And so many more that I just don't have the heart to link... what two things do these tell me?
One, I cannot stress enough - it is so important to choose the right provider and birth/postpartum team. Interview, fire, hire, question, become your own advocate and conscientious consumer. It is your responsibility to choose the best option for your needs and desires.
And two, our system is broken - birth workers need to remember whom we work for. Mamas can only make the best choice with the options they have available to them - it is our responsibility to provide ethical services within our scope of practice.
This post is for Kimberly, who requested I write a follow up post to Talk It Out, with examples of positive communication and what to look for when talking with your provider about your wishes.
If you are planning on a hospital birth, a great place to start is first figuring out which hospital will be most encouraging of your birth preferences and beliefs. Not all hospitals are created equal. Case in point, here in Houston the rates for cesarean vary from 13% to 37%, depending on which hospital you choose.
So, let's start with a hospital questionaire. Some good questions to call up and ask the hospital:
Does __________ Hospital have childbirth classes and, if so, what types of natural labor management techniques are taught/where does the instructor have certification through? If they have Lamaze or Bradley classes taught in-hospital, GREAT. If they teach deep breathing, progressive relaxation, mobility, hydrotherapy, massage, and visualization, EVEN BETTER. If they offer a number of childbirth class options, including natural childbirth, hypnobabies/birthing, Bradley, Lamaze, sibling childbirth classes, medicated birth, and cesarean preparation classes - BEST.
Are there any restrictions on the people I have with me during labor and birth? This is a very important one. If you want your partner, your doula, and your mother in the room, you should find out if they restrict visitors to a limit of 2... another thought, if you have older children you would like with you during labor and birth, do they have any age restrictions.
How does _______ Hospital encourage mom to be ambulatory or active during labor and birth?
Some good indicators that they are encourage active labor (which means less discomfort, more holistic means of pain management, and, usually, lower cesarean rates) would include: intermittent fetal monitoring, showers and jacuzzis, TENS machines, telemetry units, birth balls, hot blankets, rocking chairs, squat bars, and the like.
Do the rooms at ___________ Hospital encourage mom to create a mood cohesive to birth?
A hospital birthing room can be more homelike. The closer to homelike a hospital room can feel, the better mom will relax into the atmosphere, make her feel comfortable and secure/safe, and the better chance her labor will progress with no hindrance. Some things to be looking for: jacuzzi/tub (or the ability to bring your own in), access to lots of pillows, temperature/climate controls in your room, private rooms, lighting controls/ability to dim the lights, CD players or the ability to bring your own, the ability to silence the ringer on the phone, drapes or blinds on the windows, rocking chairs, and a nursing station that will restrict un-invited guests from entering the room.
Do the nurses or __________ Hospital have experience with doulas? Points given if the nurses or hospitals know what a doula is and are familiar/happy with a doulas presence. Bonus points if they have a list of local doulas to give to a mom who requests them.
How does __________ Hospital encourage a mom to push her baby out? Hospitals that know where and how to set up their squat bars (or even have them) are more likely to be used to using them. Nurses who are familiar with 'tug of war' for birthing understand that all women birth babies with different methods of 'pushing'. If they encourage mom to push in 'whatever position feels best', or even suggesting things like squatting, side-lying, or on all fours, draped over the back of the bed... these things all point to a nursing staff, and thus, a hospital, that encourages natural, physiological birthing.
Can you tell me what immediate postpartum for me and baby might look like IF we are both healthy and fine? Key words to be looking for are: immediate skin-to-skin, baby on mom's chest, immediate breastfeeding, rooming in, shower, meal and drink, partner cutting cord, PUSHING placenta out, routine newborn exam in the room/in mom's arms, delayed newborn procedures, etc... Bonus points if they can tell you how to get a release to bring your placenta home with you or can tell you, off the top of their heads, who their lactation consultants are and when they make their rounds (even if you don't plan on using/doing either of these things).
How does ___________ Hospital routinely care for an exclusively nursed newborn? They should support complete rooming-in and breastfeeding-on-demand. They should have the choice of either breastfeeding or formula feeding bags for mom to take home. They should have lactation consultants/educators on staff and available AT LEAST every other day, if not every day, or a list of LLL leaders available. They should respect a families choices (even if they are not your choices) to delay or selective vaccinate, refuse eye prophylaxis, vitamin K injections, in-hospital hearing tests, PKU tests, and circumcision. They should also support a parent's right to be with their child during any of these chosen/accepted procedures.
If my doctor is cool with it, can I request early discharge? Even if you don't plan on making use of early discharge, this key point will allow you to know if your hospital supports a woman's autonomy and ability to make her own informed choices. Regardless if they 'allow it' a woman is always able to sign herself out of the hospital; knowing a hospital DOES 'allow it' shows that they are mindful of your rights.
Examples of positive communication with your doctor or midwife is up next....
I met you on the boardwalk, a beautifully bronzed burst of sunshine adorned with sparkles, bright yellow, and black flowers that flowed around your barely rounded belly. Your tangled mass of thick, wavy, auburn hair reached down toward your elbows and your smile was as brilliant white as the sun-bleached wicker chairs dotting the deck.
A square jaw jutted forward as you pressed your face toward the wind as you laughed gently at something that was said between your lover and you. Your partner lovingly wrapped his hands around you from behind, caressing your abdomen, before dashing off into the crowd.
I edged closer.
"My, are you ever beautiful! I love a pregnant woman, so full of life!"
You blushed darker bronze and murmured a thanks while outlining the contours of your baby with your palms.
I introduced myself and told you my calling. Instantly, your eyes began to sparkle and dance like the sunlight on the nearby cresting waves, "Oooh! I wanted to have a home birth so badly!" you exclaimed.
"What's holding you back?"
"My partner/I thought it was too risky", "I will definitely look into it further for future pregnancies, but, with my first and because I don't know what to expect, I think the hospital is a better choice", "It seems a little too hippy for me", "My partner is not comfortable with it", "my doctor is just fine and its only one day, right?".
You named your reasons, and I listened quietly, offering only a gentle nod of encouragement to continue. When you had exhausted all of your worries, you looked at me anxiously, apologetically. Your partner appeared as if a mirage and wrapped his sheltering arms around you, moving you away from me and further down the boardwalk.
I grasped your hand in goodbye, pressing my card, and this blog address, into your palm. "I wish you all the luck in the world. You are an amazingly beautiful, strong woman who is doing a good work to bring this beautiful life into the world!"
And you were gone.
I hope you have found your way here. Because I had so much I wanted to tell you!
A midwife and a doctor view birth so much differently! There is a wonderful source of information on what to ask your care provider to find out if they are truly Mother-Friendly, and I invite you to read it here.
Additionally, here is a pretty concise outline of the differences between a midwife and a medical model of care.
Midwives Model of Care
Medical Model of Care
Definition:
Definition:
• Birth is a social event, a normal part of a woman's life. • Birth is the work of the woman and her family. • The woman is a person experiencing a life-transforming event.
• Childbirth is a potentially pathological process. • Birth is the work of doctors, nurses, midwives and other experts. • The woman is a patient.
Definition:
Definition:
• Home or other familiar surroundings. • Informal system of care.
• Hospital, unfamiliar territory to the woman • Bueaucratic, hierarchical system of care
Definition:
Definition:
• See birth as a holistic process • Shared decision-making between caregivers and birthing woman • No class distinction between birthing women and caregivers • Equal relationship • Information shared with an attitude of personal caring. • Longer, more in-depth prenatal visits • Often strong emotional support • Familiar language and imagery used • Awareness of spiritual significance of birth • Believes in integrity of birth, uses technology if appropriate and proven
• Trained to focus on the medical aspects of birth • "Professional" care that is authoritarian • Often a class distinction between obstetrician and patients • Dominant-subordinate relationship • Information about health, disease and degree of risk not shared with the patient adequately. • Brief, depersonalized care • Little emotional support • Use of medical language • Spiritual aspects of birth are ignored or treated as embarrassing • Values technology, often without proof that it improves birth outcome
No matter how natural of a birth you have in a hospital setting, it will never even come close to a home birth. Home births are different on so many different levels than simple surroundings.
"My partner/I thought it was too risky" There have been many studies throughout the years that have found that home birth is as safe, if not safer, for healthy, low-risk women, as hospital birth. Most recently, a Canadian study has shown these same findings, once again. Home birth midwives will, very often, carry oxygen, and all carry homeopathics as well as are trained in lifesaving CPR and first-aid.
Home birth midwives are experts in normal, natural childbirth. Because they are experts in normal pregnancy and birth, they will see deviations from normal and natural pregnancy and labor/birth early on, be able to assess these variations, and take immediate and early precautionary measures to ensure your safety... this is part of the reason why home birth is so safe.
If your midwife were to see something that did not match normal and natural, she would be able to attempt to get you back to normal and natural before it became an emergency and, if she couldn't, she would be able to transfer you to appropriate care. Home births have come a long way from ripping up bedsheets and boiling water.
"I will definitely look into it further for future pregnancies, but, with my first and because I don't know what to expect, I think the hospital is a better choice" This particular reason is like a punch to the midsection. There is a large body of women who choose home birth for their second birth because they had a horrible experience with their hospital birth. If you are considering a home birth, your first birth is a great birth to start with - you cannot go back and redo your first birth, and that first birth can impact your options, emotional health and wellbeing, and even fertility of future pregnancies/births.
Some women, by the end of their labor, believe that their doctor/hospital has saved them from a bad outcome, when, in actuality, the hospital or doctor (procedure that they performed) caused the risks that they ended up needing to save you from. But, the perception that is given is that a woman is so thankful that they were in the hospital and are glad that they didn't have a home birth because they 'needed' this or that intervention.
Other women end up with unnecessary cesareans and find it hard to find a homebirth midwife or hospital based doctor who will take her on for a vaginal birth with subsequent pregnancies and births. I am sure you have heard the saying 'there is no time like the present'.
Bottom line, THIS pregnancy and birth is the best one to pursue a home birth for.
"It seems a little too hippy for me" The wonderful thing about midwifery going mainstream in the last 20 years is that you have all types of midwives now practicing. There are more traditional midwives, as well as more modern midwives. This allows for families to find the right type of midwife to fit their families needs.
I know midwives who wear hemp, bohemian skirts, have dread locks, drink herbal teas, eat a vegan diet, and choose a more natural lifestyle.
I also know midwives who wear high heels, highlight their hair, like cabernet sauvignon and sushi, and have a more urban feel.
And most of the midwives I know fall somewhere in-between. The stereotypical 70's midwife is not the only option anymore, but the continuity of care, the midwifery model, will remain constant no matter whom you choose.
"My partner is not comfortable with it" Not all partners are men, and not all partners fit this stereotype, but the majority of male partners are not comfortable with home birth at first. They usually don't research and read as much and tend to follow the paternal medical suit more readily.
That said, if you can simply get your partner to go to an initial interview/consultation with a home birth midwife and present it as an opportunity for your partner to ask whatever questions they might have of the midwife, this can, oftentimes, dispel fear, uncertainty, and incorrect stereotypes and assumptions that they might have about home birth and midwives. Oftentimes, just one consultation is all it takes to get a partner to start seriously considering a home birth.
Here and here are two different examples of the types of interview questions you might ask at an initial consult.
And finally, when it comes down to it, although it is always best to have both of you in agreement over your birth options, it is your birth and body, ultimately, it should be your comfort level and decision on where and with whom to birth.
"My doctor is just fine and its only one day, right?" I know lots of good doctors, I know some 'just fine' docs, and many bad doctors. Not bad at what they do, but bad at taking care of a woman and babies needs and holistic health.
There are doctors who have great bedside personalities, but who are not good doctors. There are doctors who make you feel 'taken care of', but don't shoot straight with you about your options... or disguise your options as necessities so that you don't have true options. And there are doctors who, when you are at your most vulnerable (labor and birth) will 'not allow you' so many things previously promised. It is necessary to more than LIKE your doctor... you must trust him/her with your holistic health and life, and that of your unborn baby. If you don't, you really truly should look for another care provider.
And let's not forget that the average first time labor is around 16 hours. This is average. Some women labor for a few days, some for a few minutes. Beyond the actual laboring time, your birth experience will last with you for much, MUCH longer.. in fact, your whole life. So, if you think it is 'just one day', think again.
My heartfelt desire is for you to remember this moment, which will stick with you for the rest of your life, with joy, trust, love, and fondness. Please make sure that you can trust your care provider for that.
As Dr. Biter said in a recent interview,
They don't even know the difference between natural birth and a vaginal birth. They think that, just because a baby is born out of a vagina that that is a natural birth.
But a natural birth is an unmedicated birth, a birth that is honored, where women and their partners are respected, and where that little buddy comes into this world in a solemn sacred moment. That's what a natural birth is!
There are additional great resources out there that will help you to work through other scenarios that you might encounter to help you make the best choice for you and, hopefully, feel secure in choosing a home birth for your first, beautiful, birthing time.
And finally, just for you, Sunshine Mama, some inspiration!
"The fact that it's primarily women who had kids before and had birth in hospitals before, certainly suggests it's a reaction to their prior birth," said Eugene Declercq, a professor of community health sciences at the Boston University School of Public Health, and a author of the study. "It certainly suggests it's an experience they don't want to repeat."
ABC reports on a recent study published by the CDC showing that there is a small, but steady, increase in the number of American women opting for a homebirth over a hospital birth.
I was reading through the report and loved how thorough it was in showing the demographics, geographics, and selective characteristics of this study and where the most change is occuring. I am happy, as an advocate of women's choice in place of birth, it is good to see the 'concrete' evidence of what we, in the childbirth industry, have been seeing - women are learning of their options and are becoming proactive about their healthcare -making the choices best suited to them and their situations.
If you are a woman who had a hospital birth (regardless of mode of delivery) and have then opted for a homebirth in subsequent births, I would love to hear your comparison birth stories and reasons for these choices. If you want, email them to me (check my profile).
There have been some wonderful articles on recent studies that are very encouraging that I wanted to pass on to the women in my life (both IRL and blogsphere) that are expecting babies soon.
A new study backs up previous research showing that nuchal cord is not the threat it's percieved to be.
The second article I would like to bring to your attention is entitled Eating During Labor Has No Ill Effects. According to the study cited in this article
Allowing a pregnant woman to eat during labor does not seem to have any impact on the outcome of the infant or mother, and doesn't increase the risk of vomiting, according to a new study.
This is exciting that they have documented what many of us already know! Combine that with the decrease in labor length (albiet small) in the group allowed to eat during labor, and our knowledge of the human body and it's need for fuel during strenuous activity, eating when hungry during labor and birth is a good thing.
This borderline hypoglycemic is so happy to see this archaic practice is getting the bad attention it deserves! Hopefully this means women no longer *have* to sneak their nourishment when opting for hospital births.
I am happy to say that I have also contacted local hospitals recently to see if they have updated their NPO ("non per oris" or nothing by mouth) policy and 3 out of 4 immediately said yes.
Finally, this article talks about the increase risk of cesarean section from inducing labor prematurely.
Again, this is not new news, but definitely exciting to see it get some good media coverage. My favorite part of the article is the last sentence (emphasis mine)
"Glantz advises that pregnant women and their doctors may be better off waiting for spontaneous labor. "Try to reserve interventions for situations where risk outweighs benefit". (and I assume he means risks of not intervening)
I know that some of my posts sound extremely anti-doctor, anti-hospital. That is not the case, I am simply anti-proactive and anti-bully... that, and you will rarely (not never) see a midwife, in general, bully a mom, or a home birth planned without proactiveness. So, unfortunately, and by default, many of my rant posts sound anti-doctor and anti-hospital.
I, myself, had three OB-attended labors (4 births) and one midwife-attended birth. I loved my choices and never regretted them. I support women in whatever choice they make, and, for many women, this means a hospital birth.
Women choose hospital births for a number of reasons: finances, comfort level, and relationship with their care provider to name a few.
But, whatever their reason, women who choose a hospital birth should have some practice tools to navigate the hospital setting, especially if she desires something other than the standard of American hospital care during childbirth (ie, spontaneous onset of labor, low-intervention labor, no medication, etc..).
Unfortunately, medical students are taught with medical textbooks which teach through medical texts and tables, giving average-as-rule, and expounding on the travails of malpractice and standard of care. These medical students will grow up to be your medical doctors. As a result, many women are expected to labor under the one-size-fits-all policies and procedures as outlined in the medical texts and hospital protocols.
To be ourselves causes us to be exiled by many others, and yet to comply with what others want causes us to be exiled from ourselves. - Unknown
Because of this, a woman choosing a hospital birth should be very very prudent, educated, selective, and careful of what shows she watches, books she reads, caregivers she chooses, other support people she surrounds herself with, and classes she takes before ever entering through the hospital doors for her birthing time.
Here are some ways she can better prepare for a healthier, safer birthing time:
Take an independent childbirth class - this means a non-hospital affiliated childbirth class. Most of these will be taught in someone's home or a free-standing center like a women's center or yoga studio. Very few of these occur within hospital walls. This ensures that the information you are getting is unbiased and medical-fact - not hospital policy or routine procedure for your place of birth. These classes encompass educators certified through CBI, ICEA, AAHCC, Lamaze, Hypnobabies, and more... Many Lamaze-hospital classes are only loosely based on Dr. Ferdinand Lamaze's teachings and are hospital preparation classes, not childbirth education classes.
Take the hospital tour - ask TONS of questions. Gird yourself to know that most of the mom's taking the tour will most likely have taken the hospital-preparation class and be looking to know what 'she should expect' from the hospital's policies. You, on the other hand, should go with a list of questions, such as: episiotomy rates, if they have birthing balls, TENS machines, telemetry units, squat bars, tubs and shower in the labor and birth rooms and for use during labor and birth. Ask if there is someone you can talk to yet that day who can answer questions about induction rates, cesarean rates for first time moms, how common are VBACs, what the augmentation rate, IV rate for unmedicated births, postpartum care for mom, immediate and long-term newborn procedures and standards, and if there is a 24/7 lactation consultant available.
Request pre-admittance paperwork - then read it. If you don't understand it, ask someone knowledgeable to interpret for you. Be sure that you agree with what you are signing. Do your research on terms and procedures that you are unfamiliar with. If you don't see the epidural consent and cesarean consent forms in your paperwork, request those as well (they are often not). Look over them, read them, but don't sign the epidural or cesarean consent forms before labor. Only have read them so that, if either procedure becomes necessary during labor, you have already read it with a clear mind before labor began and understand the information within.
Choose support people who not only will support your birth philosophy and choices, but will advocate for you and agree with you. If your mother or mother-in-law cannot do this, don't invite them to be there. Don't be afraid of offending people by not inviting them or uninviting them to the birth. This is not a spectator event, it is an intimate and highly vulnerable event. Make sure everyone in your room is on-board and completely supportive of your needs and desires. If you are worried about people simply showing up to your room during labor and birth consider: not telling anyone when you go into labor except those who will be in the room, telling the hospital staff the only people allowed in your room, beyond medical personnel, are so-and-so, unplugging your hospital room phone,and consider not signing the pre-admittance form agreeing to release your room number and name to people who call inquiring about you.
Talk to your care provider about all labor, birth, and postpartum preferences before labor commences. Discuss your desires, his/her policies and routine/standing orders, and consider writing a birth plan to help outline both of your preferences before hand. If they are grossly in opposition to any of your choices, refuse to support you and your choices, or seem less thansupportive of your beliefs and choices (i.e. vague answers, 'we'll see', well, I 'don't like to see', etc..), consider finding another, more supportive, doctor. You have the right to refuse ANY procedure for your body and birth.
Establish your newborn and baby preferences and discuss them with your doctor/pediatrician before birth and make sure that they are in agreement with, or at least supportive of, all of your choices. If they aren't, consider changing doctors. If you are unsure of any procedure (circumcision, vaccinations, etc...) consider refusing it until you have time to research it further and make an educated decision based on your families needs and beliefs. You have the right to refuse ANY procedure for your child.
Only agree to induction when medically necessary. This is a sticky one in a hospital setting. Some examples of unnecessary inductions are: suspected big baby, slightly higher bp and/or swelling from late pregnancy, being ready to 'be done', a major holiday is around the corner, passing your estimated due date, your careprovider's vacation is coming up, a relative or support person is coming into town, etc...
If an induction is necessary, move from the least medically invasive and 'point of no return' as possible and move up from there. Consider things such as Evening Primrose Oil for cervical riping rather than Cytotec, stripping your membranes rather than outright breaking your water, low-drip pitocin rather than scheduled pitocin incremental induction, etc...
Keep your water unbroken until it breaks on it's own. As soon as you allow a caregiver to break it for you at any time before or during labor, you are sigining yourself up for the whole hospital experience, you are on the clock and given a deadline for birthing your baby (within 12-48 hours - depending on your doctor's shift change, your hospital's policies, and your water's appearance).
When you do go into labor, and as long as your pregnancy is low-risk, stay home until you are well into active labor before moving to the hospital environment. This usually means contractions between 3-5 minutes apart and lasting about 1 minute or more. Mom should be having to work with her body during contractions and show a serious attention to her labor. Less time at the hospital means less time for them to offer or press unnecessary interventions and medications.
Remember, you are a consumer of your health care. You are paying for the hospital and your doctor/midwife's services. You can say yes or no to anything that you want to. You have the right to have your choice respected and not to be bullied or feel coerced or pressured into giving consent.
Hospital births can be a thoroughly enjoyable, beautiful, safe, and wonderful experience; when a woman takes the time to educate herself to her options and make personal exploration of her desires and comfort levels with different aspects of hospital birth policies, procedures, and expectations.
This is what we could have here in Nashville, TN. We have a great, big, teaching hospital with a great, big, multi-million dollar high risk maternity wing... you would think we could have a few, just a few, waterbirth rooms on campus. This is what we could have.
If you read my blog much, I'm sure you have seen at least some of these stories circulating:
