Monday, April 25, 2011

You have choices in childbirth...



I'm on a journey... I'm a former Art Teacher who hung up my 'smock' to stay home to raise two beautiful boys. Two boys who arrived so differently and by doing so, altered my future career path. As a big reader, I read a fair amount about pregnancy and childbirth before the arrival of our first son. A few weeks before delivery I arrived at my prenatal check-up with a birth plan in hand. My husband and I discussed what interventions we wanted to avoid and what our expectations were. Most wishes were hesitantly accepted. It was a 26 hour labor with no epidural, no pitocin and the feeling of winning the longest race I'd ever run and it was... EXHILARATING! The repercussions of having an OB assisted hospital birth were: I was limited to the lithotomy position in bed, which resulted in a minor perineum tear (the worst recovery pain EVER!), I lacked the support/encouragement/knowledge of another experienced labor coach/assistant, and lacked food needed for energy during the long hours of labor.

Fast forward 2 years being pregnant for the 2nd time. I knew I wanted more support and encouragement from my provider. I wanted to enter a hospital feeling like I wasn't 'at risk' for something to go wrong but rather that I was capable and was designed to do this birthing thing. I sought the care of the one and only certified nurse midwife in town. She was wonderful. She explained each test, procedure and possible interventions in labor. I was informed of the risks and benefits of each. She taught and demonstrated various techniques for managing labor pains (use of a birthing ball, side lying, back massage, etc.) During labor she spent more time helping me to recognize what stage of labor I was in. She also helped ward off other unnecessary, but commonly given interventions (constant fetal monitoring, intra-uterine pressure catheter and an epidural). I freely ate, which she encouraged and shared that their was no scientific evidence to prove it unsafe. She was not only my advocate, but she empowered me to trust what I wanted and what my body could do. With this birth, I changed positions often, used a birthing ball and ended up delivering our second son in a hands and knees position. The result: a healthy baby boy with no evidence of tearing. My postpartum recovery was a snap! I went shopping 3 days later.

We have choices in childbirth and we should be questioning protocol and giving ourselves permission to say "No", because present day practices truly aren't all evidence based (meaning it's not what's best for you or baby). Maternity decisions are driven by monetary and legal reasons. Obstetricians are paid more when you arrive and deliver during their shift. On top of that, obstetricians and medical residents want to get home to their families and this means... intervening to speed up your labor process. Have you ever heard of the phrase "intervention cascade"? One intervention leads to another that leads to another. If you're considered low risk, does it make sense that you need to be poked, prodded and limited to bed? Generally speaking, obstetricians want to be in control, they want us (as one nurse summed it up) 'numb and dumb'. It's the only area I've witnessed doctors, medical residents, and nurses enter a room and state what they're going to do often without explaining risks/benefits to a patient so that she can give informed consent. You should be asking what the risks and benefits are to each and every treatment/intervention and stating that you'd like a few minutes to process the information (given it's not an emergency). You have the right to say no and to call the shots. Here's a link to 'The Rights of Childbearing Women'. It matters how our babies arrive and we'll remember their arrival forever...

Thursday, April 21, 2011

Upon arrival at the hospital...




Think you want an epidural? Here's a picture of what 'you'll' look like in a typical hospital labor and delivery unit after an epidural. What you may not know is that when an epidural is given before the active phase (2nd stage when you're dilated between 4-7 centimeters) of labor, your chances of having a cesarean section doubles. Epidurals commonly slow down labor, so you'll be put on a synthetic hormone called pitocin to speed up contractions. Since you can't feel your lower half, you'll be bed bound and need a urinary catheter put in. They'll routinely put in a intrauterine pressure catheter to "better" monitor how your uterus is contracting and this requires breaking your bag of water if it hasn't already. Now that you're all 'hooked up' you'll be left alone to be periodically checked on, otherwise nurses will be watching your progress on a screen at the nurses station.
Does this snapshot seem ideal? I recognize that for some women this common scenario is just fine and needed in high risk pregnancies, but for many others considered low risk this is invasive and induces powerlessness and fear. The best thing you can do for yourself and baby is to educate yourself on each of these interventions before arriving to the hospital and ask your OB about each one. We'll first take a look at epidurals. Since I'm no expert and there's no need to re-invent the wheel, here's a site that presents the risks and benefits along with questions to ask your provider in a nice chart...
http://www.kimjames.net/maternal%20risk%20chart.htm
I also liked this video:
http://www.youtube.com/watch?v=tXVhaVATcbQ

Wednesday, April 20, 2011

What drives OB decisions is not evidence based practice...

"OB is a business. It's a volume business," chimes another doctor, Stephen Crane, MD. "If you get paid $2400 to deliver a baby and you pay out $90,000 in malpractice insurance, you have to do a lot of deliveries to pay for that fee." ---excerpt from the book PUSHED by Jennifer Block. Does this help explain the high C-section rates and invasive interventions used during labor and delivery? YES!!! I'm returning to my blog with a new focus... posting information for the pregnant Mom-to-be on labor and delivery practices, links to informative sites, and questions to specifically ask your provider to empower your choices. Our bodies are NOT failing us, the birthing industry IS... let's PUSH back!

Sunday, April 17, 2011