Birth centers and Interventions and Midwives--Oh My!
You may or may not already know this, but Phil and I are not planning to have our baby in a hospital. We're planning instead to give birth at a birth center--an establishment run by certified nurse midwives who believe in providing women with low-risk pregnancies with a comfortable, homey, "natural" birth experience with as few drugs and interventions as possible.
I'd like to fill you in on why we made this decision, but first: a disclaimer. I understand that this is a really sensitive topic. Most people I've met have been very supportive of our decision, but some have given us "the look", and others have openly expressed their apprehension and disapproval. We know that this isn't the most popular way to have a baby, and we're okay with that. BUT--I realize that this post could be inflammatory for someone who does decide to have their baby in a hospital, and I want to say right off the bat that childbirth is a HUGE deal and can be a scary time--anything that helps a mom to feel safer and more at ease is a good thing in my book! This is just our opinion on what we want for OUR babies. Because it's not necessarily normal, we wanted to share why decided to do things this way and not the usual way. If you've had hospital births or are planning a hospital birth, we want you to know that we mean no disrespect.
Even as a child, long before I was married and thinking about making my own babies, I was interested in hearing the birth stories of the ladies closest to my heart--my mom and my grandmother. (Of course, at the time I was convinced I would NEVER HAVE A BABY EW.) My mom had four babies, and of the four I was the most difficult (anyone who knows me will not be surprised by this). I was the first, and I was in a less than ideal position (now I know it as "posterior"). My poor mother labored for about 24 hours before being taken in for an emergency C-section. She had all of her babies at Beth Israel hospital in Boston, one of the best in the world.
My grandmother has a pretty different story. For at least two of her births, she was a Navy wife. I'm not even sure if she was stationed in the same state for both births, but what I do know about her experience is that the Naval hospital(s) she delivered in were no Beth Israel. She was given the bare minimum in terms of interventions. Because of this, she was not offered Thalidomide at a time when many were, and her babies were born without defect. Because of this, she was left alone to bond with her baby immediately after birth, instead of having baby taken down the hall to the nursery and left in a bassinet. Because of this, she breastfed, at a time when it was not a popular or widely endorsed method of feeding baby. I remember my mom telling me these stories and expressing how lucky she and her brother were that they had not been born in a fancy hospital in the 1960s, where nurses and doctors could have unintentionally done more damage than anything else.
Fast forward to 2016. Childbirth in a hospital is infinitely safer in the 2000s than it was in the '60s, or even the '80s--right? Well, as it turns out... this might not actually be the case. Again, I mean no disrespect to nurses, doctors, or anyone who chooses to give birth in a hospital. It's just that if you do enough research and collect data from as many sources as possible, you will learn some alarming things. For example, if you look at a list of the maternal mortality rates for 2010, you'll see that the United States has about 21 deaths for every 100,000 live births. We are tied with Iran. Bahrain, Turkey, Serbia, and Kuwait have lower death rates than we do here in the United States. Estonia, Greece, and Singapore have the lowest maternal mortality rates in the world. Source
Why are our mothers dying at such alarming rates if we have one of the best healthcare systems in the world? I assume that it must have something to do with "the cascade of intervention". This is an expression that describes how one medical procedure may lead to more interventions and so on and so forth until the process is completely out of the mother's control and she is going into an emergency C-section which may not have been necessary at all. (See: Sky High C-Section Rates in the US Don't Translate to Better Birth Outcomes) And because a C-section is a major surgery while vaginal delivery is not, complications are much more common. C-sections that aren't actually an emergency may be what is contributing to the rising mortality rate among mothers in the U.S.
Even more concerning to me than anything else that I came across in my research was this: a LOT of the things that doctors and nurses do to laboring women and babies are not evidence based. Meaning that there has been little to no research saying that these procedures are healthy or safe for mom or baby. In fact, there may actually be more research indicating that some procedures are more harmful than beneficial! Take continuous electronic fetal monitoring, for example. This is a procedure done in a hospital where a belt is strapped across mom's belly to continually monitor the baby's heart rate on a screen. The catch is that mom has to lie still on her back in bed or else the belt can't get an accurate reading (in my research I have also found that this is the position least conducive to giving birth). There is also another type of EFM that is done internally--meaning through a sharp pin that is stuck into your baby's head while he/she is coming down the birth canal! And why do we do this--stick pins in our babies' heads and strap our moms down to tables so that they can't get into a proper position for an easy labor? Is continuous EFM really that much better than checking the baby's heart rate with a doppler periodically during labor to make sure he/she is doing ok? According to the Journal of the Royal Society of Medicine, "the existing randomized controlled trials (RCTs) can not rule out the possibility that mortality is lower with continuous fetal heart rate monitoring than with intermittent auscultation" Source. So... no. Really, it's not. And while continuous EFM doesn't lead to better outcomes for baby than intermittent monitoring, what it does lead to is... yup... more C-sections.
Even scarier than EFM is a drug called Cytotec that's being widely used today to induce labor. If you've never heard of it, here's a definition that I found on the website of a law firm that you can use to sue for birth injury reparations if your doctor used Cytotec and something went wrong: "Cytotec (also known as misoprostol) is a drug approved for gastric ulcer treatment. It is also very popular among obstetricians for the off-label use of labor induction. Cytotec ripens the cervix (thins it out or causes effacement) and promotes contractions. The problem with using Cytotec off-label for labor induction is that scientific evidence has shown there are serious, often fatal, risks associated with its use" Source Again--why would a doctor use something that is NOT approved by the FDA for use in that manner, AND that has serious and fatal risks associated with its use? This is quite the opposite of evidence-based care! Not only that, but that little blurb on Cytotec sounds terrifyingly similar to this one: "In a post-war era when sleeplessness was prevalent, thalidomide was marketed to a world hooked on tranquilizers and sleeping pills...Australian obstetrician Dr. William McBride discovered that the drug also alleviated morning sickness. He started recommending this off-label use of the drug to his pregnant patients, setting a worldwide trend. Prescribing drugs for off-label purposes, or purposes other than those for which the drug was approved, is still a common practice in many countries today, including the U.S." Source
I could go on and on about the different interventions and why a lot of them do more harm than good, but I think that's quite enough of that. You get the picture. You could understand why, after seeing some of that information, I would be more scared of being induced with Cytotec than I would be of delivering my own baby at home in the bathtub, right?! A lot of the information out there is just so, so scary. But to be honest--I'm really not that scared to have this baby (especially now that I've found a place where the doctors are only going to be called in the case of a real emergency!) because I've been learning other things in my research that are extremely comforting. Famous midwife Ina May Gaskin's book Ina May's Guide to Childbirth taught me so many amazing things about a woman's body that are not commonly spoken about in the medical world. So many things about childbirth that seem like they could be medical emergencies are just things that nature can actually handle just fine on her own. For example, did you know that a lot of women have scheduled C-sections because ultrasounds show that their babies are too big for their pelvis? Ina May Gaskin writes that nature is smarter than that, and that there is almost no chance of a woman making a baby that is impossible for her to birth. Coincidentally, my research on that topic led me to this little gem: "Only one in five of the women told their baby might be too big actually went on to deliver a big baby, according to the Boston University study, which was published recently in the Maternal and Child Health Journal. As for what was "too big"? That was defined as 8 lbs., 13 oz., which is a typical definition for macrosomia." Source (Let me just pause here to point out that my amazing sister in law just birthed a 9lb 10oz baby without any drugs or tearing in about four hours at her birth center. And the medical community is trying to tell us that a baby that is almost a full pound less than that is too huge to deliver without intervention!)
There are other things that I've learned about as well that have given me great comfort and really reinforced my decision to birth out of hospital-- like the fact that I won't have to follow the old hospital rule of no eating or drinking during labor, another silly thing with absolutely no scientific reasoning behind it. (Decades ago this rule was made to prevent aspiration in the event of an emergency C-section, because women were put completely under in those days. This doesn't happen anymore, yet the no eating rule lives on). Being able to eat and drink during labor will allow me to avoid getting an IV (unless I'm GBS positive or in case of emergency) and may give me more energy to birth baby naturally even in the face of a long labor--yay! And speaking of long labors, did you know that epidurals can actually make labor last longer? "Although it was thought that epidurals lengthen labor by about one hour, the researchers found that women who had epidurals actually took two to three hours longer to get through the second stage of labor, compared with women who hadn't received this pain medication, according to the study, published today (Feb. 5) in the journal Obstetrics & Gynecology." Source So that's two to three fewer hours until we can meet our baby!
Additionally, laboring at the birth center, which is basically like giving birth in a bedroom with a giant in-room jaccuzzi tub, will allow me to move around and get into whatever position my body feels most comfortable in. This will not only help with the pain, but moving around and changing positions during labor has been proven to be better than the on-the-back-in-stirrups position that is adopted in most hospitals. "Researchers hypothesize that pushing in an upright position is beneficial for multiple reasons. In an upright position, gravity can assist in bringing the baby down and out. Also, when a woman is upright, there is less risk of compressing the mother’s aorta and thus a better oxygen supply to the baby. Upright positioning also helps the uterus contract more strongly and efficiently and helps the baby get in a better position to pass through the pelvis. Finally, X-ray evidence has shown that the actual dimensions of the pelvic outlet become wider in the squatting and kneeling/hands-knees positions (Gupta et al. 2012)." Source
Now, all that being said (and trust girl, there was a LOT more research that was way too extensive and boring for me to include here, but that all points in the same general direction) almost all of the interventions I've researched are there for a reason. There is no shame in having had any of these things done to or for you. They are available because some people really need them! The thing that's not so great is when interventions are used on people who don't really need them, and that is what I'm trying to avoid by birthing out of hospital. In my mind, it's like when you go to the doctor and you have a virus but they prescribe you antibiotics. This is actually doing you more harm than good in your situation--even though antibiotic have saved many lives and are a great thing to have in case you actually really need them!
And THAT being said--although I am dying to give birth in that king sized bed (or, even better, in that giant Jacuzzi tub) at the birth center, and although I am mentally determined to do so without the use of an epidural--I am open to the idea of having our birth experience go in a different direction. When you're having a baby, you have to have an open mind, because anything is possible! Or at least, that's what I've been told! Also, quite unfortunately, the birth center we've chosen is currently understaffed and won't be open on the weekends for the foreseeable future. That means that if we go into labor on a Saturday night, we'll have to give birth at the hospital (but with our midwives attending. No giant bed or swimming pool sized tub, but we'll at least still be supported by professionals who believe in evidence-based birthing.)
So now you have an idea of why we're doing what we're doing--and hopefully we'll be able to actually do it!!
I'd like to fill you in on why we made this decision, but first: a disclaimer. I understand that this is a really sensitive topic. Most people I've met have been very supportive of our decision, but some have given us "the look", and others have openly expressed their apprehension and disapproval. We know that this isn't the most popular way to have a baby, and we're okay with that. BUT--I realize that this post could be inflammatory for someone who does decide to have their baby in a hospital, and I want to say right off the bat that childbirth is a HUGE deal and can be a scary time--anything that helps a mom to feel safer and more at ease is a good thing in my book! This is just our opinion on what we want for OUR babies. Because it's not necessarily normal, we wanted to share why decided to do things this way and not the usual way. If you've had hospital births or are planning a hospital birth, we want you to know that we mean no disrespect.
Even as a child, long before I was married and thinking about making my own babies, I was interested in hearing the birth stories of the ladies closest to my heart--my mom and my grandmother. (Of course, at the time I was convinced I would NEVER HAVE A BABY EW.) My mom had four babies, and of the four I was the most difficult (anyone who knows me will not be surprised by this). I was the first, and I was in a less than ideal position (now I know it as "posterior"). My poor mother labored for about 24 hours before being taken in for an emergency C-section. She had all of her babies at Beth Israel hospital in Boston, one of the best in the world.
My grandmother has a pretty different story. For at least two of her births, she was a Navy wife. I'm not even sure if she was stationed in the same state for both births, but what I do know about her experience is that the Naval hospital(s) she delivered in were no Beth Israel. She was given the bare minimum in terms of interventions. Because of this, she was not offered Thalidomide at a time when many were, and her babies were born without defect. Because of this, she was left alone to bond with her baby immediately after birth, instead of having baby taken down the hall to the nursery and left in a bassinet. Because of this, she breastfed, at a time when it was not a popular or widely endorsed method of feeding baby. I remember my mom telling me these stories and expressing how lucky she and her brother were that they had not been born in a fancy hospital in the 1960s, where nurses and doctors could have unintentionally done more damage than anything else.
Fast forward to 2016. Childbirth in a hospital is infinitely safer in the 2000s than it was in the '60s, or even the '80s--right? Well, as it turns out... this might not actually be the case. Again, I mean no disrespect to nurses, doctors, or anyone who chooses to give birth in a hospital. It's just that if you do enough research and collect data from as many sources as possible, you will learn some alarming things. For example, if you look at a list of the maternal mortality rates for 2010, you'll see that the United States has about 21 deaths for every 100,000 live births. We are tied with Iran. Bahrain, Turkey, Serbia, and Kuwait have lower death rates than we do here in the United States. Estonia, Greece, and Singapore have the lowest maternal mortality rates in the world. Source
Why are our mothers dying at such alarming rates if we have one of the best healthcare systems in the world? I assume that it must have something to do with "the cascade of intervention". This is an expression that describes how one medical procedure may lead to more interventions and so on and so forth until the process is completely out of the mother's control and she is going into an emergency C-section which may not have been necessary at all. (See: Sky High C-Section Rates in the US Don't Translate to Better Birth Outcomes) And because a C-section is a major surgery while vaginal delivery is not, complications are much more common. C-sections that aren't actually an emergency may be what is contributing to the rising mortality rate among mothers in the U.S.
Even more concerning to me than anything else that I came across in my research was this: a LOT of the things that doctors and nurses do to laboring women and babies are not evidence based. Meaning that there has been little to no research saying that these procedures are healthy or safe for mom or baby. In fact, there may actually be more research indicating that some procedures are more harmful than beneficial! Take continuous electronic fetal monitoring, for example. This is a procedure done in a hospital where a belt is strapped across mom's belly to continually monitor the baby's heart rate on a screen. The catch is that mom has to lie still on her back in bed or else the belt can't get an accurate reading (in my research I have also found that this is the position least conducive to giving birth). There is also another type of EFM that is done internally--meaning through a sharp pin that is stuck into your baby's head while he/she is coming down the birth canal! And why do we do this--stick pins in our babies' heads and strap our moms down to tables so that they can't get into a proper position for an easy labor? Is continuous EFM really that much better than checking the baby's heart rate with a doppler periodically during labor to make sure he/she is doing ok? According to the Journal of the Royal Society of Medicine, "the existing randomized controlled trials (RCTs) can not rule out the possibility that mortality is lower with continuous fetal heart rate monitoring than with intermittent auscultation" Source. So... no. Really, it's not. And while continuous EFM doesn't lead to better outcomes for baby than intermittent monitoring, what it does lead to is... yup... more C-sections.
Even scarier than EFM is a drug called Cytotec that's being widely used today to induce labor. If you've never heard of it, here's a definition that I found on the website of a law firm that you can use to sue for birth injury reparations if your doctor used Cytotec and something went wrong: "Cytotec (also known as misoprostol) is a drug approved for gastric ulcer treatment. It is also very popular among obstetricians for the off-label use of labor induction. Cytotec ripens the cervix (thins it out or causes effacement) and promotes contractions. The problem with using Cytotec off-label for labor induction is that scientific evidence has shown there are serious, often fatal, risks associated with its use" Source Again--why would a doctor use something that is NOT approved by the FDA for use in that manner, AND that has serious and fatal risks associated with its use? This is quite the opposite of evidence-based care! Not only that, but that little blurb on Cytotec sounds terrifyingly similar to this one: "In a post-war era when sleeplessness was prevalent, thalidomide was marketed to a world hooked on tranquilizers and sleeping pills...Australian obstetrician Dr. William McBride discovered that the drug also alleviated morning sickness. He started recommending this off-label use of the drug to his pregnant patients, setting a worldwide trend. Prescribing drugs for off-label purposes, or purposes other than those for which the drug was approved, is still a common practice in many countries today, including the U.S." Source
I could go on and on about the different interventions and why a lot of them do more harm than good, but I think that's quite enough of that. You get the picture. You could understand why, after seeing some of that information, I would be more scared of being induced with Cytotec than I would be of delivering my own baby at home in the bathtub, right?! A lot of the information out there is just so, so scary. But to be honest--I'm really not that scared to have this baby (especially now that I've found a place where the doctors are only going to be called in the case of a real emergency!) because I've been learning other things in my research that are extremely comforting. Famous midwife Ina May Gaskin's book Ina May's Guide to Childbirth taught me so many amazing things about a woman's body that are not commonly spoken about in the medical world. So many things about childbirth that seem like they could be medical emergencies are just things that nature can actually handle just fine on her own. For example, did you know that a lot of women have scheduled C-sections because ultrasounds show that their babies are too big for their pelvis? Ina May Gaskin writes that nature is smarter than that, and that there is almost no chance of a woman making a baby that is impossible for her to birth. Coincidentally, my research on that topic led me to this little gem: "Only one in five of the women told their baby might be too big actually went on to deliver a big baby, according to the Boston University study, which was published recently in the Maternal and Child Health Journal. As for what was "too big"? That was defined as 8 lbs., 13 oz., which is a typical definition for macrosomia." Source (Let me just pause here to point out that my amazing sister in law just birthed a 9lb 10oz baby without any drugs or tearing in about four hours at her birth center. And the medical community is trying to tell us that a baby that is almost a full pound less than that is too huge to deliver without intervention!)
There are other things that I've learned about as well that have given me great comfort and really reinforced my decision to birth out of hospital-- like the fact that I won't have to follow the old hospital rule of no eating or drinking during labor, another silly thing with absolutely no scientific reasoning behind it. (Decades ago this rule was made to prevent aspiration in the event of an emergency C-section, because women were put completely under in those days. This doesn't happen anymore, yet the no eating rule lives on). Being able to eat and drink during labor will allow me to avoid getting an IV (unless I'm GBS positive or in case of emergency) and may give me more energy to birth baby naturally even in the face of a long labor--yay! And speaking of long labors, did you know that epidurals can actually make labor last longer? "Although it was thought that epidurals lengthen labor by about one hour, the researchers found that women who had epidurals actually took two to three hours longer to get through the second stage of labor, compared with women who hadn't received this pain medication, according to the study, published today (Feb. 5) in the journal Obstetrics & Gynecology." Source So that's two to three fewer hours until we can meet our baby!
Additionally, laboring at the birth center, which is basically like giving birth in a bedroom with a giant in-room jaccuzzi tub, will allow me to move around and get into whatever position my body feels most comfortable in. This will not only help with the pain, but moving around and changing positions during labor has been proven to be better than the on-the-back-in-stirrups position that is adopted in most hospitals. "Researchers hypothesize that pushing in an upright position is beneficial for multiple reasons. In an upright position, gravity can assist in bringing the baby down and out. Also, when a woman is upright, there is less risk of compressing the mother’s aorta and thus a better oxygen supply to the baby. Upright positioning also helps the uterus contract more strongly and efficiently and helps the baby get in a better position to pass through the pelvis. Finally, X-ray evidence has shown that the actual dimensions of the pelvic outlet become wider in the squatting and kneeling/hands-knees positions (Gupta et al. 2012)." Source
Now, all that being said (and trust girl, there was a LOT more research that was way too extensive and boring for me to include here, but that all points in the same general direction) almost all of the interventions I've researched are there for a reason. There is no shame in having had any of these things done to or for you. They are available because some people really need them! The thing that's not so great is when interventions are used on people who don't really need them, and that is what I'm trying to avoid by birthing out of hospital. In my mind, it's like when you go to the doctor and you have a virus but they prescribe you antibiotics. This is actually doing you more harm than good in your situation--even though antibiotic have saved many lives and are a great thing to have in case you actually really need them!
And THAT being said--although I am dying to give birth in that king sized bed (or, even better, in that giant Jacuzzi tub) at the birth center, and although I am mentally determined to do so without the use of an epidural--I am open to the idea of having our birth experience go in a different direction. When you're having a baby, you have to have an open mind, because anything is possible! Or at least, that's what I've been told! Also, quite unfortunately, the birth center we've chosen is currently understaffed and won't be open on the weekends for the foreseeable future. That means that if we go into labor on a Saturday night, we'll have to give birth at the hospital (but with our midwives attending. No giant bed or swimming pool sized tub, but we'll at least still be supported by professionals who believe in evidence-based birthing.)
So now you have an idea of why we're doing what we're doing--and hopefully we'll be able to actually do it!!
...even push out a giant Rea baby without drugs
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