Wednesday, January 28, 2009

Same Old, Same Old??

Adbusters published a provocative essay on childbirth last fall, "Industrial Childbirth," and while the piece was written about a birth that took place in Dublin, Ireland, there are many similarities between the management of this birth and how birth is routinely managed throughout the United States. The author, Shonagh Strachan, begins her essay, explaining that
"My experience of childbirth was not an unusually traumatic one. In medical parlance I had an NVD: a Normal Vaginal Delivery. The midwives were pleasant. I was given an epidural. I was admitted to hospital at 2pm and delivered a healthy baby boy ( 8lb 7oz ) eleven hours later. This is the essential information, is it not? This is the only kind of information that we ever really hear about other women’s experiences with childbirth.

But there is more to it than that. It took me a while to sort out my feelings after the birth – the elation you feel at the presence of a new life combined with your physical exhaustion leave room for little else. And I never really experienced the hopeless grief of the flippantly named “baby blues” in the weeks or months that followed. What I felt – when I was finally able to identify the reasons for my confusion – was anger.

Is anger only blame and self-pity? Or can it be illuminating? For me it can – anger has traveled beyond blame, beyond the individuals involved and my personal experience, and shocked me into changing my whole outlook on life."
She goes on to describe her birth experience: artificial rupture of membrane; contractions that did not progress dilation quickly enough, which led to Pitocin; an epidural. This birth story is what is typically offered in United States hospitals as well. The 2006 Listening to Mothers Survey II reports that, "Despite the primarily healthy population and the fact that birth is not intrinsically pathologic, technology-intensive childbirth care was the norm. Each of the following interventions was experienced by most mothers: continuous electronic fetal monitoring, one or more vaginal exams, intravenous drip, epidural or spinal analgesia, and urinary catheter."

Okay, so this is where I admit: already, I'm shocked. But remember, the author of the essay is explaining how, so far, she is not angry. Yet.
"The point at which I started to feel a twinge of anger was when, after the delivery, I wasn’t allowed to feed my baby. It was only then that my instinct was strong enough to say, “No. This is really wrong.” There is a period of about an hour after the birth where the newborn is alert and breastfeeding can be established. However, after a brief hold, he was taken away as I was given a Syntometrine injection and his placenta was delivered (by tugging on the cord). He remained away as I was stitched and examined and had to wait for a doctor to examine me.

By the time I was given the all clear (in tears at this point asking, “Can I feed him now?”), I had to be moved from the delivery ward and down to the post-natal ward. It was now 2 am, so friends and family in the waiting room were told to go home without ever having seen the baby or me. The baby’s dad had been present at the birth but was also sent home. Yet again I asked, “Please, can I try to feed my baby?” but he had to be taken away again – this time for a Vitamin K injection and for the nurse to bathe him and put his first vest and Baby Gro on."
But the whole separation of mother/baby: that's old-school, right? Now the baby's first examination (weighing, measuring, etc. & etc.) can be done by the mother, and he never leaves mother's side, right? Well, that may or may not be the reality. Listening to Mothers II reports that "Despite the importance of early contact for attachment and breastfeeding, most babies were not in their mothers' arms during the first hour after birth, with a troubling proportion with staff for routine, nonurgent care (39%)." Add that to babies who needed urgent care, and that's a significant number of babies who are away from their mothers during that first hour. Of course, as the Adbusters' essay shows, even one baby separated from mama for nonurgent reasons is significant, at the very least to that baby and mama.

[And as a public service announcement, here is a link to a blog entry that discusses and shows one newborn's bathing experience, "How NOT to Bathe the Baby". I couldn't get through the video myself: it's horrifying. But I do believe it's incredibly important, if at all possible, to have someone who cares about baby accompany him or her at all times as an advocate.]

Shonagh Strachan explains another source of anger:
"In theory, a woman has the right to refuse any of the interventions offered to her. In practice, the normality of intervention and the culture of risk minimization (read: liability minimization) mean that women do not feel empowered to say “no.” I certainly never thought about saying “no” or asking what the alternatives were. I blame myself for this – that I was not more informed and proactive. But I am also angry at the bullying system in place. It is hurried and overwhelming so there is never time or space to question the “professional” medical opinion as to what is really right for you and your baby. So we become numbers, subject to routine interventions."
And ends her essay with these paragraphs:
"It is my belief that at some deep level, we all feel that we have been robbed. We pass through our childbirth initiation to become disempowered, disconnected, long-suffering, patriarchal mothers. We tell our horror stories as just that, or we say nothing at all. But it doesn’t have to be this way. If I ever have another child, it will not be in the same way. And it doesn’t stop there. I will never again blindly place my trust in authoritarian professionals and institutions. I will recognize all capitalist patriarchy for what it is and I will do my best to speak out against it.

Every day, in every way, my son is a wonderful gift. I would go through ten more hospital births just to keep him. I am sorry for his shabby entrance into this world but I am thankful to this little person for helping me to see something: the bald, blatant, oppressive, damaging, misogynistic forces at play in the most vital aspects of women’s lives. Revisiting his birth has made me angry, but that has made so much else clear: how blinded we can be by the guise of protection, how crippled we can be made by fear.

I wish that we talked about it. That we could stop reveling in horror stories and better place our fingers on the reason for our traumatic births – not the curse of Eve medicated to by our benevolent system – but the systematic violence that delivers our babies for fear that we might give birth to them ourselves. For in the process we might begin to understand our own strength and find words for our anger. We might begin to disobey."
Very, very powerful.

Here's another thing that shocks me: it seems like we're fighting for the same things, over and over again. In her excellent memoir, Lady's Hands, Lion's Heart: A Midwife's Saga, Carol Leonard tells how she tries to institute changes in a local New Hampshire hospital - back in the late seventies. She creates a list of changes that she thinks would result in more family-centered maternity care, and offers them to the Chief of Obstetrics, "First on this list, obviously, is discarding the wrist restraints. No more being tied down like a deranged animal. Also, deep-six the standard prep of high enema and shaving" (116). These routines have thankfully ceased to be standard, as they were for my birth, in 1974.

However, most of the rest of Leonard's list looks appallingly familiar: "No more routine, continuous electronic fetal monitoring for normal, uncomplicated births. No arbitrary, elective Pitocin inductions without some clear medical indication . . . no more routine drugs, episiotomies, or mandated supine - flat on one's back - positions. No more withholding fluids and nourishment, 'just in case anesthesia is needed,' and no more routine, artificial, early rupture of membranes, which has never been proven advantageous by any evidence-based data. And babies are allowed to remain with their mothers at all times" (117).

How are we going to change this system? I think it goes back to basics: being informed, asking questions, networking, and insisting on a different experience, whether in a hospital, birth center, or at home. Excellent hospital births are possible - I know, because I had two: go check out Madelyn & Owen's birth stories here, if you'd like. Or go read this terrific article in the Los Angeles Times, "Midwives Deliver".

I have more ideas in old posts, "Mother-Friendly Childbirth", and "Questioning Safety" and "Choosing a Care Provider and Birth Place" and "Pregnancy and Birth: What Are My Choices?".

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

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2 Comments:

OpenID womantowomancbe said...

Excellent post, and unfortunately still all too true.

I would say one thing about the immediate postpartum experience in the hospital, which I've gleaned from reading numerous birth stories on L&D nurses' blogs -- the mother-and-baby's experience depends to a large extent on the particular nurse, her training, and her hospital protocols. As you pointed out, unless the baby is in need of medical care, there is no reason for mother and baby to be separated after birth. I should say, no medical reason -- the practical reasons have a lot to do with whether or not the particular nurse believes that skin-to-skin contact is important and how far she is willing to go to safeguard that.

One nurse said that at one hospital where she worked, other people (including the doctor) were dependent on her processing of the baby in order to get their paperwork done -- so basically, she had a restless OB and maybe another nurse or two drumming their fingers waiting for her to put in her paperwork so they could wrap up the birth and leave. If she let the mom have the baby the first hour, while leisurely doing all the newborn checks, she'd get the doctor and maybe some of her coworkers irritated by holding them up in their jobs. Not all hospitals are set up that way, but those that are, are slow to change -- "if it ain't broke, don't fix it" thinking, because they don't see mother-baby separation as being broken.

I am always impressed with nurses who go out of their way to ensure that mothers and babies can have a leisurely postpartum time.

But sometimes nurses are in charge of more than one mother at a time, and they have to rush the postpartum mom to get back to their other patients.

Which is another good argument for home-birth midwives!!

-Kathy

January 28, 2009 at 4:56 PM  
Anonymous Carol Leonard said...

Hi Christina! Thanks for including the piece from my book, Lady's Hands, Lion's Heart, A Midwife's Saga...it is true, the things I thought were "antiquated" practices, barbaric medical rituals from the past...semm to be looming their ugly heads AGAIN!?! the pendulum is sweeping backwards, it seems. We have to wake up the sleeping women NOW. if you could include a link to my book: www.badbeaverpublishing.com, I'd appreciate it tremendously. Keep up the good fight! xoxo Carol Leonard, NHCM

January 28, 2009 at 5:53 PM  

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