Tuesday, June 10, 2014

Born in the Wild

"Born in the Wild" segment on the TODAY Show  June 6, 2014

I was ALMOST elated when the video clip (link above) had two hospital professionals stating that home birth (out of hospital birth) can be a safe option for women with no pregnancy complications.  Then the in-person interview/fear campaign began.  I would just like to say that the medical professional that was interviewed...in my humble opinion...was HIGHLY BIASED.  She fervently avoided answering specific questions using hypothetical fears to steer women to the hospital, and there were a few holes in her claims.

First, while the hospital she works at may support women to have freedom of movement and allow for more alternative options (which I'm not sure I believe, she mentioned sitting on the yoga ball on more than one occasion, which is ironic because over an overwhelming majority of women giving birthing the hospital are medicated and would not be able to use it) there are thousands of hospitals that are stuck in high intervention policy and routine procedures that often lead to (some necessary, but MANY unnecessary) cesarean sections.  I'm sick of hospitals painting this rosy picture "we'll follow your birth plan unless there is an emergency" bull when the reality is that as this woman stated, these Obstetricians are surgeons.  Nice to have as a back up safety net, but a fundamental problem with hiring a surgeon to deliver your baby is that they like to perform surgery, at the very least they are not fundamentally opposed to or at odds with the practice.  That's why they entered into a profession that requires surgical training.  That doesn't happen accidentally, it takes a very specific skill set, and a very specific way of looking at the human body to be able to do that kind of work.  It is miraculous, when necessary, and flagrantly irresponsible when it isn't necessary.  Obstetricians are also working closely together with their buddies...the anesthesiologists...and they support one another.  There is some truth to the dramatic medical tv shows, kind of an ugly truth, they want to intervene.  They want to use their skills and training. They are specifically trained to hunt for reasons to need to intervene, it is in their nature to manage labor.  Years of heavy training followed by years of practice are not going be undone by a silly birth plan. You can see by the comments listed in the link below, how various professionals feel about birth plans:
Midwives tend to believe that they offer what a woman who would write a birth plan wants anyway, rendering the birth plan relatively unnecessary...with exception to very specific circumstances.  Nurses often feel that the birth plan is a patients way of telling them how to do their job and find it offensive, or feel that women who are too opinionated about their care require counseling.  OB's are "ok" with birth plans as long as they are given the power to overrule any element which they find inconvenient or unreasonable.  The overall take away from this simplified, fluff piece, is that in-hospital staff are more likely to blatantly disregard your plan due to personal/emotional feelings and beliefs about being told how to do their job, making it very important to either: A. Know how to effectively advocate for yourself in a medical environment, or B. Bring an experienced Doula/advocate with you to make sure all your questions are being asked and answered and that you are being respected, within the parameters of safety of course.  No one is interested in taking unnecessary risks with the health and well being of themselves or their baby, you may just have a difference of opinion about what that means exactly.

Second, this woman made it seem as if there is NO recourse if a woman, or baby, who had an uncomplicated prenatal course, begins to show some sign of distress during the labor process outside of the hospital. Most midwives operate under a very conservative liability umbrella and have no interest in keeping you at home or in their birth center if there are signs that it may not be the safest option for you. They often have relationships with area OB's and in hospital midwifery and can transport in to the hospital before there is an emergency situation.   An expecting family should rigorously interview any out of hospital health care professional they may hire to support them through this process, and the interview should include the following questions.
  • Do you have a positive professional relationship with area hospitals that you prefer to transport to in a non-emergent situation?
  • Do you have a positive professional relationship with the nearest hospital that provides obstetric care in the event of an emergency?
  • Do you stay with your clients if a transport becomes necessary?
  • What are the circumstances of non-emergency transports in your experience?
  • What kinds of emergencies have you managed and what were the outcomes?
  • What is your current rate of transport?
  • What are the most common reasons to move to the hospital?
Third, the implication that being at a hospital guarantees your safety or your baby's safety is ludicrous.  I have seen many women come home after a questionably necessary cesarean and have significant health and wellness challenges, including infection at the surgical site, fever, challenges nursing, mastitis, discomfort following major abdominal surgery, difficulty caring for baby in the first few days, overuse of pain meds, underuse of pain meds, and a range of postpartum mood disorders to name a few. In addition, every single one of the "bad outcomes" I have witnessed have taken place inside the hospital walls.  Not during "emergencies" either. The circumstances of most of these births would not likely have changed if those women had been laboring in the woods, and there is strong evidence to support that hospital policy and procedure was the cause of one. That doesn't mean it's always true, those are just my experiences and I understand and take responsibility for the fact that it may bias my own position.  The truth is that there really are no guarantees, and though there are certainly women and babies who benefit from life saving medicine and surgery, there are also women and babies who suffer from the overuse of it, perhaps not fatally, but having short or long term effects from procedures and chemicals is a significant factor, especially if it could have been avoided.  If you are planning a birth in the hospital, be very wary of the "safety sales pitch".  Often women and babies are being rescued from problems that would not have existed without previous interventions, and consider the fact that they have a legal department that protects them and that their statistics may not be what they may lead you to believe. Bad outcomes happen, they are just undisclosed, and no one asks because we don't really want to know.  It's scary to accept that there are no guarantees.  Just as I stated above regarding out of hospital inquisition...the Obstetrician(s) you interview (usually at your expense since OB's don't generally offer a meet and greet) should include the tough questions as well. You're paying for it, make it worth your time and money.
  • What is your rate of cesarean section? (if greater than 15-20%, you should interview more providers, could save you TENS OF THOUSANDS later)
  • What percentage of those would you consider to be medically necessary, meaning that the benefit of the surgery outweighed the risk of it.
  • What do you consider the risks of cesarean to be?
  • Why do you think the national average of surgical birth is so high?
  • Under what circumstances precisely would I risk out of a vaginal birth under your care?
  • Will you actively support low-no intervention when there are no complications present?
  • What is your professional and personal opinion about women who want to take part in the decision making process and do not accept routine interventions blindly?  What if I ask a lot of annoying questions? What is your opinion about birth plans? Doula's? Informed Consent practices? Women who believe that they're the expert on their own bodies and want to collaborate with your expertise in medicine? 
To wrap this up neatly with a bow, I am not for or against home, birth center, or hospital deliveries, I have seen plenty of beautiful births in all 3 birth environments.  I am PRO-respect.  I am PRO-informed consent.  I am PRO-individualized care.  I am PRO-kindness.  I am PRO-education.  I am PRO-advocacy.  I am PRO-support.  I am PRO-wellness; physical, mental, and emotional.  When all of these things are put together and a woman has a beautiful home birth....OR....all of these things are put together and an intervention is chosen for the health and wellbeing of mom and baby, it is a success.  It is a beautiful birth.

For a great little read to prove that I honestly support thoughtful, conservative care that looks at the broader implications of a woman's birth experience and how it may impact her health and wellness, check this link.  I am PRO-this:

I wil be speaking tonight at the Bellevue, Wa location of Babies R Us on the subject of "Birth Plans".
Please call to register!

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