I just don’t get it.
I attended a birth on Wednesday. It all went well. I think she was satisfied and informed and is totally in love with her new baby boy. It was good. This woman did receive her fair amount of interventions, but she seem completely content with them at each step of the way. This morning we had a visit and she felt that everything went as well as it could and didn’t think she would have changed a thing (she wasn’t anti-intervention, really, but I thought she’d have liked to stall more on some things). So yay! That’s what it’s all about, right? Also, zero complications with mama and baby, which was really nice to see considering that my other two clients both had some emergent situation towards the end (precipitated by what, I’ll never know…). The moment of birth is magical, for sure, and it was a privilege to be there for them on such an amazing day.
Aside from the doula portion, just the experience of the hospital is really crazy to me. I just can’t for the life of me understand some of this stuff. It’s all so invasive and rushed. Doctors say things that are untrue- or at least are based in untruth. For instance, with the last birth I attended we had to continually bargain our way out of pitocin. My client was at 8cm (and had been for an hour) and was having strong, piggybacking contractions. They came in and said "It’s not anything you’re doing wrong, but for some reason your contractions aren’t doing the job that they are supposed to…" It’s stuff like this that makes me want to burst out of my peaceful doula role and say "Well how the hell do you think her cervix has been dilating? huh?" I also went on the hospital tour with this particular client, and the nurse told the group that the reason they don’t allow food during labor is because you actually aren’t able to digest it… Uhm. No. That’s not why, and it’s not even true. I also happen to know that her doctor was actually irritated that my client didn’t want an epidural (she was talking about it in the hallway and my nurse friend overheard). What is that about?
With this birth in particular, there were a few things that stood out. First, they started her on pitocin from the get-go, and had her convinced that her labor was already taking too long. They also didn’t really listen to her when she said she didn’t want more pain meds towards the end- upping her pit and sending in the nurse anesthetist anyway (at which point she was overcome again and didn’t care). They fed her lines about her contractions not being strong enough to "do anything" and her labor needing to move along (for the record, she was admitted at 3:30am at 3cm and baby was born exactly 12 hours later). They also basically ignored her desire to try pushing in different positions and just kind of swept in and put the bed back and lifted her legs up. They also forgot that she wanted to wait to cut the cord until is stopped pulsating and cut it immediately. They were (to me) very aggressive about the delivery of the placenta at the end, giving her more pitocin to get it going just moments after the birth and pushing on her tender belly. At the very end, it’s all going so fast- I just want them to take a minute to give her an option and let her know what they are doing!
I don’t mean to sound like such a rookie- I know this is common procedure and my client didn’t take issue with any of it. I’m a new doula, but I do a lot of research and have heard my fair share of stories. The thing is- this was so mild compared to my experience of the doctors with my other two births… I just end up feeling like we narrowly escaped some disaster this time- and I resent feeling that way. I also end up feeling SO lucky that I chose to have a homebirth- both because I really think I would have faced lots of intervention and bargaining out of things (44 hours of labor is probably not acceptable to them…), and also because it gives me fresh eyes while I’m a witness to the system. This model of care is SO DIFFERENT from what I experienced with my midwife. In many ways it leaves me questioning motives and feeling utterly confused. I don’t want to think of these doctors in this way, and of course there are many exceptions, but sometimes it’s really hard not to see many of them as detached and bored, unable to question their way of doing things.
I think the thing that I dislike the most about this model of care is the notion that women can’t birth on their own and that their bodies are somehow faulty. They never explain why they are adhering to this timeline for "progress" and why it means that the cervix has to so steadily dilate, or why a woman’s instincts are so frequently wrong to them. I can’t tell you how often I read some new mama’s reflection on her birth where she says something like "My pelvis was too small" or "I couldn’t dilate" or something about how her baby was somehow saved. That kind of thing always makes me wonder what kinds of interventions were in place before those conditions came about, because I can’t accept that so many women grow babies that they can’t naturally birth.
This is nothing new to me, but it frustrates and confuses me to no end. I really do see the need for doulas and birth educators and just people who will help to empower women and their families. I feel like I’m doing important work. However, I can’t for the life of me understand so much of what’s going on at the other end. I truly hope that we are on the cusp of some revelatory change in the birth world (at least in the US), but until then I am left to wonder why so much is still broken in spite of all the knowledge at our fingertips.
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It’s not a lot different in Canada, really. Even though I had a midwife with me, a doctor was there, in control, pushing me into things that I didn’t want. He made it seem like I was endangering my baby by not listening to him. He kept pushing for a c-section, and even wrote it on my chart that he wanted to do one. Basically, told me that I had a choice of pit or c-sec. Anyways, I ended up with the drip and epidural, which I’d been so against beforehand, but felt like I didn’t have a choice, as I was terrified of being forced into a c-sec.
It’s very much about time, it seems. If they think you’re ‘taking too long’, they start pressuring for all kinds of interventions. I think the reason I wasn’t progressing is the constant stream of different nurses that wanted to check me,poking and prodding…it’s like they don’t accept that some births take longer than others. Anyways, I’ll stop rambling now. I guess this subject just reminds me of my own imperfect birthing experience.
I’m really sorry that you went through that! This is one of the big things that bothers me- did they ever discuss WHY your labor taking longer was a risk? I mean, did you have a fever, or was baby in distress? Even if there was a justified reason, there are a lot of cases where there isn’t one, and I think that’s a big problem. You also really hit it on the head about labor slowing because of not feeling safe (the poking and prodding and talk of danger to baby). I think that could be a big reason that labor stalls- just not being allowed to labor.
The midwife was awesome, she did try to explain things to me, and encouraged me, telling me that I could do it…but as for the risks, the doctor just said vague things about the baby’s heart rate during contractions…because of course they’d hooked me up to the fetal monitor, which sucked. I didn’t have a fever, and as far as I could tell, the baby was actually fine. But I hadn’t changed from 6 or 7cm(I can’t remember exactly) after something like 10 or 12 hours of camel-back contractions(20 hours total at that point, it was almost 28hours in all before E was born, but awake for over 40 because I’d not actually gone to sleep yet when I went into labour). I was definitely getting pretty weak, but I just don’t think that I would’ve gotten to that point if I’d been in a more relaxing, safe environment. My midwife said the same. Before I went to the hospital, I’d been in labour since 2am, about 8 hours,(I didn’t have a slow start, the contractions started bad and got worse)I was already at 5 or 6cm when my midwife checked me. But once I got to the hospital, I basically stopped dilating. I wish that I’d had a home to stay and give birth in, but my inlaws were not comfortable with that.At all.I still might have done it, if we weren’t over half an hour drive from the hospital.
My midwives gave me all these books to read before Eilidh was born, and one of them talked all about how we’re supposed to use a different,more instinctual,primitive part of our brain when we’re giving birth. That having to make decisions, or even talk much at all, takes us out of that ‘zone’, and can slow or even stop labour. I fully believe that. I wish I could remember the title, because it was really interesting. I’m sure it’s different for everyone, but for me, I needed privacy, to feel safe and mostly alone, beyond Kris and my midwife. Maybe next time…
I am one of those women. I had two c-sections. The first one I was okay with. Merritt was headside up and there were no midwives or doctors in the city that would do breeched births. I wasn’t going to give birth totally alone unsupervised so I went with the c-section. (Since then the city of Montreal got one doctor who will do them! Yay for all those other moms!)
For Alex, I tried a Vbac. There was one intervention after another. My water leaked for a week before I let my doctor find out and then I went another 24 hours before they started pictocin. I walked most of that time trying to get labor started, took homeopathic whatevers, and just couldn’t get labor started. So pictocin. After a couple of hours on that I needed an epidural. The doctor was getting worried that I’d need an emergency c-section and she wanted the epidural in place just in case. I got stuck at 9 cm and went four hours like that. By then Alex’s… I can’t remember if it was his heart rate or my temperature that changed, but they started to get worried and they cut him out. The doctor said that after she opened up the first layer, the uterus started ripping on its own. All of the timelines they give about how long a person can go after their water has broken, about stalling and stuff… well I ended up breaking most of them. At the end my doula ended up commenting to me that she’s never seen a doctor so scared as my doctor was by the time I was wheeled into the operating room.
I can look and see lots of interventions were in place before I got to where I got, with Alex. Yet even while I can see them, I can’t see what steps I could have taken differently. Each step led closer to the second c-section, but each step was necessary at that particular moment. The big change would have been if I could have avoided that first c-section. If there had of been a doctor willing to let me do a breeched birth.
You wrote: “That kind of thing always makes me wonder what kinds of interventions were in place before those conditions came about, because I can’t accept that so many women grow babies that they can’t naturally birth.”
Shortly after Alex’s birth, I was in conversation with an elderly lady from my church, who told me that she remembers how almost every woman she knew of her mother’s generation, and her grandmother’s had lost at least one baby. I don’t know if that is true or not, or just her perception, but her argument was that a lot more babies were lost before and that was just a part of life before these interventions.
It still seems strange to me. Then I think about the Weston A Price stuff, and the idea that people’s bone shapes change due to diet. Could that be part of it? When I was a teenager I had a dentist want to take my wisdom teeth out. He said most people didn’t have room for their wisdom teeth. That made no sense to me – how could evolution mess up like that? How could it be? I refused to have the teeth pulled then but gave in to another dentist a few years later when my jaws were causing a lot of pain. Part of the reason Weston A Price stuff makes sense to me is that I have come to believe that my body is not the way it should have been. And if jaw size and shape could change, what about pelvis?
I still wonder why my children were so badly positioned. Alex was head down at least, but facing “the wrong way” and he was never fully engaged. I’ve wondered if it is because I don’t hold my stomach muscles tight enough. I wonder if it is because I sit wrong. Knee problems drove me to a foot doctor and I now know that one leg is about 7mm shorter than the other and until this last year when I’ve had a shoe lift I’ve always leaned slightly to one side. Could a crooked pelvis have been the problem? I’ve walked a little strange all my life but it wasn’t till last year that I discovered there was a reason for that. If it was that, and I had that and didn’t know about it, could other people have problems they don’t know about too? Reasons why things don’t work right?
I don’t know. I know hospitals can get too pushy. I know doctors can. But I also wonder if there aren’t other problems in play too.
I totally agree with you. I probably should have included a disclaimer that says that I really do value the fact that we have hospitals and surgeons and people equipped to deal with the many higher risk women. I know that there are complications that can arise, and it sounds like yours was a case (with Alex) where it was a really good thing you were there. Those are definitely not the cases that I’m concerned about- and I’m glad you were taken care of. It does prompt questions about the first c-section, but I dunno. It’s a good thing they were there to intervene regardless.
I think what that older woman said was probably closer to truth than not- but there’s also been a lot of development that I think would probably make a difference today. Sterile environments and tools and a knowledge of what causes infection, drugs that can help stop hemorrhaging, a better handle on good prenatal care and nutrition and things like that, etc. And we’re also able to catch the woman with pre-eclampsia and whatever other risk factor and monitor her closely. As far as messing with the normal processes of birth, though? I think it tends to do more harm than good, even if our infant mortality rates are better than they were, because I don’t think the same risk factors are at play. At least they are better able to save baby and mom from the complications that arise after all the intervention, but why have the trauma in the first place?
It’s an interesting notion that our bodies are actually not how they are supposed to be. I’m sure that obesity and toxic environments and poor nutrition do play a part in our health and our ability to have good births. I also wonder if we are sometimes bypassing natural selection in some ways, but that’s a whole other discussion…
In general, though, I believe that birth/women are not broken and it’s more likely that the system is.
I have no doubt the system is broken. There is definate evidence of that in the really obvious things – c-sections or inductions done because a doctor is going on holidays, pressure to have an epidural right now because the anethesiologist is going to be leaving the building in a while and you own’t be able to get one then if you decide too, etc, etc. Times when cost or convenience end up setting the rules.
I guess what I’m wondering is whether there is a growing percentage of women whose bodies are broken too. Could a shortage of essential oils affect a woman’s abilities to produce the right hormones? Could other women have slight physical things, like a crooked back (more common apparently than one would think) or hips unaligned? It would be interesting to know if there is research being done about why women “stall.”
No one has the full information as to if a particular woman’s body is or not. Doctors can only guess based on odds. Once they push the intervention, the woman is left wondering whether she really would have had a “bad outcome” or whether or not she was pushed into it by overpushy doctors. So for people in that grey area, it becomes the woman’s choice whether she believes her baby was “saved” or whether she was “pushed into unnecessary interventions.” It is a very awkward position to be left in, because one’s friends are all going to argue one way or another when in reality probably no one can tell.
It’s like an economics question about how to deal with incomplete information. Every once in a while there’s a child deprived of oxygen for long enough to cause brain damage and it is a complete disaster for that family. Yet no one can see which baby that will be until it is too late. Would you subject 30% of women to interventions in order to save 0.01% of babies from “adverse outcomes”? (I don’t know what the percentages are.) It might be that because of the lack of information (one only knows when one is too late) a larger amount of women need to be subjected to the interventions to save that smaller portion that would be real problems. I think hospitals are focused on trying to prevent that rare death rather than encourage health for all.
At least that’s what I think when I’m not skeptical enough to think it has more to do with profits and pay structures, which it might also.
I know the system is broken. But I also know odds are a hard thing to play when it is your baby in question. The time I had the longest time to think about the odds was when I was offered an external version to try to turn Merritt. I was told there was something like a 10% chance the version would be successful and a small chance that it would trigger my baby to go into distress in which case I would wake up in the recovery room after an emergency cesearan. I remember wondering if it was selfish of me to want the natural birth – if something bad happened, how would I forgive myself for trying it? 1 in 10 chance isn’t very high for it to have succeeded in anything anyway. Yet I tried it. Because nothing happened (either good or bad) I am glad I tried it. Now after the second c-section I don’t look back and think, of why, didn’t I do more to prevent the first?
I’m sure it is hard to reliably measure those things you mention. However, if I take the example of Ina May’s practice- where her c-section rate is around 2%, it makes me wonder. I’ve heard her say that the difference between the many many births that she’s been to and hospital birth is the rate of intervention. Infant death rates are the same. So what does that say? Also, in my experience, I think I was what would be considered “stalled” for some time. It was just normal. I did need to be rehydrated, and I’m grateful for that, but that was the ONLY intervention that I needed.
Then I start to think about the unspoken casualties- the women who deal with greater postpartum depression (which I really think has a relationship with birth experience and immediate bonding, hormones, etc.), babies who struggle to nurse, PTSD, fear of their bodies, etc.
However, I do think that we live in a toxic world, and I’m sure that affects things. I think there are more women who don’t take care of their bodies, and I’m sure that affects things too. On the whole, I don’t think our bodies are broken, and I think most women can give birth naturally and safely despite these things.
My doctor who used to be a midwife, has attended many births. I hope to learn more about what she expects in the delivery room. Though the nurse who works closely with her assured me that she will fight for a good birth experience and has a lot of years experience and sway in the hospital.
I go Tuesday for my check up at 25 weeks. I am hoping to voice my concerns about keeping my B/P treatment natural. I don’t believe there is any other sign of pre eclampsia or danger.
what you discribed above is how my 2nd labor went and I will do my best not to allow that again. I agree very much with your statment that you have a hard time believing so many women are unable to birth their babies naturally. I personally plan to stay home as long as possible, short of delivering at home…but if that happens I wouldn’t be too upset either. 🙂
My first labor Jorri was also as mentioned above “positioned the wrong way” she was face up but my labor was slow, allowed to progress and it did so for 13 hrs steadily and she was born very healthy.
I hope everything goes really well for you, and I anticipate that it will- it sounds like you have a good care provider who’s seen normal birth and cares about it. That’s great! You also seem prepared and educated and healthy, and I really think that’s half the battle. 🙂
What you say about Jorri is great- birth is just variable sometimes, and lots of things can be really normal (perhaps a more painful labor, but normal!). My first client was told that she probably wouldn’t be able to deliver her baby vaginally because the baby was posterior. They had no reason to tell her that, as it’s entirely possible to do and it happens all the time! Ugh! I JUST DON’T GET IT.
I have a friend who was scheduled for a C-section due to a breech birth and she went from 0- to suddenly there were feet! and delivered vaginally just fine 🙂 I think it’s a neat story of nature showing doctors who’s the boss 😀
I think pregnancy, labor, and birth are fascinating processes and I agree with you on the “half the battle” statement. My experiences were vastly different, my first labor was great and my second was rough the only difference was the doctor attending. I felt violated, I was given piticon with out being informed and an episotomy. I learn a little more with each experience though. I am going to get some information in advance this time and write up a birth plan so that my husband can also help us stay on track…he has a way about him 🙂
What I do to prepare for labor is mostly to repeditively coach myself on breathing and staying very calm as long as possible. I practice it as time draws near…it’s really very exciting to go through labor and even better the moment your baby is handed to you!
That’s so great about your friend. It’s sad that in order for stuff like that to turn out well they have to have crazy fast labors!
You’re going to do great- and I’m glad that you trust your care provider. A birth plan is really a good idea, too. 🙂
I am frustrated and sad by the way maternity care is ‘run’ in the US. At the same time, I’m a little frustrated and fed up with women who don’t PREPARE themselves, mentally or physically, for the demands of pregnancy and birth. Instead, they just let it all ‘happen’ to them and go along for the ride, then wonder ‘how did this happen that I’m in the hospital being overridden by doctors and nurses and my plan for the birth is being destroyed?’
I think women really need to put the onus on themselves to learn everything they can about being healthy and having a healthy delivery to ensure the best for their babies. I mean, if you can spend HOURS discussing the minutiae of strollers and carseats, can’t you at least be bothered to figure out HOW your body is going to get that baby out and how to help it along?
I think part of the problem is doctors being on a time and insurance clock but also a big part is mothers just going along with the status quo. ‘So-and-so HAD to have pitocin because her baby was just too big, and she’s the same size as me… so I HAVE to have it too!’ or ‘I don’t know anyone who has given birth naturally and I’m scared of pain, so I’m going to mentally stall my labor until the doc can just take this baby out!’
I’m glad that you’re doing your doula thing. I hope that the women you’re with are helped by your presence. (I know if I was having a hospital birth, I’d want a caring female person there to support me!)
I agree that part of the load needs to fall on women, for sure. It also seems like even if you do educate yourself, it may be a huge hassle to get what you want (while you are laboring, making it that much more difficult). I mean, I think of my 2 hours at the hospital (if it even was that long) and I remember having to go through 3 different doctors until I could get the AMA forms to go. Also, the doctors kept talking at me during HUGE contractions that took me almost out of body, and then going “Oh, oh, she’s having a contraction. Oh. Is that one done yet?” They just didn’t really SEE me. They were really nice, but ya know. And so I guess the problem is that I don’t expect every woman to be comfortable with homebirth or something like that, and that sometimes even if she is really informed, she still won’t get what she wants because the system is set up just so. Clearly, in my case, I got what I wanted. So I do think it can happen and there are ways to prepare yourself. It just might be a headache to get it. I can’t imagine having been there for my whole labor. In some ways I think you have to be prepared to almost not take them seriously, and that sucks.
Also, I totally hear you on the hours spend researching this and that baby related product but not your BIRTH or breastfeeding or other stuff that really MATTERS. So terrible!
I should add the disclaimer that I don’t think your client deliberately went into her birth uninformed: I think she may have been overwhelmed by the system and that is truly unfortunate.
I agree on this do you have any suggestions specifically on preparation or websites?
Hmmm… I had a homebirth, but what I did to prepare was read ‘Birthing from Within’ by Pam England and everything by Ina May Gaskin I could get my hands on.
I would suggest hiring a doula for a hospital birth! Seriously, her job is to support you, know what your wishes are, and help you to achieve them. She’d be the one to request that you have a minute to process ‘requests’ given by doctors or nursing staff and gently remind you (in the heat of the moment) what you wanted.
Also, what helped me was reading every birth story I could get my hands on! I’m not sure if you’re already a member, but there is a great naturalbirth community here on LJ and it has a lot of resources for preparing for hospital births, writing birth plans, etc.
Best of luck! 🙂
makes me wonder what kinds of interventions were in place before those conditions came about, because I can’t accept that so many women grow babies that they can’t naturally birth.
In my great-grandmother’s case, she was only ever above 100lbs in her life (105lbs) the week before she gave birth to a 16lb baby. The labor progressed so quickly that they had to break her pelvis to get the baby out. Whatever may have caused big babies, likely (we suspect) gestational diabetes, these days they would have scheduled her a Cesarean right before she was due to avoid such drastic measures which really did cause problems for the rest of her life. Which just goes to prove your point that SOME interventions aren’t ALWAYS bad.
I think now we’ve hit a point of having SO MUCH information about medical science, that we think we can control the body’s natural processes. Sometimes, and I think childbirth especially, we need to simply let nature take it’s course. I’m glad that we have systems in place to deal with emergencies, and to handle complications, but I’m afraid that those systems are being used for perfectly healthy women and children who don’t need them.
I’m sure that there are perfectly logical reasons for the “concerns” and the timreframe the doctors have developed. Likely they have all sorts of evidence showing that women who are in active labor without progressing to x point in y timeframe have z chances of serious complications up to and including death. But I think doctors in our society are trained to look for and treat the worst case scenario, rather than accepting each woman and her situation as it is presented before them. And to be sure, a number of them are arrogant and wanting to say (or actually saying) to their patients, “Excuse me, where did you go to medical school? yeah, I’m the professional here, bow to my expertise.”
I agree with all of this. It’s stories like your grandma’s that I appreciate, because it helps me to build gratitude for all that we could do for her today. They likely would have caught that far before the onset of labor and a surgery would have been way better for her.
I think what these doctors have yet to grasp is that by trying to control the bodies natural processes in normal (safe) birth, they are robbing women of the opportunity to do something beautiful and powerful, partially because they’ve unintentionally told women that they don’t know how to do it and that their bodies are faulty. This creates a culture of fear surrounding the issue, and I mourn the loss of the spiritual connection that is so often made in normal birth- a deeper understanding of the connection to life and pain and surrender and power… That’s just my own personal reflection on my own birth.
Also, on the arrogance issue- I really think that they need to at least humble themselves to the mother’s instinct. I read this really interesting article just a few days before I got called to this labor:
http://www.midwiferytoday.com/articles/Ruleof10.asp
So strange that my client had an unmistakable and powerful urge to bear down at 8cm, and they wouldn’t let her. She spent the next hour feeling completely helpless and awful until they gave her the okay to push, and baby came out fast. After reading that article, I wonder if she had pushed if it would have shot her from 8-10 faster…
Have you seen “The Business of Being Born?” If not, you should…it’s available on Netflix instant play. It’s an independent documentary on exactly what you are talking about – how the system is treating birthing women as if they are only there to make the hospital money. And the best way to make money is to get them in and out to free up a bed for the next woman. It has great stories about home births. I never imagined myself having a natural birth before, but it was this movie that has made me think about options other than the “normal” hospital birth.
That movie is great! I’m so glad that it helped you to think about your options. I’d like to see the new one called “Orgasmic Birth”.