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Childbirth Issues - Lack of Good Medicated Childbirth Advice

Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.

Tuesday, March 13, 2007

I was thinking this week about my post on the lack of good information for moms that end up exclusively pumping. My biggest frustration with that wasn't just that there was a lack of information but that there seemed to be a lack of information because no one CARED about helping those moms. I could never help but shake the feeling that many people were secretly thinking "well it's nice that you're giving your kid breast milk, but you should have tried harder to make nursing work."

Now I'm well aware that that's MY issue...I'm sure it was the minority that thought that way, but I'm interested in how I see that type of attitude carry over to childbirth issues as well.

I host the Childbirth Choices Debate board over at BabyCenter and I do a lot of reading on natural childbirth, home birth and so on. While I don't know that it's intention, I see a lot of "all or nothing" attitude in that realm as well and it disappoints me.

Here's what I mean by that...

When I see a post by a mom talking about their first birth experience and how disappointing it was or I read a post from a mother that's pregnant and is running into problems with her caregiver, I'm often astounded at the response. Generally, the response boils down to "you should have a home birth, that will solve all of your problems" or "you need a midwife, that will solve all of your problems" or "plan for an unmedicated birth, that will solve all of your problems."

If a mom jumps on any of those three ideas, advice and support literally rains down on them as people share detailed information about how to get the birth they want, what studies support low-intervention birth, where to find a low-cost or even free doula and so on.

This is fantastic! I'm one of the first to ask people if they've ever considered using a midwife or having a baby at home. After all, that's how I "solved" the issues of my first birth when I wanted to make sure that they didn't happen a second time.

However, I also realize that home birth and even unmedicated birth isn't for everyone. Believe it or not, there are moms (and good ones too) that educate themselves on the risks and decide that they would like to have pain relief or that they would like their baby to be born in a hospital. No, they aren't crazy or deluded, they're just exercising their own choices. Homebirthers (myself included) spend a lot of time explaining that mom will progress much more easily in an environment where she feels comfortable. Well, guess what? Some women feel more comfortable having a baby in the hospital than they do at home. Yes, even when they know that home is just as safe.

The issue here is that once we find out a mom is planning a hospital birth and (gasp!) is using an OB instead of a midwife and (bigger gasp) might want to have the option of medical pain relief, we tend to just say "good luck" and leave it at that.

There's very little info from the educated childbirth community about how to have the BEST medicated birth possible. In other words, many childbirth advocates sort of act like if you plan to have a medicated birth, you kind of deserve whatever you get.

This bothers me. The same way that the subtle attitude against exclusively pumping from some breastfeeding moms bothered me.

So, I'd like that address that in this thread. I'd like to share some tips and suggestions for "medical mamas" on how to have the best birth possible and I hope that my readers would kick in their own suggestions. Let's go against the flow and realize that moms that choose to have pain relief during their labors also deserve to know how to avoid the problems that can come with that cascade of interventions.

My tips to medical mamas...

1.) Make sure that your health care provider is on the same page as you. Just because you plan on having an epidural doesn't mean that you want the whole intervention combo platter. Educate yourself about the various interventions and talk honestly with your doctor to find out when they use them and why they use them. Don't be afraid to switch providers to find someone that shares your philosophies of birth.

2.) Check out your hospital before the birth. Find out what their intervention rates are, what their c-section rates are, what their pre-birth and post-partum policies are. Is there an IBCLC on staff? How quickly can you have access to her? Basically, know what you're getting into and if you have a choice between hospitals, pick the one that best shares your philosophies of birth.

3.) If you plan on having medical pain relief, opt for the epidural instead of IV narcotics. While IV narcotics have the benefit of allowing you to be more mobile in labor, they carry greater risks for both you and your baby. If you do choose to have IV narcotics, find out which ones your doctor prefers to use and do your research on the possible side effects to you and the baby.

4.) Consider signing up for a natural childbirth class so that you can learn coping techniques. Even if you plan on having an epidural, the longer you can delay it, the less chance that you'll have the cascade of interventions and the less chance of harm coming to you or your baby. You may even find that the coping techniques work well enough that you don't want pain relief. Also, realize that 25% of epidurals do not give full pain relief...having some backup techniques can make that situation much more bearable.

5.) Refuse an IV until shortly before you get your epidural. Some women will labor for hours before they feel the need to have pain relief. While you do need to have your IV long enough to get some fluids before getting your epidural, you do NOT need to have it in for your entire early labor. In fact, having the IV in place can inhibit your mobility plus the longer it's in, the more fluids that will flood into your system. An overload of IV fluids can cause blood sugar issues for both you and your baby and can also cause edema which can significantly impact your breastfeeding abilities in the early days.

6.) Avoid induction unless there is a medical reason for it. Inductions carry increased risks to both mother and baby and mothers need to be aware of when the risk of baby staying in is greater than of being induced. Suspected big baby, being between 40 and 42 weeks and your doctor going on vacation are NOT medical reasons for induction. ;) If you do get induced, ask for a "long" induction using cervical ripening agents and then the absolute lowest doses of pitocin. Avoid Cytotec inductions like the plague.

7.) Try to push in an upright or side-lying position. Even if you have an epidural, most women can be assisted into upright positions that take the pressure off of their tail bone and that keep them from pushing against gravity. Pushing on your back with your knees shoved into your chest not only closes the pelvic outlet by 30%, it also greatly increases your risk of having a bad tear.

8.) Avoid an episiotomy unless baby is in distress. Episiotomies are not only unnecessary in 99.9% of moms, they also greatly increase your risk of having a third or fourth degree tear. Read up on episiotimies and make sure that your health care provider is on the same page as you and rarely does them.

9.) Get a doula. There's a common misconception that doulas are only for moms that plan to have a natural birth. While it's true that most doulas really enjoy helping a mom achieve the goal of NCB, most doula have the primary concern of helping mom have a good birth. Be honest with your doula upfront about your desire to have medical pain relief and find one that you can work with that has experience supporting medicated mothers. (As a mom that had an epidural with my first after a failed NCB attempt, I can attest that a doula would have been VERY handy.)

There are more, but that's all I've got off the top of my head. I'd also love to hear any advice from c-section moms on how to have the best c-section experience possible. Not everyone can or wants to have a natural birth at home, that doesn't mean that they don't deserve to have the best shot at a good birth.

What advice do you have to add?

Labels:

  1. Blogger Laura Gallagher | 9:16 AM |  

    Honestly, I think the reason we don't have a lot of good advice for them is that in a medical hospital situation, they're really not in charge. Advice on what choices to take implies that you're going to be able to make those choices. In a hospital, they may tell you ahead of time that you can - but when you get down to it, they're going to pester and push you on anything you refuse, wear you down, and often do things without consent. I know I was given medications without even my knowledge, let alone active consent. The attitude at hospitals is that the doctors know best and are in charge, not the mothers.

    Possibly some of the birth centers that are adjacent to or attached to hospitals might be an option - but I expect the doctors are in charge there, too.

  2. Blogger Judy | 10:03 AM |  

    As you know Jen, I wanted a home birth but was forced into an almost emergency c-section because of a previa.

    I think having a doula or someone to advocate for you shortly after the c-section is very important. I was in the most pain ever in my life and was high on narcotics right after the birth and was in no condition to fight nurses.

    Also, educate yourself no matter what kind of birth you plan on. I knew about c-sections even though I'd planned on a home birth. I discussed wanting a VBAC with my doctor and how I wanted the incision closed. (NO STAPLES!)

    Be prepared for some annoying hospital staff. Be confident in your opinions if you have educated yourself. Be prepared to have to fight some to get your way on some things.

    You have to make the best of whatever happens. I had a few weeks to get over the "loss" of not having a natural home birth. I thought that C-sections were the easy way. Ummm, they're not. I did plenty of work to have my baby and don't feel bad about it at all.

    Oh yeah, also be prepared to work your tail off to get your milk to come in. Pump, pump pump.......

  3. Anonymous Anonymous | 10:53 AM |  

    This type of information is necessary not only for women that choose specific interventions, but also for women presented with unexpected complications and those that have to negotiate and advocate for themselves regarding hospital policies and procedures. Every labor is unique and unpredictable. I encourage moms to have a plan, but try to keep an open mind. It's important for all moms to educate themselves about all interventions and choices, even if they do not plan to use them. I've known moms that did not want to hear about natural methods of coping with labor because they had banked on an epidural that didn't work. I've also had moms so intent on natural births that they didn't want to learn about anything else only to have a complication catch them off guard. I teach childbirth classes to groups that tend to be very young, not well educated about birth, and have little support. By the time I see them, they are very near the end of their pregnancies so their choices about caregivers and birth environments is limited. It's a constant challenge to present them with accurate, evidence-based research and skills to be able to make informed decisions on behalf of themselves and their babies, while realizing the difficulties they will face when and if their choices are counter-medical culture. The Official Lamaze Guide is a good resource. It has a section about birth plans showing moms different interventions in labor, their appropriate use, how to avoid unnecessary use, and how moms can keep labor as normal as possible in the context of specific interventions.

  4. Blogger gina_w | 11:09 AM |  

    I just wanted to say first, thank you. I was an educated mother who chose a hospital setting and took most of the steps you described. I am happy to say that I had a very pleasant experience.

    The only thing I would add is that it is well within your rights to schedule a meeting with an anesthesiologist in the weeks BEFORE your labor. (Some hospitals actually offer this as a class) I did this and was able to get educated on drugs offered, side effects and options. Thanks to that meeting I actually ordered which drugs I wanted in my epidural and had a CSE which allowed for full range of movement in my legs, the ability to percieve pushing and the ability to move into various positions. It was invaluable to my experience.

    I am sorry that Laura felt that a woman could not make choices in a hospital- as that wasn't my experience. I do think, however, that it helps you stand up for your choices when you are as educated as possible and have an advocate (for me, my husband) with you. We did have one nurse who tried to push narcotics but a simple "I understand what that drug is and I ask you to leave my wife alone" from hubby took care of that. :-)

  5. Blogger heidi | 11:34 AM |  

    This is a wonderful post, and you're absolutely right; it is a necessary one! What I love about your blog is how inclusive and positive you are. That's so important. It's not only unsupportive but also counter-productive to take a holier-than-thou attitude.

  6. Blogger Labor Nurse | 11:44 AM |  

    I think you make a lot of good points. First, there needs to be a release of the "all or nothing". And homebirth, unmedicated birth, etc will not solve everyone's problems.

    As a labor nurse, I see women who have all of the intentions to have a positive birth experience. They have done their "homework", so to speak, and frequently encounter something totally unexpected. However, the women who want an intervention free birth typically do not come to the hospital.

    Hospital childbirth education classes offer a glimpse of medicated childbirth advice. This is because the curriculum is typically approved by the physicians, and they want their patients to know all about the interventions that will come their way.

    My advice for those looking for medicated childbirth: educate yourself and be your own advocate. Make informed decisions, and do not let anyone sway you from exercising your rights as a patient.

  7. Blogger Jennifer | 11:47 AM |  

    You catch more flies with honey, eh Heidi? ;) Seriously though...it was women that warmly and openly shared advice without judging that got me looking at home birth. The same women that honestly tried to help prepare me for a hospital birth.

    I'm not one for pushing my beliefs, simply for educating and encouraging and when necessary, fighting...but always fighting for the RIGHT to make a choice, not fighting to make others make the SAME choice.

    Laura, While I'm with you in terms of many hospitals taking choice away from women, I do firmly believe that you can still IMPROVE a hospital experience by going into it prepared and with a supportive health care provider.

    I'm just not willing to give up on hospitals since that's where 99% of American women give birth. (I think less than 1% of births were at home last year...0.6% is the exact number if I recall correctly.) Also, some women simply don't have the choice to birth at home.

    Should women that are high risk, that can't find midwives, that need c-sections for medical reasons not deserve the best shot at a great birth? Should women that simply choose the hospital because they WANT a hospital birth not also deserve the best shot at having a good birth?

    (I don't say that to be sarcastic, simply to make a point.)

  8. Anonymous Mary Jo | 12:09 PM |  

    Thank you, thank you, thank you Jennifer! I love your blog and when you described your home birth, there was a big part of me that was jealous. But in reality, when I start thinking about having a baby in my house, well, I get light-headed and nausous. I KNOW how safe it can be. I KNOW how much better many women have found it. But I also know it's not for me. I would be paniced, not relaxed by being here!

    You're also spot on about the "all or nothing" attitude. It gets us in a lot of trouble in all areas of life (like the Supernanny weaning techniques, LOL!). I'm not pregnant yet, but I am now seeing an OB/GYN who works with midwifes in hopes of having a less medicated birth than the first time around.

    Some advice . . . stand up for yourself and have someone else to stand up for you, too. My doctor ordered a pitocin drip at 7:30 AM (my water broke at 5:00 AM) over the phone from his office, having not seen me since my office visit 3 days prior. Like an idiot, I just let them give it to me, because I was nervous and scared, and didn't know what to do. If I had taken the time in pregnancy to explain to my husband how important certain things were to me, there is no way that man would have let it happen, but, well, I was young and stupid. So, that's my advice . . . know what you want, tell others what you want, and make sure someone stands up for you in the hospital!

  9. Blogger Elizabeth | 12:34 PM |  

    I really want to thank you for this post! As a pregnant mom who has to give birth in a hospital due to thyroid issues, it has been incredibly frustrating trying to learn about all my options. Thank you for showing everyone that all moms deserve support and education!

  10. Blogger Cairo Mama | 1:54 PM |  

    I had a wonderful childbirth teacher whose focus was unmedicated, natural childbirth, but she covered everything. She gave us information on all the intervention procedures and medications and how they work. The reason one intervention often leads to another and another all the way to a cesarean is that the first intervention was done too early, for example, when the cervix is still hard. I wish I had my information from that class, but it is in Pennsylvania and I am here in Cairo.

    Here is my advice:
    1. I agree that you should be educated on all aspects and for all scenarios, no matter what your plan so that you can make better choices. Even if you are planning a home birth, you should know about the hospital's procedures and medicated births in case something goes wrong and you end up at the hospital. You may be sure that you want an epidural, but once you learn non-medicated pain coping techniques, you may find that you don't need one.
    2. Know what the intervention options are, what they do and when is best to do them. This is especially true for pain relief. You need to know what kind of pain a particular pain reliever stops and how long it takes to become effective to make an informed decision about whether or which you need/want it.
    3.Have a doula. Doulas are great advocates because even though they care about you, they are not overwhelmed by emotion or nervousness as can sometimes happen to a mother and her partner. They can be more objective and explain your options in the moment.
    4. If you can't or choose not to have a doula, make flash cards with the interventions and the appropriate use so that you can reference them if you need to make a choice.
    5. Do as much advanced preparation as you can do: tour the labor and delivery floor, know how to get to the hospital and how to check in, talk to the doctors about their philosophies and practices, take the hospital's childbirth class to see what they are teaching (I took both the hospital class and another more in-depth class in a doula's home), let your doctor know that you have a doula and make sure they will be allowed in with you, meet with a lactation consultant before the birth.
    6. Learn to recognize the stages of labor and labor at home as long as possible. The further along you are when you go to the hospital, the less likely you will be pressured to have interventions.

    I planned for a natural childbirth, but had to have a scheduled cesarean due to breech position (he was breech for months and not making any major movements) and placental issues. For me, the cesarean was very easy, too easy. I had a great hospital experience as well. The doctors let my doula in the OR after they got the baby out so she stayed with me when my husband went with the baby. The nurses were all supportive of breastfeeding and I saw an LC everyday. Luckily, I had time to accept the cesarean before it happened. I had a great birth, though it was not what I expected. I wrote about it here:

    http://cairomama.blogspot.com/2007/02/great-expectations-and-first.html

    Bottomline, you can and should be prepared. You should plan for the type of birth you want, but you can't control all factors in a birth. If you try to hold onto your ideal birth when confronted with unexpected circumstances, something might have otherwise been mild disappointment can turn into devastation and overshadow the most important thing: your child's entrance into the world.

  11. Blogger analisa_roche | 3:03 PM |  

    Another great, balanced discussion. I have done birth three different ways - vaginal with IV meds, c/s, all-natural VBAC. I had a wonderful doula the last time around, who had assisted at all types of births, including c/s. Her philosophy is that every woman has a natural birth unless she has delivered a frog. Anyway, there was a great thread on mothering.com about how to have a good c/s that I benefitted from greatly. I disagree with Laura that you are automatically not in charge if you are in a hospital. My VBAC was awesome, with an amazing OB who fully supported me. I *was* in charge. I found an OB who agreed with my birth philosophy, working at a hospital which supported my preferences. It is certainly possible.

  12. Blogger Cairo Mama | 3:11 PM |  

    On cesarean: make sure they do the type of procedure where they separate the muscles instead of cut them and that they double stitch the uterus instead of single stitch. It makes for a better, faster recovery, reduces complications and increases your chances for a successful VBAC.

  13. Anonymous Anonymous | 3:25 PM |  

    I also want to share another resource I use in my childbirth class that I think is very especially for those choosing a hospital birth. It is a card from a resource manual with these questions that can be asked about suggested interventions.

    Informed Consent Questions
    1. Is this an emergency, or do we have time to talk?
    2. What would be the benefits of doing this?
    3. What would be the risks?
    4. If we do this, what other procedures or treatments might we end up needing as a result?
    5. What else could we try first or instead?
    6. What would happen if we waited an hour or two (a day or two, a week or two, etc.) before doing it?
    7. What would happen if we didn't do it at all?

    I encourage moms and her support person(s) to be familiar with the questions and carry the card to their prenatal appointments and to the hospital.

  14. Anonymous Nev | 3:50 PM |  

    I wound up with a medicated, hospital birth. To be honest, not having given birth before, even though it was only a teeeeensy chance, I was terrified of being anywhere I couldn't immediately have a c-section if the baby had problems. And I hate surgery, and wanted to avoid it at all costs!!

    To be honest, I stayed home for 14 hours, no medication, no problem. I went 26 hours, doing fine, before I became exhausted and overwhelmed and asked for the epidural. It turned out to be a blessing...I was able to take a much-needed nap.

    After 30 hours, I wasn't progressing much and my contractions weren't regular. So I was given pitocin.

    That finally made me dilated enough, after about 4 more hours, to push. I did lay on my side quite a bit--that was my favorite. It took another 2 hours of pushing plus an epesiotimy (sp) before I managed to have him. This may sound weird, but being cut was the least horrible thing that happened to me--I was exhausted, to the point of tears, after 36 hours--and he just popped out once I was cut.

    It turns out, I had also suffered a laceration internally, hemorraghed, and required emergency surgery. I lost enough blood to be on the borderline for requiring a transfusion. I spent the next few weeks a literal zombie.

    Did it go the way I had hoped? No. I wish I could have attended some natural childbirth classes. (I had other, severe issues going on in my life at the time that kept me too distracted.) I was, however, glad to have been in the hospital. I could hear his heartbeat the entire time via the monitor, and found it very reassuring. I think I would have been too worried about the baby to have had him at home.

  15. Blogger evil cake lady | 5:26 PM |  

    I am glad that this subject is being talked about in a positive way; thanks Jennifer for bringing it up!

    As a bith doula who supports women who usually are giving birth in the hospital, I just wanted to remind you all that doulas can be very useful for a mom who had an epidural. However, doulas really aren't there to speak FOR you, we are there to support you and your partner (if there is a partner) to speak for yourselves. I usually tell the partner it is their job to speak up, ask the questions, and make the decisions. The woman in labor should be too busy having a baby to deal with the staff, and as I am not part of their family, it really isn't my place to tell the staff what the couple does and doesn't want. Usually, at least in my experience, that's how doulas start to get bad reputations with hospitals.

    I can and will nudge the partner to speak up and ask questions, and I will ask some questions if I feel there is information they are not getting that they should. I will provide the couple with information if they need help making a decision, but in the end the decision and the act of telling the staff is theirs.

    I also think it is important for women to understand that getting an epidural will affect the baby--not as severely as IV or IM narcotics will--but there may be a shift in the baby's personality about 2-3 weeks post partum, and that's because it takes that long for the baby to detox the epidural. This isn't judgment, this is just the information.

    I have supported moms who just needed that wonderful break that only an epidural could give them to be able to gather enough strength to fully dilate, or relax enough to fully dilate. There is a wise and compassionate use for epidurals, to be sure. This isn't to say that I haven't seen epidurals take a birth that seemed to be progressing great and de-rail the process, but with any intervention, there are risks and benefits.

    Epidural births are still births, and just as miraculous, and those parents who opt for them deserve our support and encouragement too.

  16. Blogger Shylah | 5:50 PM |  

    The birth of my daughter was before I was "enlightened", so to speak, of the choices available to me. As such, it was fully medicated. I was induced with pitocin, received a shot of Stadol, and eventually had an epidural. I told the nurses when I came in that I only had a couple of requests: wait for a few minutes to put the antibiotic in her eyes (because I'd heard they make baby's vision blurry, and I wanted her to be able to see me clearly the first time I held her), and not to do all that vigorous rubbing with towels and such.

    Both of those requests were "forgotten" by the nurses, so my advice is to make sure that you (and perhaps the people with you) remind the hospital staff of your preferences, and do so as often as you feel is necessary to ensure they don't forget.

  17. Blogger Casey | 6:43 PM |  

    That's a great post! I am a mom who chose to have a natural birth in a hospital. I found that my wishes were respected, and that I was given choices in respect to the nursing staff.

    For me, it wasn't the hospital setting that took away my choices in labor. It was my particular doctor. My labor went great until the 10 minutes before delivery when my OB showed up. :-) I have since switched and now have a doctor who includes me on the labor "team" as opposed to having labor be something that happened to me.

    I agree that coping skills and pain management are beneficial to anyone having a baby. Some women labor so fast they have no time for the pain meds. Some don't get full relief with their meds. Some can't get their meds when they feel they are ready for them due to staffing issues.

    Thanks for a great post!

  18. Anonymous Anonymous | 7:08 PM |  

    Regardless of what you may have discussed with your OB/GYN or midwife, it is important to clearly state your wishes to hospital staff when admitted. A friend of mine initially said "not yet" when she was offered an epidural. When she later decided it was time, the nurse indicated that she would see if an anesthesiologist was currently available. She didn't have much of a wait, but the possibility did surprise her. Epidurals for normally progressing labours are (with reason) NOT at the top of the priority list at this hospital. It is important to have other coping methods available just in case you have a bit of a wait for your medication. Understand how long the wait could be and what else the hospital can do for you in the meantime.

    Also, there may be some medical conditions that prevent certain requested interventions. I heard about one woman who was unable to have an epidural due to a back injury she had suffered in a car accident. I believe she knew of the restriction before she went into labour, but that's not a surprise you want to encounter in hospital!

  19. Anonymous Natalie | 9:07 PM |  

    Ditto on the sentiment that you CAN have choices in a hospital birth. But first you need to know what your choices are! You need to know that when someone says, "Here, you need this," you can say, "Wait, unless this is an absolute emergency, I know I have a choice. What are the options/risks/benefits?" One big difference, in my opinion, comes from who you choose to surround yourself with--partner, coach, friends, family, midwife, doula, OB, whatever. If you have done your homework and had discussions ahead of time, then the people who are with you can help you participate in making choices rather than having choices made for you. A doctor might be "in charge" at the hospital, but you can often make a choice about the doctors and practice you are seeing. My hospital experience was incredible--the whole staff was very respectful of our wishes. No one ever badgered us once we had expressed our preferences.

    The various couples in our birth class (Bradley method, BTW) were a great example of the benefits of knowing all the options and risks and benefits. All of us had hospital births, and were hoping to be unmedicated, but each couple's various circumstances called for decisions during labor about epidurals, pitocin, IVs, narcotics, and more. And because we all knew what these options entailed, everyone made decisions that they felt were informed and necessary. Several ended up using pitocin, but knew that it was right for their circumstances and specified smaller dosages. Several received pain relief, after deciding that it would help them avoid a c-section. I know that not all instructors are equal--every one has their own bias--but we were intentional in seeking an instructor who was supportive of hospital birth. This realistic group of people all recognized that even though unmedicated was our goal, we still needed to know about medication, and that ultimately it was more important to have input and choices than to "succeed" at avoiding all interventions.

  20. Blogger Catie | 12:19 AM |  

    I am a childbirth educator and doula in the central Ohio area and I will say that many of us try very hard to educate mamas on all their choices. I give all my clients and students the risks and benefits to procedures and then support the mom's decision 100%. I have no issues with women who choose to birth differently then I did. There have even been times in my doula career that I recommended an epidural as it can, at times, be the one thing that still allows mom to birth vaginally for a variety of reasons. I know there are some wonderful classes out there for women who know they would like to have an epidural. Even classes geared toward natural childbirth can be helpful for those desiring an epidural as most women won't be able to have one as soon as they feel their first contraction and they will need some of the labor coping techniques taught in CBE classes. I start off every one of my series by saying "I do make assumptions about the type of birth you prefer, but I make no judgments about you or the choices you make in birth." I urge all my clients to make a birth preferences list but then I remind them to be open and to understand they can never plan for their birth. I ask all my clients to make a cesarean birth preferences list so they know what their options are if this becomes the necessary choice.

    I feel most women are uninformed of the risks and benefits of epidurals and other procedures, though. As I stated before I have no issue with a woman making an informed decision regarding the use of an epidural or having a planned cesarean. I do get angry about the lack of informed consent given before and during labor regarding epidurals and cesareans. I have heard doctors and nurses flat out lie to women about the "safety" of epidurals. How many women know how an epidural can impact her birth and her baby? How many women know the effects it CAN have on breastfeeding? How many women know the long term effects of cesareans? How many women know the impact it has on their ability to get pregnant again or carry a baby to term? Is it a life saving procedure? YES! Can it also be a life ending procedure when over used and not respected? YES!

    I feel strongly that the labor and birth room isn't where informed consent/refusal needs to take place. This has to happen sooner so that women can really hear the risks and benefits and then do what needs to be done to achieve their birthing goals.

    In addition to this, women need to ask more questions and seek out information. I have been attending births for almost 4 years and I have NEVER heard a doctor give a mom true informed consent. Never. Usually, half of the risks are left out...when they tell mom what the risks are at all or even give her a choice. The number of times I have seen procedures done without consent or permission from mom is horrific. And these are births I am at to help advocate for mom! I can't even imagine what is happening when women don't have a support person who is well versed in labor and birth with them. But women have to start asking questions! Women have to start demanding evidence based information! Women have to do their homework and educate themselves rather than relying on the doctor who is paid more for every procedure mom chooses!

    For me, it all comes down to information. Once a woman is informed she can make the best birthing choices for her and her labor/birth. But if a woman isn't informed, she has no choices. If a woman isn't informed, she will get pulled along; things will be done to her and most of her choices will be taken away from her or decided for her. When women are informed they are able to take ownership for their birth experience because THEY made their birthing choices, no one else. Once women realize how much power they have and how each choice they make affects the next step in labor and birth they will be able to take ownership in their birth. But as long as women aren't questioning their doctors or the hospital staff, things will be done to them. And I in no way saying women should be rude or disrespectful to their care providers. I am saying it is ok to ask your doctor why. To ask for the evidence that backs up what the doctor is saying.

    Read Born in the USA...you will find out so much about the US and our broken maternity system.

  21. Blogger Meg | 1:57 PM |  

    I think all of these comments are a really honest sampling of birth experiences and attitudes in the USA.
    My extra two cents: If you choose birth at the hospital, choose a care provider who will listen and work with you. Don't decide 1st which hospital and then a care provider. Going to a large teaching hospital may mean cutting edge, but it may also mean that alot of your care is done through residents. Going to a hospital with a great reputation is good sense, unless your particular care provider is the most interventive in the place!
    Also, choose a smaller practice size of caregivers. Eight docs or midwives in a group really decreases your ability to get to know them. You may LOVE a certain person and the one who annoyed you actually is on call for your birth.
    I have seen enough births affected simply by who is on call not to advise this.
    I would reiterate a previous comment to be prepared for unmedicated birth even if you plan on having medication. I have also seen enough epidurals that didn't work well and had to be replaced to advise anything else. You can't be overprepared! Plus, all those coping techniques help for sore nipple latches too!
    Let's all work to increase the RIGHT to make a choice by being informed consumers.

  22. Blogger Amber | 8:51 PM |  

    I am a 2-time c-section mommy. I am also a mommy who got pregnant both of those times while on birth control (not really important, but hey so much for modern medicine). I was 30 when I had my first child. I was of course totally about an OB cause I had not been planning on children anyway, then to find out I was expecting--oh wow! I had never felt an urge to have children, I never looked at babies and felt that "ache" to have one of my own, so needless to say birth plans and the like were unfamiliar to me. Now, as a mommy I wonder what I ever did without these wonderful little people. Anyway, I was sure that the dr. had my due date incorrect with my first child. I felt that she was not due for at least another 2 weeks-based on my own personal sex calculations. So, anyway I agree to let him induce, 1 week after the ultra sound determined due date. He broke my water early in the day, gave me the dreaded pitocin, and waited, and waited, and waited. Well the nurses finally said they thought I was regressing. I had been dialated to 2 for 3 months (I had even been put on bed rest), yet here I was having a lot of contractions, and not dialating anymore. I was stuck at 2. Well, the dr. comes in after I had been in labor all day (8 hours) and says "hey I think we need to do a c-section" I am concerned that you are not dialating, and we need to get the baby out. She was stubborn and had not even attempted to move to the actual birth canal, she was hanging out way up under my boobs, going nowhere near the exit. Well after I agreed to this major surgery for the sake of my sweet baby, I was whisked off to the operating room. I was scared silly, and so was my entire family,most of whom had been gathered around me all day. Well I get the big spinal, get the cold numbing feeling in my legs, then the next thing I know, there is my baby. After that, I remember waking up in the room where I had been all day, everyone coming in telling me how pretty the baby is and that the nurse is coming soon so I can start nursing. Well I was numb from my neck down, and my mom had to hold the baby for me so I wouldn't drop her. According to the experts she latched on perfectly, and I was a great breast feeder. My milk came in the day I got home from the hospital (3 days after the birth). I had so much milk that I could have nursed all the neighborhood kids. Milk squirted out every time I moved. And if I got too close to the baby-everyone needed umbrellas. It was insane. I used washcloths in my bra, regular nursing pads did not work. Well I was very sore from the incision, walking hurt, I refused to even watch sitcoms while I was healing because it hurt to laugh.
    So journey ahead 4 months and here I am pregnant again. To heck with the birth control people. Well The closer I get to the due date the more I decide I really want another c-section. I dont want the "risk" of the VBAC. So I scheduled my son's birthday. It was lovely, I knew exactly when I was going to the hospital. I planned out the childcare arrangements for my daughter who was now 1. I even planned out the family and friends that would come to help me at home after the birth. I mean I had a toddler and and incision to deal with. So I went in at 5:30 to have the baby (paperwork and all that), and by 8:00 I was back in my room waiting to be moved to the actual room where I would spend the remainder of my hospital stay. I can honestly say that I was in pain- major surgery-remember. This pain was nothing like the previous c-section. I decided that logically, cutting through sore, tired, contraction wreaked muscles was way worse than cutting through those that had not experienced contractions. After a day I was really not feeling very much pain at all. My milk came in just fine. Once again I was a milk machine.
    So here is my advice to women who are seriously contemplating c-sections:
    You are the boss of your body. You are no less of a mother because you did not have a vaginal delivery, or a drug-free delivery.
    I did not have a problem with breastfeeding, although I have learned that some women do.
    Although I was mostly incoherent while the babies were removed from my body- there was a proud daddy watching the entire process, while holding my hand. (I couldn't feel my hand, but I could see him there beside me when I was awake.)
    The anestheisiologist brought me to, in order to see both babies and for a picture with them each up next to my face.
    The recovery is not fun, but it was ok. I was not completely miserable. I did also take pain medication after both births. Low doses, so as not to make the babies drunk.
    In all, I think if you want a c-section, go for it. I do not feel guilty or ashamed that I was not at home, or having natural childbirth. I do believe women should know all of their options, and the pros and cons of all options, but I feel that it is our right as the hormonal pregnant lady to choose our delivery method. The test of good mothers, is how we take care of the children after they are out of our bodies. I know I am an excellent mommy, and I feel absolutely no remorse for my choices.

  23. Blogger jill | 8:54 PM |  

    Because of this and m-a-n-y other posts I nominated (tagged) you for a Thinking Blogger award. Do with it what you will. No pressure. Just know that I enjoy reading your thoughts as they inspire my own.

  24. Blogger Jennifer | 6:33 AM |  

    Hey thanks Jill!

    I'm not going to pass it on again as I did when someone else nominated me a few weeks ago, but I very much appreciate the sentiments! :)

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