Thursday, November 13, 2008

<24 hours

Tomorrow I finish my stint at Magee. Today I did my presentation on Implanon and had my meeting the the program director. So...tonight I really didn't have anything to do.

So I watched The Business of Being Born. Questionable choice, I know. I went into it knowing that it would get me all riled up. But what with that article in the New York Times and my fellow telling me she is briefly in TBoBB, I felt inspired.

I expected to be angry. But mostly I'm amused by how internally contradictory the whole message of the movie is. Early on, they talk about how awful it is that women are exposed to TV images of birth: screaming, sweaty, grunting - it's totally not true, guys! That's just the media buying into the Message of Fear! But then they go on to show multiple screaming, sweaty, grunting births. Real ones. Far more fear inducing than TV.

Then, they spend a lot of time talking about how awful pitocin is. The evil, evil pitocin that causes the uterus to crush the baby! But then, when the safety of home birth is questioned, they argue, "But, look! We have pitocin in our home birth bag! See? Totally safe! No post-partum hemorrhage here!"

The thing that actually made me mad was when they basically blamed Cesarean sections for the fall of society. You see, when a woman has a Cesarean, she is deprived of a critical bonding moment with her baby and thus never truly becomes attached and loving as Mother Nature intended. What? Sure, it's awful that moms don't get to hold their babies immediately after Cesarean. And a Cesarean is major surgery with all the associated risks. But, really? Moms who have Cesareans don't love their babies as much as moms who have vaginal deliveries. That's offensive. And ridiculous.

Yes, the idea of a home birth surrounded by the people you love, getting to move how you want and eat what you want is lovely. Viewing birth as a personal journey, your own mountain to climb is a nice personal growth tool. And, honestly, if every home birth was in a major metropolitan area with a Certified Nurse Midwife as rational as the one in this film, my feelings on home birth might be different. When they cite statistics on the safety and prevalence of home birth in Europe, it is important to remember the different systemic setting for those births. I'm not saying our system is right. It's clearly flawed. But it is the system we are in right now. In Ohio, for example, you cannot have a CNM at your home birth. Only lay midwives do home births in Ohio. This means less training, significantly reduced ability to handle or recognize complications and no prescription powers (thus no pitocin, no methergine, no hemabate). I'm not comfortable with that. Frankly, after seeing what I've seen in the brief time I've been doing this, that terrifies me.

In conclusion, I'm pretty sure I've said some things that will make people angry. Have at it. I respect your right to choose the birthing process you desire, but as a practitioner I'm not comfortable with sacrificing the option of emergent interventions just for an experience. My final outcome is a healthy baby, and I really don't see what's so wrong with that.


Tam said...

I was invited to a screening of this last year before it hit theaters. I thought it was actually a really good depiction of home birth (except for the sausage nipple shot! Ew!) but it was definitely bias and almost ANTI Medicine. I actually bitched a girl out over it at a dinner discussion. P.S. you didn't mention the doctors/interns that were interviewed in the movie "I have never seen a natural delivery" Well, J finished OBGYN and he didn't either... he also never saw an actual husband (baby daddy, yes. husband, no.) Funny how those things go together no? Income, husband, granola birthing tricks...hmmm. But this point: she is deprived of a critical bonding moment with her baby and thus never truly becomes attached is a slap in the face to every women who loves her cesarean baby! I also saw the NYTimes article, interesting but again, biased. Funny because I was just talking about this tonight with a friend of mine who is trying for her second and we went to the screening together. She now wants a water birth and I told her I would support her 100% but I am not getting in that puddle of YUCK!
Cheers to medicine, healthy babies, and a woman's right to choose!

Tam said...


Lisa H. said...

>>In Ohio, for example, you cannot
>>have a CNM at your home birth.
>>Only lay midwives do home births
>>in Ohio. This means less
>>training, significantly reduced
>>ability to handle or recognize >>complications and no
>>prescription powers (thus no
>>pitocin, no methergine, no
>>hemabate). I'm not comfortable
>>with that.

So can I assume that you are supportive of licensing for CPMs (certified professional midwives) in Ohio & other states? This would be a great step toward increasing safe birth choices for moms and specialized knowledge and training for midwives.

>>as a practitioner I'm not
>>comfortable with sacrificing the
>>option of emergent interventions
>>just for an experience.

And as a mom, I'm not comfortable sacrificing the option of a peaceful, yet evidenced-based birth so some docs can pressure me into interventions that I don't want and don't need. (I'm not saying that you would do this, but my experience is that many OBs do.)

>>My final outcome is a healthy
>>baby, and I really don't see
>>what's so wrong with that.

I also believe that a healthy baby is an important thing, but it is not the only thing. A healthy mom is important too.

twinsetjan said...

I think the problem is people who proceed in a brainwashed fashion -- those determined to home birth without thinking through how they would access professional medical care if a problem develops (not to mention how to recognize a problem)...and those in the medical system who have a blueprint for how births should take place and intervene if progress doesn't match their textbook definition of how it should be.

Two tales --

I am convinced Marie's birth got started on the wrong foot because a young doctor insisted on breaking the amniotic sac (through a minimally dilated cervix) because it had "trickled" a very small amount of fluid. That started the "24 hour clock" to get her out before infection was sure to set in. Pitocin is a needed drug, but let me say it sure ain't fun. Fourteen fun-filled hours later -- during which I was manhandled and made to feel I had no role in any decisions (even if just to offer my input) -- Marie was born. I was so drugged at this point I can barely remember the actual birth and am told I held her.

Allen's birth -- we stayed out of the hospital for 34 hours of labor and showed up essentially fully dilated and with Allen in a negative position. The doctor on duty (nighttime, of course) refused to examine me because two other women there were screaming and moaning and he was convinced that there was no way I was anywhere as far along as them. Dale and I were put in a labor room and he was only able to gain attention (a few minutes later) because he shouted that he could see the head. They insisted on moving me to a delivery room, during which process they asked me to "just wait a few minutes" and where I had to physically push away a nurse who wanted to "medicate" me with some injection to "take the edge off" though I was not in distress or asking for anything. Allen was born within minutes and I remember it vividly. And I was walking around and taking a shower about an hour later. (The nurse was now my ally as she had never seen a single completely unmedicated birth in 12 years of practice. !!?!!)

So...I DEFINITELY see the lure of home birth. BUT I would never do it myself. Marie's birth had other challenges that I don't attribute to the forced early start. A home birth for her would likely have been tragic. For Allen it would have been fabulous. But I'm not willing to gamble on a child's life.

What I would like to see is more people like you, Karen. People who are willing to use their brains to make individual judgments to make the birth as safe as possible while allowing it to progress on its own as much as possible. (I kid you not, in Marie's case they had a checklist they were following that allowed them to take actions without responsibility -- "We followed the list, so it's not a bad decision.") OBs should be good lifeguards -- not blowing the whistle unless something's going wrong...and letting play continue unheeded elsewise.

If more moms believed they would be treated individually and not subjected to writ protocol, they'd have a more favorable view of hospital births.

But, even as things are, I'd go with the hospital -- I don't have statistics, but have to believe that despite over-medication and over-control of the natural process that happens in many cases (and I do have a sense of why that is -- shortages of doctors/nurses, malpractice, etc. -- but those are different, but related issues), a higher percentage of babies have good outcomes in hospitals. And if someone else insists on birthing at home, fine...but they need to remember that lots of moms and babies in the wild die in childbirth. It's a natural thing.

I think I surpassed you think this is an emotional topic?

twinsetjan said...

And to make it even longer --

Let me mention that our experience with Marie led to our deliberate decision to stay out of the hospital as long as possible with Allen. BUT we did that in an informed way -- having studied and interviewed as many doctors as we (okay, as I) could (the wife of a friend was an OB/Gyn and gave us access to several others) to learn what to watch for...any indicators that would tell us to get to the hospital while we had the chance. And we had a strategy to lurk in the parking lot if needed. If unsure, drive to the hospital and make the decision about going through the door virtually at the door. We mitigated our risk of staying away too long by increasing our knowledge. I was even certified as a child-birth instructor. So, I wouldn't recommend that strategy unless someone was willing to devote a LOT of hours to learning about the birth process.

twinsetellen said...

Jan touches on something I feel pretty strongly about - being informed and prepared BEFORE the birth. You know the story but for your reading public, I repeat it. With Jenny, the OB group I was seeing informed me that upon arrival at the hospital in labor they would automatically perform an amniotomy "to speed things along". I protested this - I'd had one of those when I was in labor with you (more on that later) and knew that the pain would escalate from 2 to 10 in seconds. I was told it was their policy but I was free to discuss it with whichever doctor was on duty when I went into labor. Unacceptable, so I found a new doc, at 7.5 months pregnant, and had an astounding in-hospital birth experience. I even caught the baby - yes, me, the birthing mother. It was wonderful.

With you, had I been determined to give birth at home, I'm not sure what would have happened. Maybe we would have been smart enough to head to a hospital at around 28 hours of nonproductive yet hard labor which was exhausting me. I didn't have to make that choice - we were already there and had a good OB who did as much to figure out what was going on NON-invasively as he could before he discussed the option of the amniotomy. For the pain that resulted from the now very productive labor, he gave me a half dose of pain medication so when you were born four hours later I was wide awake and remember all the details.

Long way to get to the point - good doctors and nurses can result in good hospital experiences. I'm not comfortable with the risks of home births, especially knowing that there are several "died in childbirth" records on our not so distant family tree.

Sourire11 said...

As someone who is about 3.5 months from going through this for the first time I really appreciate this post. I'm trying to inform myself of options and situations and all of that because to be quite honest all of the drugs and such scare me more than the actual labor and delivery. But I'm finding it difficult to find actual information because people are so passionate and convinced that they are "right" on both "sides" that often actual facts don't come through. I am having a hospital birth - that much I know. So it's good to hear someone talk rationally about that option.

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