Thursday, January 17, 2008

"I could NEVER do that"

Thanks to The Human Pacifier for an intriguing post about how achieving a "natural" birth in a hospital is an incredible feat. She raises a very important point that having an unmedicated birth at home or in a freestanding birth center is worlds apart (and arguably much, much easier) from a "natural"* hospital birth. Women who achieve this in a hospital really DO deserve a medal! It's so much more challenging than doing it out of hospital. I think women sometimes assume that it would have been/felt the same no matter the location. Perhaps when we're holding conversations about this, we need to emphasize that a lot of the things that cause pain, discomfort, and stress aren't present when you birth outside a hospital, so things are usually much less painful in the first place.

Now, I don't want to turn this into a simplistic home vs hospital kind of post. But that is one of the fantastic advantages of laboring outside of a medical institution! No IVs or heplocks.** No Pitocin augmentation. No fetal monitor straps. No internal monitors. No restrictions to bed. No one asking you to "rate your pain 1 to 10" or "would you like something to take the edge off/help you relax/help you sleep." Generally vaginal exams are limited-to-none or only on the mother's request. No mandatory birthing in the stranded beetle position. No Valsalva pushing ("hold your breath and count to ten and push Push PUSH!!").***

In some ways, I feel like I got off easy. All I had to do was labor and give birth! No fuss, no fighting, no declining this or that. Just birth.

* I really dislike the term "natural birth." It's too vague to be useful and carries a "holier-than-thou" connotation. You know, "natural" is better than "artificial" kind of thing. So I generally use a more specific word depending on what I am trying to convey: unmedicated, physiological, undisturbed, etc.
** Occasionally you will see IVs/heplocks used outside a hospital setting, usually to administer abx if the woman is GBS positive and requests that treatment, or to correct severe dehydration due to vomiting. But these are really exceptional circumstances.

***Okay, okay, I betcha some out-of-hospital birth attendants have done this...and I know that not every hospital does either. But it's true generally.

25 comments:

  1. Yes -- no fighting, just birth. That's what I wanted and that's what I got. At home.

    A couple people have commented that I was brave to have a homebirth. Personally, I think I took the easy route. I give tons of credit to all the women who give birth in hospitals and manage to deal confidently and effectively with all the pressures they encounter there.

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  2. Amen!
    I have always agreed that women birthing in a hospital setting must have 110% conviction in EVERYthing they want/hope in their birth experience and their post-partum experience. And that's another thing: I find so many of us forget how crucial the post-partum period is. Time for bonding, learning, healing, support. And that period is VASTLY different at home vs. hospital. I know; I've had both.

    As a doula, I find hospital births to also be exceedingly more difficult as so much of my emotional support goes to strengthening that protective bubble for mama and baby.
    That said, when they go as the mama had hoped, they also can be incredibly rewarding. :)

    I, too, agree with you over the term natural birth. I'd rather just see the word "birth" used. Natural birth should be the norm, it should be assumed. One should only clarify if they plan on having a medicated birth. But - ahem - that's opening myself up for a huge debate with linguistics.

    Keep bringing on these insightful topics, Rixa. You always make me think.

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  3. Okay, Where's my medal! Would you like my PO Box?

    leighsteele - yeah, don't go there...

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  4. My second child is 7 months. He was born at home. Just birth. It was wonderful. My husband was around and my daughter was asleep. It was great.

    My daughter is 17 months older and was born in a hospital. It was a "natural birth" (that's what I wanted... I thought natural meant natural...whatever) It was insisted upon that I was induced with pitocin (cause it was the day after my due date! oh my.) I declined and declined and declined. I was stuck in a bed the whole time with monitors. I was turned on my side and told to wait 10 minutes when the doctor wasn't there when I was ready...and when she came out, she had a wire screwed into her head! (I have no idea when they did that! The one thing I said I didn't want them to do.) You know, I felt pretty good, all in all about my "natural birth".

    I didn't get it, but no drugs. I was happy about that. That was about all I could control. Saying "no thanks" and working my butt off while following the rules and staying in bed and trying not to move too much 'cause it messed up the monitors...bizarre.

    I look forward to having another child...just birth, but when I think about it, I do get nervous about what I will hear from my family (specifically my mom who was not pleased that I didn't go to the hospital)...

    Enough rambling, but how do I resolve my nervousness about being pressured to go to a hospital throughout the whole pregnancy? My mom has joked that she will have to fly out here to make sure I go... SHE doesn't get it... :(

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  5. Exactly! No one can push drugs or interventions on you, because...those things aren't there. One of my main reasons for doing it at home this time. ;)

    I don't see how on earth anyone has natural birth in a hospital either! I have heard the rare story of a staff that was totally supportive, that no one pushed drugs, no one even bothered the mom-to-be at all and she got to do whatever she wanted. They seem almost mythical, esp. in comparison with the average hospital birth!

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  6. "a home birth? my god. nothankyou give me the drugs!!"

    not once did i ever feel i needed to transfer JUST for the drugs. granted i was using hypnosis for childbirth, and i'm not sure if i stated this on here before, i only had 9 days practice *out of 6 weeks* but even with that i had half of my entire labor pain free. completely. i think if back labor hadn't kicked in i would have sailed through it completely.

    doesn't mean to have a pain free labor you need hypnosis, but it worked for me.

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  7. This is a hard topic to talk about without it becoming a hospital-bashing-fest, you know? And I know that not all hospitals do all of those things...and it depends on caregiver to caregiver.

    I was at one hospital birth where people were pretty laid back and the mom did her own thing: labored and birthed on hands and knees Actually we had really no clue the baby was on its way out, and suddenly the head was out. The family doc was on the other side of the room chatting with the nurse! The nurse did intermittent monitoring wherever the mom was--floor, bed, whatever.

    Now, part of that was probably the fact that the mom, a first-timer, arrived at like 9 or 10 cms dilation. I think she was there an hour before she had her baby, so there wasn't much time to "do" stuff anyway.

    Postpartum was a little different story: doctor cut the cord immediately, took the baby outside for measuring and dressing(baby was totally fine, this was all just routine stuff), and then handed the bundled baby to the dad. Then they sutured a tear (2nd degree, nothing requiring immediate treatment) and then mom finally got the baby. I would have liked to see the doc hand the mom the baby right away; it would have been easy to scoot it under her legs.

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  8. Jen.b.in.az1/18/08, 9:54 AM

    I can't believe that *I* am the one writing what I'm about to...but just Monday I was witness to a fantastic "just birth" at a hospital! Of course, you have to ignore the initial check-in period and idiotic questions "is this your correct home phone number?" Come on, the woman is actively laboring and she's HERE. You're NOT going to be CALLING her. Anyway, after the initial in-bed monitoring (20 minutes or so), there was NOTHING said, suggested, or stated to my friend that didn't involve working with her body and finding more comfortable places to labor (shower, tub, couch). The nurse was supportive and only positive. Early on the nurse had asked the husband and me if we knew what mom wanted with an IV...we said she didn't want one, and that was the end of that. Later the RN asked if I knew her preferences for birth, and I said "anything but on her back in bed." Again, that was the end of that. Since the mom was actively laboring, she wasn't even bothered with those questions...She ended up birthing side-lying on the floor. The nurses had actively spent a few minutes figuring out how to best dim the room (trying different combinations of on/off) - there were no bright lights, no spotlight on her crotch, just a little light coming from the bathroom. She had no IV, only intermittent doppler monitoring in the least invasive, polite manner (no worse than my first midwife birth). I was shocked. I should add, I was nervous the peacefulness would end when the mom's water broke with light mec. Nope. They barely took note of it. Again, baby was pretty floppy and purple and still after birth, and she was put right on mom. No "hurry up and save the baby" antics or anything.

    OK, end of my supporting the nice hospital birth...I was pretty much horrified with the initial 1/2 hour - the questions, the lack of communication, the weird "you're in OUR place" atmosphere, the wheelchair into triage...I could never do it myself. However, it was somewhat of a relief for me to see this whole thing transpire as peacefully as it did. It gave me hope that for those women who DO choose hospitals for birth, there are some folks out there who can help them have a good birth too - without fighting every step of the way.

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  9. Jen.b.in.az1/18/08, 9:57 AM

    p.s. I should add, mom was only there about two hours total...she arrived at 4-5 cm dilation. It was obvious she was moving quickly - it was also her 3rd baby (1st unmedicated).

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  10. I had one of those rare, un-messed with, natural hospital births. It was with my second.

    My water broke at 12:20 AM, and I valiantly tried to just sleep through the early part of labor, but I couldn't - I was too excited, and it hurt to just lay there. If we'd been in our own home with no worries about waking anybody up, I would have just stayed home for a while, but we weren't. We were living in my mother-in-law's basement. Finally around 3:00 in the morning I gave up trying to labor quietly and we went to the hospital. I was maybe 2 or 3 centimeters. We walked and ate and walked and I sat in the tub and bounced on the ball and talked to my doula and the midwife and finally birthed my baby around 4:30 in the afternoon. 13 hours later! And yet, I wasn't messed with very much. I had intermittent monitoring, but no one offered me pain relief, refused me food or drink (though a lady in the hospital cafeteria seemed horrified that I was having breakfast while I was in labor *still rolling my eyes at that one*), or anything weird like that. I pushed on my knees with my upper body draped over the back of the bed, and the midwife handed my baby to me through my legs. I shook like crazy afterwards, but they loaded me up with warm blankets, and everything was fine.

    As far as birth goes, it went pretty well, even for a hospital birth. I prefer home birth, but I don't do it in response to some horrible birth experience in the hospital; I do home birth because I like it more.

    Even with all that said, though, I have heard some awful stories and I have no intentions of risking my luck again in a hospital. I really think climates change with the state you are in. Utah was fantastic, but Kansas City is not very tolerant. I recently had a horrific conversation with an L&D nurse who works around here, and I came away from it assuring myself and my husband I had no intentions of ever having a baby in a KC hospital unless I or the baby were in serious trouble. No way!

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  11. My hospital births were humiliating mis managed overmanaged torure fests, nearly comical in their bungling and bumbling and neglect and cruelties deceptions and lies. But I am really glad that some of you have seen or had births in there that were just births. Respected, protected, sane.

    I raise a toast to those who say they could never give birth without the straps and tubes and blips and bleeps and masked strangers and bossing and ignoring--to them I say "you are brave/crazy, I could never do that, I am just way too afraid of something going wrong"

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  12. Since Mommymichael mentioned childbirth hypnosis... now, my turn to say something unorthodox: with adequate preparation, EVEN IN A HOSPITAL, many mothers have been able to tune out much of what would otherwise disturb them to the point that they might not be able cope any more.

    I've read so many good hospital stories where mom used hypnosis. Women with self-hypnosis skills come to the hospital very well prepared to focus inward and no, NOT fight, NOT argue. Their adrenaline levels don't go up and their neocortex is not activated by engaging in any of that frustrating stuff we know to be utterly counterproductive.

    I wonder if the definition of interference is any circumstance that distracts a mother and pulls her out of 'laborland', her trance, whatever. But if that is the case, the answer for the laboring woman is to choose to stay centered, positive, tuned in, peaceful (and hopefully take very deep relaxing breaths during those vaginal exams, eek). This is a choice. Not easily done without practice, but it is a choice within a person's own control.

    I still wouldn't want to do it at the hospital, but I know for a fact that many women have, and without much drama...

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  13. Totally off-topic, Rixa, but I was wondering if you had a good link that showed the "newborn crawl?" You know where a newborn (when left to its own devices) will crawl to the breast, latch on, and initiate breastfeeding without assistance. We were discussing this in a class today and I can't find a good video -- wondering if you knew of one.

    Thanks :)

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  14. Try http://breastcrawl.org for starters. There's a link to the video. Anyone else have links to other newborn crawl videos?

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  15. English version here:
    http://www.youtube.com/watch?v=zrwfIcPB1u4

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  16. Judit, what you're saying is entirely right on! I think that's why hypnobirthing works so well in hospital settings; it essentially allows the mom to tune out all of the distracting stuff that most out-of-hospital births don't have in the first place, essentially recreating the conditions necessary for a more physiological birth. Now, I think it would be nice to eliminate a lot of the distractions in the first place (and we have heard of some of these in the comments section). But yes, that's probably where hypnobirthing is most valuable.

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  17. I tried hypnobirthing in the hospital when my daughter was born and I wish that I had practiced more! I only read the book, I didn't take the classes. I ended up getting an epidural when I was 9 cm dialated.... I don't know if I regret it but next time I really want to hypnobirth. My labor just hit really fast and really strong- I went from not being in labor at all to having contractions 5 minutes apart and then 3 minutes apart before we even went to the hospital. I was throwing up with each contraction... I guess I wasn't prepared to deal with the pain. Now that I know what to expect hopefully my next birth will be what I want. There were a few things that annoyed me about my hospital experience. For one, my nurse wanted me to fill out paperwork in the midddle of full blown contractions! Then I wanted to labor in the tub and I had to wait to have permission and wait until they had my IV tube in. I didn't enjoy being strapped to the monitors. And all of this was in a baby friendly hospital. Hmmm.

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  18. Thanks, Rixa. I'm going to share the link with the class next week. It's amazing to see a baby crawl to the breast like that.

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  19. delivery self attachment is also a good video. shows several different babies, and also compares the affects of medications on babies and their ability to crawl to the breast.

    some medicated babies make it there, and nurse. but nurse poorly.

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  20. Yup, yup, yup.

    Don't know how those ladies manage to go unmedicated in a hospital setting. I'm always in awe when I hear about them.

    I had it easy at the birth center. As you say - just birth.

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  21. Wonderful post. As someone who has had both hospital and home births, I can attest to the fact that having a unmedicated birth in the hospital was a fight from beginning to end, even with the determination on my part to do so. Birthing at home was just so simple and uncomplicated- just like birthing is supposed to be :)

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  22. I am always curious about you HBAs. You bash and complain about hospitals but if there is a problem you go running for the nearest one in an emergency transfer and expect them to clean up the mess you've created. Seems somewhat hypocritical doesn't it?

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  23. KB -

    I wouldn't call that hypocritical. I would call it logical.

    HBA's like myself only "bash" on a hospital's treatment of normal, low-risk births. We all know that emergencies happen, and that's where most all of us agree hospitals fare extremely useful and necessary.

    And as far as expecting a hospital to "clean up the mess you've created."...I don't believe that women/midwives/homebirths "create" a mess. It is the unfortunate, unforeseen circumstance of birth in general that can sometimes cause emergencies. No one "creates" them. They happen; at home AND in a hospital.
    I am sorry you've garnered this impression of homebirth advocates.

    Also, please note that a number of homebirth transfers are due to the fact that mere legislation and laws REQUIRE that a midwife transfer a women (of course, a birthing woman can always decline...). For example, here in AZ, transfers can happen due to breech babies, "extended" second stage, etc. These are not always emergencies, but midwives are placed between a rock and a hard place; between laws and the women they serve.

    Birthing is about having options. All options.

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  24. Do you know what? In recent years I've become frustrated with how certain things that have come to be seen as markers of good care influence the care we provide. A case in point would be asking your laboring client to rate their pain every hour in active labor. JCAHO requires this and considers failure to document a pain scale a sign of poor care. In practice, I find that constantly bugging women to quantify their pain to be not very helpful, and sometimes all this focus on pain talk makes them focus on pain more than other factors as well. Also, implied is that if we aren't doing things to lower that pain scale, we aren't providing good care. Many women who I care for who are planning unmedicated births might still rate their pain a "10" in labor, and be completely satisfied with their care and their birth experience. In practice, my labor nurses tend to make up a pain score for the client who obviously looks like they don't want to be bothered!
    Also, all the admission procedures we must do are getting more and more extensive and require a lot more input from the woman being admitted - we have to document an awful lot of stuff - I mean, for pete's sake, we have to document that we offered a pap smear - like that would ever be appropriate in labor! And if there is an advanced directive, in the person feels safe in their home, when the last bowel movement was, etc., etc., etc. Even with wonderful nurses such as mine who want to be providing as nuturing an environment as possible, and a supportive provider, we are all under pressure to document all this crap.
    I think all these requirements have risen out of concern that we provide good care to our hospital clients, but the result is a lot of intrusion and production to get yourself into the hospital, often really bothersome when you are trying to labor and have a baby.
    And all these are not even factoring in environments that aren't so nuturing, where women's choices aren't respected, where non-evidenced based practices are used, where there is no continuity of care - and it's amazing that unmedicated births occur in some settings!

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  25. I agree with the way you expressed this. I did have to fight and contend for my "natural" birth in a hospital. That conflict caused me to experience months of PTSD. I also prefer the terms undisturbed or unhindered birth, because just because I gave birth vaginally without medication does not mean that I was in a "natural" environment. I was so disturbed and hindered by hospital procedure that a very straight forward process of birth became a longer and more difficult ordeal that it had to be. And then with long term psychologically negative effects.

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