Friday, April 13, 2007

Food for Thought

I just came across this interesting article, "Drugs, Knives, and Midwives" about the state of childbirth in the US.

Marsden Wagner is a favorite author of mine. He is a neonatologist and worked for the WHO for 15 years as director of Women's and Children's Health. Some of his articles of interest include:
As a side note about the first article, I found the claims at the end of the article a bit exaggerated. The author makes it sound as if women are frequently denied pain medications. I would argue that the opposite is true; it's very easy to obtain drugs while in labor, and many women in fact find themselves pressured by their nurses or doctors to take medications.

For example, a CNM practice at a large university hospital where I used to live had an epidural rate of over 50% (and a C-section rate between 20-25%; they didn't know their actual statistics, but guessed it fell somewhere in that range). I interviewed one of the midwives for a paper I was writing as a doctoral student, and she told me that "the drugs that we use today are very safe for the mom; they're very safe for the baby" (direct quote).

Women who choose to birth in hospital alternative birth centers often do so because they DON'T want the option of immediately available pain medications.

For those of you who birthed in hospitals, what were your experiences of pain medications? Did the staff pressure you into having narcotics or epidurals? Did they try to talk you out of them? Did they suggest other non-pharmaceutical comfort measures, such as showering, hot tubs, birth balls, massage, etc?


  1. For my first birth, in a hospital when I was 19, the nurse (a recent CNM graduate who had not yet taken the NARM and was my introduction to a "med-wife") pushed pain relief on me from the beginning. Even though I didn't want any pain medicine, she offered it every time she came in the room, and after talking me into getting a shot of Demeral had the equiptment for an epidural brought in. My husband, then boyfriend, was thankfully aware enough that he ordered that stuff out of there and forbid the nurse from offering an epidural again. It was totally a culture of drugs, though, and I was made to feel inconvienent because I took more effort and actually required support.

  2. My only birth was in a hospital here in Canada. I was not pressured into getting drugs at all. I planned on not getting any, unless I felt I needed to. I did end up getting morphine( I never thought I would feel right about doing that!), but it worked out great, and helped me settle down. The nurse suggested it only after I said that I needed some sort of pain relief. She also suggested other soothing methods, such as the shower(I loved it!), and bouncing on an exercise ball.

  3. My 1st birth was in the hospital and my last 2 were born at home with a MW ... Im pregnant again and planning my first UC ( dancing with glory about taking my power back)
    Anyway,At my first birth they pressured me and pressured me to have drugs. Finally at 8 cm I agreed to HALF of a dose of Stadol. Well, it made me so out of it I couldn't hold my newborn. I had to have my friend who was there with me hold her for the 1st 2 hours until the drug wore off. It was very depressing.

  4. When one of my friends had her daughter in the hospital the nurse was like, "You're not getting a break from your contractions. The anestesiologist is here and he won't be back for an hour so I suggest you get an epidural now if you're going to get one." She had originally thought she would try to have a baby without pain meds but wasn't totally opposed to them or anything. What was she to say when, in her moment of weakness, the nurse said, "it will be an hour before he's back!?" Aside from that, she labored on her back the entire time and wasn't "allowed" to get up an walk around. Urgh. If only she knew what she could have had.

  5. Yes, no, and no.

    I wanted a drug-free birth. I outlined in my birth plan (what a waste of paper that was! Nobody even looked at it!) that I wanted to use the birth ball, stool, jacuzzi, etc. instead of drugs, but no one even mentioned any of those things. During the first stage of labor they gave me sleeping pills, no mention of other things I could do to make the time go by easier. Later on, they gave me a drug cocktail shot, but didn't ask me first if I wanted it. I took it anyway. After 40 hours of labor the MEDwife and nurses started pressuring me about the epidural. I was exhausted from lack of sleep and not being able to eat or drink, and was feeling anxious about the way things were going, so I consented. Again, there was no mention of any other alternatives I could have taken, not even so much as a suggestion. When I got to 10 cm they told me to push, even though I hadn't even gone into transition yet. But the epidural robbed me of any feeling in my body, so how would I have even known? Pushed for four hours, got a C-section, and a week later found out that my cervix had torn and I then nearly hemorraged to death.

    I never asked for any of the drugs I recieved, but I never refused them either, because I wasn't exactly in a state where I could stand up for myself. Man, those nurses really know how to push their agenda when you're at your most vulnerable, don't they??

    I was a naive first timer who honestly thought the hospital staff would work with my desires. Boy, was I wrong. (I still have both copies of my birth plan, they are in my son's baby book. They sat in my purse the entire time I labored.) My birth experience cemented my desire to DIY next time and advocate home birth.


  6. P.S. I forgot to mention the IV they inserted "just in case." I got to drag that thing around with me the entire time I was in labor. Fun! And the Pitocin too. UGH.

    Is it any wonder I never want to give birth in a hospital again? When my friends look at me askance like the hospital is just "where you have babies" and it'd be crazy to deliberately have one elsewhere, I tell them my story and they shut up.


  7. Wow Jill, I had never heard the circumstances of your birth before. You got the whole package deal, eh?

  8. At my three births, all at major university medical centers I never had pain meds pushed. With my last delivery, with a nurse midwife, as part of my birthplan, the group asked whether I'd like to be talked out of pain meds if I asked for them. I was encouraged to use a birthing ball, jacuzzi tub and other non-med alternatives for my first two births (both attended by a great OB-- and nurses). With my third there wasn't much time for anything.

    You mention that CNMs said pain meds are largely safe for mother and baby-- you may feel that these are not ideal and deprive the mother of a full birht experience, but do you argue that this is untrue?

  9. It is unfortunate that Jill had an experience so unlike what she wanted, but how were the nurses to even know what she wanted if the birth plan never left her purse? If you're not up to pushing what you want in labor, that's why you bring along a birthing partner to advocate for you.

    And choose an OB/Midwife from the start who's willing to work with you. I haven't found this hard to do in two different states, with regular health insurance or medicaid. I did switch partway through my third pregnancy. Just b/c you had a bad experience doesn't mean the obvious solution is to just go it alone the next time. That requires a lot of education and guts and may not be the best choice for most people.

  10. Jill- I'm sorry your friends shut up when you tell them your experience. You tore your cervix and almost hemorrhaged to death and so you think you should just do it at home next time?

    Does anyone else find this a little risky?

  11. Responses to the ever-present Anonymouses:

    When I was first admitted, I told the nurses that my birth plan was in my purse and to please get it out and look at it. I couldn't exactly reach it at the time since I was trapped in a bed with monitors around my waist, and my purse was on the counter. They ignored me. The next time they "allowed" me out of bed, I got it out and held it out to the nurse, and she said, "I'll look at it later." So I put it back in my purse, for lack of a better place to put it, and there it stayed. You're right, though, a birth advocate would have likely saved me from many of the things I endured. Unfortunately I had no one to offer such support to me at the time.

    I didn't say that I am now a UC advocate...although that is an admirable choice and I deeply respect women like Rixa who have the courage and knowledge to do it. I said I am a *homebirth* advocate. I will have a midwife in attendance. The leap from textbook hospital birth to UC is far too great for me. Perhaps if I have a successful homebirth, I will consider UC next time. But regardless, who's to say that it isn't "the solution?" Would the solution be to go to the hospital next time and have a repeat C-section? Because I would be willing to bet you money that that's what would happen.

    As for tearing my cervix...that was due to pushing at an improper time in an inopportune position. Lithotomy is the most taxing position one can push in, and it certainly took its toll in my case. It had nothing to do with birth itself, but rather the environment I was giving birth in. So yes, you are right that I think I should do it at home next time. Eliminating the factors that caused it will prevent it from happening again, correct? But you are also right that the hemorrage is very much on my mind when I think about homebirthing my next child. It is likely that it won't happen again though, since as I said, the circumstances that caused it will be nonexistent. But in the case that it does, I won't hesitate to go to the hospital. Contrary to popular belief, not every homebirther is willing to sacrifice her life or the life of her child just to have a "perfect birth." ;)


  12. RE "You tore your cervix and almost hemorrhaged to death and so you think you should just do it at home next time?

    Does anyone else find this a little risky?"

    The absolute best way to *cause* PP hemorrhage is by exhausting and overstimulating the uterus during a 40-hr pitocin-augmented labor, so it can't clamp down to stop bleeding. Likewise, the recipe for tearing is forceful directed pushing in a phyisiologically absurd position under epidural anesthesia, where the mother's conscious efforts are not checked by any feedback of her sensations.

    Jill is absolutely right. These complications are known to occur comparatively rarely and to a much lesser degree at home births, because the interventions which often cause them are never used. Staying home is her best bet.

    Can we absolutely *guarantee* she won't bleed or tear? No, but if she does, being home won't put her at unacceptable risk, while being at the hospital is just not a good place to avoid these complications in the first place.

  13. I think there's a certain naivete in the belief that we can get what we want in a hospital if we just fight for it. That can be true for some women, if they have the right caregiver and nursing staff. But...

    The last thing a laboring woman should have to do is fight for what she wants. Labor is a time to enter an altered hormonal state, ideally a state of ecstasy (see Dr. Sarah Buckley's explanation of this phenomenon). The problem with needing to fight for what you want, is that it is detrimental to the hormones that enhance and facilitate labor.

    In addition, a laboring woman is in a vulnerable state. Not weak, but vulnerable to others' fears or suggestions (another reason I wanted to eliminate other people from my own birth). A lot of women end up with "choices" they really wouldn't have made otherwise.

  14. You are 100% right, Rixa. It took me a long time to process what happened during my birth, because it was so far from what I'd planned....yet who did I really have to blame but myself, since I hadn't tried hard enough to stop anything that I didn't like? I know now that it wasn't entirely my fault, but at the same time I can't help but feel guilt that I "allowed" this to happen.

    I think it's terrible that in order to have the kind of birth a woman wants at a hospital, she and her partner have to fight tooth and nail every step of the way. Their minds should be focusing on this amazing transitory experience and the impending arrival of their child, not on fending off needle-happy nurses and knife-happy doctors. When friends of mine say that they are going to birth at the hospital but want to do it naturally, I warn them to be prepared to put up a fight, but they brush me off since I just think "hospitals are the devil." Afterwards, they come to me and say, "You were right." :(


  15. I'll add my experience here.

    I checked into the hospital at 3 cm dilated and didn't progress very quickly. After 4 hours of laboring, a MEDwife suggested 3 options: narcotics, AROM and pitocin stimulation, morphine and sleep in the hospital or sleeping pills and go home. I had a problem with that logic, if they were willing to drug me and put in some other part of the hospital so they could have their precious L&D room, then they could have moved to another place in the hospital where I could labor without drugs. (Option 1 was immediately rejected, obviously). They wouldn't consider my wishes and instead forcefully (verbally, not physically) made me leave the hospital. I returned to the hospital the next morning (after over 24 hours regular, strong contractions, and with much fear to return to that environment) and once I was there pain medication and epidural was mentioned a few times but refused each time. Nurses and MEDwife insisted that the anestiologist come in the room and hear my refusal for myself. Because they couldn't pass on that information saying I was refusing? Whatever. To me, that was their attempt to cajole me into accepting the epidural. In the end, I refused all pain medication, but there was definitely a push, and even manipulation to get me to accept.

    It was that manipulation and then the feeling of being vulnerable and exhausted that caused me to give into other procedures and interventions that I wasn't willing to accept. It would seem that a few unwanted stitches and EFM is not a big deal, but in my case, the result was feeling like I was raped and experiencing PTSD from what I consider to be manipulative and bullying treatment.


Related Posts Plugin for WordPress, Blogger...