, and doctors spend 4 years in medical school and 2-7 in residency to learn the things that normal people don’t know about medicine. Obviously they have no right to do procedures to which you have not consented, but they do know some things about birth that the average person does not.
I definitely agree that a lot of doctors are paternalistic and take advantage of patients to make their own jobs easier, but most don’t do that (they might get sued!), and medical schools are now teaching patient autonomy as the standard. Hopefully the new generation of doctors will be more open to different birthing preferences because of this standard.
Let me preface my comment by saying that I am not a parent, but I want very much to have children some day, and all of these comments resonate with me.
Vanessa, I think you’re dead on with this comment:
But I think that pregnant women are under a lot of pressure to have the perfect natural birth, to be perfect breastfeeders, to bond instantly, or what have you, otherwise they’re failures. That’s what I felt, anyway.
I think this is especially true among liberal/feminist women, though I imagine it exists across the spectrum. I am a big proponent of breastfeeding, but I see some people (if I call them lactation nazis, am I hitting Godwin here?) who essentially argue that women who can’t/won’t breastfeed are “bad” mothers who don’t love their children. I know some of this is just backlash against the anti-breastfeeding sentiment that many breastfeeding moms get, but it’s still wrong and disturbing.
And that’s one reason I agree with Vanessa. Even though I, too, find the approach of the birthing industry *terrifying*, I feel like there’s a certain subtle pressure here to have a home birth or a totally natural birth, when for some women that’s just not possible, whether for financial reasons or for personal ones.
After all, if we’re constantly pushing people into our own ideas b/c it’s “what’s best for you and the baby,” aren’t we, on one level at least, committing the same sins as the doctors/nurses we’re all angry at?
Wishing you the very best.
When I got pregnant, I knew nothing — cruised some books in the library, and very quickly decided, that if I wanted to avoid a cesarean, which I desperately did, it was homebirth for me. We scraped up the cash, and as others said, often lay midwives will offer a sliding scale.
I planned only to go to the hospital if there was an emergency. But most hospital trips are for “failure to progress” as you no doubt know. In my case, labor went on, but only nights, very weird, for over a week. Water broke but it probably another 5 days before baby born. Midwives came 3x, still no baby. We monitored temperature and fetal heartbeat, because like another poster said, if the waters are clear, you’re good.
But the baby was transverse, and the midwives couldn’t legally turn its head. I’d been in labor, off and on, for nearly 2 weeks. (really.) Off we went, with baby’s head crowning, and they still talked cesarean. So we let them do episiotomy, sigh. Midwife and even husband gritted teeth while dr wiggled shoulder dystocia, because they knew what to do, and dr didn’t. We lied about the waters breaking, so they wouldn’t put the baby in intensive care.
Even my mother, who thought I was crazy, decided I was better off going with home-birth after that. Though I didn’t quite succeed with the first one, it prevented the cesarean. Hospitals will not let your birth go on for days. They’re not used to outliers that are still able to do vaginal.
2nd baby completely at home, even with cord wrapped 2, maybe 3 times, and split at placenta. Oh, so glad, even though it was a bit hairy for the midwives. And lay midwives do have oxygen and other modern tools, which I luckily didn’t need. And yes, I made a mess and yelled and the neighbors heard, and it so doesn’t matter. Of course, I live in a city, where hospital is only a few miles away. That might not be an option. But I’ll add to the advice everyone else has. Get an advocate. Don’t get one like me, who is not quite knowledgeable enough. Get one who is aggressive. Wait till the last moment to go. And realize that the dramatic blood-spurting gonna-die-this-second stuff is rare. If you do manage homebirth, and live near the hospital recall that chances are there’s likely to be time to go if you need intervention.
And kids that are 2 or 3 weeks can be usual. Both my sister and I were that late.
Sister did nurse-midwives at hospital, and I was her coach. They were good, they tried, but still, too much in a rush. They pricked, they gave pit, (with consent) and her birth, though vaginal, was much harder. She should’ve just gone back home. I have never heard so much pain in a real person’s voice. But at least she didn’t get cut. And by the third baby she even got her water birth, so things are improving, I guess.
I’m sorry you have so many fears. I hope my little stories have helped a bit. My births were the kind that get many women cut, yet I managed if not perfectly. It still galls me that the midwives could not turn the baby’s head, though they knew how — that’s the medical industry for you, making the laws to protect their bottom line. But as another poster said, you do your best, and not beat yourself up for the coulda-shouldas.
Best of luck, again.
I allowed myself to get sucked into birth by intervention with my daughter. I was induced with cytotek but it didn’t do anything. Then, without my consent and under the guise of “checking my progress,” the nurse proceeded to strip my membranes. This led to my water breaking a couple hours later but still my labor didn’t kick in. The next morning (after 18 hours at the hospital) the nurse brought in pitocin and I put my foot down. I was done with their interventions that weren’t working, done wondering if I could get through another 18-24 hours in the hospital, and I wasn’t about to let pitocin throw me into intense labor pains (at this point, I was only dilated to 2 cm) that distressed my daughter. I made what might seem like a radical one: I asked for a c-section. My doctor was willing to oblige, and my daughter was born at 2:21 pm, 24 hours after my water broke.
I don’t regret the c-section. The situation had gotten very out of control and I needed get that control back. The sweeping of my membranes, the five doses of cytotek, the three doses of i.v. penicillin that were necessary after my water broke…all of these were due to that one decision I made, allowing an induction due to fear that my daughter would be large (she wasn’t; she was just 8 lbs, 1 oz). I wasn’t strong enough to say “no” to the induction, and finally regained that strength when the situation had reached, to me, the absurd. Fortunately, I recovered easily and was able to nurse my daughter, who roomed in with me. But I so wish I’d said no to begin with.
Your post is the first time I’ve heard the term “birthrape,” but my goodness, it’s exactly right. The pain and humiliation of the sweeping of my membranes, while the nurse literally chuckled over my discomfort, was one of the worst violations I’ve ever experienced.
I would like to end on a positive, though. When I look at my daughter, I don’t remember my experience in the hospital. I just see the beautiful child for whom I would have gone through much, much worse in order to bring her into the world. She’s worth every moment.
Vanessa, you’re not an asshole. Everyone’s birth experience is different, and your experience is no more or less legitimate than anyone else’s.
Group B Strep is a real condition – I was tested for it both times. I don’t know exactly how serious it is or what can happen to the baby, because I was negative both times.
Also: I broke the absolute, cardinal, unforgivable hospital rule of NO WATER during labor. I sneaked sips of water throughout my entire second labor. Of course, I puked it all up during transition, but who cares? For no other incredibly powerful athletic event are you told NOT to drink. And I did that one with no drugs, so I really wanted to be as hydrated as possible. It turned out fine. Plus, puking after several hours of labor is a sign that you’re near the end! Woo-hoo! Birth is messy. Your attendant(s) will get over it.
I also ate a big dish of Kung Pao chicken after I went into labor, because I remembered being so damn starving and weak the first time.
The no food/no water rule is to protect your potential anesthesiologist! If you eat or drink and they have to do an emergency c-section soon after, it makes giving anesthesia more dicey. But anesthesiologists are SUPPOSED to know how to deal with this. For chrissakes, does every person who has emergency surgery show up in the ER on an empty stomach?
/soapbox
There’s a way to use this thought to excuse uncaring and unfeeling hospital experiences and there’s also a way to use this thought to allow mothers who didn’t have a Perfect Birth Experience (TM) to forgive themselves. I was all set to go with a birth plan and the whole nine yards and ended up with a c-section. Little guy had his face up instead of tucked nicely. 33 hours later and I was tired, my doula was tired and my husband was tired. I’m so glad that I could have a c-section.
I’m completely horrified by the uncaring and downright abusive experiences that some of my fellow moms have endured. My doula is a goddess. I read Henci Goer’s book too, and it helped a lot.
Best wishes, Dr Confused.
“Birthrape” is the perfect description of what they do.
I had no idea how many decisions were going to be made for me or flat out against my will until it was happening and I was too scared and high to handle it.
Good luck.
BabyGirl checking in, 33 weeks pregnant. Good luck to all the other pregnant women out there in the blogosphere. I’ve been pretty luck with my OBGYN so far. When I expressed to him the kind of birth I wanted to have (no IV, no continuous fetal monitoring, no pitocin, no pain meds, no bag of waters being broken,etc.) his advice to me was to stay home as long as possible and try not to come to the hospital until I am about 6 or 7 cm dilated. If I do show up before that point, he’ll send me home. He says he absolutely does not want me to have a C-section or an episiotomy. I am hoping when the day comes, it goes as I wish. I am not afraid of the pain, I am more afraid of panicking and consenting to things that I don’t need or want done to me. My husband will be there with me, as well as my mom who is a nurse with 30 years of experience. NO ONE messes with my mom so I know she’ll be a great advocate for me if I do freak out. She had me back in the 70s without any drugs and breastfed me for 18 months. I actually could’ve used a midwife with my insurance and had NO CO-PAY for the birthing center (hospital co-pay is $250) but my mom is urging me to go to the hospital at least for the first one. I think it is possible to have a good birthing experience at a hospital, but you have to have a great OBGYN, a plan and an advocate. It wouldn’t hurt if the hospital were also a small community hospital like mine, not an industrial complex where they cut first and ask questions later.
Dr. Confused, here is a nice link from a great site, Ask Moxie.
http://moxie.blogs.com/askmoxie/2006/02/preventing_ppd__1.html
You are doing a lot of the right things. I highly recommend the Bradley training.
What I wonder is how is your relationship with your doctor? Are you able to talk about these issues now? How is the trust? I ultimately think that these are your real keys in a hospital birth–along with not showing up early. Arrival really starts a clock to maximize profits in many hospitals. It’s as sad as it is true.
I really like your posts and hope we see more of them!
What you need to do is read up on your options and decide what you want–but be open and flexible if things change.
Before I was even married, I picked an OB with top certifications and an all-woman practice. These ladies are very pro-intervention, if you want it, but they also have a less than 5% cesarean section rate. I asked about the c-section rate way back when, b/c I didn’t want a relationship with a doctor who would do that.
The most important thing about having a good birth experience is to vet your providers first. If you have high quality doctors that you trust, then you don’t have to lie about when your water broke or when contractions started. If you have to fight your staff, you really need better doctors. I know you can’t always get them, thanks to insurance nonsense, but if you know your doc’s c-section rate and episiotomy philosophy before you go in, you won’t be “surprised” during labor.
The first time, I tried going “all-natural”, and really, I think it’s bunk. It’s like running a marathon–some people really enjoy doing that. Not me. Not big into the pain at all. I much prefer being able to talk to my mom and husband and focus on the birth without being in a tunnel of pain.
YMMV, and I know many women who are proud of delivering unmedicated. What I don’t understand is why people act like choosing an epidural is somehow less fulfilling–everyone’s different, and what you think you might want for a birth plan may not be what works best for you.
As for Group B strep–yes, it’s real. Tested all 3 times, positive twice. My labors don’t last long enough to get 4.5 hours of antibiotics, so they end up testing the baby (one more stick). Babies can contract it during delivery, and it can cause meningitis, so preventing it is a good idea.
I like epidurals–my mom and husband are in the delivery room with me, and we can laugh and joke the whole time b/c I’m not in blinding pain. Number 2 had a labor from passing of the mucus plug to delivery in 3 hours. I still got my epidural, which is why I was laughing during contractions.
My mom is the most competent woman I know, and she’s my advocate in there. She also cuts the cords b/c my husband’s a wimp.
Last March I gave birth to our “oops” baby. As soon as she was born, the doctor gave her to me. “Warm the baby on the mother.” she told the nurse. Let her start nursing immediately–there’s plenty of time for weighing, measuring, cleaning later.
It was a joyful, fun experience.
Again, it’s my choice to have epidurals, and for me they are GOOD things. I would recommend signing the consent before your delivery, so that if you change your mind, you don’t have to wait on the papers.
I’m not saying all natural is bad, but it’s not what I would choose. Your choice is what is paramount, and that’s why it’s so important to have doctors you trust. If you don’t want c-sections or episiotomies, you need to know your doctors’ philosophy and rates for those procedures. If the only doctor you can get are strict “2 hours laboring then emergency c-section” types, then by all means stay away from the hospital until contractions are consistently 5 minutes apart.
But I truly wish you helpful and supportive birthing staff, for whatever method you wish to give birth. And most of all, for a healthy happy baby.
I think the summary word, the core thing, is always, CHOICE, informed, CHOICE.
After the baby is actually here, the baby needs to be care for, but we need to provide women the knowledge and the actual means to care for the baby, and then let her chose the options. There are things that One Does Not Do, but we shouldn’t demand or set a standard of perfection, especially when the jury is still out on perfect standard. ‘Boob Nazis’ really annoy the hell out of me, because yes, just as surely as some women give birth to stillborns, there are those who just can’t produce milk, OR, their milk just can’t be used. It’s a sad fact that while mother’s milk can provide her baby with immunity, some mothers have to be on drugs that render her milk unusable, and/or, she has something like H.I.V.
Note: The best alternative to human breast milk, if you can afford it, is /goat milk/, sadly, most don’t, and result to /soy formula/, which will harm the baby with all sort of bad hormones. There seriously need to be more human breast milk banks, arrangements, and promotions of. There are mothers out there who will be willing to help nurse a baby whose mother just can’t, or use the pump and donate. It’s a matter of organization, and funding for facilities, and standards enforcement (since diseases can be passed down through breastmilk)
Great responses. One thing I want to add is that the first time you give birth you have no idea really what to expect. You think (or hope) that yours will be problem free, you tell yourself that you’re “tough” or “prepared” when in fact you just don’t know what will happen. When I read, “I won’t have this, or that”, I think that is setting up a situation where if you end up with some kind of intervention you feel like a failure. Women who experience complications are made to feel as if their body betrayed them or they are less than somehow. If a woman admits interventions she is treated as a patriarchal dupe. I remember being at a baby group and having a mother berate another for getting an epidural and then boasting that her birth experience was “better”. I find this kind of posturing to be offensive and hurtful. With my first I was involved in a horrible car accident at 36 weeks (with a complete premature rupture of the membranes) and was taken in an ambulance to the hospital where I ultimately gave birth. I could NEVER have foreseen all that would occur. I had interventions that I swore I would NEVER have but under the circumstances they ended up being the right choice. I just think you need to be open to the possibility that things may not go as planned despite your best efforts…and if something does go awry it does not make you a “failure”. My other births were unmedicated and intervention free thank goodness but some of that was just plain old luck. The lack of empathy that women show each other around birth, feeding and motherhood in general is depressing but the “real woman” or “better woman” cred that some women try to wield as a result of their birth experience(s) is truly sad. Have a plan but be open to the fact that things just might not go as planned and that you might have to readjust for unforeseen circumstances. Good luck.
Dr. Confused, I too am scheduled for a December birth, so I’ll be thinking of you when I go in and wishing us both strength and the best of luck (since both are all too necessary). I will be having a hospital birth, but I’ve heard many good things from women who’ve birthed with my OB practice and share my values, so I’m hopeful.
I nearly killed my mother.
Well, it wasn’t me as such, but rather the circumstances of my birth…I was told the story much, much later on in life. I’m vague on the details, because I’m sure by the time I was told many had been forgotten or set aside. Suffice it to say that my birth was difficult, from what I understand, and there was some hemorrhaging as a result. Pop, I’m out, in the bassinet, and my mother’s wheeled to the recovery room.
She knew something was wrong, but couldn’t get any of the nurses or doctors to take her seriously. She was bleeding internally, getting steadily weaker and weaker, and her protests and pleas fell on deaf ears…until finally someone listened and examined her, discovering the source of the bleeding and stopping it – preventing by just a hairsbreadth me growing up without a mother just hours after my birth.
It still gives me the cold sweats when I realize how close of a call that was. It’s endemic in medical care; objectivity and detachment is a trained response, rationality while dealing with people’s bodies and pain stressed so that professional composure can be maintained, but many doctors go beyond that to desensitization and alienation. I’ve experienced it myself, knowing something was terribly wrong and being ignored by the doctor, and I understand, witnessing the experiences of my wife and mother, that it’s much worse for women.
Vanessa — I don’t think you sound like an asshole AT ALL. I requested my first epidural while being wheeled into delivery and slept like a baby during most of my labor, during which I was surrounded by people who had graduated from medical school. I don’t want to universalize this, but I also don’t feel that comfortable when other women universalize the beauty and sanctity of natural or home childbirth. I don’t think there’s one right way or that we can accurately say that all medical births are some sort of assault to our feminism.
dr. confused, i felt sad when i read your post because of all the fear in your voice. i too am a survivor of sexual assault and can understand just what being violated like that can do to your head, and the sort of fears that can be triggered.
that said, i’m just not comfortable with the term “birthrape” that you brought in. maybe it’s unfair of me, because the hospital where i gave birth was, i gather, extreme in the positive choice end. they insisted i fill out a birth plan. my reaction was – how can i plan for this when i have no idea what is going to happen? i went into my birth ready for anything, and ruling out nothing. i ended up having a successful birth – both my baby & i went home alive and healthy. an epidural helped me along the way, and i don’t regret it for a nano-second.
i guess i really fall down in these discussions because i, like vanessa, don’t understand the expectation or desire that so many women have for a “positive birth experience”, and the disappointment when that doesn’t occur. maybe i’m too pessimistic by nature, being an engineer by profession doesn’t help. but the thing that i can’t get away from in my head is that — prior to/without modern medicine “interventions”, the fatality rate for human birth is 1 in 10.
that means that if a woman goes out into a field and gives birth all by herself, 9 times out of 10 it will be just fine. it may hurt a lot, but both mother and baby will survive. which is why we hear so many women talking about what great experiences we have. but if you’re that 1 in 10 – you’re dead.
who here would get on an airplane that they know has a 1 in 10 chance of crashing? and yet we think that this “natural” childbirth thing is the shizzy. (and unmedicated home births are not natural childbirths in my book, not as long as you’re an ambulance ride away from emergency intervention. do it without that back up in place, like women have been doing, and dying, for millenia, and i’ll agree that it’s “natural”.)
but we seem to have lost site of the fact that hospitals, with all their nasty interventions – are keeping us alive! when without them we have only a 9 in 10 chance that will happen. which are good odds, and have led us into a state of overconfidence. the standard line, and i heard it straight from a midwife that i was interviewing to be a birth doula for me, is that “these interventions are unnecessary. women have been giving birth forever just fine without them”. maybe it’s the engineer in me, but i don’t see a 10% fatality rate as being “just fine”.
the woman above who posted about having pre-eclampsia, and the subsequent horrible experience her hospital birth turned out to be. i’m very sorry you had what was to you a horrible experience. but. pre-eclampsia can kill you. am i being an asshole if i say that i honestly don’t understand viewing any experience that brings you through the birth process alive when you’re experiencing a potentially fatal complication is “bad”. i honestly don’t get it.
it just seems to me that when you’re staring death in the face (which i have a couple of times, though not during the birth process) – that’s what’s bad. what the hospital does to save one’s life is incidental in terms of “bad experiences”. it seems to me.
and the standard response is how many of the interventions are unnecessary and done without the patient’s permission. i believe that is true, but it also seems like it is changing. i guess it just depends on what hospital you have access to. but again, i seem to come from such a completely different place on this, and did before my baby was born.
i look at birth as something that has a 10% chance of killing me, if nature takes its course. it’s the whole walking upright thing. no other mammal has the mortality rate we do when it comes to giving birth. our heads are too big and our pelvises are too small. that it works out okay 90% of the time is not good enough numbers for me to have gone into the process with an expectation of a “positive” experience – even if some women are lucky enough to have that happen. what the hospital does or doesn’t do to enable my baby and me to both leave their alive – i’m okay with, across the board.
i understand that in my milieu (liberal/feminist/middle-class/educated) i’m a distince minority. i hope i haven’t trod on anyone’s toes here.
I also want to suggest a doula. A doula can be a wonderful help, especially if you have a difficult birth. You can sit down with her before hand and she can clearly explain all the various procedures to make sure have the most informed consent.
but I want to speak to what vanessa said: But I think that pregnant women are under a lot of pressure to have the perfect natural birth, to be perfect breastfeeders, to bond instantly, or what have you, otherwise they’re failures. That’s what I felt, anyway.
I absolutly agree. Not all natural birth advocates are feminists. Certainly, La Leche league is one of the most anti-feminist organization around.
While it’s very important of have the kind of birth that you want (as much as possible), don’t give into the crap about how you will bond with your baby best if you breast feed or attachment parent or have a homebirth. That’s misogynistic bullshit.
I was born by emergency c-section and was bottle fed. There is no one I know who has a closer, move loving relationship with their mother than I do. I am 26 years old and I see my mother every day. The only person I know who has anything close to as strong a bond with her mother is my best friend who was also a c-section, bottle-fed baby (and is now a midwife who once starting shouting in the middle of a midwifery class on lactation, “CAN WE PLEASE STOP JUDGING MOTHERS???” the answer was evidently: no.).
Don’t make the mistake of assuming that only OBs and nurses have this mindset, and midwives never take the “I know what’s best for you, STFU” approach. When you sign up for the alternative-birth route, believe me, an awful lot of care providers want to make sure you go for the whole alternative-birth ride.
I had a very alternative-medicine-oriented OB who was fantastic. I had a Bradley instructor who was very sensible and helpful. I also ran into a lot of natural-birth advocates who were anti-intellectual, bullying assclowns, who got upset and angry if you questioned their Earth Wisdom or suggested that maybe “being in charge of your own birthing experience” meant doing things other than meekly obeying whatever advice they dished out.
Sarah – Bradley is fine if you have the right instructor. The ‘official’ version is ‘husband-coached childbirth’. Some instructors are smart enough to leave out the patriarchal, scolding BS and stick to the useful parts of the method.
Dr. Confused – the absolute best thing to do, no matter where you are giving birth or who is assisting, is to have a calm, informed advocate with you. This can be a doula, or your partner (if s/he is not in freak-out mode), a family friend, whatever. You want somebody to run interference and stand up for you.
“nazis”
“nazis”
“nazis”
A request: Would people please consider not comparing child health advocates and women’s health care workers (however passionate and/or extreme a tiny minority of them may be) to antisemitic racist fascist homophobic ableist eugenicist mass murderers? Please? It’s offensive on so many levels.
I’m due in March with my first baby and I’m hoping to give birth at the hospital where my clinic is at. Alas, it’s also 3 hours away, so I don’t know how feasible this is going to be, or if I’m going to have an uncomplicated pregnancy later on.
I’d love to have a homebirth but my husband is terrified of the idea. I’m more terrified of going to the local hospital, personally, even though my OB and the midwives who work in her office are wonderful. A lot to read about before March, certainly.
Trishka,
“Birthrape” is a controversial term, and I understand both those who are uncomfortable with it, and those who feel it’s the best word applied to their own situations.
Do you have a source on the 1/10 maternal mortality rate? The highest stats I’ve seen are 7/1000 in the 1890s, a time when the majority of births were taking place in the hospital, but before the introduction of antibiotics and good infection control measures. Unfortunately we have very few statistics prior to the era of hospital births, but most experts agree that the move from home to the hospital increased maternal mortality rates significantly. They declined rapidly after the 1930s as hospital births improved. In Mozambique, the worst country for maternal mortality in the world, the rate is about 11/1000, an extremely high number but only a tenth your estimate.
I didn’t use the word “natural” in my post. I don’t like the word, applied to pretty much anything, including birth. Of course homebirthers are an ambulance ride away from emergency intervention, as they should be. Of course interventions save lives. If I develop severe pre-eclampsia, I will have an induction (probably including an epidural), or a cesarean section. Those with complete placenta previa should get cesareans, no question. But using these same interventions inappropriately increases, rather than decreases, the maternal mortality rate. Thus why the United States has an increasing maternal mortality rate.
That said, if you’re most comfortable birthing in the hospital, I’m glad you did. I’m glad you had attendants who respected you as a person and your choices. I just want all women, in whatever environment they choose to birth in, to be treated with the same respect.
What I feel like has gotten lost a bit in this discussion is that the concept of “birthrape” is not a synonym for “hospital birth” with the opposite and ideal being a “home birth.” The concept of birthrape is one in which the physical integrity and agency of the mother is violated and she is treated in a way that is contrary to her express wishes. Simply — her “no” is not allowed to mean “no.” The term “birthrape” is useful, but only insofar as the concepts involved in rape are transferred to the birth experience in a consistent manner.
For example, a woman whose membranes are stripped without her knowledge or consent has her bodily integrity and agency violated. A woman who is given an IV with the understanding that it’s just a saline bag — when it includes Pitocin against her wishes and without her knowledge — has her bodily integrity and agency violated. A woman who has talked through a birth plan with her midwife but decides she wants to go to the hospital but is then harangued into remaining at home at risk to her health is pressured into relinguishing her agency.
While a medicalized labor presents more opportunities for birthrape, because there are more opportunities for medical intervention and more medical professionals in the birthing room who can, in one way or another, violate a woman’s express wishes, birthrape is not exclusive to medicalized births, and avoiding a medicalized birth is no guarantee that a woman’s wishes will be respected. And medicalized births can and do take place frequently without any violation of the mother’s wishes, which may or may not involve substantial medical intervention, so having a medicalized labor is no guarantee that a woman’s wishes will be rejected.
As for the “Can we stop judging mothers?” question, I would so love to see that answer in the affirmative, but I suspect we’re still a long ways away from those days…
I’m curious as to the source of your figures. Because you’re sure not talking about a healthy, well-nourished, anatomically intact adult population birthing in a clean environment with a competent midwife attending.
You may be quoting figures from a population with pelvic rickets, lifetime malnourishment, scars from FGM and other violent rapes, pregnant 11-year-olds, rampant HIV/TB/other infections, unclean environments, fistulas from previous births without emergency care available, no birthing education or trained attendants to identify risks and zero access to transport to medical care in the event of adverse events or risk factors. Those figures do not apply to most women in America, Australia, and so on. (And while you’re thinking about it, go donate to the Fistula Foundation, MSF, UNICEF or whoever else, if you can.)
Maternal mortality with well-managed natural birth by a healthy woman, including homebirth, remains a very rare event. See this study for some details.
I’m not sure why you have a problem with the term “birthrape”. It is used specifically to refer to fingers, hands and instruments being inserted into women’s vaginas without their consent. It is experienced as rape by women who suffer it, and it can cause severe and long-lasting trauma. The fact that some women negotiate the hospital delivery system without being victims doesn’t mean that it doesn’t exist.
Actually, Lauredhel, you’ve hit on an interesting intersection of ideologies – Heinrich Himmler, the head of the SS, was very much into holistic “natural” medicine…and some of those techniques were applied in the Lebensborn program (“pure” Aryan women were encouraged to get pregnant – even out of wedlock – by specially-selected SS officers of impeccable racial credentials and were housed in special hospitals away from prying eyes.) I’m not saying natural birth advocates have anything in common with the Nazi Party other than this tenuous commonality…and now we conclude our trivia moment.
dr. confused, i will have to ask my husband about the stat of 1 in 10. he is a physician and said that was the number he has always heard. (he works in the ER and has attended the delivery of a number of births in his career.)
following up, to be honest, i wouldn’t get on a plane that crashed 1 in 100 times, either. that is ten times as likely the positive outcome, for the sake of argument, but still way too high for my engineer’s caution.
i think it’s because the risk of death is so low when we fly airplanes that we’ve come to focussing on the delays, the lack of leg room, the poor service, &c. (have i hit you hard enough over the head with my anvil of metaphor yet?)
that said, the issue of administering drugs without or against a patient’s consent is an interesting one. at first glance it seems like a no-brainer – of course it shouldn’t be done. on the other hand, i honestly don’t understand why someone would absolutely rule out any intervention, should it be necessary.
and of course, whether or not it really is necessary is the issue, and what makes it a gray area.
ekf, that was an excellent explanation of the term “birthrape.” I’m sorry I didn’t make it clearer in my post.
Trishka,
I’m curious about where you’re getting the 1 in 10 figure, and whether it refers to maternal death, infant death, or both – a quick google search hasn’t helped me find your source. Also, I think that it’s maybe not so helpful to declare that the “fatality rate” is 1 in 10 “without/prior to modern medicine ‘interventions,’ and then to eliminate unmedicated homebirth with emergency backup from your definition of “natural” childbirth, since most women who choose unmedicated homebirth in Western countries do consider that “natural” birth.
Although I’m sure this wasn’t your intention, it does seem to set up an unnecessarily frightening straw man. Or straw birth. Or something.
Also, after refreshing, what Lauredhel said.
uccelina, see my above post re: the source on the stat. i will have to get back on that. also the mortality rate is, i believe, where either mother or baby, or both, die.
also, i am curious (genuinely) what the safety/risk level is for people here in undertaking something, anything, and whether or not that level of risk varies with the activity.
like, obviously, the 1 in 4 death rate for climbers of mt. everest is too high of a risk for most people.
but is 1 in 100 okay? is it okay if it is childbirth or kayaking, but not okay if it is an automobile. (i.e. if a manufacturer like GM put a car on the road that was known that 1 out of 100 of them would fatally crash, would that be okay? and who would buy that car?)
we all know that we cannot expect to be completely safe, but what level of safety are we comfortable with?
>
that’s right, it does. however, it’s important to note the high mortality rates for homebirths are a result of births that suffer complications being removed from the equation – i.e. if you’re suffering complications you go to the hospital. (usually, not always).
for example, pre-eclampsia. when i was pregnant, the literature they gave me said that 6% of all women giving birth suffer pre-eclampsia. that is a potentially life-threatening complication. and i don’t know what the stat is for breech babies, but it’s not insignificant, and that is another potentially life-threatening complication.
and “natural” childbirth is, in my definition, a system that does not have procedures in place to deal with those life-threatening complications. i.e., anytime you’re an ambulance ride away from help, you’re not doing it naturally.
“Maternal mortality with well-managed natural birth by a healthy woman, including homebirth, remains a very rare event”
this is the quote that got lost in my above post.
I also have to question the “1 in 10″ figure. In fact, I pretty much call bullshit on it.
My googling found the a maternal mortality rate of 14.4/1000 births in 15th century. That’s pretty much the worst time and place I can think of for a woman to give birth: an unhygenic, openly misogynistic, urban environment with rampant malnutrition and disease.
I think it’s very important in conversations about the way that allopathic medicine can harm or disempower women that we understand that allopathic medicine does not have a monopoly on the scientific method, in fact, allopathic medince is historically incredibly unscientific. In, for example, 15th century Florence who was more scientific: a midwife who learned how to be a midwife by watching and assisting at hundreds of childbirth or a university educated physician who learned how treat birthing women by learning about horoscopes and theology and Aristotle? In 19th century England would a lay midwife who has attended over 200 births be a less scientific choice than a doctor who has never seen a naked woman before and who believes that the inflamed uterus is the source of all women’s psychological troubles?
Midwives are medical professionals too.
I want to totally second what EKF said: any time the person around a birthing woman violates her trust , takes advantage of her vulnerability and does a medical procedure without her consent that is birth rape. No one medical idealogy has the monopoly on violating women, we do, after all, live in a patriarchal society.
For my SIL the most violating, humilating, degrading experience of her birth came when she met with a lactation consultant. The lactation consultant berated her loudly for not “trusting her body more” and told her that going back to work while her child was small, was just irresponsible. My brother called me and my friend the midwife. She perscribed, in her medical opinion, “hot compresses for the sore breasts and a punch to the face for the lactation consultant”
i may have chosen my words poorly in the emotion of what i was writing…doctors and nurses may know more clinically than most women, but when it comes to things about our bodies when it comes to medical care, they don’t know shit about allowing us to make chioces about our care. this is evident to me, when the nurses refused to use the veins i told them would be best…at 22 (at the time of delivery), i had had enough IVs, blood drawn, and given enough blood to know which veins are not going to roll, and how best to avoid being bruised to my elbows when leaving, and yet not one doctor or nurse will listen to me w/o my throwing a world class fit about it.
also, i see no medical reason, and noone could tell me, to give a woman contracting that fast pitocin (as i said, i was already one minute apart, lasting 45 seconds, and it sped me up to 30/30)…i had specifically told them no drugs (beyond the antibiotics i had to have), and they still gave me a sedative (that i still don’t know what it was, but made me hallucinate), and would probably have given me an epidural had my labor not been going so fast. the “highly trained” doctors and nurses sped my labor up for no need, had no time to watch if i might rip or tear, which i did…deeply and damaged some pretty important stuff. they are also the people who told me laying in bed is the best for getting labor to progress, when every idiot who ever picked up a pregnancy book knows that walking around and moving will help the process along, and those same people mistook my post partum labia for “the biggest hemmroid” they had even seen, until i had my mother check for me (no roids for me!)…so yeah…despite all their magical years at medical school, i think that women might know a thing or two more about their bodies in childbirth than a lot of doctors and nurses. (and this isn’t exclusive to childbirth, i have similar experiences b/c i have a chronic illness, and guess what…all that training means squat if they refuse to listen to patients)
and thank-you to everyone who answered, b/c i was beginning to think that group b strep was something someone made up to scare me into getting an IV. they just made it sound as common as blue eyes, but until now i never met anyone else who had even heard of it!
i forgot to add…if new doctors are being taught “patient autonomy” at medical school, i have yet to see it in the slew of doctors i see almost daily for over a year now. everyone from well seasoned to the new med students, not a single one willing to listen to the patient. it seems to be “i’m the doctor, i’m the boss” mentality.
bullshit.
One in ten what? …it just ranks of damn lies and statistics.
Best Scenario: A doctor who helps
Worst Scenario: A doctor who violates
…and ya know what, there are hospital births where for the sanctity of the fetus and/or speediness of their time-money, they KILL the mother.
If I can’t guarantee a doctor who won’t violate, I rather be by myself. It’s the old, lick your wounds in the dark versus exposure to hostility making things WORSE again. I would like a midwife, and ideally, my spouse would be a family doctor, hahaha, but if the risk of being HARMED is high, I rather be alone.
On the scenario note; I’m in (Toronto, Ontario) Canada, anyone else? Where healthcare is for profit, it occurs to me that the doctors might on a grand scale, be less considerate. So far, the professionals I have the fortune to encounter have been kind,I’m afraid of the needles but the all the nurses who gave me shots or took my blood took care. I had a surgery where I was put under, and I did remember feeling safe before I went out, the nurse/doctor was talking to me, telling me to count backwards after they put the gas mask on.
The major problem in Ontario is that there is baby bloom, but not enough maternal professionals of any sort, this was featured in Ming Pao several days ago.
In HK, where the healthcare was advance but for profit, I broke my jaw open when I was little, and the /first/ doctor I was taken to, put a /bandaid/ on it and considered his job done.
I don’t mean to derail or overtake the thread, but I do want to respond to Trishka’s concerns, which I think are valid, but could benefit from some alternative perspective.
What is an acceptable risk? I don’t know. But birthing in a hospital does not automatically lower the risk.
Example: Pitocin, used in labor induction, leads to strong, fast contractions, therefore increasing the chance of an epidural, which can lead to drop in maternal blood pressure and fetal distress, which often leads to a C-Section, which carries a risk of infection and may be linked to a recent rise in US maternal morbidity . And yes, if you’re already in a hospital, then they generally have the ability to deal with these cascading complications. But it’s worth noting that these very common complications would probably not have occurred without that first intervention.
Look, I’m going to be birthing in a hospital, as I mentioned above, because I’m carrying twins and am therefore automatically labeled “high risk” by the medical establishment. And of course, if, god forbid, complications arise, I will take the pitocin and have the C-Section or do whatever is required to make sure my babies are safe. I am absolutely not arguing that all birth should take place out of hospital and that women should never have an epidural. I do believe, though, that all women should be able to make educated, informed decisions about what is best for them, and that hospital birth ≠ lower risk.
I do not believe anyone here has said that “natural” childbirth as you define it above is “the shizzy” at all.
I just want all women, in whatever environment they choose to birth in, to be treated with the same respect.
Dr. Confused — Yes, EXACTLY. It’s not about home vs. hospital. It’s about *informed* consent and respect.
They began testing pregnant women for GBS in the early 2000s. So, if your example group gave birth prior to that, they’ve probably never heard of it, after that, they probably have heard of it. For unknown reasons, the infection rate among pregnant adult women has been steadily going up for the past two decades.
GBS can cause immediate and serious post-birth infection of newborns, although the infection risk is low even with a GBS+ mother.
Any OB who tells you that you MUST have a c-section due to being GBS+ is a lying BASTARD and I know women who have been pushed into a c-section due to it.
@ Trishka #70
following up, to be honest, i wouldn’t get on a plane that crashed 1 in 100 times, either. that is ten times as likely the positive outcome, for the sake of argument, but still way too high for my engineer’s caution.
Again, I think that a person should birth wherever works well for her. However, I believe this statement is unfair to homebirth, as it assumes that there is no plan for transport and/or emergency involved. Any midwife worth her license will have a backup plan for transfer — and make use of it when necessary. I forget the exact statistic, but 5-10% of planned homebirths do result in transfer. Equating a transfer with a plane crash seems a bit much.
in response to everyone’s posts: i’m fine with the 1 in 10 number being too high. i’m happy to work with whatever number everyone feels comfortable with, in terms of being backed up by data on google.
if 14.4 in 1000 is a number you like, let’s go with it.
would anyone here get on a plane if the standard of design was that 14.4 out of every 1000 flights fell out of the sky & killed everyone on board?
and i’m not saying that is what home births today with emergency hospital backups in place entail, so allison i think you misinterpreted my point.
i’m saying that this is what NATURAL childbirth entails, and that is the reality of our bodies. we are as poorly designed for childbirth as an airplane that fell out of the sky 14 times out of 1000 flights. our heads are too big & our pelvises too small, compared to all other mammals.
and if that’s scaring people, then so be it.
the reason i’m bringing this into the picture is that i think it is important to keep in mind what all the medical intervention is keeping us from – it is keeping us from that 14 in 1000 number.
and it’s easy to say that all medically necessary interventions are okay, and all unnecessary interventions are not, but the bottom line is that in a complex system, we’re not going to get it exactly right. there’s a lot of overlap, a lot of leeway, a lot of grey area in terms of making judgment calls, and it’s not going to come out right.
for me, if we’re going to err, i’d rather we err on more interventions than less, if it means the over all mortality rate is lower.
and – i think that we’re moving in that direction, with more and more hospitals adopting a position that allows the mother and her advocates autonomy. and that’s a good thing, don’t get me wrong. it’s good to have these conversations, and keep pushing this advocacy with hospitals. reducing the error (i.e. unnessary intervention) is a good thing.
i’m just looking at expectation management on the part of mothers who are going to be giving birth. the perfect world has the medical establishment doing no more intervention than is necessary or desired, but giving exactly that much. (i myself could have done with more epidural anaesthetic during the pushing stage, but it didn’t happen. oh well.)
but given that perfect might not happen, i think it might help if a woman gets more intervention than she might have wanted, to keep in mind that the end net result of all that intervention is a drastic overall decrease in the mortality rate.
by the way, i’d be curious to find out exactly how many instances there are of a woman involved in a birth with no complications being given pitocin that started the “cascade of complications” that resulted in death. i warrant it is possible, but how common is it?
“for me, if we’re going to err, i’d rather we err on more interventions than less, if it means the over all mortality rate is lower.
and – i think that we’re moving in that direction, with more and more hospitals adopting a position that allows the mother and her advocates autonomy. and that’s a good thing, don’t get me wrong. it’s good to have these conversations, and keep pushing this advocacy with hospitals. reducing the error (i.e. unnessary intervention) is a good thing.”
i want to amend my post by adding between the two paragraphs that i agree we should work towards reducing the error, no matter what.
While I see your point on the nazi bit, I’m also somewhat offput about your emphasis on teeny-tiny minority.
I mean, I’ve heard enough anecdotal evidence of negative experiences with midwives, LaLeche Leaguers, lactation consultants, and what have you to suggest it’s not that tiny of a minority being extreme or “passionate.”
I know there’s studies showing OBs have increasing C-section rates and whatnot. I’d be (actually) curious to see if there are some statistics or studies or anything about negative behavior of natural birth practitioners.
Do doctors and nurses know more than I do about how the body works? Yes. Do they know more about drugs, procedures, complications, side-effects, and the like than I do? Yes.
However –
Do they know whether my pain is “bad enough” to “need” medication? No — in either direction. Sorry, folks, only one of us is inhabiting this body, and it’s me. As it happens, I (like my mother) have a very high pain tolerance, to the point where it delays/inhibits diagnosis of problems. The worst that’s ever done to me is delay discovery of a broken arm for several hours, but Mom’s had major issues – mostly related to complications from my birth, actually. Both of us are aware of this tendency, and know we need to be proactive about saying what we need and how we feel otherwise. Still we both have had doctors insist that we must need meds because “that condition is so painful!” Nope, I’m fine, thanks. The opposite result too — “you can’t possibly have X. If you had X you would be screaming in pain right now.” If I have all of the other symptoms of X, I probably have X.
Several people here have mentioned problems with injections/IVs — rolling, bruising, fear of needles, etc. This is another place where the doctors and nurses ought to shut up and listen for a moment. Do I know how to give a stick? No. Have I been stuck often enough to know how my body reacts to it? Yes. For one thing, I give blood regularly. If I tell a doctor/nurse — and I do, every time they stick me — that I have thin veins and bruise easily, and the best/easiest/least painful/most likely spot to get a vein on me is right there, do NOT tell me you’re going to stick me over here. Five sticks later, as I’m gritting my teeth and visualizing the needle shoved where the sun don’t shine, you’ll just wind up where I told you to try at first.
Maybe these would be different if we had more contact with our doctors, instead of seeing them once, maybe twice. If we had “regular family doctors” instead of going to whichever one our insurance will let us see this week, they would know as much about our individual quirks as we do. As it is, a quick glance at our chart isn’t going to give them familiarity with decades of history — so yeah, there’s a lot they DON’T know.
Trishka, I’m not sure my repeated objections to your rhetoric are really doing much good here, but I’ll add another one anyway.
This reads as if you are saying there is no middle ground today between “natural” childbirth by 15th century European standards – with malnutrition and rampant disease and no attention to hygiene and no emergency access to care – and “all the medical interventions.” This is a false opposition, and does not address the possibility that many medical interventions performed today are performed less for the health and safety of the mother and infant(s) and more out of fear of lawsuits (one doctor told me, “you’ll never be sued for performing a C-Section too early”) and a view of birth as pathological and in need of management rather than a natural process which may need to be assisted.
Again, the key factors are choice and education. I don’t think we disagree on that.
okay, i went to lunch and digested this conversation and was able to formulate in my own mind what i want to say here, which i wasn’t clear on before (even in my own head).
(so, thank you to this great blog for helping me get clarity. this is an awesome bunch of respectful thoughtful women here).
the problem that i have with this whole issue is one of expectation management (like i said above) and the number of women in my milieu who end up feeling very unhappy about what happened when they gave birth. (and the subsequent fears around such as expressed by dr confused, who made the original post).
it seems to me like there is an expectation present around birth, this desire for a “positive birth experience”. women hear other women talking of how great it was for them, and they want that too. and there’s something empowering feeling about keeping the male-dominated patriarchal western medical establishment out of it when they’re not needed that feeds this. it’s like there seems to be this assumption that has taken hold of us collectively that it is our (birth)right as human women to have a “positive birth experience”.
and unfortunately, a lot of unhappiness seems to come out of this. happiness for the women who give birth easily, but not so much for the women that don’t have that experience. there is, at the least, disappointment, if not a sense of failure. and that, in my mind, is really sad.
i keep harping on the mortality rate for true “natural” childbirth. my husband, who is a physician, said that he had read that it was 1 in 10. someone else brought in the stat from the 15th century of 14.4 in 1000. my suspicion is that it is higher than that, even if it is not actually 1 in 10, but since i can’t produce a better number, am fine with using 14.4/1000 as the “natural” mortality rate.
and why i keep harping on this, and airplanes, is that when i was pregnant & looking around for childbirth classes, the local bradley method teacher had written on their website that “women’s bodies are perfectly designed for giving birth”. and THAT MAKES MY HEAD EXPLODE.
because a mortality rate of 14.4/1000 is a really crappy design, relatively speaking in today’s modern world. plug in anything else – airplanes falling out of the sky, buildings or bridges collapsing, antibiotics killing patients – and think of that number, and think how acceptable, much less “perfect” we would consider that design.
the bottom line is that our bodies are actually poorly designed to give birth. we’re not designed nearly as well as, for example, airplanes. and it’s all because of walking upright. the national geographic did a whole article on this very subject within the last couple of years. so: blame evolution. or, if you don’t believe in evolution, blame god or the disco ball or whomever you believe designed us.
that doesn’t mean that 986 times out of 1000 they don’t do the job, but my understanding is that no other mammal, even primates, experiences the mortality rate we do during birth, and we don’t accept that fatality rate with any other commonplace modern activity. (of course there are other activities that people take on that are riskier like rock climbing and race car driving, but not the percentage of the population who undertake childbirth).
so what i’m saying is that – because of our physiology it isn’t necessarily terribly realistic to *expect* to have a “positive birth experience”. i’m not saying be afraid, or don’t love or trust your body. i’m a former endurance athlete, practice yoga regularly, i’m all about loving and trusting your body. but also, i wish we women could be more realistic about the hand that evolution has dealt us with respect to childbirth, rather than believe what the bradley peopleet al tell us about how “perfectly designed” our bodies are.
and so enters the western medical establishment, which is flawed as well. and we’re taking a flawed system (modern medicine) and applying it to another flawed system (human physiology vis a vis childbirth) – and problems emerge. but more problems are solved than are created, overall and for the most part.
which doesn’t mean that western medical hospitals can’t and shouldn’t improve. it’s important that we women keep talking to them and working for change. i’m all for that, just like i’m all for imformed choice.
but as far as what we expect (and flipside: fear) about childbirth, i think we collectively have lost perspective about the fundamental source of the problems we encounter, which is our physiology. that the western medical establishment fails to deal with this problem perfectly, for a variety of reasons already elucidated, is not okay & i’m not excusing it. but they’re not responsible for our flawed physiology, they’re just trying to deal with it and, number one, keep mother & baby alive. avoiding lawsuits is tied closely to that, and making money is in there too. but their mandate is first and foremost to get the mortality rate down from what evolution has decreed it to be.
i realise that what i’m saying flies in the face of conventional wisdom of our milieu concerning childbirth – which is that women’s bodies are perfectly designed for giving birth and it is only the problems of the western medical establishment that result in (very nearly) all women not having a “positive birth experience”.
and that’s just not true. first and foremost, we’re NOT WELL DESIGNED TO GIVE BIRTH – relatively speaking. that’s the root cause of women not having “positive birth experiences.” anything hospitals do on top of that is an exacerbation.
i would hope that keeping this in mind would help more women to not be unhappy or disappointed with their outcomes.
True. I’m taking a Human Biology class this semester, and it’s helped me come to better terms with having a miscarriage and with having a difficult pregnancy.
Oddly, my friend who I have known for almost 20 years didn’t seem paralyzed by fear at the thought of giving birth at the same hospital where she’d had her first daughter. She did complain quite frequently that she was heavily pregnant in the middle of summer but they had no air conditioning.
She was definitely more stressed with the second pregnancy because, as she put it, she was much more acutely aware of the things that could go wrong with the pregnancy and birth than she was the first time around. But she was talking about stuff like finding out the fetus was disabled or the baby being stillborn, not being worried that the doctors were going to assault her. And, yes, both of her labors were induced with Pitocin, and she had a positive experience with both, anyway.
I suppose it’s possible that my friend that I’ve known for almost 20 years lied to me about everything and that she actually had a horrible “birthrape” experience that she just can’t express to anyone, including her husband (who would tell me), but I certainly hope not.
Trishka, do you mind if I summarize you? Let me know if I don’t do it right:
What Trishka is saying is that childbearing in the human animal is more risky than it is for other animals. Because we are smart and have been able to come up with various interventions to get around those limitations over the last few hundred thousand years, people have a false sense of childbirth being much more inherently safe than it is.
She’s not saying that homebirth is riskier than hospital birth. She’s pointing out that homebirth is medicalized too, because it’s something that’s been developed by observation over hundreds/thousands of years.
It’s like the people who don’t vaccinate their children against measles because, hey, nobody gets measles anymore. The problem is, the reason people don’t get measles is that we vaccinate against it, so they have a false sense of how risky the vaccination itself is versus going vaccinated. Homebirth is very safe, because we know how to do it. But with no modern intervention at all — including homebirth as a modern intervention — childbirth is actually quite a risky thing.
D’oh:
“The problem is, the reason people don’t get measles is that we vaccinate against it, so they have a false sense of how risky the vaccination itself is versus going unvaccinated.”
…and ya know what, there are hospital births where for the sanctity of the fetus and/or speediness of their time-money, they KILL the mother.
Good grief. If we’re being skeptical about statistics, how about this one? On what planet do you believe that “speediness of their time-money”, whatever the hell that means, makes it more efficient to actively murder a woman in childbirth?
I’m about the last person in the world to say wonderful things about doctors, but the natural-childbirth community seriously needs to take more credit for the impact it’s had on the way OBs and nurses practice. Birthing rooms, ‘walking’ epidurals, a reduction in episiotomies, putting the baby in mom’s room instead of an industrial nursery, and so on are all things that came out of women knowing they had alternatives.
Women with money, anyway. I doubt many women without health insurance or savings are going to hiring midwives and doulas.
mnemosyne, yes, you did a good job of summarizing. and this:
“people have a false sense of childbirth being much more inherently safe than it is.”
is the important thing, because i believe this is the cause of a lot of unhappiness that women have with their birth experiences – the unhappiness results from unrealistic expectations.
that are widely promoted by the so-called “natural” childbirth community, mind you.
I think mythago has a good point — the hospital-medical version of birth is (slowly) improving, and it’s largely because there are other options for women.
trishka says even homebirth is medicalized. I’m not sure anyone’s arguing that it isn’t. And the natural childbirth crowd does provide some overly-optimistic views of the risks in birth. But the medical community provides overly-pessimistic ones. If 986 times out of 1000 the body can get the job done, then 986 times out of 1000 it should be allowed to, if that’s what the woman possessing the body would like. But that’s not how hospitals operate. 45% C-section rates? 450 women out of 1000 had bodies that “couldn’t get the job done” on their own? Something’s very wrong with this picture.
Should the natural, homebirth crowd be talking about the risks the 14 take? Yes. Should the OBs be talking about the 986 that don’t need intervention? Yes. And while some of the OBs are doing that, right now there’s a whole lot more honesty, proportionally speaking, on the homebirth side.
45% C-section rates?
I thought it was more like 29%…where’d you get your number?
I realize that we’ve pretty much argued this point out already, but if the mortality rate is only 1 in 10 for first-time spotted hyena mothers – and their particular genital setup makes me wince every time I even think about it – then I doubt very much that it was ever that high for human mothers except for certain very specific populations, such as early maternity wards.
I thought it was more like 29%…where’d you get your number?
Nationally, it probably is — I was referring to particular hospital/OB numbers that turn up in some of the anecdotes women relate when these topics come up in the blogosphere. Still, 14/1000 is 1.4%, so anything over 10% is pretty staggering.
Quick addition, since I brought in the questionable stat.
The national rate is sometimes cited as 28% and sometimes as 29%. Here’s an image by state ranging from 21 to 36.9%: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5615a8.htm
And in a quick check for rates by hospital, I’ve found rates as high as 44% cited for certain hospitals in NJ and VA.
Trishka – may I suggest you read “A Thinking Woman’s Guide to a Better Birth” or, even better, “Obstetric Myths versus Research Realities” both by Henci Goer.
Both books look at ACTUAL studies based on the necessity and, yes, safety of common interventions in the US.
For instance “no food or water” is a silly rule. It’s based on the idea that you MIGHT aspirate during a c-section. Which should only 15% of the time (according to WHO). So 85% of women giving birth should give up taking care of their nutritional and hydrational needs? For why? It’s not like people in car accidents who need surgery have been fasting. And the lack of water can, as you should know since you’re an athlete, enhance the feeling of pain.
Brandann – group b strep testing was being done in the mid-90s. It became more common after “Promised Land” (the spin-off of Touched by an Angel) showed a baby dying from GBS.
I wouldn’t have a problem with a medical birth if I could trust the doctors to actually follow the research and not just some feeling of what will reduce their liability if they are sued. The resident who broke my client’s water without 1) consent and 2) checking position should have been sued.
For everyone recommending doulas – I agree with one caveat: Check with your hospital and see what their policies are. When my clients were in doula friendly hospitals I could really stand up for their rights. When they were in a couple of other hospitals in town, I couldn’t even address the nurse directly because they didn’t want me there in the first place and told the mother that if I gave them ANY excuse they would have security escort me out. And that in fact did happen to other doulas in my doula group.
gaia –
thank-you! and to everyone about GBS. that really helped.
totally OT, but i realized that i know very little about midwives and doulas, and honestly don’t know the difference b/t the two…can you direct me in a way that i could educate myself? “back when i gave birth” (goddess that makes me feel older than i am) i didn’t hear a lot about them, didn’t have the resources anyway if i had, but if i decide to have another child, i would like to know more.
i just have to say…this has been an awesome post! i have learned so much!
we are as poorly designed for childbirth as an airplane that fell out of the sky 14 times out of 1000 flights.
Not exactly. Many of the maternal/infant childbirth deaths resulted from rickets, an illness that malforms the uterus and is caused by malnutrition, which was of course much more common prior to the 20th century in this country and England, and puerpal fever, which is what claimed Mary Wollstonecraft, and can more or less be traced to doctors not washing their hands between patients and/or when coming from the morgue (that would be later than the 14th century, of course). I can provide citation for the statistic that the risk of maternal mortality (not infant, that wasn’t what I was researching) in England from 1650 to 1850 was no higher than 1% for each pregnancy, which, and this can’t be stressed enough, was no higher than the rates of mortality for numerous other conditions prior to the advent of antibiotics and modern understandings of hygiene and sanitation.
Citations:
Loudon, Irvine. Death in Childbirth: an International Study of Maternal Care and Maternal Mortality 1800-1950. Oxford: Clarendon Press, 1992.
Pollack, Linda. “Embarking on a Rough Passage…” Women as Mothers in Pre-Industrial England: Essays in Memory of Dorothy McClaren. Ed. Valerie Fildes. New York: Routledge, 1990. (I don’t have the page numbers to hand, sorry.)
In fact, Loudon writes that ““as maternal mortality was declining faster than mortality from other causes in the eighteenth century, the relative risk of dying in childbirth decreased.” He cites a number of studies and writes that “taking all these estimates together, there is broad agreement. It seems there was a continuous and substantial decline in maternal mortality in England from the second half of the seventeenth century to the first half of the nineteenth” (160).
Which tells us that not only is 1/10 far too high a stat, but that it was falling rapidly far before the advent of contemporary hospital interventions. Loudon ascribes the credit for this trend largely to an increased number of skilled (and at this point in history, female) midwives.
I have no stats on infant childbirth mortality, so of course I can only give half the picture.
Oh, brandann, you might want to look at the ALACE website (Association of Labor Assistants (Doulas) and Childbirth Educators). http://www.alace.org/
The essential difference is that a midwife is a medical professional whose role is to deliver the baby, but a doula’s role is to assist the mother in whatever way she needs during labor (and sometimes for a while afterwards), and that can range from putting chapstick on her lips to making her tea to massaging her back to supporting her physically in a number of delivery positions to advocating for her in hospitals etc. No matter what is happening with the baby, the doula’s role is to stay focused on the mother, her needs and desires. Also, she hasn’t really got any medical training, though she can usually feel your cervix and assess your dilation.
Some points that I feel need to be added to this discussion.
You need to talk to your blood female relations about their experiences as they will be the closest to what you may experience. By the way, if they all talk about how easy it is, you may need to look up silent labour. It isn’t in most of the literature and it isn’t like the labour everyone tells you about.
While knowing your OB very well and trusting them is important, babies come when they will and your doctor may not be on the floor the night you deliver. I had to deal with a doctor who was miles apart from my own in attitude and ended up with an episiotomy that I hadn’t wanted. As the hospital’s natal unit was experiencing a baby boom that night (18 deliveries in 8 hours), I don’t really blame the staff for being less than focussed on me.
Finally enjoy this time, eat foods that you crave, nest and revel in the hormones. Get used to the hours that you need to pee in the night, they corelate to the hours that you need to feed the little blighter after the birth.
EG, DONA trained doulas don’t do cervical checks or anything else medical.
We can, however, catch a baby if we have to ;). My first doula experience was with a friend of mine. She called me at midnight and said she thought she might be in labor (3rd child). I realized on the phone she needed to be leaving for the hospital RIGHT then (I think maybe this is the “silent labor” mentioned by Hawise).
Well, due to car problems she didn’t leave right then. When I got to her house, she was past transition. Her water broke and then here came baby. So I caught that baby (and caught is exactly what I did, those suckers are slippery).
We did call 911, though, so paramedics arrived about 5 minutes later to clamp and cut the cord (she wasn’t planning a homebirth so she didn’t have a kit) and check heartrates, etc.
I told her if everyone could have that easy a birth, we’d all have a dozen kids.
Re: mythago
Time is money, and in America’s For-Profit healthcare, speediness of the delivery is going to have an incentive to be priced over safety, and lawsuits will be avoided by following strictly, set policies that might or might not be good for the woman in question.
As for kill, I didn’t bring up a stat, I stated /sometimes/, because we are still living in a patriarchy, and traditionally, they ask the husband whether to save the woman or the baby, as if the woman is disposable.
Did you check out the links of this post, the Angela Carter one specifically;
http://www.advocatesforpregnantwomen.org/articles/angela.htm
Thank you so much, Dr. Confused, for writing this post. It’s too bad the intent was somewhat lost in the false dichotomy of home birth versus hospital birth, or natural birth versus medicated birth. That’s not at all what this is about!
I’m due with my second in December, and experienced what I now believe is best described as ‘birthrape’ with my first. Thank you so much for the term and for introducing me to it, I’ve had a really difficult time articulating to people what happened to me, but nobody seems to truly understand.
My first birth ended up being premature, one of those instances where certain interventions and precautions are legitimately taken. What people don’t understand it that it isn’t about the interventions. It’s about the way I was treated, the things that were said, and finally, the birthrape I experienced (forceps and 3rd degree episiotomy) that I begged and pleaded against to no avail. It was rape. I was brutalized. It was unnecessary. I will never forget the sound of the scissors cutting through my perenium or the feeling of my daughter being ripped from my vagina.
The parts of my birth that were the worst didn’t necessarily have to do with the interventions themselves, they had to do with how I was treated. I was treated like a lunatic, like somebody who couldn’t make any decisions. I was talked about in the 3rd person. I was disparaged for asking questions. I was made to feel guilty, that I was selfish for worrying about my perenium. I was degraded and then I was brutalized.
Anyway, I cried through my six week check up, mostly because my stitches didn’t heal right and they had to use sulfur, but honestly I think I would’ve cried anyway. I couldn’t bring myself to go into get a pap for two years after that. I’m still real sensitive about it, I can’t talk much about it without getting angry, or upset to where I start bawling like I am now.
Quite frankly, Dr. Confused, I’m so very scared of the same things you are. I’m not scared of the epidural, I’m not scared of necessary interventions, I’m scared of my autonomy being violated again. And what scares me the most is that I was a very informed woman the first birth, and I am somebody who has a very strong will and who isn’t afraid to stand up for my convictions. And you know what? It still happened to me. It kind of reminds me of the idea that you can act a certain way, or make certain choices so that you’re safe from rape. In reality, these types of things give you a false sense of security because rape can happen to anyone, ANYONE.
I also want to point out that the ethics of it are suspect. The idea that the end justifies the means, that if a baby is healthy, then it is all okay is such utter BS. The end never justifies the means, never. It’s that kind of moral ineptitude that got us into Iraq, that has been used to take away our civil liberties. So, the fact that my daughter is healthy and beautiful is absolutely no reason for me to condone the violations I experienced. In fact, that type of talk gets my blood boiling. Don’t march my daughter out to me as proof that everything is ‘okay’. Don’t make me feel bad for the fact that my daughter doesn’t vindicate my OB. The birth and the baby are separate, and I’m glad for that.
My sister’s son had group B strep, it was AWFUL, especially because she tested negative. Even with a positive test and no antibiotics, the chances of transmission aren’t great. What I’ve heard, however, is that intravaneous antibiotics aren’t necessary. You can request that you get the antibiotics in shots. I was in preterm labor with my current pregnancy at 28 weeks (I’m now at home on bed rest) and they were giving me intravaneous fluids and antibiotics because they hadn’t done a group B strep test. After the first day, I asked that they redo my IV as it HURT. The doc said I could just come off it and take the antibiotics orally. So that’s what I did. Understandably, most people aren’t in a hospital for two days giving birth (and in this case I got them as a precaution in case I gave bith, which I thankfully did not), but it seems like oral could be an option if started at the first signs of labor.
Trish521, I’m so sorry. The more I read, the more I realize how lucky I was to a) have an incredibly uncomplicated first pregnancy and b) to deliver in an atmosphere where my wishes were respected (happened to be at home, but that’s neither here nor there).
Dr. Confused – You’ve gotten me started reading the archives at Navelgazing Midwife again (ack, what a time suck!), and I just saw this post about Birth Plans that might be helpful to you, even if just as a trigger for thought.
Everyone — how cool that there’s a great discussion here about a really sensitive topic without huge flame wars! I keep finding myself coming back to see what new has been posted.
I’d be curious to see statistics on who does/doesn’t aspirate. For myself, I would be extremely wary of eating or drinking during labor, but that’s because after my one and only surgery, I did vomit pretty violently after the surgery from the anesthetic they gave me even though they loaded me up with anti-nausea drugs. So because I’d had that reaction to other anesthetics before, I would guess that I’d be at higher risk of aspiration than someone who hadn’t had that reaction.
Some observation on the subject of epidural:
All women who never gave birth that I spoke to expressed some reservations about getting it, and said they’ll try to avoid using it.
All women who’ve already given birth at least once said that they’ll definitely ask to be put on it as soon as possible (so not to miss the moment). So did all women who’d worked in the delivery room (nurses and doctors). They described dozens of fervent “natural birth” proponents pleading for epidural as the contractions get stronger, but it’s not always possible at this stage.
It convinced me to use epidural when and if I’ll be giving birth myself.I’m sure the OP studied the subject extensively, so I’m not pretending to give to her any new insights, just sharing my experience.
The end never justifies the means, never.
I’m so sorry for your experience Trish, I had a very similar thing happen to me but under different circumstances perhaps. I had an emergency vacuum extraction and third degree tear as well but in my case it was life saving for the baby and the ends in fact did justify the means. It took a long time to heal but (for me) my daughter’s life was well worth it.
I went on to have subsequent births that were not traumatic nor as damaging and so please don’t lose hope. I found a very good OB and she had experienced a similar birth trauma (yes, it even happens to doctors) and was aware of my fears and so we worked together to make sure that I was safe during birth.
Another epidural-related anecdote: One of the clients at my law firm is an anesthesiologist. When he saw I was pregnant, he began to extol the virtues of the epidural. “It stops all the screaming and sweating and makes it so you can just lie back and do as you’re told.”
Y’know, speaking of not respecting women’s autonomy and all that.
And after reading through some comments here – well, I really don’t care if my birth giving experience will be “natural”. Fact is that with the advancement of medicine mother and infant mortality had fallen dramatically. So I’d rather entrust the decisions concerning my birth process to a medical professional who studied this knowlege humankind had acquired for >5 years, passed qualification exams etc, than to a midwife or an “experienced” woman about whose qualifications I cannot at all be sure. I think a woman giving birth should have same rights regarding her birth process as anybody having a medical emergency. The last word should ultimately belong to the more informed and experienced person – the doctor.
“It stops all the screaming and sweating and makes it so you can just lie back and do as you’re told.”
I’m sure for many women it has the opposite effect. My SIL was having a very difficult labor and was really altered (and I would say susceptible), once she had her “walking epidural” she was able to think and communicate much more clearly and I think it helped her to avoid a C section. I’m sure it depends on the circumstances.
As for kill, I didn’t bring up a stat, I stated /sometimes/, because we are still living in a patriarchy, and traditionally, they ask the husband whether to save the woman or the baby, as if the woman is disposable.
And “sometimes” is so usefully vague. Do you think that homicide might lead to a lawsuit or two? That a husband would never sue a hospital that allowed his wife or his newborn child to die? That murdering a laboring woman generates more profit than a C-section if labor is going slow, or that hospitals are not allowed to charge for doctors’ time, equipment, and the use of the hospital premises after a certain number of hours in labor? Who are “they” who refuse to seek consent from an actual, conscious patient in favor of her husband? (Names would be especially helpful; I have colleagues who are med-mal attorneys and any evidence that can help their cases would be awesome.)
But thank you for perfectly illustrating the anti-factual, scare-tactic attitude I encountered “sometimes” in the natural-birthing community when I was pregnant. I got very, very tired of hearing “booga booga! do what we say or male doctors will kill you and/or your baby for profit!” Empowering women to make choices and think about their decisions sometimes means, I’m sorry to say, that they will question what you tell them is best for them, and they may make different choices than you want them to.
Re not eating and drinking, the Evil Patriarchal Doctors at the hospital where I had my kids told me to go ahead and eat and drink if I felt like it, because a) I needed to keep up my strength and b) I’d probably barf it up during labor anyway. Both of these turned out to be correct.
Matter of what population you’re talking to, I think. I had an epidural with the first, chose not to with the second. I wonder if the women you talked to considered that second labors are generally shorter than first labors, sometimes much shorter (in my case, one-quarter the time). Of course, they tend to be more businesslike labors, with less of the early-labor farting around and more good hard contractions.
I am also curious as to why it’s said to be difficult to give epidurals later in labor. I was given one, oh, say five minutes before delivering? I am afraid I wasn’t holding a stopwatch on my anaesthesia, but as pain relief following epidural generally takes 10-20 minutes, it was certainly under 20 – no numbness until after delivery.
D’you mean in your case, or in all cases? That is, do you mean that you’d trust the doctor to do the right thing when you’re in labor/delivering, or that the doctor should be able to override the laboring woman’s wishes simply by declaring that there’s an emergency? I’m assuming that you don’t automatically consider childbirth to be a medical emergency.
I do think it’s important to remember that you can have a doula, midwife, birth ball, tub, etc. etc. etc. and not find birth a spiritual experience at all. I never felt spiritual, or impressed by my own strength or any other birthing cliches, just very relieved to be done with it – and adamant, after the second one, that I wasn’t doing that again.
It’s one thing to have a life saving forcep or extraction birth, the problem is that if that is the case, it can be communicated. In my case, my daughter’s heartbeat kept going up. This was the only sign of ‘distress’. From what I know, and what I’ve read, this indicator by itself is not adequate to justify an intervention. It’s, once again, based on the constant fetal heart monitoring.
I was told when I was 5cm, in some serious pain, that I would be given an episiotomy no matter what, because a ‘preemies head can’t remain long in the birth canal’. At 35 weeks, that is utter BS.
The problem with birthrape is that you’re made to be afraid whether it is really warranted or not. So when it is warranted, how do you know? When it isn’t, how do you know? What is lifesaving?
I think most importantly, when a woman is saying ‘no’, that the OB STOP and explain. Not stop and berate, not stop and shame or degrade, stop and have some goddamn empathy. That’s all my forcep birth required, it wasn’t the intervention itself, it was how they intervened and the way I was treated. If I found out today that my forcep birth and episiotomy was life saving, it would change nothing because that isn’t what this is about.
Cat – I didn’t have an epidural either time. Absolutely did not want one. Most of the women I knew at the time were on second and third births and were adament about NO epidural. It’s a self-selecting sample, don’t you think?
Trish, I’m sorry you went through that. That’s really awful. That’s really wrong. Have you worked through your feelings about it enough that you are sure you won’t have any hangups during your labor with your current baby? Mother’s emotional distess can cause failure to progress, so you should be talking with your caregiver now about all that went wrong and how it made you feel.
Mnemosyne – throwing up isn’t necessarily the issue. It’s the job of the anesthesiologist to make sure that if you do throw up (and it’s not necessarily that rare) that you don’t aspirate it. It can be as simple as making sure your head is turned. This is what they’re trained to handle – people having surgery off the street haven’t been fasting. And dehydration and lack of nutrition can cause a labor to stall and CAUSE a c-section for “failure to progress”. How far do you think you’d get in a marathon with just ice chips to suck on? I did have to compromise with my hospital and agree to “clear fluids” which includes such things as jello, broth, suckers and energy drinks. I really wanted protein, but those were better than nothing.
Ledasmom,
By The last word should ultimately belong to the more informed and experienced person – the doctor I meant, that I’d trust the doctor’s advice over mine or anybody else’s opinion over any major issue with my birth process. Just as I’d trust the civil engineer and an architect to build my house and an electrician to fix the wiring.
Regarding epidural – what you write makes sense, of course. My eveidence is anecdotal, so I can’t tell what most women think on the issue. But I think most women now give birth with epidural, am I wrong?
Um, did you actually read what I said?
I HAVE A HISTORY OF THROWING UP FROM ANESTHESIA.
In fact, I have a history of throwing up from most painkillers. Vicodin was a horror show when I had to take it after my knee surgery, and the only thing that prevented me from having the same problem with Darvocet was that I had to shove anti-nausea suppositories up my ass every four hours.
So I would like to know if PEOPLE WHO HAVE A HISTORY OF THROWING UP FROM ANESTHESIA will have more of a problem if they eat during labor and then have to be anesthetized.
Telling me that you didn’t have a problem when I have no idea if you also have a history of anesthesia causing vomiting is not helpful. Would you tell a diabetic to go ahead and eat whatever s/he wants because you’re not diabetic and you’ve never had a problem?
Re: mythago
Just read the link for the Angela Carter case, which the OP has linked to.
No, I believe you’re right, especially for first labors. With a long labor sleep deprivation can become an issue; I don’t know about anyone else, but I never managed to sleep through a contraction.
MG, thanks, I’m very aware of the Angela Carter case. It was not a situation where a women in for routine labor was murdered by her doctors because they were impatient and thought it would be more profitable to do so. Pointing out that bad things happen to women, publicizing those things, and trying to make sure they don’t happen again is very, very different than what you’re doing–namely, trying to frighten pregnant women away from doctors or hospitals with handwaving that OMG YOUR OB WILL KILL J00 FOR MONIES!
All women who’ve already given birth at least once said that they’ll definitely ask to be put on it as soon as possible (so not to miss the moment).
Yes, all women, everywhere. Or at least the three or four you’ve talked to. And the doctors sneering about those foolish natural-birth proponents who confessed their foolishness TOO LATE! and were denied the epidural they’d have gotten if only they weren’t so stubborn.
Pull the other one. No guarantee of the presence or absence of bells.
Mnemosyne, roughly 15% of Cesarean’s are done under general anesthesia, some due to emergencies (this is the risk) and some due to the inability to use local (due to health reasons that are generally forseeable). So, if 1/5 of first births are C-sections, and less than 1/6 are emergency Cesarean’s requiring general anesthesia, then the question is whether it is prudent to ban food and water for all laboring women. Most people become nauseated from anasthesia, I’ve never met a person who didn’t throw up after awakening from a surgery, even on an empty stomach. The risk is throwing up during the procedure and asphyxiating. As another poster mentioned, most women who are allowed to eat and drink to their preference don’t choose 4 course meals, and what they do eat may not stay down for long. Thus, banning women from eating or drinking when they are exhausted seems pretty ridiculous, they just want some energy and nourishment for their worn out bodies, and our bodies do have a way of letting us know what we can or can’t accept in our stomachs.
Why is it that women can’t simply be told the risk of a general anasthetic emergency Cesarean, and then based off that let them decide if they feel the risk of eating a couple of crackers is too great? Trishka was talking about acceptable levels of risk, but isn’t that something for the mother to decide? If she wants to get on a plane where 14 out of 1000 crash, then why do you get to say SHE can’t? As you mentioned, many people choose to climb Mt. Everest with way worst chances at survival. Hell, the risk of chromosomal abnormalities is like 1/8 for women over age 45, do you get to decide that the risk is too great for them? It’s not about the risks, its about the communication of risks to the patient. Why aren’t women trusted to make their own medical decisions????
I’m the weirdo who doesn’t (as far as I know) vomit after anaesthesia; I’ve been under for wisdom-tooth extraction and a D&C, and didn’t vomit either time.
My experience, your experience is liable to vary greatly.
I wanted the epidural, I had planned for an epidural. I gave birth within 15 minutes of arrival- the best laid plans etc…
I projectile vomited a half orange and I was lucky to be in the tub at the time. Best advice ever- when you have contractions and aren’t yet ready to head to the hospital, run a hot shower on your lower back. My water broke in the bathtub with the water running. Saves a lot on post birth cleanup. My sister, who was on the way to pick me up, was also thankful that my water broke before we got in her car.
Sucking on ice chips actually helps. It gives you something to do and helps cool the system and rehydrates you. As long as they offer unlimited ice chips take them, we were also offered popsicles.
Dr. Confused, this really worried me:
I’ll be refusing cervical checks, so no one can strip or break my membranes. I’ll refuse an intravenous drip, so no one can sneak anything in.
Refusing what might be good medical procedures because somebody MIGHT try something on you is a bad idea. If you have good medical providers you trust, and can tell them about your concerns, they should be able to address that without pooh-pooh’ing you. And your husband should expect to be your advocate–”Why are you doing this procedure?” “Could you tell me what’s going into the IV, please?–politely, but firmly refusing to be told STFU and go along.
It was fascinating to read this post and the comments. I am 57 years old and have had 3 children, now 35, 33, and 27. The first one started as a home birth and ended in the hospital. Scary, horrible and I won’t go into it. But I had a beautiful, healthy baby girl. So the second time I did more planning. A hospital birth with a mid-wife and my husband at my side was so much better. The 3rd time I went back to the hospital, gave birth and took my baby home the same day. Six hours after he was born I was in my own bed, with my daughter and other son by my side. I had to fight the doctors to get out of the hospital, but I told them I’d sign anything and I was leaving no matter what.
Fast forward 28 years and I was present at the birth of my first grandson. My daughter chose to have a home birth. Her husband was frightened but she is a power he couldn’t move. It was the most wonderful experience of my life. The mid-wife was extraordinary. Aterwards I told her, with tears in my eye, that I wished she had been there when I gave birth. I cut the cord! And that child is the apple of my eye.
I now have 4 grandchildren. Being Grandma is ever so much more fun than being Mom. All the pleasure and none of the responsibility.
I still cry when I think about my firstborn’s birth. I recommend a home birth to anyone who is not at risk. You are pregnant, not sick. Hospitals are for sick people.
Ledasmom, I don’t throw up from anaesthesia either. Appendectomy and wisdom teeth, no nausea after. I’m lucky like that.
Good luck, baby ladies!
Mnemosyne – yes, you throw up, but that isn’t a problem. Most people do throw up. The anesthesiologist is TRAINED to prevent you from aspirating. That’s his job. They’ve taken something that might happen with a poorly trained anesthesiologist and turned it into a huge problem. Although many OBs will tell you aspiration is a leading cause of maternal mortality – it’s not, check the stats. If it could fall under the heading of infection (I guess this is the best place since the cause of death from aspiration is recorded as pneumonia) then it falls into a category that accounts for 13% of deaths, FAR below the category of hemorrhage which causes 25% of deaths.
Mythago – what can cervical checks tells an OB? I’ve asked. Basically it tells them if you’ve started dilating. I asked if that really told them anything. The answer? No. I saw this first hand with my 1st child. Thursday 9/10 I had an appointment at 2:00, she did a check and said “well, that baby’s not coming out anytime soon, see you next week”. I went back to work, had contractions the rest of the afternoon – but that normally happens after a cervical check, so “probably not labor”. That night I ate many pieces of pizza, drank dr. pepper and went for a long, long walk with my DH. Contractions stopped, so she must have been right. Ha! At 12:20 my water broke and the baby was born at 11:40am on Friday, 9/11 – less than 24 hours after she was soooo sure I would not go into labor.
So, with the next child I asked and asked and asked again. Every single time I was told it was just so they could check dilation and because “most women want to know”. Sorry, it’s just a way to introduce more germs, the only valid reason to do a check before labor is to check for GBS. The only valid reason to do one during labor is if it’s been 24+ hours and mom isn’t showing any signs of progress or mom is saying “I need to push”. OBs will actually tell you the same thing if you ask and push past the initial BS.
Another problem with cervical checks during labor is that some OBs still believe in the old rule of one centimeter per hour, and consider labor not to be progressing fast enough if you don’t dilate at that rate.
As for the IV, while it may be needed sometimes, I suspect it’s the routine IV that Dr. Confused plans to refuse. In most cases there’s no need for an IV; in some cases they do one because it’s still their protocol, regardless of whether it’s actually necessary (I would have had one if I had given birth in the hospital the second time, which is part of the reason I didn’t).
And IVs filled with Saline aren’t necessarily good for mom and baby. It pumps both of them full of fluids (swollen ankles anyone?) and it artificially raises the baby’s birth weight, more than you’d think. Of course, then the birth weight drops ‘too low’ after birth and they justify supplementing. Everything has a consequence, and every intervention leads to higher risk that there will be more interventions thereafter. I know if you know to ask, they’ll just give you a saline block, no fluids, but this way they feel good because they have an IV ready if need be. If you’re induced, automatic IV, if you get an epidural, automatic saline IV (to keep your blood pressure from dropping). They’re all so interrelated.
I have to add that if an emergencey should happen, if you don’t ahve a nurse who can slap an IV in you in under 5 seconds you’re in the wrong hospital to begin with. If a paramedic can put in an IV in the dark, the rain, in an unconscious person after a car wreck than your nurse should be able tog et on in the few minutes you are being wheeled in to surgery. There’s no reason for a routine IV other than hospital policy.
Besides, they can put a hep lock in if they’re really worried about having to give medications, can’t they?
The saline IV can help prevent a blood pressure drop, but doesn’t always do so. A very odd sensation, having one’s blood pressure drop.
Catgirl, contemporary midwives do indeed study modern medicine and possess a medical degree. They’re not just “experienced women”–they’re registered nurse-midwives.
Mythago – what can cervical checks tells an OB? I’ve asked. Basically it tells them if you’ve started dilating. I asked if that really told them anything. The answer? No. I saw this first hand with my 1st child.
If we’re going to play Battle of the Anecdotes, with my first child, a cervical check told the nurses that what I felt was not just the pressure of dilation, but the baby actually, like being born. It would have been a bit of a surprise for everyone if they hadn’t bothered to take a look. With my second child, a cervical check showed that I needed to change position so that my cervix would dilate evenly.
It’s one thing to say that you don’t want routine Just Because things done to you unless there is a good reason that the midwife/OB/nurse can articulate. It’s another thing to say “I won’t do X because I’m afraid that my midwife/OB/nurse will do something nasty to me without my consent or even knowledge”. If you don’t trust your midwife enough to know she won’t strip your membranes, she shouldn’t be in the birthing room with you, period. If you aren’t sure you will be able to act as your own advocate (and you probably won’t, in labor), that’s your husband’s or mom’s or friend’s job, to run interference and say “No, I’m sorry, but you’re going to need to give me a better explanation than ‘that’s how we always do things’.”
Count me in for cervical checks. With my second birth I was getting so tired and starting to second guess my abilities when the doc came in and after a quick check told me I was at 9cm…I got a second wind that carried me through to the end. I think that it can be a very positive thing psychologically to know where you’re at. When you are really laboring and someone tells you you’re at 8 (and not 4!) cm it can be a great boost.
Zofia – wanting to know doesn’t make it a “good medical procedure” that shouldn’t be refused. It might help you feel better (and for every woman who finds out she is dilated further than she thought, there is a corresponding woman (or more) who finds out she isn’t dilating at all) but it isn’t necessary.
Mythago – I’m guessing you must have had an epidural, because without pain meds you KNOW when the baby is coming. There’s no second guessing.
I read Dr. Confused’s statement about refusing cervical checks to mean during routine OB visits – that’s generally when they’ll “sweep the membranes”. It rarely happens during labor. During labor they just go ahead and break your water. There is only one valid reason to check the cervix before labor and that’s strictly to do a GBS test (and that doesn’t require an actual cervical check but instead just a swab). Any other checks are just because many women want to know if they’re dilating yet and OBs like to try to predict when you’ll go into labor. And if you ask an OB, they’ll admit just that.
As was pointed out, routine IVs are also unnecessary and can even be harmful (and there are studies that prove just this, they’re cited and quoted in Henci Goer’s books).
Zofia – wanting to know doesn’t make it a “good medical procedure” that shouldn’t be refused. It might help you feel better (and for every woman who finds out she is dilated further than she thought, there is a corresponding woman (or more) who finds out she isn’t dilating at all) but it isn’t necessary.
Ah there’s the rube. Knowledge is good and just because the answer might not be the one you’re hoping for doesn’t mean you don’t ask the question. In the midst of labor it can be hard to know where you are in the process and having someone provide data is a good thing. I ain’t into the ignorance is bliss scenario.
Wow…I mean “rub”. But… hate when people act as if women shouldn’t be told the damn truth so maybe “rube” is good too.
Oops….I think you forgot the for you…
I suppose I have to clarify the refusal of cervical checks.
I’m refusing most cervical checks because the risks outweigh the benefits. In late pregnancy, there are pretty much no benefits to cervical checks. They won’t tell me when I’m going to go into labour. The risks are infection, and that the midwife turns out to be an asshole who strips my membranes without consent.
In labour, the benefits are what Zofia said, that they may give you some information on labour progress. Even that isn’t particularly useful; women dilate at very different and uneven rates. I’ve heard lots of stories of people going from 6 to baby in 15 minutes. The risks are, again, infection, and that the midwife or nurse turns out to be an asshole who ruptures my membranes without consent.
I will be refusing cervical checks at my prenatal appointments. In labour, I will take one when I first get to the hospital (this is really just picking my battles). The second will either be when I “feel pushy” or it’s been a really long time, I don’t feel pushy yet, and I want to know what’s going on.
Ugh, another reason to be grateful I am infertile. I’m an agoraphobe (i.e. total control freak) who has a rather extreme aversion to being touched unexpectedly, especially by strangers. Just about all the things listed would have me so far out of my comfort space I would be a danger to myself and others around me. (Like a trapped animal, I get agressive when pushed too far.)
That being said, it pisses me off to know end that women are not trusted to know what is best for their bodies, whether it’s pregnancy or infertility.
No Kiki – it isn’t medically necessary for anyone. It may be something you want to know, but it isn’t medically necessary. And there are some very real risks as Dr. Confused listed.
Zofia – knowledge is fine. But again, it ISN’T medically necessary. You can take risks with infection if you choose, but don’t decide that that decision is medically necessary because it just isn’t. And since most OBs will never explain the infection risks (which are very real, especially if you test positive for GBS) it isn’t really an informed decision, now is it?
Now come and kill me, but I just don’t understand why do you all care about those minor medica interventions like IV and cervical checks so much. So you took medical literature, and you read it and you arrived to some conclusions, like cervical checks are useless and they can pump you with saline solution trough your IV. But doctors read those books as well! And chances are they were exposed to more information than you, and are more qualified to process it, because it’s their profession. Why not just pick a doctor or/and a hospital you trust and let him/it supervise the birth? Just like you hire other professionals to assist you in other areas of your life…Doctors aren’t evil by definition, and books and statistics you read are most likely written/gathered by doctors too…
Anyway, that’s my personal take on the situation :-)
While I whole heartedly agree that cervical checks should be kept to an absolute minimum for the reasons discussed, and I know that there are many women who have uncomplicated births and never have a single cv, to say that they are not “medically necessary for anyone “ is simply not correct. This type of absolutist language is counterproductive and smacks of zealotry. There is a huge difference between rarely and never.
I came into L&D at 4cm; 15 minutes later I was at 7cm. That was when the nurse started shouting: where in hell is her OB?
Do you have a stat on “most OBs will never explain the risk of infection”? I would appreciate that. I would also be interested in knowing where you found that a cervical check is never medically necessary. I would imagine that there must be cases where it is deemed necessary but I’d love to see the numbers.
That being said, I have a similar educational background to the Dr. and I have to admit that I like technology. I want to know the numbers. When I was planning my second birth I met with a midwife and realized that I could not buy in to the whole earth mother scene. I don’t overestimate technology (I know all too well its limitations) but I am comfortable in that environment. I liked my female OB because we spoke the same language. I’m not saying she was smarter or better (as the midwife was a very intelligent and earnest woman) but I could not get behind the earth wisdom meta-conversation we kept having.
Cultural Catgirl, it seems to me you’re only looking at this from a very narrow individualist perspective. Birthing is an industry, its a system, a machine. It’s not about ‘choosing’ the right doctor. Institutions are created to perpetuate beyond the individual. It doesn’t take ill will on the part of doctors or the nurses for outcomes to hurt women in the long run. Especially when we look at the rise of medicine as a profession and their role in perpetuating sexism, racism, etc., over the years. They are a product of our culture, and our culture doesn’t trust women.
It seems to me that everybody on this message board is for evidence based medicine, I’m the biggest stats nerd there is, but there is much regarding obstetrics that is simply not evidence based. Period. I might not have an MD, but I am just as capable of understanding the research as an MD, and it does not match their practice. Continuous electronic fetal monitoring is the just the tip of the iceberg.
Kiki – I listed the two reasons cervical checks are medically indicated – 1) to test for GBS pre-labor and 2) during labor to check that mom is fully dilated when she’s ready to push.
I would love to have the choice of picking an OB that agrees with the statistical evidence. Unfortunately, we are all limited by our insurance and most OBs do things a certain way because ACOG handed down guidelines and as long as they follow those guidelines, they will not be successfully sued. Whether ACOG’s guidelines are evidence based is something you can decide for yourself, but I’ve read the studies and I know that much of what they tell OBs to do is NOT evidence based and never was. They are very, very slowly edging towards evidence based but they are still very much in the realm of iatrogenic care.
Granted my “most OBs” is based on anecdotal evidence. But none of the literally hundreds of women I have spoken with knew anything about cervical checks as a source of infection. What’s really scary is the OBs/nurses/residents doing cervical checks on woman who are GBS+, especially after the water has broken.
wow, lots more conversation over the weekend. i just wanted to add a couple of points/comments:
my assertion that humans are not well designed to give birth is supported by the national geographic “the downside of upright” which unfortunately is not included in its entirety in their archives. an excerpt can be found at
http://www7.nationalgeographic.com/ngm/0607/feature5/
i was under the impression that “national geographic” is a fairly respectable journalistic source, but who knows, maybe they are just a tool of the patriarchy like everyone else.
anyway, talking about how in centuries past, a certain percentage of fatalities (mother and/or baby) may well have come from infection, but the issue still remains of why the infections are occuring in the first place, when (virtually) no other mammal experiences the tearing or rupturing or whatever that will introduce bacteria into the inside of the body. (the uterus & birth canal are medically considered to be the outside of the body, as are the stomache & digestive tract).
besides, modern antiseptic precautions do nothing to help situations like: pre-eclampsia, breech birth, cord being wrapped around baby’s neck, et al, all of which are potentially life-threatening.
there is a mortality rate associated with human birth, baby and/or mother, that is not the result of medieval doctors not washing their hands, and is higher than the crash rate for airplanes in the united states. if you don’t like the 1 in 10 number, use 14.4 in 1000. if you don’t like that number, because some of those might have been because the doctor didn’t wash his hands, come back with another. but you’ll be hard pressed to beat air safety, or bridge safety, or building safety. that’s all i’m saying. we think we’re so “well designed” to do this, when statistically we’re not.
furthermore, saying that just because the mortality rate is 14 out of 1000 means that 986 times it goes just fine is a bit of a stretch. there’s a lot that can happen between “not dying” and being “just fine”, that modern medical intervention can help with. i could give examples if requested….
with respect to throwing up after anaesthesia, i’ve been under 5 or 6 times, and had one instance of vomiting, and in that case i was under for several hours (an unusually long surgery). so it doesn’t happen to everyone as a matter of course, not by a long shot.
and as to the value of cervical checks during labor, it can be helpful to know where you are in the process. even without meds, when it is the first time you don’t necessarily know. my personal experience: when i requested an epidural, i was laboring (ha!) under the false assumption that i was not nearly as far along as i was; i thought that what i was experiencing was the middle stages of labor when it turned out (via a cervical check done right after the epidural went in) that i was in transition. i had a ridiculously short, fast labor, and thought that the pain i was experiencing was something that would go on for hours & hours & hours, when that simply wasn’t the case. had i known how far along i was, i still would have requested the epidural, i think. but it’s neither here nor there as everything ended up fine.
i had one more thing i forgot to add:
the prohibition against eating — when i was pregnant, i remember being told that it wasn’t because they were afraid they’d have to put me under and i might vomit, aspirate & die; at our hospital they said they didn’t do general anaesthesia for c-sections anyway.
their recommendation was based solely on the issue of vomiting during labor, and the added discomfort of vomiting solid, spicy, rich, whatever food, so they said that broths & things like that were fine, but don’t eat anything i wouldn’t like to have come back up.
of course, i didn’t know i was in labor, so i ate a bunch of crap that hurt like HELL when it came back up (raw carrots? not recommended) so it was a moot point.
also, speaking of moot points, thanks for the book recommendation but i’m done having kids. no more for me, thank you very much. also:
“I do think it’s important to remember that you can have a doula, midwife, birth ball, tub, etc. etc. etc. and not find birth a spiritual experience at all. I never felt spiritual, or impressed by my own strength or any other birthing cliches, just very relieved to be done with it – and adamant, after the second one, that I wasn’t doing that again.”
bears repeating. that was my experience exactly! my labor was fine, it went well all things considered, but it wasn’t this big life-changing spiritual thing.
Catgirl and trishki, what you’re not getting here is that midwives are medical professionals. They are medical professionals who specialize in childbirth, and who adopt a different perspective on it than ob-gyns.
Midwives screen their clients for risk factors. They examine you medically during pregnancy and labor. They look for all the threatening conditions you have named, and they will either treat them or refer you to a medical specialist in that condition. Contemporary midwives aren’t just showing up to hold your hand, make herbal tea, and collect a few in the form of a dozen eggs. They do actually know how to cope with situations such the cord being wrapped around the baby’s neck, which is not uncommon, and only dangerous in a few situations. Breech births are not crises–my father was breech and delivered vaginally with no harm to him or my grandmother. Midwives often know how to turn babies during labor, and many know how to deliver a baby presenting breech. If you are at a birthing center, they have emergency equipment right on hand, and can do every single thing that would be done in a hospital to immediately respond to that emergency, stabilizing you long enough to get you to the longer-term treatment. If you are having a home birth, they will bring that equipment with them. Giving birth with a midwife and opting for non-invasive treatment is not equivalent to giving birth in the middle ages or to giving birth with your grandmother holding your hand.
I, and others I have known object to IVs because they interfere with your ability to move around. One of the reasons some women choose natural childbirth is that labor pains can often send messages about what one’s body needs to be doing at a certain point in the labor (of course, sometimes the message being sent is “get this thing out of here right now,” which is not as useful as one might hope)–pain can pull a woman over into a position that’s best for her at that moment. If she’s hooked up to an IV, then her mobility is limited. Also, I don’t want a needle stuck into my arm unless it’s necessary.
1) You don’t stick your fingers in to check for GBS, you take a swab. This isn’t a “cervical check”, it’s a low vaginal swab. It doesn’t even require a speculum, and it can be self-collected.
2) Since coached pushing is a non-evidence-based intervention (and is associated with complications of its own), in a normal labour, simply waiting until a birthing woman can no longer resist the pushing urge no longer does the job. Occasionally a woman may have a cervical “lip” that complicates things slightly; in that situation, a competent midwife should be able to detect the signs that things aren’t quite right, rather than routinely performing vaginal examinations on all women.
Neither reason (even if they were valid) justifies routine 4-hourly vaginal examinations in labour, nor routine VEs during pregnancy.
EG, i never said midwives are not medical professionals.
look, i’m going to try to make my point one more time and then i’ll stop (the internet rule of three).
i don’t care whether people choose to give birth at hospitals or at home, with midwives or OB’s or both or doulas or epidurals or tubs or balls or herbal teas or chanting shamans. i know what was the right choice for me & i’m not out to try to convince others on what choices to make.
the issue that i have is the fundamental premise that the so-called “natural” childbirth community seems to operate under, which is that the human body is perfectly designed to give birth. from an evolutionary standpoint, there is too much evidence that suggests otherwise, first and foremost our relatively high mortality rate when compared to other animals.
that’s why i bring up breech births, pre-eclampsia, cords wrapping around babies necks, things like that. i’m not saying midwives can’t deal with them, but rather that they are examples of the potentially fatal problems we encounter during the birthing process.
the problem that i have with the premise that our bodies are perfectly designed for this process, instead of the opposite (which is that we’re not well-designed and that makes it a risky proposition) — is that it appears to lead a number of women into false expectations around giving birth. and that in turn leads to disappointment and unhappiness when they don’t end up with this “positive birth experience” they’ve been led to believe is their birthright as a human woman. and furthermore, that it is entirely the fault of the nasty patriarchal western medical establishment, who got in the way, and if they’d just stay out of it then the “positive birth experience” would have happened.
the above paragraph is all i’m trying to say. i see a lot of unhappiness (& fear, in the original post) out there that it seems to me is un-necessary. and i believe it is a dis-service to women to downplay the risks of childbirth, not because i want women to be afraid or to choose hospitals over homebirths or whatever, but because of the false expectations that are set up.
trishka,
I think your point — that human childbirth is not a perfect process — has been agreed with at least three times already in this thread. If you’re looking for more specific affirmation, I will personally acknowledge that I can understand why, as you say, someone saying “that ‘women’s bodies are perfectly designed for giving birth’ … MAKES [your] HEAD EXPLODE.” Yes, the situation is more complicated than that. This pushes a particular hot button for you, and I respect your need to express it. Consider it expressed.
Is that enough? Is there anything else you want?
I’m sorry if this sounds snippy, but come on, you’ve been pounding us over the head with something that, precise statistics aside, no one is contesting. What people are reacting to is your patronizing attitude that the main source of fear of being vulnerable to a doctor or midwife who may or may not respect your bodily integrity is an unreasonable hope for a “positive birth experience” (scare quotes incessantly in your original).
Here’s the thing:
Mythago, expressing a sentiment that is reasonable on the face of it, wrote that
Feel free to substitute ‘doctor’ or ‘nurse’ for ‘midwife,’ and ‘do anything to your body without your full consent’ for ‘strip your membranes’ — this is a general principle that everyone on this thread seems to agree on. What you and Catgirl either don’t understand or don’t want to acknowledge is that sometimes it’s just not possible to achieve that trust with your “care provider” (since we’re using scare quotes).
Sometimes your “care provider” is assigned to you randomly by a hospital when you arrive, or you don’t have any single “care provider” at all as shifts change out. Sometimes your “care provider” will smile and nod and encourage you to trust them with your wishes for your body and then turn around and betray that trust.
The non-”positive birth experience” that people are expressing fear about is not “realistic birth experience” or even “painful birth experience”, it is “violating birth experience.” Which, as you should know if you’ve been reading this at all, happens and is a legitimate thing to be worried about, especially since (as with so many other violations) the victim is in a position where her power over the situation is greatly reduced.
You didn’t have those experiences, it seems. I’m grateful on your behalf, and I hope that my partner will be just as lucky in a couple of months. But have some common decency and write into your position an awareness that a non-negligible number of women do, that you were lucky to some degree, and that it’s not just a matter of being disappointed that birth wasn’t all sunshine and daisies.
I :heart: moderation.
cranefly, the only reason i restated my position was because EG addressed me directly in stating that i didn’t understand that midwives are medical professionals.
i never stated that, i expressed no comments about midwives, i don’t know where she got that.
that led me to believe my point hadn’t been heard. like i said, going with the internet rule of three, i’m done now.
i’m sorry that some women have had the experience of feeling violated while giving birth. i truly am. i agree with everyone here the importance of a birth plan and good communication with your midwife, OB, doula, advocate, in short everyone on your team.
i don’t know what else to say, so i think i will bow out of the conversation since it seems my participation is verging on the unwelcome.
trishka, I think I can help with that confusion. Even though you weren’t directly mentioning midwives, almost every post of yours set up an [insert scary middle-ages/Mozambique statistic here] mortality rate as the only alternative to the epidural-pitocin-ceasarian chain. You seemed to be insisting on a definition of natural birth that would have to eschew any medical assistance entirely. I could pull back quotes to show you where you did this if it’s still not making sense to you.
EG’s reply to you could be prefaced by pointing out that birthing at home with a midwife and the availability of transport for true emergencies is a more common usage of “natural childbirth” and one that you were tarring with the same brush as the middle ages. In other words, these days when someone says that they want to have a natural birth, they are, in fact, taking advantage of a medical professional and not throwing themselves blindly to the mercy of biological circumstance.
Does that help?
[...] wonderful responses to my posts, and I’ll be taking much of your advice, especially from the Birth Fears and Leaky Pipeline threads. You have great insight, and I like that there’s a variety of [...]
Though I’m adding my 2c very late in the game here, I want to emphasize the point that the culture of medicine is influenced by misogynist elements in the wider culture. For those who want to say “the doctors and nurses know better than I do”, I’d suggest reading
http://upalumni.org/medschool/
(The diary of a 3rd year medical student)
especially the chapter on Obstetrics and Gynecology
There’s no question that doctors, nurses, etc. DO know more about the human body than the average person, and they deserve a high degree of respect for that knowledge. But I would caution strongly against the unquestioning support of ANY authority figure EVER (not just in health care). That’s exactly what leads to abuse of power.
Thanks for a great post Dr. Confused. I dont have the time to go over all the comments but I wanted to just say that I paid out-of-pocket for a home-birth the first time I gave birth 6 years ago when I was uninsured. I could have gone to a hospital using Medicaid but chose not to. Why? Because I had just spent 3 years observing obstetrics at 7 major metropolitain hospitals as a labor support doula. The lack of informed consent, the lack of mobility and flexibility, the lack of privacy and the lack of respect in maternity care convinced me that it was worth every penny (and every ounce of prenatal “what if something goes wrong” anxiety) to stay home.
Today I am pregnant with my second and this time I am insured. Would I consider using my insurance which only covers birth in a hospital setting? No. I am staying home. I will seek out-of-network reimbursement of course but I am expecting to pay at least $600 out-of-pocket. For me, it’s a no brainer because the risk of being mistreated is just too great.
But in support of your decision I will reemphasize what you already have heard: Stay Home As Long As Possible.
Though I have to warn you, the last birth I attended before retiring as a doula this spring we did just that, came to the hospital fully dilated and pushing. However, the staff (all women, btw) STILL managed to treat my client (a second-time birther) like a second class citizen. We were able to fend off the IV (she’s crowning, for chrissake!) but they were paternizing and dismissive of my client (Why did you wait so long to come in?) Sigh.
Well, good luck in there and enjoy those first moments – they are extraordinary!