Update: Please go visit Brandy's blog for her very eloquent, sensible response to this... (She's planning a home birth this fall).
Last night I had my first dream about giving birth, then breastfeeding (by the way, the baby was a boy). This had not happened since my third trimester with LP I think. My body and mind are both clearly starting to shift back into that mode… Or maybe the dream was just the result of a conversation with my husband I had the night before about this very topic.
This time again, I will be giving birth quite "traditionally" (for our time anyway), in a hospital. Strangely, this choice seems to be in need of a slight justification these days. The conversation with M was as a matter of fact sparked by how I was telling him of this big wave and buzz I’ve noticed all over the Web, blogs, social media and such for the last couple of years, of how women were really dissatisfied by the way their childbirths were being handled and feeling patronized and in need of reclaiming these very special, vulnerable, emotional moments in their life. The documentary The Business of Being Born caused quite a stir a few years ago, and its message was pretty much: normal childbirths are better done at home, with a midwife.
I can’t exactly say how hospital births routinely work in the US (or elsewhere), but according to accounts I've heard or read about, it seems quite bad at times. I can’t really imagine for instance how newborns can still be separated from their parents and put in the care of nurses who will give them bottles even against the mom’s wish, and so on. It seems like a tale from my mother’s time, but apparently is still frequent, among many other problems that really do seem to exist in a lot of hospitals, unfortunately. Recently in an article on the politics of breastfeeding, I came across this staggering fact: 22 establishments here in Quebec have the "Baby-Friendly" certification (awarded by the Unicef and the World Health Organization, which outlines very specific guidelines to promote early bonding and breastfeeding) for a population of 7 million. In the whole US, with its 300 million people, only 89 hospitals do, including only 17 in California, which is generally considered the more "evolved" place when it comes to this. This only hints at how different the systems probably are.
If it’s that bad, I’m not surprised that such a backlash against hospital births has risen, that such weariness towards doctors is occurring. I get it. I kind of understand it. I don’t think births necessarily need to be highly medicalized affairs, I don’t think women should be told what is right for them against their best sense and their will. I’m very pro-breastfeeding (if possible because let's get real, sometimes it's just not, all right, Gisele?), I think drugs of any kind should only be taken after careful consideration, I think that "natural is best" for most things. I agree with a lot of what the pro-home-birth movement is saying, for instance, that every medical intervention during childbirth (i.e. inductions, epidurals) increases your chances of requiring further (undesirable) intervention (i.e. forceps, C-sections, etc.)
But I still can’t get my head around a home birth. I’ve read about several of these being done in recent years, and I respect and support that choice (it truly made me understand the reasoning behind it more. I mean the aspect of being in your own home after seems quite appealing). I know that chances are things will go well –I even realize that in retrospect we could have had LP in our living room and really it would have made no difference. But I still won’t do it. Why not? Well, as it is wonderfully put in this review of the documentary mentioned above, I just cannot for a second forget that even in normal, low-risk pregnancies, things can go very wrong for either baby or mommy at any instant. To this argument, home-birth extreme advocates will reply that it’s untrue, that it’s just what the patronizing doctors want you to believe so you remain scared and don’t take back control over this.
But I’m not buying it. It’s not that I have blind faith in modern medicine (despite my dad and godmother being doctors), I’ve never been afraid to question it and not take all it promotes for granted. I simply don’t think the solution is rejecting it altogether, especially its strongest argument: it knows how to save lives.
I have very personal reasons for confidently stating that a hospital birth is right for me. They are emotional and varied: before the fifties every mother here (including my grandma) was losing 1 out of 4 babies in childbirth, and that’s when she wasn’t dying as well. My aunt died in childbirth following a spectacularly sudden and unpredictable bout of eclampsia (this was the 70s but they lived in a remote village in Northern Quebec and she was at a small, not well equipped clinic instead of a hospital). As you can imagine, this had a profound impact on my family. One of my best friends, who had prepared extensively for natural childbirth including hypnosis and such, started one only to have her son suddenly become in grave distress due to a lack of oxygen. He was born via an emergency C-section, which was not was she had planned. But had she decided to give birth at home like a lot of people she was taking classes with planned to, she’s very well aware that her baby would have died. Another friend's baby girl had a stroke eight hours after birth, and her (understandably inexperienced, tired) parents had not picked up on it (it was a really stressful time and she spent many weeks in the NICU, but she's 8 now and she's completely fine). My cousin also planned a home birth, but had a hemorrhage that led to a horrifying emergency ambulance ride to a crowded hospital she wouldn’t have chosen in a million years –everyone is OK now, but she doesn’t wish this experience to her worst enemy. Some people are fine with these only being anecdotal cases and rely on the fact that the odds are in their favor –which I know they are (I’m not denying all of my other aunts, cousins and friends had uncomplicated deliveries). This is what makes sense to them and I think they should absolutely be given options. But I can’t forget about any of these.
I have nothing negative to say about the hospital we plan to go to or the way they handled my childbirth the first time. It’s always coming back in polls and studies as the best one to give birth here in Quebec, which I realize is probably a good place to give birth in general. Not only do they have that prized "Baby-friendly" certification, but it has everything else we could ever want. They are relaxed, and respectful, and open-minded: you can bring your midwife or doula, they have birthing pools. They are there to assist, ready to intervene, but not forcing anything on you. They will give you an epidural if you want, but will also support you if you don’t. They won’t induce labor unless sustaining the pregnancy at this point could be harmful for the baby, they don't believe in episiotomies, and their C-section rate is significantly lower than average. They don’t prevent you from eating or moving around. I thought the whole process was very humane and dignified (given the circumstances): every room is private, and you stay in it (unless you want to go walk around or go to the pool –I tried both but neither made me comfortable) throughout labor, alone with a nurse and your birthing partner(s); when the moment becomes close, in the last fifteen minutes or so, the doctor and an assistant come in with all the equipment needed. After, they initiate the skin-on-skin contact, help you with the first feeding, check on both of you, and then pretty much leave you alone. They don’t bother you with visitor hours, they’re there in a second if you have questions or need assistance… The bed is even a real, double one, so the partner can comfortably stay the night.
I guess my point is in this case, if it ain’t broke, why fix it? I feel I was truly able to have the best of both worlds: a natural childbirth in a setting which I perceived to be safer. I still have some apprehensions about the second time (for instance I’ll really try not to have an epidural again, but don’t completely rule it out. Who knows what can happen and how I will feel?), but I’m also very reassured about knowing it will take place there again. What I’m trying to say is, I’m not exactly defending hospital births, more like hospital births as I experienced them. And I think if more hospitals and doctors shared the same attitude, it would greatly help.
Tuesday, August 17, 2010
Being born
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8 comment(s):
Ok I wrote a big long comment and then thought "this is a blog post." so I'm just going to post it over on my blog instead of taking up a crazy amount of space.
First thing, I should declare my interests - I am a doctor, though obviously, as a head-shrinker babies and birth are not my forté!
I also have mixed feelings about home births. I find the basic idea very attractive, especially for it's ability to make something so new and scary (when you're having your first, in particular) feel that little bit more comfortable and familiar. But as a medical student doing my obstetrics attachment, I saw a woman nearly die from haemorrhage during childbirth. I don't know exactly what experiences my (also a doctor) husband had, but he is even more wedded to the idea of a hospital birth than I am. This isn't universal - some of our medic friends recently had home births, so it's clearly a personal thing.
The thing is, reading blogs and birth stories set in the US, hospital births *do* sound atrocious. The business model on which things are run there is set up so that more procedures and interventions pay better, and then there is the huge risk of litigation. Over here in the UK, the most cost-effective outcome for the NHS *is* natural childbirth. Women who have no drugs or interventions save the government money. I think this idealogical difference must be responsible to a great extent for the difference in hospital births as I experienced it here (watching), and as I read about them in the US.
Here, even if you choose to go with a consultant led service instead of a midwife led one, midwives run all the maternity units, as far as I can tell. Doctors are around in the medical units, but in both of them, are only called on for emergencies. They *never* routinely deliver. I never saw women being told to get into the lithotomy position to push - I delivered one baby from a mother kneeling on all fours, another in water, and so on - and I wasn't based in any 'special' unit, just your average small town hospital. I'm sure I remember being encouraged to eat so they'd have energy to labour. People were allowed to get on with things. If anything, unless you brought your own cheering section, women could be abandoned a little during those long hours of contractions before the pushing bit, due to occasional staff shortages, but there was never an attempt to 'hurry' anyone, or intervene unless it was medically necessary.
All in all, I thought the hospital experience here looked quite positive. Clearly, it may vary from one place to another, and I don't know what my local unit is like. Despite now living spitting distance from the hospital where my training was based, I did my maternity placement in a different hospital, so I'll have to see how I like it when the time comes. And I have a huge beef with the use of CTG (fetal heart monitoring) in hospitals in general, as the evidence for it is dubious. But yeah, like you I think hospital births don't only deserve a bad reputation in general. At least, not in Quebec and the UK. :)
The hospital where I had my 1st wasn't as great as yours (not all rooms were private, no double bed, etc.--actuelly I'm really wondering what is that great hospital of yours!), but I, too, can't complain at all about how it went. After reading "horror" stories, I was expecting that I'd have to argue to, for example, eat during labor, but no, the nurses warned me that it increases the chance of throwing up during labor and recommended to eat just a little at a time (and I appreciated the warnings), but never forbid it and I ate. I was also prepared to argue to get skin-to-skin contact with my baby right after birth and have procedures delayed, but I didn't even had to say a word and my baby was on my chest seconds after he was born. And so on. So I, too, chose to return to the same hospital for my 2nd baby!
In my mother's family, I also have an aunt who almost died along with my cousin while giving birth--and that was in 1994, not in the 1950s or 1970s! Plus, P. has been working in hospitals for years and has heard of all the rare complications, some of them have even happened to his coworkers, so for him safety is even more important than for me. I totally undestand you on that one. I hate it when proponents of natural childbirth dismay risks and tests--risks DO exist and test ARE useful to detect anomalies or rule them out.
There are still things that could be improved in most hospitals, even here in Quebec and even when they are officially "Baby-Friendly". For example, they could hire real breastfeeding experts or make sure the maternity's nurses have an appropriate training on breastfeeding, because this varies from one nurse to the other and is often more influenced by their own personal experience than anything else. But overall, my experience of giving birth in an hospital was a good one.
I've had friends deliver in a hospital. They were happy with the experience, using a doula and a doctor! I've had friends use the convention doctor in a hospital approach. I've had friends have very healthy babies.
I realize a home birth can be very safe.
But I'm with you: if anything should go wrong, I want the medical facilities near by.
Ultimately, I believe it's the parents' choice, but I believe the choice should be an informed choice based of facts, not fear. And I mean that in the best possible way.
It really is shocking how bad the situation is in many US hospitals. I find it hard to believe, in 2010, that there are hospitals that still take newborn babies to nurseries as standard. Not to mention inducing because the doctor's about to go on holiday, performing episiotomies etc. The Business of Being Born (DVD and book), plus Misconceptions, and perhaps some other things I read (can't remember now) made me feel very lucky to live here in UK, where we have midwife-led care as standard.
The statistic about 1 in 4 babies not surviving birth as recently as our grandparents' time really illustrates how far things have come.
Obviously I considered things very carefully before deciding to have a homebirth. I was reassured that midwives monitor you very closely throughout the labour and in the vast majority of cases where there are problems, these present themselves before we find ourselves in an emergency situation. Homebirth midwives are on high alert and will have that ambulance there within minutes of any suggestion that everything is not going 100% to plan. For my decision, I factored in how far we are from the local hospitals, and how quickly an ambulance would get me there in case of emergency. Apparently we would get to the hospital in about the same time it would take for the theatre to be prepped for surgery. That was good enough for me.
Of course there are cases where things go wrong right at the last minute. It's exceedingly rare, but it happens. Each of us has to make the decision whether it's worth taking that risk, weighed up against our own perception of the risks/disadvantages of being in hospital.
It sounds like you are very lucky to receive such excellent care there. Reading this post, it crossed my mind that I would most probably have chosen a hospital birth if that was the care available to me. I remember you writing about the great experience you had with LP - I hope this one is just the same or even better!
First congrats on your second little one! Second, thanks for all of the information, esp. about the "baby friendly" certification. I'm not family planning yet, but that will come sooner than later.
Thanks for stopping by my blog too. Drop by if you ever want to talk fashion and decor again!
I totally agree with your point of view and I will add my own. I felt a lot of guilt after my own c-section: as if I had given up. And I think if I was to be given a "do over" I would not let them induce me until I was at least a week past my due date, advanced maternal age be damned. But I don't understand the desire to be home while giving birth.
At home with all my crap all over the place, worrying about whether the cat was going to come in while I'm laboring and who was going to do the dishes?
I was very happy to be in a hospital where my meals were brought to me and my bed adjusted with a button. The nurses were AWESOME! I loved them. They didn't push anything on me and were supportive of my breastfeeding wishes. Since I had a c-section, Michael couldn't stay in the room with me if I was sleeping and no one else was there, but you know what? It was fine.
I would have stayed 3 weeks if they had let me. Michael was born in the winter, so it was bad enough being stuck at home after he was born.
stopped by from brandy's blog. she's singin your praises over there, ;)
she's right. great blog! congrats on the baby on the way. all this pregnancy talk, maybe it's time to start begging the hubby. ha.
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