Tuesday, September 04, 2007

The Childbirth debate

I've mentioned before and I will continue to mention that I LOVED giving birth. Not the typical reaction to pushing a 7lb object through something much smaller, but really, it was one of the best experiences of my life.

And yet I hear of woman after woman, friend after friend, who did not have anything close to the experience I had. With very little exception, it started with "we went in for an induction", and then went from there.

I am EXTREMELY passionate about this subject, but am afraid to really write what I think. Why? Because I don't want to hurt anyone's feelings or make them feel bad. Childbirth is beautiful, no matter how it happens. The entrance of a child into this world is an amazing event. I also beleive that MOST mothers want to do what's best for their child and believe that the way they are having their child is best. A lot of what I believe boils down to preference for the natural that some people don't have. It's loosely defined as crunchy. (I'm sure I'll define that sometime).

For example...when I look at it if all else was equal...I'd MUCH rather have a natural (read: vaginal) birth than face the major surgery that is commonly referred to as a c-section. Some people, even when knowing the risks and danger associated with such surgeries, would rather have the convenience of it. (I fully realize that some c-sections are essential). I'd much rather have something least invasive, childbirth or not.

Now, I realize that all else is not always equal. Sometimes there are reasons that people NEED a c-section. There are certain situations that prevent a mother from giving birth vaginally. Unfortunately, women today are being told that a c-section is going to be likely necesary as soon as they are pregnant (or shortly thereafter), priming the mother to believe that she will need one before that decision can really be made. Then, as the time comes, the dr. can say "we've been discussing this all along and it seems we were right" and out comes the scalpel.

It seems to me (through my observations and discussions, and experience before the midpoint of my pregnancy) that women are just NOT educated fully on childbirth. But WAIT you say...I took a childbirth class! Yes, you probably did. But with few exceptions, childbirth classes, particularly those put on by hospitals, are designed to prepare the parents to do things the way the hospital wants you to do it to prevent litigation in the future. The more control they have over your birth the more they can say "they did what they could" and it was YOUR fault that things went wrong, if, God forbid something does go wrong. What isn't REALLY taken into consideration, or at least emphasized, is that childbirth has a design. Yes, it is difficult, and there are many theories as to why depending on your belief system. (Not the least of which is the mere physical difficulty in doing what needs to happen to get that baby out!). But childbirth has a way about it that is supposed to happen. The more you interfere with its design, the more complications you cause. This is just logically common sense.

Did you know that the average on-time delivery is after 41 weeks? (I believe it was 41 weeks 3 days, but don't quote me on that one). Wow! Its amazing to think then, that dr.'s start talking induction at 37 weeks. And it keeps getting earlier. There are a wide variety of reasons dr's claim to encourage the mother to induce...not the least of which is that the dr will be on vacation, as if, there is no other dr available that is qualified to catch the baby when it wants to come and instead we must yank it out before hand.

So here is what happens (and I've seen it over and over again in birth stories since I've been looking into the subject)...

Its time for induction (for whatever reason)...

This is done with pitocin (for the most part)...this leads to increased pain!

Pain leads to need for narcotics and/or epidural...this leads to decreased heart rate for mother & baby. Also leads to decreased strength to continue with labor. Typically slows down the process the moment it is administered. Labor Slows.

Labor is not progressing fast enough....we need to...break the water!

Breaking the water increases the labor pains. Does not necesarily increase the speed of delivery. Now the person has 24 hours, at the most, to deliver the baby before the hospital and dr demand to have a c-section due to the risk of a c-section. (Let's remember that we are doing an induction here, which means the baby hadn't started to come yet, which probably means that the baby was not quite ready to make the journey out).

The stress of the forced labor on the baby, along with the drugs, is now showing as 'fetal distress' on the monitoring. The babies heart rate is dropping, so they need to put in an internal monitor to make sure the baby is doing ok (did you know this is done by inserting a screw into the baby's scalp to hold the monitor in place?).

Due to all of this, checks are done frequently, which increases the risk of infection (due to germs being spread from hands/medical equipment inserted in the vagina). This is especially true since the bag of waters (aka...the water) has been ruptured (aka broken) and now the protective fluid that encapsulated the baby previously is no longer in place.

Labor is not progressing as rapidly as it should, and not nearly fast enough to prevent the hospital from being free and clear of litigation if you develop an infection (because, remember, they broke your water and increased the chance of infection). Therefore, it is time for c-section, where they cut through the skin, tissues, and muscles to get into the womb and pull out the baby. Because the baby doesn't go through the birth canal, he/she doesn't get the benefit of the natural suction process that clears the lungs, throat, and nose of fluid (if you haven't seen it, this is an extrememly neat process!).

Not only was the baby not quite ready to come out (or it would have started the process on its own, in the majority of cases), but it was also exposed to higher doses of narcotics and the epidural medicine than the mother (because it hadn't had a chnace to be filtered out by the kidney's yet...the meds are stuck in the babies body), so the baby is lethargic and slow to respond....the baby isn't doing "well" and is immediately take to the NICU or nursery for observations and care.

The mother, gets to see her baby as it is taken away, and now, instead of being able to hold her baby up to her chest (to start initial bonding, which has been shown to both help the mother heal and the baby adjust to the new world), now is faced with healing from a major surgery, unable to walk for at least 24 hours, most likely more, and has to deal with the emotional roller coaster not having her baby with her immediately. Additionally, she is super sleepy fromt he narcotics.

The process was described to me at one point by using the analogy of domino's. Once one is pushed, it leads to knocking down the next, which knocks down the next...in this order:

Continuous electronic fetal monitoring leads to:
inactivity: (the mother can't move around & it seems to show the baby isn't active) leading to:
increased anxiety leading to:
false positive monitor readings (signs of "distress", increased bp, increased heart rate) leading to:
slowed labor which leads to:
artificial rupture of membranes (breaking the water) leads to:
pitocin, since labor has to finish within 24 hours, which leads to:
increased pain, leading to:
medication & anesthesia, leading to:
abnormal fetal heart rate patterns, which leads to:
forceps/vacuum and/or c-section.

Is this process sometimes necesary? Yes. Is it always this way? No...the domino's don't always fall down all the way. Some women have had "fine" births when induced and/or with medications. And this is where I have to concede that there are choices that need to be made by each mother to determine what is best for her and her baby.

I just wish it was done from a fully educated point of view... that they knew that their doctors aren't necesarily telling them the whole truth or what is absolutely best for them (for goodness sake....many dr's now are taught to control the birth, not natural birth progression, so they are less comfortable with natural birth and therefore try to push the control as the "best way"). They also need to know what the procedures are actually doing to them and to their baby. Although it may be relatively safe, it isn't necesairly the "safest" for mom and baby, nor the healthiest.

I try to encourage every mother to REALLY do their research about birth. Women were made with the capability to give birth "naturally"....that is part of the awesome design of the woman!. I have added a few links to my list of links about birthing. Some are a bit opinionated and, well, straightforward, but look into what they have to say. At least maybe that point of view will encourage you to research for yourself the different procedures and options available for birth so you can truly make an educated decision on what your birth should be. Another option is to look up an online birth plan creation tool. Regardless of how you feel about having a birth plan, by looking up the tool it may help you see all the options that are out there, that some people choose, and then you can research for yourself why people choose certain things.

I also found a link to a post from the lactivist...I found this to be a good "middle of the road" opinion for those who want a hospital birth and who aren't necesarily against medication...good information...

Please don't think I'm judging your decisions to give birth the way you have decided. I think the last thing we need in this world is more mothers questioning whether they have made the right decisions ex-post-facto. I'm just trying to promote that there IS a different way.

As I've said before...even though I was in labor for 10 1/2 hours post water breaking (which = hard labor), 2 1/2 days total, I had no medication (other than 40 minutes total of IV with antibiotics for GBS), I was energized after having given birth (and I mean, immediately afterward...), I wasn't at all exhausted, I didn't have to recover from an episiotomy, just small surface skin tears, I was able to nurse my son for 90 minutes before they took him from me to do all his evaluations, I was able to spend one on one time with him within the first hour of his birth, I was able to immediately get up and go to the bathroom, I was able to eat as I pleased. I loved giving birth and can't wait to do it again.

Please let me know how I can help you get information about anything before, during, and after birth. I have a ton of resources (on both sides of the issue)....remember...to me its all about being educated.

1 comment:

Candice said...

Love this Marie! I feel the same way. I would be pregnant and give birth 20 more times if I could! I wasn't as educated as I am now when I had Emily but I new I DIDN'T want a c-section and I would do everything I could not to have one. I am lucky that everything went well. BTW, I LOVE your blog.