Tuesday, September 8, 2009

Why Ask Questions?

I've read several blog posts lately that highlight the importance of asking questions in very dramatic (and uncomfortable: reader beware) ways.

Birth Trauma
Navalgazing Midwife wrote "Just because it's the standard of care* doesn't mean it's ethical" which lists and lists and lists some of the abusive things done and said to birthing women. She writes, "How can people NOT believe women would consider their experiences traumatic and abusive"??

Ask questions well ahead of time about the standard of care used by your doctor/midwife and birth place. Their answers and attitudes will help help you assess the likelihood that you may be on the receiving end of treatment like that listed by Navalgazing Midwife.

Lest you say, this could not happen to me, not here... let me offer you two examples in this local area:
"You have to have an IV or your baby could DIE!"

The details in this situation are that the woman (who took my birth classes) was asking about IVs because needles made her very nervous, and she was hoping to avoid one. She was also planning an unmedicated childbirth. This hostile (and untrue) response prompted her to change care providers. She ultimately had an unmedicated birth without an IV - a gorgeous, healthy baby girl - in a different birth place, with a different care provider.

"The anesthesiologist is leaving. If you want an epidural, you need to have it now."

Said to a friend of mine (who didn't take my classes) whose water had broken before contractions began. She went to the hospital, where she was admitted, and was waiting for contractions. Because she felt pressured, and didn't want to cause a scene, she had the epidural before she ever felt one contraction.
There is not any 100% guarantee against birth trauma. There are certain things you can do to avoid it though. Here are a few:

  • Ask questions.
  • Think carefully about where you are planning to birth and with whom.**
  • Educate yourself.
  • Have continuous support with you at the birth (partner, friend, relative, doula).

    I think there are certain uncontrollable/less-controllable factors that come into play as well. Mostly I believe we "make our own luck", but I do think there is a certain amount of luck involved too. I'll use my birth stories as an example.

    When I was pregnant with my first child, I did everything I could think of to educate myself, and to work towards having a relatively smooth, trauma-free, unmedicated birth. Which, thankfully, happened. But looking back on it, I realized that I had left one big variable open - care provider. I had established a wonderful relationship with my OB. She was in a practice with three other OBs. It didn't really dawn on me that I only had a 25% chance of birthing with her. I had not met two of the other OBs in the practice because, as a teacher, I could only schedule appointments after school, and these two OBs didn't have appointments after 3pm. The other OB I met I was not happy with - he measured this, checked that, said "any questions" without looking at me or sitting down, and strode briskly out of the room.

    It turned out that the doctor who attended my daughter's birth was neither of the OBs who I had met - though I am very happy and thankful to say that she was fantastic. Very supportive and friendly. She ended up helping me off the bed where my pushing wasn't very productive and onto a birth stool on the floor. She and the nurses sat cross-legged on the floor surrounding me, with the blue drapes all around me. I was like a birthing island in an ocean of blue. I gave birth as the sun rose, surrounded by these wonderful supportive women, one of whom remarked, "This is lovely! It's like a slumber party!!" I'll never forget that. At the time, it didn't feel much like a slumber party, but looking back I understand why she said that - it was the energy in the room. And that's where the luck came in - what do you want to bet that the birth energy would have been very, very different if the OB whom I had met and not liked attended the birth?

    I realized how lucky I was after the birth. For my son's birth three years later, I wanted to be sure I didn't leave care provider so much to chance. I chose to birth with two midwives, so I would know for sure that the person who attended my birth matched my preferences for standard of care and philosophy.

    I believe that in this country at least, there will always be some new technology (machine that goes "ping" for you Monty Python fans) awaiting some women when they give birth in a hospital. Think forceps, earlier in the 20th century, or continuous electronic fetal monitoring. There is nothing inherently wrong with technology, certainly there are times when a Cesarean birth, or using a vacuum extractor or a dose of Pitocin, is what has become necessary for a healthy baby and mother. But! Technology used most of the time, for most births, low and high risk? Maybe not something all women want during their birth...

    Which is why it's so important to ask questions. Things like this lurk on our birth horizon.

    While you're at Nursing Birth's blog, take the time to check out her "Don't Let This Happen to You! The Injustice in Maternity Care" series. Scroll all the way down to start at the beginning. I think this series could highly motivate someone to ask questions, lots of questions!

    *What is "standard of care"? Standard of care is the typical, common (standard) care that is usually provided by a doctor/midwife/hospital. Various pressures (legal and financial and bureaucratic and staffing) as well as training, philosophy, routines at the birth place, peer pressure and current trends all impact the standard of care offered by a particular doctor/midwife. It is very much part of the time and place in which a woman births. For example, some hospitals have a Cesarean birth rate of 50% while some homebirth midwives have a Cesarean birth rate of less than 5% - with similar outcomes for mom and baby. Clearly the standard of care offered would be very different.

    **There are some that say "you bought the ticket, you go for the ride". Which is usually true. For example, if a woman gives birth at a hospital with a high Cesarean rate, she should not be surprised if she has a Cesarean. It would be like going to McDonalds and expecting a luxurious, five-course, chef-prepared dinner. Not going to happen.

    Christina @ Birthing Your Baby
    Independent Childbirth Classes for Central Maine
    Mamas & Muffins: New Moms Group

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    Blogger Nursing.Birth said...

    Christina, Thank you so much for the links and for spreading the word about the "Don't Let This Happen To You" series! And I love the slumber party comment! I know what that energy feels like from a labor support standpoint. You can feel it in your blood! It's intense!!!


    September 8, 2009 at 10:24 AM  
    Blogger Joy said...

    Very thought-provoking!

    September 8, 2009 at 4:46 PM  

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