Jaded

I was sent a funny email this morning, and it's not too often that I am sent something that I haven't read before, so this was a surprise to me.

The Gynecologist who became a Mechanic:

A gynecologist had become fed up with malpractice insurance and HMO paperwork, and was burned out. Hoping to try another career where skillful hands would be beneficial, he decided to become a mechanic. He went to the local technical college, signed up for evening classes, attended diligently, and learned all he could.


When the time of the practical exam approached, the gynecologist prepared carefully for weeks, and completed the exam with tremendous skill. When the results came back, he was surprised to find that he had obtained a score of 150%. Fearing an error, he called the Instructor, saying, "I don't want to appear ungrateful for such an outstanding result, but I wonder if there is an error in the grade?"


"The instructor said, "During the exam, you took the engine apart perfectly, which was worth 50% of the total mark. You put the engine back together again perfectly, which is also worth 50% of the mark." After a pause, the instructor added, "I gave you an extra 50% because you did it all through the muffler, which I've never seen done in my entire career".

As I was reading this little story I expected a severely different outcome. Which is often what happens when I walk into a birthing situation. I've had a hard time going into hospital deliveries without looking for a fight. While reading this story I expected something to the effect of "You failed my class because you approached each repair with a circular saw, which you used to to cut through the hood in order to open it up and repair the engine."

I realized how jaded I've become.

The first birth I attended was the birth of my brother when I was 15. Not knowing what to expect, I read up some prior to the experience. I'd heard horror stories, I'd read horror stories...but it seemed to go well. The doctor was kind, although MIA most of the time. The nurses seemed fine, but they weren't around much. I think that the experience was a really great bonding experience for my mother and I. Although some of it was spent plotting the demise of my stepfather...some men really should be kept in the waiting room handing out cigars.

The birth of my sister came a few years later, and I attended her birth as well. I was pregnant with my own child by then, and had read a lot more information. My mother's labor started out much in the same fashion, with much of the same results. Towards the end though, I was surprised to see an added element of pressure and slight panic. Many more things were introduced during this birth.

Do you know why?

Night and day.

The staff wanted my sister born before the "end of business" that day.

My own delivery with my son started much the same as the end of my sisters birth. My water broke early in the morning, and without contractions they wanted to start right up with Pitocin. As the clock ticked, and I repeatedly said no to interventions, you could feel the tension increase.

My son was born at 8:10 p.m. less than seven hours from the time I agreed to Pitocin, and fourteen hours from the time my water had broken.

Those three births molded my attitude about modern day obstetrics. I took those experiences, and commited them to memory. I took the comments and remarks from staff and commited those to memory as well.

Each birth that I have attended since then, has been compared to those first three. Many actions and attitudes have been dictated by events that took place during those first three labors, and those first three births.

The fourth birth I "attended" was actually another one of my own. Based on the experience of my son's birth, coupled with the high c-section rates in Memphis, I chose a homebirth. It was quick and without incident. I delivered standing up in the doorway of my master bathroom.

A year after my homebirth, I assisted with the homebirth of my youngest brother. When my mother stood in front of me with frustration and pain in her eyes I told her to put her arms around my neck and hang on to me. I held my mother as she went through transition, and would have continued holding her until she delivered my brother. (or she bit me, which she informed me later that she had had a strong urge to do) The midwife insisted that she lay down, which actually caused my mother great distress.

I committed to memory to do what mom feels is best, and not what is best for me.

When my brother crowned and it was discovered that the cord was wrapped around his neck three times, I witnessed the midwife instruct my mother to stop pushing, while she calmly unlooped the cord from around his neck. Later I discovered that my mother had no idea it had even happened.

I committed to memory to remain calm, and attend to problems as they come.

When I assisted a neighbor in her delivery and she told me she felt like pushing, I called a nurse. The nurse came in and checked mom, and proceeded to declare her a "7", and told me "she isn't ready" and she left the room. Based on a prior experience with my mother, where the nurse no sooner started to removed her glove after declaing my mother a "7", my mother bore down and said "I need to push" and the nurse looked at me and rolled her eyes. After donning a new glove and checking my mother again, it was discovered that she was fully dilated and ready to start pushing. Within seconds my mother was ready to deliver her baby.

Based on this, when my neighbor told me she was ready, I believed her. When she bore down with all the strength she had, I believed her still. Although seconds had elapsed since the nurse had left the room, I sent dad out to get her again. Dad returned to inform me that the nurse told him that mom wasn't "ready".

Come again?

I supported mom because I believed her. When her husband told me "she isn't ready" I moved her gown aside and showed him the head of his then crowning child. (Actually I pointed and said "That's a baby")The baby was delivered onto the bed with only her parents and myself as witnesses to her entry into the world.

I noted the time.

Later, I listened to the doctor berate the nurse, but not for the reason you might expect. The doctor was angry that the nurse had "allowed" mom to deliver before she (the doctor) had arrived.

Now, I think that there is a proper place for Obstetricians. They provide a service to high risk women in numerous categories and they do have their place in birth.

Just not every birth.

Birth is not an illness or a disease. In the majority of cases things will proceed as they should. Having a midwife there allows for safety in the treatment and prevention of certain issues that can, and do, arise in labor and the subesquent delivery. Having a doula is what I consider a back-up plan. My doula joined me in my labor before my midwife, and I was glad to have her there when my daughter decided to fly into the world two hours and forty minutes after labor began...but before my midwife arrived.

Over the years I've been able to join and assist other women during the births. I've taken each experience with me, and tweaked my attitude. I've been able to see how things went from normal, to horribly wrong and I've been able to look back and pinpoint how and where the horribly wrong came in.

I haven't attended any births since my doula training, but the training gave me a better understanding of the role that I get to play as a doula. I learned that there are things that I did that were right, and things that aren't acceptable by a doula serving in a professional capacity. I was most surprised that many of the measures they teach in training, were things I had done instinctively anyway. I was happy that there were very few instances where I behaved in a manner unbecoming for a doula.

I can't wait to add to my experiences.

Each and every birth is an honor to witness.

I am jaded....in a good way too.

Common Sense

Some people don't know me, I swear.

It seems that whenever someone catches a story about some potentially "life threatening" thing happening at a birth, I hear about it. And not in a good way.

Nooooo, I get to watch these peoples faces while they recount the story, and then we're both subjected to a *dramatic pause* before I punch them in the face.

Just kidding.

I always seem to find some really educated reply, comment, comeback. Because the majority of the time the "life threatening" issue was something that could have been prevented and/or managed had mom not been narc'd to the gills...or numb...or in the care of impatient medical staff.

So, last week someone clucked off about a shoulder dystocia issue that took place during a home birth of a mutual friend of ours. The thing that is really entertaining is:

The baby was really big.
The mom was pretty little.
The midwife handled the situation appropriately.
Baby was born completely healthy.

This person, who clucked off, gave me the "what now?" look...you know the one given to you by folks who think they know everything? Well...my response was "I guess it's a good thing that she was at home then, because if she'd been in the hospital she probably would have ended up with a c-section."

What I find appalling is, it's true. Giving birth in a hospital is a slippery slope. Choosing a hospital as the location of your delivery is the first step in a sick game of Red Light-Green Light...and it starts long before you even step into the halls of the maternity ward. Oh wait, Women's Center.

Through the months of your pregnancy, your visits with your OB are probably routine...for your OB. You however, may be new to this whole birthing thing. You have a million questions, which your OB has neither the time, nor the inclination to answer. Like I was, you may have been handed a copy of What To Expect When You're Expecting, which I believe should be subtitled How To Be A Good Patient. The book contains too little information and too much at the same time. It's giving you access to some good information, while at the same time it's subtly guiding you towards a managed birth.

If the book has been revised since I read it 17 years ago, I apologize. Every time I see the title of this book I burst into flames...so I avoid it.

On the personal front, for the months preceding the birth of your child you will be accosted with birth related horror stories. It will seem like everyone has a story to tell.

And they do. Everyone I know, has either given birth or knows someone who has. Strange, I know.

What's sad is, the good stories, the positive stories, tend to be the ones that you don't hear.

This is why...

When I am with a group of women, the conversation will, at some point, turn towards birth. I am most regularly with a group of 11 other women. Statistically speaking, considering the national c-section rate is approximately 33%, there could be 4 out of the 12 of us that have had cesareans.

Which I find horrifying...because in my opinion, the only time a cesarean is necessary is when the woman or child would have died without the procedure. Obviously, this is open to interpretation...and where things get hazy and people get upset.

How do you tell a woman that their birth trauma was unnecessary? That their cesarean could have been prevented? How do you tell them that not having the epidural would have allowed them to move and reposition in order to help a baby out that was "stuck"? How do you explain that qualified midwives are often trained to handle these situations, and most OB's are not? How do you tell a woman, weeks from her "due date" that her breech baby could be delivered vaginally, but it was of utmost importance to find someone who had the education to assist her? How do you tell a woman late in her pregnancy, that the answers she's gotten from her medical professional are huge red flags, and that she should seek out someone else?

Oftentimes, you don't. Not because you don't want to scream it from the rooftops, but because you just don't want to look like a jerk. Which is how 99% of women perceive comments like these. No woman wants to believe that their pain, physical or emotional, could have been prevented. For some reason, believing that their pain was justified by a stalled labor, fetal distress, failure to progress, shoulder dystocia...on and on forever, is easier than considering that some bad choices may have been made. And those choices were ultimately approved by the women themselves, under the guidance of someone who, more than likely, was not even in the room.

Don't be deceived by "informed consent". Most of us who have done any kind of research, especially after the fact, realize that the idea is absurd. What I consider risks, and what the medical model consider risks, are two completely different things. The first time around, I had no idea that many "routine" procedures, that are "policy", could contribute to jaundice, breastfeeding problems, or additional time away from my newborn. I was prepared for some of the bigger fights, but it was little ones wedged in between the big ones that got me in the end. I consider myself lucky that the bigger choices may have prevented me from ending up in the operating room.

When women are induced, are they always informed that their chances of having a c-section just increased? I've never heard a woman being informed that the contractions from Pitocin are more painful than regular natural contractions...that not only are the contractions more painful, but now you're tied to a monitor and an IV, and you're even less capable of coping with them. Is it so bad to just wait the pregnancy out? To be uncomfortable for a few more days, a week, two weeks...in order to let nature take it's course?

I've heard mothers tell me that their cesarean was needed...that it literally saved them or their baby. I find this mentality to be very concerning. It leads other woman to believe that birth is inherently dangerous, when in fact nature gets it right more often than it gets it wrong. There are genuine reasons to get a cesarean, but those are few and far between. And once you throw in inductions, epidurals, pain meds, being bedridden, lack of food and water, etc...you've ceased being able to blame nature, and have to transfer blame to the procedures themselves. The tragic thing is, mom gets the problems from the procedures, and the medical provider goes home. You've traded the convenience of "induction", for a potential long stay in the hospital and an even longer recovery at home. You've traded some additional time being pregnant, for a slew of other problems. You've replaced the pain of labor with the pain of recovery.

Some women become educated. Some women are happy to hand themselves over to their providers, learn nothing about the process, and suffer the consequences. Each of those women will react to those consequences differently. Some women, educated or not, can take this hindsight and reconcile their choices. I dare say many, even the majority of birth advocates had a bad birth experience that led them on their road to advocacy. And then other women continue through life not really caring about their experience, or justifying it forever.

What I wonder though is, how come all the horror stories I hear are the result of over-managed hospital deliveries? How come the pain and anguish seems to always be found with women who opted for the interventions and/or had medication? I've heard about difficult home births, yet these stories are never horror stories? How come my hospital birth with medication was more horrible than my home birth without? And why is it most women who went unmedicated seem to be more positive about their birth experience?

Are we crunchy girls delusional? Are those accidental natural birthers delusional too?

I didn't find birth to be orgasmic. I had my own reconciling to do with myself while I labored and then gave birth at home, and fortunately for me it was a short conversation. These reckonings come on their own time, and I often ponder the psychological aspects of birth, despite the location. If yours is orgasmic...you should be thanking your lucky stars!  I mean, really, who wouldn't want that?!

Every woman needs to decide what works for them. I would never suggest that a diabetic birth at home, but I would never take that choice from them either. I try to talk to a woman one-on-one when I believe that they've been given wrong information. I put what I believe out there, I do tell people that I gave birth at home, and often that stimulates a discussion. I spoke to a couple of friends about breastfeeding, and one of them relayed how hard it was, and how long she tried to breastfeed with each of her three children. I asked her if she had had any "problematic" issues while she was in labor, and I was informed that she had had 3 cesareans. I felt really bad when I told her that breastfeeding problems are often associated with cesareans.

Most of us, in this society, have been raised to fear birth. We grow up believing that delivery in a hospital, with an OB, is safest. We see a potential risk around every corner, but when you really sit down and think about many of the procedures, and many of the policies, it stops making sense. How many of these procedures are done for convenience? How much more attention would a woman need if they labor without monitors? How much more support would they need if they went without medication? What about long labors? Without the monitors and medication to numb a woman, or speed up a labor, there would need to be a great deal more staff. Which makes me wonder how much of a profit margin there is with maternity care and all it's bells, whistles, and machines that go "ping"?

The ACOG has a vested interest in the management of pregnancy and birth. More than likely your OB is unable to attend home births due to malpractice insurance restrictions or their contract with the hospitals they work at. Home birth is a hit in the pocketbook for the many providers in the medical model of care. Much of the overkill that is practiced today is directly related to money...profit margins, fear of litigation, high malpractice rates. Moving birth primarily back into the home would effect almost every aspect of our society. We'd reduce the cost of birth, which would affect insurance rates. Without the bells and whistles, we'd reduce the rate of iatrogenic problems, thus improving maternal and fetal outcome. Breastfeeding rates would increase. There would be a more consistent standard of education of midwives, instead of the varying state-to-state laws. Midwives and OB's would work together in order to ensure the safety of low-risk women delivering their babies at home. Even high-risk mothers could utilize a midwife in a hospital, with the knowledge that the care is there if needed. Most women don't need the amount of care that is offered, or thrust upon them in the hospital setting. For some of us, the hospital is not the best choice to have a baby.

An ounce of prevention is worth a pound of cure.

It's cheaper too.

Restoring Faith

Sometimes your heart and your head can't coexist.

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When I was growing up, I always knew that I would want to birth a baby naturally. Before you start giving me props for being so intuitive, let me tell you, my desire was fueled by one thing only...avoiding needles.

Not really a great foundation for supporting natural childbirth.

I was lied to by a doctor for the first time when I was five. I remember it as if it were yesterday. While getting my kindergarten check-up I asked if they would be sticking me. I was told no. Then, I took my little self to the bathroom for the required urine sample when I overheard the conversation about doing a blood draw next.

My distrust of medical personnel started early.

I left the tiny bathroom and proceeded to leave the hospital. No idea what my big plan was, I only knew that I was escaping the needle.

They caught me. It took nine people to hold me while they drew my blood.

It might have been that moment that I decided I would never have kids. Who knows.

Fast forward 13 years, to when I found myself pregnant. I read everything I could about childbirth and I discussed my desires with my doctor. I thought that I did what I needed to do, to avoid feeling that same helplessness that I felt 13 years prior. I was never afraid of the pain of childbirth, I was afraid of needles and helplessness, I was afraid of being vulnerable.

When I delivered my first child I discovered that fear was justifiable, and that is when my thinking turned around.

Being pregnant is not an illness. It's a natural function crucial to the survival of the human race.

Birth is the end and the beginning. The end of what you were, and the beginning of what you will become. It's a defining event in the life of a woman, and the way that event is viewed can deeply affect the impact it makes in her life. Childbirth can be approached in a loving gentle manner, or it can be defined by chaos.

I believe that women and babies benefit from an experience that is tender and respectful, and I believe modern obstetrics has corrupted that. Women have lost faith in their ability to birth, and that faith needs to be restored.

One woman at a time.