Tuesday, November 18, 2014

Ode to Mayim Bialik by Kind Birth, Kristin Dibeh


As I patiently await a planned home birth...little one is taking her sweet time...I was drawn to read this article again.  There is something special about it.  I don't disagree with a single word in this piece, so I want to share it widely.  Additionally, for my two cents, I am going to respond to the same myths, from the Doula perspective.

Births need a hospital. 
The simple answer for me is, "No, they don't".  Babies come out..I swear I could write a birth edition of Dr. Suess's "Green eggs and ham".
"I will birth them over here, I will birth them over there.  I will birth them anywhere.  I will birth them on a boat, I will birth them while I float.  I will birth them in the night, I will birth by candle light.  I will birth them in a bed, I will birth them with no med.  I will birth them standing tall, I will birth them on a ball.  I will birth them in the day, I will birth them my own way."
Honestly, I could go on and on for a LONG TIME.  Babies come out, on their own, almost all the time.  If there is some complication that is making it difficult for your baby to find it's way, then a trained midwife will recognize the signs and symptoms and THEN either guide you to assist your baby using positions and their skill, or they will take you to the hospital where they may need to intervene.  Going to the hospital "just in case" is like taking your car to the shop just in case something might be wrong with it...no reason to suspect, no noises, no lights on the dash, just worry.  You know that every time they tinker around in there, there is a risk that something else will come up.

Interventions may be necessary.
Yeah....so what?  Most interventions though, become necessary because of non-essential routine procedures that make progress in labor challenging.  Again, as I stated above, your midwife is trained to recognize complications that may require intervention...and you would "risk out" of their care if there were any known indications of a complication prior to your labor anyway.  The home birth option would be off the table if it wasn't considered to be safe.  Now let's talk about what it looks like if you are in a hospital and some kind of intervention becomes necessary.  I'm sure what you imagine looks something like what you might see on a medical show, like "Grey's Anatomy" or maybe "The Mindy Project".  Everyone is ready for an emergency cesarean, instantaneously.  They make it seem as if the OR staff is always scrubbed up and standing around the table in the OR, just in case someone might need them.  The reality is very different.  There is a lot of waiting.  The nurses are often communicating via phone with the doctor and many times I don't see a doc (other than an periodic pop in) until the baby is actually crowning.  If some intervention becomes necessary, the nurse communicates with the doctor.  If it is  non-emergent intervention, catheter, IV, pitocin, pain management, etc. then either the nurse performs it, or we wait for the appropriate specialist.  IF there is some real concern about Mom or baby that requires an immediate transport to the OR, it really doesn't look much different in or out of hospital.  They are not standing, scrubbed in, around the table in the operating room.  So in hospital...mom is being attended to in her L&D room until they are ready, then we transport down the hall and mom goes in first for "prepping", administering or adjusting the pain medications at the appropriate doses...not the same for general pain management in labor... and then the procedure begins.  If we are out of hospital and an urgent need arises to bring the baby into the world sooner, then mom is attended by her midwife during the transport, usually via ambulance, and the OR team is getting their theatre set while we are in route.  We would then arrive and go through a quick triage and then off to the OR...if they think it's necessary.  I often find that even in situations where I am confident that a cesarean will be performed upon arrival, the obstetric staff is not as quick to the draw as I had expected.  BECAUSE they have the OR down the hall, they have a ability to watch and see, and I have been grateful for their confidence on many occasions. I have actually never seen a woman be brought in on a home birth transport, and be taken directly to the OR for cesarean.  So long as you live a reasonable distance from a hospital that can provide obstetric care, the reality is that there is a negligible...if any...difference in the amount of time, or the quality of care provided while the OR team assembles and sets the stage for any intervention up to and including cesarean.

What about the pain?
First and foremost, where we ever got the idea that birth should be a pain free experience continues to baffle me.  So let's begin by acknowledging that there will be periods of considerable discomfort and it will, at times, feel overwhelming. I'd like to take moment and tell you why I think it is important. First and foremost, the pain that you experience in labor is  not something that is happening to you...it is OF you, it is the divinely feminine power of YOUR BODY. Motherhood is not an easy job...even under the best circumstances.  It's really hard sometimes.  Knowing that you are tougher than you could have ever known will be important information to have in those moments.  You can look back and remember that in your moments of weakness, that there is a secret place inside where a reserve of strength and resolve lie in wait.  The discomfort you will feel in labor is also informative.  It can tell us a lot about what is happening inside your body, where your baby is, without probing and using machines.
I should also mention that having an unmedicated labor is not just a decision we make.  That would be silly and arrogant.  It is true that some women experience more pain than others. It is also true that some women plan and prepare alternative comfort measures to help get them through those moments of feeling overwhelmed by the physical challenges of labor.  I am not one to stand in judgement, you and you alone have to decide if you can withstand the pain that labor brings.  Having said that, I do not think it is fair to make that decision before you have educated yourself, compiled an arsenal of comfort measures to give labor a solid go of it, and given yourself an opportunity to experience it.  I talk to many women who are very quick to tell me that they "want the epidural in the parking lot".  I don't find this funny at all.  I find it sad.  Learn a few skills, make sure you have someone to guide, support and nurture you, do YOUR PERSONAL BEST (no one can ask for more than that) to try to avoid using drugs that 100%, without a doubt, absolutely, cross the placental "barrier" and will have some effect on your baby, whether or not it is visible at birth.  If you have exhausted all your non medicinal strategies and your pain is not manageable, you will have the knowledge that you gave it your best, and then your pain management becomes medically indicated and not just a punchline.  Don't be a punchline. You are stronger than you realize, and in those moments when you can't see your own strength, there are people out there, Doula's, who are trained to do their best help you see yourself clearly, and also to use: massage, heat, positions, cool compresses, mothering support, and guidance to help you to USE the labor to your advantage. There is one other point I'd like to address regarding home-birth and pain.  When we are at home, and we are well supported and feel safe there, when there is no anesthesiologist present, when a woman knows that she will not have that option, she (hopefully) creates a circle of support around her and actively works at developing skills that help her her to minimize tension, and encourage relaxation.  The art of doing these two things automatically creates a labor that will be LESS painful than it otherwise would be.

What if something goes wrong?
Let me begin here by saying that I am 100% against unassisted home births, and I have refused to provide doula care if a medical professional was not going to be present.  If you have worries about home birth, you interview a skilled midwife.  One with a lot of experience.  Ask her EVERY question you can think of. Not sure what to ask? you can find a thorough list in my book, click here: http://www.expectingkindness.com to get a copy. The liability umbrella of a licensed midwife is conservative, and I recommend that if there are grey areas, or questions regarding yours or your baby's care/wellness, that you additionally consult with a back up OB/Gyn, though your midwife will likely be arranging that for you.  Ideally, midwives will have an established, existing relationship with one or more obstetrician that will give you unbiased information to help you make the right decision for you and your baby.  There is no reason to take any risks just to have a "prettier" birth.  Of course the well being of the Mom and Baby are infinitely more important than geography.  There is always chatter in the obstetric world about the "risks" of out of hospital births, but they are, at the same time, very guarded about the risks of birthing in a hospital.  I'm not going to go into detail, but you can trust me when I tell you that hospitals are definitely not without risk factors.  There are no absolute guarantees that everything will be alright, we don't get that EVER.  You don't get that, and neither do I. That is one of the most challenging elements of parenthood. You can do everything right, follow every rule, go to every appointment, have every test, take every vitamin, eat right, exercise, laugh, play, and there can still be health complications, minor or major.  All we can ever do is our best.  Our best involves being informed.  I hate to see women choose their care provider and their birth place by default or out of fear.  Interview, at least one OB, one CNM (usually practicing in hospital) and one licensed Midwife who attends births at a free standing (not attached to a hospital) birthing center as wells home births.  Ask all your questions and then choose what makes you feel most secure because that sense of security will help you to let your baby be born.

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