Tuesday, September 27, 2011

Why I don't want another hospital birth

I've told you all about Marko's hospital birth. And I've mentioned that I didn't much like it. So I bet no one will be too surprised when I tell you I don't want to do it like that again. Luckily, there's another option: home birth.

What a lot of people will tell you about home birth goes like this: "The hospital is the safe place, so if you don't care about your health and the health of your baby, go ahead and stay home just so you can get some 'positive vibes.' While you're at it, why don't you have a shaman catch your baby in a mud hut?"

The fact is that in many cases, home can be safer than the hospital.

Think about it this way: our bodies were designed/evolved to give birth. You are descended from a long line of women who were capable of giving birth. Every one of your ancestors, up to the past hundred years or so, survived birth without medical intervention.

Of course some mothers and babies did die before modern medicine. So why not use modern medicine to improve the situation so not only most, but all mothers and babies survive?

Because our bodies have not had time to catch up to all these changes, that's why. Birth is a very delicate physiological process which, under normal circumstances, unfolds perfectly with no interference. Routinely interfering in birth might cause more problems than it solves.

In fact, this seems to be the case. Fifty years ago, it was pretty standard to knock out all the mothers with chloroform and pull their babies out with forceps. Most survived. But some children had broken skulls, some had mental disabilities from being born blue (from the chloroform), and nearly all the mothers had some injury or other from those forceps. We know more now, so things are better. But even so, the perinatal mortality rate (death of babies shortly before, during, and after birth) in the US is fairly poor, and it has shown no improvement in the past 25 years. There are still many things hospitals do that are not backed by any evidence and which are actually harmful!

For instance:

*Episiotomy. Some doctors routinely cut the perineum of every laboring woman. Others do it for various indications, such as "the baby isn't coming out fast enough" or "you'll surely tear otherwise." But there are few or no real reasons to give one, and the side effects are pretty severe -- such as pain and sexual problems for a year or longer! Why make women suffer something like this if it's not necessary?

*The lithotomy position -- delivering the baby while lying flat on one's back, with feet in stirrups. This is pretty much the worst position you could give birth in (except maybe hanging by your ankles from the ceiling -- and I hear that's been tried). There is only one person it benefits -- the doctor. It's much more convenient for the birth attendant. It can cause a lot of problems for the actual labor, though -- such as restricted blood flow to the baby and stuck shoulders. But at least the doctor got to sit on his swiveling stool, right?

*Immediate clamping of the umbilical cord. There's no particular reason why doctors do this, except force of habit. Throughout history, doctors have decried "premature cutting of the navel-string" as "very injurious," but somehow it became a fad. This way you can easily zip the baby off to the nursery in a hurry. However, that leaves almost a third of the baby's blood still sitting in the placenta! Study after study has showed delayed clamping to be better, but hospitals are slow to catch on. Instead, we are told that anemia in babies is a result of breastfeeding.

*And, of course, a c-section rate at 32% and still rising. It's not just because women prefer them (for the most part, they don't). But doctors prefer them. They get a good deal more money, and none of this pesky waiting around! Not to mention, since it's the "most cautious" choice, you're unlikely to get sued for doing one. They happen all the time for all kinds of silly reasons, but it's telling that the rate surges at about five o'clock when the doctors like to go home.

I could go on and on: continuous fetal monitoring, routine use of pitocin, artificial rupture of membranes, and many, many more. The standard policies in hospitals are based mainly on convenience, avoiding lawsuits, and what was considered safe twenty years ago. Doctors don't have much time to read all the latest studies, and why should they? Their patients are all healthy, so even if you mess up quite a bit, things are still likely to be more or less okay. And if they're not, just tell the mom that she and her baby would have both died without your help!

Okay, so not all doctors are like that. Imagine your ideal doctor. He (or, better yet, she) is up-to-date on the newest studies. She carefully reads your ten-page birth plan and agrees with every point. She won't interfere with the natural process unless there's a need. Great!

But even then, there is a slight problem. Birth is hormonally driven and responds to psychological triggers. If the mother is afraid, it will halt or even reverse. Why? Well, think about it -- if there's a danger around, it's a bad idea to have a baby right now. Even when it's too late to give up on labor and come back tomorrow, it can stall, leaving the baby stuck.

Imagine this scenario. You're at a party. You suddenly realize you have to go to the bathroom. So you unobtrusively make your way over to the hostess and quietly ask where the bathroom is. She directs you to a table in the middle of the room. After stripping off your clothes and putting you in a skimpy hospital gown, she has you lie down on the table and gets two of the guests to hold your legs in the air. All the guests, who are strangers to you, gather around. All of them are yelling "PUSH! PUSH!"

Could you go to the bathroom under these circumstances? I couldn't! And people who tell you, "Just suck it up, it's no fun, but you have to deal with it because it's what's best for your baby," don't really understand. There may be a psychological basis, but you can't make yourself relax, stop releasing adrenaline, and believe that you are in your own home surrounded only by those you trust. There are many methods of meditation and hypnosis that are supposed to help you do that, but it's hit or miss when you're already in an unsupportive environment.

It seems much safer to me to give birth at home, where the natural birth process will be interfered with as little as possible. Rather than being told "relax, relax, it won't work unless you relax!" I will actually be able to relax easily, in my own environment. And I will have the freedom to do things my way -- move around, choose comfortable and safe positions, and avoid interference. As an added bonus, most midwives are experts in normal birth and do study up on the latest scientific knowledge. They know what normal birth looks like -- and what a problem looks like. And since they stay with you throughout the birth (unlike doctors, who might check on you every couple of hours), they will recognize a problem immediately and can take appropriate action.

All I have to do now is figure out how to pay the midwife!

6 comments:

Sally Thomas said...

Congrats on the new baby! And good luck with the homebirth. My first was an emergency c-section, so I never felt confident enough to go for a subsequent homebirth, though in England, where our third was born, I was offered the option. As it was, that hospital birth, with a midwife and literally nobody else around at 2 in the morning, was easily the best as birth experiences go (my favorite word for childbirth is "over"), and the closest to a homebirth: it was my husband and I, the midwife, dim lights, and a really cushy pad on the floor.

I will say that should you *have* to go the hospital route for some unforeseen reason, and you know this enough in advance to plan for it, a doula is a very, very, very good idea. With our second, when we were going for our first VBAC, we hired a doula, and it was one of the best decisions we've ever made i our lives. She did all that advocacy stuff for us, down to getting me popsicles to eat instead of ice chips, and preventing the docs from mashing my stomach afterwards. It was an intense birth -- my pattern was typically that my water broke, but then I didn't naturally go into labor, at least not in time for infection not to be a serious concern, so with 2 of my births I had pitocin, and this was one of them. The doula truly got me through it (she got my husband through it, too . . . ). But I did it without any drugs, and did not have to have a repeat caesarean, so it was worth it.

My fourth baby was also a pitocin baby, but by that time I guess my body was so broken in that I just didn't feel it all that much. Now, *that* was a hospital birth -- we'd come back from the UK and midwife-land to discover that everyone in the US had changed their minds about the desirability of VBACs while we were away, and that the only way that I, at six months pregnant, could get any doctor to see me without my committing to a c-section on the front end was to throw myself on the mercies of the teaching hospital downtown, where all the teenaged crack mothers go. There, there was none of this "getting out of bed to go to the bathroom" business; you were on a monitor, baby, and they would pass you a bedpan, I guess to make sure you weren't going into the bathroom to shoot up between contractions. That was . . . not my favorite birth experience . . . though when the baby turned out to have Group B strep, I was glad to be in the same building with a world-class neonatal unit. Also, just as I was contemplating the idea of letting myself have an epidural this time around, because really, life was hard enough already, it turned out that I was at 10 cm, and had the baby as the doctor was rushing into the room. (nurses had said, "Wait! There's not a doctor in here!" "Too bad!" I said.). Gotta love those subsequent births.

Anyway, congratulations again.

Sheila said...

That last one sounds really awful! I feel for you. I'm well aware that I actually got a pretty good deal, as hospitals go. It's just because my mom and other friends had midwives that I know it could have been a lot better.

Heather said...

I think midwives and/or doulas are great, particularly if they are accredited and experienced and have a personality and connections to a welcoming hospital just in case, but I also think hospital staff aren't so... callous... as many people who advocate for midwives seem to think they are. And I think midwives and doulas have been increasingly popular lately, with greater awareness in the States. Perhaps it's just because I surround myself with all this information re. "alternative" medicine and holistic practices, and I live in a major city that's as diverse as they come, but I generally think/hope you'll be pleasantly surprised by people's reactions to your intended birth plan. =)

(If they're not, though, then to heck with them!)

Sheila said...

Well, that is what I expected the first time. I had a good birth plan, tons of knowledge, and no complication. The hospital was known to be the best in the area and had policies I agreed with. I even liked *some* of the doctors in the practice. But that didn't stop the doctor from being a jerk (I got unlucky -- there were only two I hated, out of eight), me being forced to stay on my back in bed strapped to monitors (which was incredibly painful), being injected with drugs I didn't consent to, and being talked into letting my baby be taken away at birth (which, I admit, I could have and should have refused). I found that it is very hard to stick up for yourself while also doing the hard work of having a baby. I did refuse two things -- the IV (which caused a huge ruckus, but my nurse advocated for me) and the episiotomy (though I had to stop pushing to yell "I don't want that!" as she reached for the scissors). But I still think back on that experience as being one of the worst in my life ... and I still sustained a rather severe injury which still hurts sometimes. I don't think that was necessary.

So, yes, I was willing to give the doctors a chance. And I know some people do the same and actually do get good results. But I've been burned too bad to want to try it again.

Anonymous said...

Better luck second time round, Sheila! I'm wishing the same for myself (I'm due mid-February, and it's coming up fast!). I also had a rough first delivery - due to legitimate complications, though. I was thankful that I had a doctor who really fought against doing an emergency c-section that everyone else was advising, and managed to bring to completion a natural, if complicated, birth... The baby did have to be taken away right afterwards, but it was legit - he had swallowed myconium, so they had to do something about it immediately, and then they brought him back... Anyway, overall, I've been surprised to see the number of doctors over here in this region, which is fairly "conservative" in terms of medicine, also pushing for c-sections, inducements, etc., and am grateful that I found a doctor that really prefers and works well with the natural way. Just hoping my own body does better the second time! Good luck with the home birth - I'm interested in knowing how it turns out!
Ellen

Sally Thomas said...

(Coming back to this really late -- my attempts to wean myself from the internet are meeting with . . . erratic . . . success):

I think that whatever your particular circumstances turn out to be, you go into subsequent births with a lot more sense of your own empowerment than you have the first time. With a first birth, no matter how prepared you are, no matter how well worked-out a plan you have, it all turns out to feel pretty hypothetical, abstract, and not-there when you're faced with flesh-and-blood people who are thinking and saying, yes, yes, every new mother comes in with this same plan, but we have seen it all before, and weeeee know better!

I know that I meekly accepted a lot more stuff than I needed to throughout my first pregnancy because I felt intimidated by my doctor (even though I thought I was supposed to feel some empathetic bond because she was also female). I consented to a lot more prenatal testing than I ever had again, because I didn't feel I could say no to it. It wasn't that I wasn't doing research; it was that I'd get to the doctor's, and she would go, "Yes, I've heard all that before, but . . . "

And yeah, that last hospital was pretty intense . . . sigh. "Over" is definitely my favorite word for that experience, though I got my darling youngest daughter out of it and would go through the same again if that were the reward. But yeah. Not something I'd go around recommending as a norm. Had we not been jobless and broke after my husband finished his Ph.D and, at the recommendation of family, on Medicaid, I'd have chosen to go just about any other route.

Still, having had three children already, I felt a lot calmer even in the face of interventions I didn't want, a lot more able to focus, and a lot more able to say, "No, I'm not lying down, and you're going to have to deal with that, because this baby is coming out now. Catch!" Or words to that effect, with possibly some phrasing that I don't use in ordinary conversation. I felt a lot more able to stand up for myself to the extent that I could in the face of hospital rules designed for the management of 14-year-old crack mothers in leg irons. There, they took the baby away for SIX HOURS, non-negotiable, which I did not get at all until I realized that they were watching for withdrawal symptoms. Of course, the hyper-vigilance also meant that they caught her Group B Strep before she began to manifest any symptoms. So as rough an experience as it all was, I can see a lot of grace in it.

And I know what you mean about anxiety and stalled labor. At that birth, my mother brought her knitting and camped out beside me for the day, to watch me have the baby. I really, really, really had tried nicely to persuade her that she didn't want to do this -- I love my mom, but I don't love being watched like a public event about to happen (I can screen out strangers a lot more easily than I can my family), and it was easier to assert myself with doctors and nurses whose feelings I didn't care that much about than with her. So nothing happened for about seven hours. Finally she had to go home and make dinner for my dad. The baby came within . . . half an hour, maybe? Coincidence? I still laugh about that. My poor mom, cheated of a birth experience by my performance anxiety!

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