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.