Wednesday, March 12, 2008

On your back, please

On the heels of this wonderful conference--which I am sure you're all dying to hear about--I came home and heard that my SIL had her third baby, their first boy and born OP! Welcome to the world little one!

I'm going to tell a story about her birth, with her permission (and correct me if I have any details wrong, J.!) My SIL had her second baby with a hospital CNM, but when she became pregnant with her third, the midwife had closed the practice. So she was left with two fairly undesirable options: drive over an hour away to the nearest CNM practice or use a local OB practice. She did the latter, figuring she's done this twice before anyway. No biggie, right? Her second birth was fairly quick and straightforward and she gave birth to the baby on her hands and knees.

So, this third birth was a rude awakening for her. She did almost the whole labor at home and got to the hospital an hour before the baby was born. She was laboring on her hands & knees, as comfortably as you can when a baby is on the way, but when she was ready to push the nurse asked her to flip over onto her back. She didn't want to, and her husband spoke up several times for her as well. The doctor (one she had never met, since she was with a large OB group that rotated call) came into the room and insisted--I kid you not--that she flip over "because it's easier for me." She really didn't want to but she was in no place to argue since she was now in Get-The-Baby-Out-Mode...So she flipped over and then started the most excruciatingly painful experience of her entire life.

Here's a little of what she wrote about pushing on her back:
So...instead of using gravity and an easier position I was forced into birthing on my butt. They wanted me to pull my legs towards me and curve my back and tuck my chin and push. It was the MOST painful experience of my life. And the thing that was killing me is that I knew it would have been better in the position I was previously. So...while I'm going through all this pain. I said something like,...I can't do this, it hurts so much....which in my head was meaning...I can't birth in this ridiculous position, it's too painful. Lovely Angela [her nurse] smirked..."sweetheart, it's supposed to hurt." Had I any expendable energy, I would have drop kicked her. Angela, doesn't HAVE to hurt...not like that at least. Trust me, sweetie....I've done it before. Brandon eventually almost passed out from all this, and just as the baby was coming, he disappeared...meaning he had to sit down and take a few breathers. I was confused and wondered where my man had gone. He quickly came back to my side and Wade came out soon there after.

I don't want to take away from the amazing experience it is to have a child naturally. But, it is NO wonder to me why women have epidurals if they are required to birth in such a ridiculous and painful position. So...what did we learn?

1. What's easier for the Doctor is best.
2. Labor is supposed to hurt.

Those are two lessons I hope never to learn again.
This kills me. Here we have a doctor and a nurse inflicting pain on someone, for no good reason, just for their convenience! She told me that the ironic part was that she was staring at a framed poster on the wall while having her baby, and the poster said all these things about the hospital being concerned about the patient's comfort and to let the staff know if they could do anything to help make the experience more comfortable.

So, here's to a ridiculous custom that does no one any good--no birthing woman, that is. I vote that we force any doctor, nurse, or midwife who asks women to birth on their backs to do 1,000 hours of the most unpleasant community service imaginable!

So my slogan of the week is...

Stand and Deliver--Don't Give Birth Lying Down!

(my business name and motto, by the way)


  1. Awesome post! Still very on fence; looking forward to hospital delivery, but also pumped to do it my way there. Will let you know how that works out. :)

    But really, this is a great post -- illustrative of what you do best here. Powerful, short, personal story that highlights wrong without ranting. Will appeal to broad audience (imho), not just the already-converted.


  2. My midwife has told a number of doctors that after they do a hands and knees birth they'll never want anything else, because you'll never get better access than in hands and knees! She's even offered to show them how to "deliver" the baby when it's "upside-down."

    I'm sorry about your SIL's experience (ach, that nurse!!). But at least she will seek out a better experience next time; the women who don't think they CAN have a better experience are the ones who make me feel mad at the world.

  3. Oh, how terribly sad and infuriating this is!!!

  4. What would happen if a laboring mom simply said, "No, I'm not flipping over, thank you. If you don't think you can handle a birth this way, then find someone who can." Seriously, I don't think that women lose the ability to voice an opinion, or voice a reasonable demand, just because they are in transition. Maybe this should be hubbie's job. Like Nancy Reagan said, " Just say NO!"

    I'm not dissing your SIL - her experience just got me thinking...

  5. "What would happen if a laboring mom simply said, "No, I'm not flipping over, thank you."

    I did just that, with my first (also a hospital birth). I had been pushing for three hours (an all natural birth) trying to get my dd to move down and pushing upright on a portable commode. The midwife tried to pull the bottom of the commode out and use it as a sort of birthing stool but couldn't get it out so she told me I'd have to move to the bed. Well, a bunch of nurses sort of pulled me over to the bed and immediately tried to lay me down and it hurt SOOOOO bad; I literally sat up and screamed NOO, I CANNOT lay like that, it HURTS! And flipped over onto hands and knees and STAYED that way. The midwife sort of shrugged and said "I guess we're doing it like this then".

    I've heard of hospital births, though, where nurses were literally PUSHING on a mom on hands and knees to try to get her to turn over, INSISTING that she be on her back. It's ridiculous.

  6. What would happen if a laboring mom simply said, "No, I'm not flipping over, thank you. "

    You know, I have found it can be very difficult to deal with confrontations like this, and come out without regrets. Over the years I have avoided doctor visits and invariably when I do have to take my children or myself I have had to combat doctors to varying degrees. I have often been blind sided, having things said to me or done that I hadn't thought of previously and therefore was unprepared for battle.

    My point is that many times, even when we try to stick up for ourselves or our children we have so many authority issues (brainwashing) to deal with and they are on such power trips, that it is difficult to get our way.

    I think your sister-in-law might have been well served to have used a doula since she was delivering in a hsp with an ob.

  7. Rixa...I'm glad you've passed on my story to others.

    It's interesting to read the comments on my experience. It was a difficult decision for me to choose the OB practice. I birth relatively quickly. With my second, I was in the hospital for just an hour and I had my girl. I really didn't want to be en route to the hospital and in intense labor...not much fun. I wouldn't have minded taking the hospital/doctors out of the equation at all. But, my insurance wouldn't cover a home midwife (nor was there one available) and going unassisted didn't feel right to me. Hence the 'choice'.

    It's true, I could have refused to move. Had I more wits about me, I may have been able to do that. My husband tried. I was very focused and inside myself. I didn't want to fight for whatever reason, so I consented.

    But really, I don't think that is the issue. I shouldn't have been asked to do something against my will, no matter how strong(or weak) my will was at the time.

  8. I am so so sad for your sister and I hurt for her. I am scared for myself and scared for everyone.

    People who dare to say she "shoulda" done anything different just dont get it. I send her a hug and I am sorry that she had to have it this way.

  9. Congratulations Jodie on your new baby! I for one think you did pretty darn good, given the situation.
    Right on, "I shouldn't have been asked to do something against my will, no matter how strong(or weak) my will was at the time."
    Especially for such a dumb reason as easier for the doctor. Someone please teach these people how to catch babies, fer cryin' out loud!!! Or can we just chalk it up to serious deficiencies in 'bedside' manners? Or, even, to the BED itself...

  10. I'm so sorry for Jodie's experience!
    Is she in your community, Rixa? Someone needs to find a sympathetic employee at that hospital (midwife, nurse, doc)and let them know what happened. Not in a complaining, someone should apologize to me way, but as a small way to hopefully protect the next person.
    It's totally ridiculous and unprofessional of them. Are you in a community with a medical school? Contact them too.

  11. About doulas--please don't think that doulas will somehow "save" you from the worst of the hospital system. It puts us (speaking as one, although I'm not attending births right now) in an uncomfortable position of knowing and seeing a lot that we know isn't a good thing, but not really having any authority to change or challenge it. I can understand what you're saying, Susana, and perhaps if I (or another SIL, etc) had been there it might have made a difference. You betcha in that situation I'd have said "Hey it's your body; you do what's most comfortable for YOU." But I don't like feeling like I need to *protect* the woman from the hospital staff, which unfortunately doulas do a lot of. Make sense?

    My whole point: EVERY hospital nurse, doctor, and midwife should freely encourage women to birth in whatever position is most comfortable and effective for them, and should never tell a woman to change from a position that she strongly prefers.

    And it's true, Lynette--H&K is the best access you'll ever have! LOL

  12. i'm telling everybody this...

    I just had my second baby using hypnobabies. woke up at 5am, he was born at 3pm. I didn't feel any pain or discomfort until starting at about 1 or 2pm.

    I labored mostly on my hands and knees, it felt like sex from the inside out.
    And i can't TELL you how GOOD it felt to birth on the birthing stool. it helped SOOOO much. i birthed my little boy 9lbs 5oz, 22in, with NO TEAR at home in our living room. with his 15mo old brother with me the entire time.

  13. Jodie... I am so so so sorry.

    I spoke at the Trust Birth conference last weekend, and Rixa might remember that after my talk, which had a lot to do with unnecessary cesareans, Dr. John got up and basically said that women could just say no.

    I think your experience highlights something desperately important that, no matter how enlightened a person is, if they haven't been in labor, they don't get how vulnerable you can be.

    A woman in labor should be being protected, enabled, encouraged. And you're should NEVER have even been asked to reposition.

    Thanks for being brave enough to put your story out there...

  14. woohoo! another baby to welcome into the world!

    Laureen, could I possibly obtain the powerpoint presentation you gave on Sunday? I wanted to show parts of it to my dh, who teaches freshman composition (among other things) and I think some of the things about multimedia would be great for his class.

  15. When I was training, I never saw an upright birth, except for 1 - one woman hauled herself up to squat on the foot pedals of the bed after the doc had taken the bed apart to put her up in stirrups for delivery, and before he could manage it, she pulled herself up (quite an athletic feat!) and pushed the baby out. When I started to practice on my own, I desperately wanted to make a change, and wanted to encourage upright positions - and it was hard at first. I was so ingrained in doing things a certain way, it was hard to let go of the things I did that promoted lying down - liking checking for complete dilation before pushing and checking for progress during pushing. Once I finally attended a few upright births (helped out by experienced mamas who were thrilled to demonstrate an upright position for me!) it was easier to encourage it as well. Now, it is rare for me to catch a baby with mama lying down and only happens if that is really mom's preference (which, once in a while, it is.) I find that if I talk a lot about upright births during prenatal care moms with no experience that way start to think of it as normal. And if when we are getting close to birth I don't disturb them, they tend to naturally adopt some kind of comfortable position, usually hands and knees, squatting, or standing. I don't do exams much when moms want to push, I don't ask them to move for me, and my nurses are all intuned to scramble to rearrange any monitors or IVs or whatever if mom moves suddenly.
    I don't understand why as physicians we are not taught upright birth, but I do understand how disconcerting it is to relearn everything you thought you knew. That doesn't excuse that doc, but I do understand where they are coming from. Maybe a letter would be helpful, if just to encourage the doc to listen to the next client who knows what they want.
    As a laboring mother myself, I let myself be talked into a position I didn't want. Yes, I could have said no - but while I was in such intense labor what I needed to do was focus inward and concentrate on my body, and like your SIL, even with my dh trying to help, it was easier for me to just do what they said and get my baby born than to try to swim upstream. That's why, somehow, we have to change how we do things in hospitals!

  16. You know, it really ticks me off when the anti-homebirth crowd goes on and on about how you can just say "no" so we so-called "selfish" homebirthers should just quit our whining and birth in hospitals and say "no" to everything. Sure, you can just say "no", I've done so before myself (like the example I gave above), but my big hangup is WHY SHOULD WE HAVE TO? EVERY SINGLE BOOK I have EVER read on the physiology of labor (and this is not just the woo-woo midwifery books) says that on your back is the worst position for birth and that movement and being upright during labor will help the baby move down. Many generic Lamaze classes even still teach this, but once you get to the hospital they seem to find some reason that you cannot do any of it.

    I had a good experience in the hospital with my firstborn but I really do believe it was because I had an open-minded CNM and a good doula. People I know are actually SHOCKED that I gave birth in the hospital with no IV and no stirrups, and that I wasn't tied to the fetal monitor the entire time. They say all the time, "How did you get away with that? They wouldn't allow me to do (insert X here) when I asked!"

    I had one friend who was having a natural birth who tried to refuse an IV. Her nurse, get this, actually told her it was against the law to deliver without an IV@@. No joke. Wow, it's a wonder I didn't get arrested then. I have another friend who just delivered her fifth who was shocked that I wasn't told I had to stay on the fetal monitor the whole time, she has low-risk pregnancies and was never ONCE allowed up (and she has given birth in three different states now); she told me that she did ask with one of her children and the nurse YELLED at her for even ASKING!! Said that the nurse snapped "This is for the health of your baby, NO, you may not get up and don't you DARE ask again!" I love how the nurse used the "bad mother" card to not only make her comply but to make her feel like a piece of dirt for even daring to ask. I have another friend who had a similar experience with the monitoring issue; it felt better to labor on the toilet so she took the monitor off and got up and it wasn't five minutes later the nurse was in the bathroom bawling her out and ordering her back to bed. I also post on Babycenter (a mostly mainstream parenting site) and this kind of treatment is not unusual. I see this kind of crap all the time on the due date boards (keep in mind these are women from all across the country). I see women fired from their OBs for hiring a doula or writing a birth plan. That's another thing that kills me about the ACOG statement; oh, don't plan a homebirth, instead write a birth plan. Do you know how many posts I've seen on Babycenter from women whose OBs tell them that they do not allow birth plans? Do you know how many nurses on that same site I have seen admit that they sit around and take bets when someone comes in with a birth plan as to when they are going to get their C-section? Yeah, don't plan a homebirth, instead WRITE A BIRTH PLAN! But hey, you cannot win there, either, because we will just hate you as a patient and find a reason to give you a C-section. Yeah, great alternative.

    I am happy to see nurse blogs out there like Atyourcervix and House of Harris to remind me that not every birth worker behaves like this and their blogs give me real hope, but the thing is, what happens when nurses like these two women are not there? Then what do mothers who are meeting resistance to the rules of the system do? It isn't like we can clone these two wonderful nurses and stick them in every hospital in the U.S. and put them on a nonstop 24-hour-shift in L & D. Wouldn't it be great if we could?

    I have to wonder why people who are so pro-medical birth even care so much about criticizing those of us in the minority. Why the heck is the minority so threatening to the majority? No one is trying to outlaw epidurals; I am not aware of any legislation in the making from the "natural birth crowd" that is trying to get primary elective C-sections outlawed but there is plenty of opposition to midwives for those of us who want to choose them. And I'm not just talking about homebirth midwives and the law in some states, I am talking about hospital midwives as well. If a hospital has a great midwifery program and they want to save money, it seems like the first thing they will cut is the midwifery program. I've seen it. A few years ago when I was living in Southern Cali I had civilian friends have great experiences with Kaiser's midwives, but in 2004 Kaiser got rid of all their hospital midwives. In the Midwest where I grew up, there are VERY FEW nurse-midwives practicing in hospitals.

    If someone wants an epidural or an elective C-section, more power to them. I have friends who birth that way and I don't begrudge them their choices; so why do those of us who do not want these things have to work so hard to avoid them? I have never heard of anyone being fired from their doctor for wanting an epidural but like I said I've seen plenty of women fired for leaning in the other direction.

    Honestly, I wish some people from the "other side" would take a short walk in our shoes for once. No one repeatedly tells them to "have an open mind" about their epidurals at their baby showers, they don't have to shop around for the correct doctor, midwife, or hospital or drive for hours to have the kind of birth they want for their baby, they don't have to listen to some nasty postpartum nurse lecture them about how they used to care for nasty, dirty, uncircumcised older men when they announce that they do not want their son circumcised (I've had friends have this happen to them also, there are some nurses out there who are MILITANTLY pro-circ, still, if you can believe that), they don't have to endure being asked repeatedly what kind of birth control to use because they have a large family. That friend of mine who delivered her fifth child was asked about TEN DIFFERENT TIMES during her stay what kind of birth control she wanted to use and she said it was really beginning to make her angry (she refuses to use anything hormonal or that could potentially be an abortifacient, I am the same way); the first time they asked her was when they were YANKING HER FREAKING PLACENTA OUT! I mean, come on, like she's going to get right up out of bed and have sex as soon as it is removed. And her dh is in Iraq right now and will be for the next year, I think that's good enough birth control for awhile, don't you? I have other friends with large families, many due to religious convictions, who have endured the same thing during their hospital stays, repeated offers of birth control, even nurses outright criticizing the number of children they have.

    I want to see every mother regardless of her birth plans, parenting choices (breast vs. bottle, circ. vs. non, vax vs. non vax) treated with respect, regardless of what the person caring for her thinks of her decisions and religious beliefs, regardless of what a particular nurse did with their own child(ren) (I have also met postpartum nurses who seem to think their position allows them to get on a soapbox about every childrearing issue out there, that is NOT their job). It really hurts my heart that some of my friends have been treated the way they have on such a special day in their lives. No laboring mother deserves to be made to feel like a selfish piece of garbage for not wanting to be on the monitor the whole time or not wanting an IV placed. No mother sitting on an icepack newly delivered deserves to be lectured on how she is going to ruin her son's life if she doesn't circumcise him. I cannot stand hearing things like this from fellow mothers that I care about, many of whom have husbands who are away serving our country, are raising their children alone much of the time because of that, and really do love their children and their babies and are trying to do the best that they can.

    Off my well-worn soapbox now, sorry, but this vent has been in my head for awhile now and it HAD to get out! Carry on!

  17. Doctorjen, you and I posted at the same time and I just read your comment! I think I luv ya! :) I'll be adding you to the blog ranks of great birth workers who are trying to make a change!

    Also, for those who say that mom should just say "no", note Doctorjen's last paragraph - even SHE, a doctor, an EXPERT had trouble saying "no" in hard labor, it is NOT always easy to do! So it isn't always just about mom needing to "grow a backbone".

  18. I agree with everyone who has said it's not that easy just to say "NO." I have trouble just asking a nurse what my blood pressure reading was, so I'm pretty sure I'd be completely incapable of challenging an OB in the middle of a birth. I'm usually very skeptical of doctors and hospitals and procedures but I did grow up in a culture where they have a lot of authority and I am intimidated by them.

    Yes, we should empower ourselves to speak up for what we want, but there are a lot of other changes that need to happen too.

  19. Rixa,

    With all the hours I have put into reading birth blogs, I simply cannot believe it took me this long to find yours!

    What a great post, and great follow up too. As a doula I am always leary when someone suggests that somehow I can "save" them from their care(less) providers. Since I never, never take a combative role in the hospital, it is really hard to be witness to those kinds of situations.

  20. I had a similar situation with the birth of my 4th baby. I was up on my knees, leaning on the back of the bed in the hospital. The doc rushed in (baby was already crowning, and would have been born without any attendants at all if my doula hadn't rushed to the door yelling for the nurse) and told me to turn over. I simply said I can't, and proceded to birth the baby. There was nothing the doc could do about it. That was my last hospital birth... all my others were born at home.

    I'm sorry I didn't get to meet you at the conference, Rixa...


  21. As a home birth midwife I find it ironic that obstetrical experts, who generally feel we are undertrained, are themselves so unskilled in birth with anything but the semi-reclining position. It is so amazing to see the difference in mechanics of a birth with a woman sitting on her sacrum, compressing it, and birth in which there is no pressure on the pelvis (or at least not the sacrum) (standing, hands and knees, waterbirth, side lying...) As the baby descends, you can see/sense the pressure exerted on the pelvis and its need to be allowed to expand freely. Also, if necessary, the simple act of changing positions moves the pelvis around allowing the baby to work out those turns it needs to make. This is so straighforward and sensible but the fact is that hospital practices don't follow normal physiology. Even if a practice insists "we let women give birth in whatever position they choose"--question this. Chances are with the high number of epidurals, most doctors just don't get much experience with positions other than semi-reclining.


  22. Also--just had to add about shoulder dystocia--compress the sacrum by sitting on it and you shove the baby upwards where it is more compacted against the underside of the pubic bone. Add to this a big baby (but not necessarily so, even) and then you may get stuck shoulders! Flip the woman over to hands and knees (a la Gaskin's recommendation) and not only is gravity and movement helping but now the sacrum can expand as it needs to. Preventable, perhaps, by not having the mother recline on her sacrum in the first place.


  23. SIL's story reflects my own - with a different ending. I too laboured at home with my husband and doula until very near the end of my labour. It's really important to have an advocate in the hospital - that person for me was my husband. (Where I live, doulas have no rights in the hosptial to speak for the labouring mother). We only arrived at the hospital 45 minutes before the arrival of our second child. I had four nurses frantic and literally screaming at me to turn onto my back - I had climbed up onto the bed on my hand and knees and wasn't moving - the baby was coming immediately. My husband had a direct confrontration with the nurse in charge of my room - and said "she's not lying on her back". We had discussed this for months before the baby's arrival - and I had talked to my doctor about my desired birthing position. When the doctor arrived - a short 10 minutes before the baby arrived - she too insisted that I turn over as they couldn't get a good read on the fetal doppler machine because I wasn't on my back. I just kept saying "I can't" (meaning turn over). She then told me that I had two options: push the baby out with the next push OR she would put a heart monitor on the baby's scalp. I opted for the first - I gave one last good push - and she flew out! I did not have the urge to push her out as fast as I did - and it resulted in an unnecessary tear. But, I had decided in those few short seconds that I would take the stiches rather than the baby taking the possible scaring on her scalp. Our little girl arrived - fully alert and absolutely perfect. I had no IV, no drugs - a totally natural birth. I felt like I could run a marathon after delivering her! It was amazing how energized I felt!

    I can testify that giving birth on your hands and knees SIGNIFICANTLY reduces the pain.

    My advice:
    - talk to your doctor about your birthing position in advance and if they're not comfortable with what you want then find someone who is
    - make sure you have an advocate in the hospital who knows what you want and who has the authority (from the hospitals perspective) to give that direction
    - have a birth plan and specifically state the birthing position(s) you want

  24. Rixa,
    I appreciate your post and the other post from the doula who wrote:

    As a doula I am always leary when someone suggests that somehow I can "save" them from their care(less) providers.

    I trained as a doula then attended only a few births in the hospital afterwards. One birth was really frustrating for me and left me with guilt all these years (about 8 years). Your post and the other one I mentioned just helped to alleviate that guilt!!!!

    I will tell you the source of my guilt. The woman I was acting as doula for ended up having a precipitous labor. She called me to say they were on there way to the hospital. I had to organize my family a bit then I raced off to the hospital that was about 1/2 hr. away.

    I arrived at the hospital within an hour of her call. Upon entering the birthing room I found her in stirrups, draped, and being told to "Push like you're MAD!!"

    I clearly felt like I had no authority at all, having just walked in and not having been introduced to this doctor who was the on-call Dr., even though I knew she had to be unhappy with what was transpiring.

    As the baby crowned the dr. announced that he was going to do an episiotomy to help make things faster. The husband "stepped up" and asked if this were truely necessary. The doctor said,"Yes," then abruptly cut her and yes the baby came out quickly.

    She didn't look about to tear to me. Her skin was pink and not cracking. But how could I say that?

    Anyway, I felt like it was my responsibility to help stand up for her. But i guess this ob was determined to do things a certain way and probably would have dismissed my potestations anyway.



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