Birth #1: fun birth last week was a good reminder not to think we can understand the mystery of birth. A, a second time mom, came in Sunday, 2 cm. Monday 3 cm. Wednesday, 4 cm. She got in the tub (my trepidation was known), 15 min after her exam, SROM, 15 min later she asked me if she could push, and then with the next ctx said, "I can't NOT push . . . ugh - something came out!!!" Yep - the HEAD! Her baby was born 35 minutes after her exam. WOW! i didn't have gloves on (insert sad face here) so the LM caught the baby. Oh well. Fun birth.
Birth #2: M was a G1 who dilated quickly, and then pushed for hours without any change. I was pretty sure that her baby was military & LOP (what this means is that the baby's head was not flexed, and was basically sunny-side up - and her head was STUCK!). When we transferred TO the hospital (to an asshole doc, unfortunately), I asked him what position the baby was in. He said, "LOA, of course!" So after her cesarean, I looked at that head. Guess what? Bruising on the forehead, caput (swelling) just above that. LOA my ASS! (The point is, the baby's head proved that my assessment was correct. LOA is sort of the "best" position for a baby to be in as they begin to descend through the pelvis - which isn't a straight shot! It's actually a bit of a maze - babies have to rotate their heads and shoulders in different directions at different times . . .)*
Birth #3: I was in the car on my way to the birth center when I got a call to let me know that the birth had already happened. Bummer! This was a first time mom (G1) who woke up at 7:30 AM with contractions, thought she was being a wuss, told her partner she was in labor, he had a hangover so went back to sleep for an hour. When she woke him up again at 8:30, her water had just broken, and she felt like she needed to push. They arrived at the birth center at 9:00, and when the midwife made it to the car, (after a frantic dad came to get her!) and pulled the mom's pants down, the head was already out! The rest of the delivery happened right there in the car, and when I arrived, they were nicely settled in the birth center, getting to know their son. Crazy!
Birth #4: I had an amazing VBAC over the weekend - mom must have said 100 times "I just want this to be over, I just want to meet this baby . . ." and ONCE I said, "you need to dig deep," which didn't go so well. She said, "I am digging deep!" I decided not to use that line anymore. We did offer a hospital transfer for an epidural (gently) and her response was, "I'm having my baby here." She had a lovely birth in the end, with a 7#8oz baby with a nuchal cord, nuchal hand, minor periurethral skid marks. Score! She was an amazing and controlled pusher. Wow! (nuchal is a fancy way of saying neck - cord around the neck, hand up by the neck - a hand by the neck or face means an elbow by the shoulders, which make the baby even bigger, making descent (and pushing) usually slower!)
I do love it here. I love it that these ladies don't have epidural as a real option. I have to admit, every time someone asked for an epidural when I was training at the hospital, my heart broke just a little. I know it's not my birth, but it is just so amazing to be a part of an unmedicated birth, and to see the mom's utter thrill when she delivers her baby!
*Epidurals change labor. They really do. Sure, they make the mom more comfortable. But they also make it a lot harder for baby to rotate through the pelvis because mom is static, and usually laying down. An unmediated mom is moving around, rocking her pelvis, walking, lifting her legs, etc. - and all of this helps the baby negotiate the pelvis. Without movement, the baby is more likely to get stuck = more likely to have a cesarean.
Tuesday, May 17, 2011
Tuesday, May 10, 2011
Medicalization of Birth
Dear Student
In spite of the evidence that birthing outcomes are better with less interventions, the medicalization of birth continues. The cesarean section rates, the number of inductions and the generalized interference with the normal processes of birth are escalating each month. I am doing a short survey to seek your opinions. Your participation is voluntary and there will be no personal data collected. Your completion and return of this survey indicates your consent to participate. If you have any questions, please contact me . . . . Thank you for your time and participation. Sincerely, E
So, here are my answers:
1. What do you think are the main causes for the present medicalized approach to birth and the increasing interventions into the birth process in the United States.
History: OBs took birth out of the home, and into the hospital. In other countries, the midwives went with women, but not in the US.
Technology: Technology is fun! Right? Helps us do things faster, easier, etc. Use a machine rather than your hands. Ugh. During my training I was frustrated to work with wonderful family doc residents who didn’t know how to do Leopold’s maneuvers . . . so just used the ultrasound every time to check presentation at the onset of labor. Ugh. I kept trying to tell them that they won’t have access to ultrasounds at every hospital/labor floor!
Mainstream media: messages that birth is fast, furious, dangerous, scary. I cringe almost every time I see a birth on TV or in a movie . . . her water breaks, everyone freaks out, and the baby is born within minutes. Right. Or a movie where I saw the OB coaching an unmedicated woman to push . . . and then the mom died, somehow, but why that was never clear. Awful.
Media & history lead to: what women want. Women want epidurals because birth is painful. They have no idea about the effect of epidurals on their labor. And most don’t care, when you tell them. They just want to be distanced from the pain, the experience.
Fear: fear of clients and fear of providers. Watching someone in pain is not comfortable for many, and especially with the current cultural/hospital value of minimizing pain (pain scales, taking care of pain) – that works backwards in the L&D unit, where pain is an indicator of progress, of a normal experience, and when too extreme, of something going wrong. Clients/patients are scared of pain. Pain is not seen as good in our culture. We try to minimize pain, rather than learn to cope with it and learn from it.
2. How is your educational program preparing you for the reality of our Obstetrical/intrapartal care in addition to exposure to birth centers and/or home births? What is being taught to give you the skills to practice midwifery in the hospital/institution setting.
My education focuses/d on typical hospital intrapartum care. I think our clinical sites prepared us for the reality, at least as much as or more so than the book learning, but of course, each preceptor & each site plus luck of that shift give us the experiences that we get. Overall, I think our education is preparing us for what hospitals are doing now, rather than teaching us to make change in those hospitals, even though our professors (for the most part) are truly believers in the midwifery model of care.
We kept track of “skills” we learned, including IUPC, FSE, fetal monitoring, etc. We did not keep track of “skills” we learned, in terms of hands on or observational skills, unfortunately.
I had the opportunity to have some exposure to OOH birth three of the five quarters I had intrapartum clincials. Two of those quarters, I was with a CNM who offered both hospital and OOH birth; my Integration quarter I spent training at a Birth center that also provides home birth. I set up that site myself because I was motivated to learn more about & get more experience with OOH birth. I will have over 10 births OOH when I complete my program . . . and more than 20 in hospital.
3. How are you planning to make a difference when you graduate?
I will be working at a Birth Center/home birth practice after I graduate. I’m excited to be working in a place that lets women’s bodies birth without unnecessary interventions, and believes in the power of the human body to know how to birth.
After I get some experience, I will precept students in OOH birth. Then I will do some formal teaching – nursing school? We’ll see . . .
In spite of the evidence that birthing outcomes are better with less interventions, the medicalization of birth continues. The cesarean section rates, the number of inductions and the generalized interference with the normal processes of birth are escalating each month. I am doing a short survey to seek your opinions. Your participation is voluntary and there will be no personal data collected. Your completion and return of this survey indicates your consent to participate. If you have any questions, please contact me . . . . Thank you for your time and participation. Sincerely, E
So, here are my answers:
1. What do you think are the main causes for the present medicalized approach to birth and the increasing interventions into the birth process in the United States.
History: OBs took birth out of the home, and into the hospital. In other countries, the midwives went with women, but not in the US.
Technology: Technology is fun! Right? Helps us do things faster, easier, etc. Use a machine rather than your hands. Ugh. During my training I was frustrated to work with wonderful family doc residents who didn’t know how to do Leopold’s maneuvers . . . so just used the ultrasound every time to check presentation at the onset of labor. Ugh. I kept trying to tell them that they won’t have access to ultrasounds at every hospital/labor floor!
Mainstream media: messages that birth is fast, furious, dangerous, scary. I cringe almost every time I see a birth on TV or in a movie . . . her water breaks, everyone freaks out, and the baby is born within minutes. Right. Or a movie where I saw the OB coaching an unmedicated woman to push . . . and then the mom died, somehow, but why that was never clear. Awful.
Media & history lead to: what women want. Women want epidurals because birth is painful. They have no idea about the effect of epidurals on their labor. And most don’t care, when you tell them. They just want to be distanced from the pain, the experience.
Fear: fear of clients and fear of providers. Watching someone in pain is not comfortable for many, and especially with the current cultural/hospital value of minimizing pain (pain scales, taking care of pain) – that works backwards in the L&D unit, where pain is an indicator of progress, of a normal experience, and when too extreme, of something going wrong. Clients/patients are scared of pain. Pain is not seen as good in our culture. We try to minimize pain, rather than learn to cope with it and learn from it.
2. How is your educational program preparing you for the reality of our Obstetrical/intrapartal care in addition to exposure to birth centers and/or home births? What is being taught to give you the skills to practice midwifery in the hospital/institution setting.
My education focuses/d on typical hospital intrapartum care. I think our clinical sites prepared us for the reality, at least as much as or more so than the book learning, but of course, each preceptor & each site plus luck of that shift give us the experiences that we get. Overall, I think our education is preparing us for what hospitals are doing now, rather than teaching us to make change in those hospitals, even though our professors (for the most part) are truly believers in the midwifery model of care.
We kept track of “skills” we learned, including IUPC, FSE, fetal monitoring, etc. We did not keep track of “skills” we learned, in terms of hands on or observational skills, unfortunately.
I had the opportunity to have some exposure to OOH birth three of the five quarters I had intrapartum clincials. Two of those quarters, I was with a CNM who offered both hospital and OOH birth; my Integration quarter I spent training at a Birth center that also provides home birth. I set up that site myself because I was motivated to learn more about & get more experience with OOH birth. I will have over 10 births OOH when I complete my program . . . and more than 20 in hospital.
3. How are you planning to make a difference when you graduate?
I will be working at a Birth Center/home birth practice after I graduate. I’m excited to be working in a place that lets women’s bodies birth without unnecessary interventions, and believes in the power of the human body to know how to birth.
After I get some experience, I will precept students in OOH birth. Then I will do some formal teaching – nursing school? We’ll see . . .
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