Improving the birth experience

I’m not one of those granola women who avoided hospitals and medical interventions during labor. But I was (and still am) a big believer that birth is a natural process, which sometimes gets treated like an illness by the medical profession. I chose to give birth to Monkey in a hospital, in case – God forbid – something happened, but I made it clear that I wanted Monkey’s birth to be as natural as possible. As a result of my preparedness and support system (a doula), interventions weren’t proposed until my labor stalled and I started asking questions. And I was offered an epidural only after muttering my safe word to Hubby (since breaking my water also led to hell breaking lose throughout my body). In spite of the fact things didn’t go the way I planned, I was clearly in charge of how I was treated during labor. And I like being in charge.

After Monkey was born and the doula left, that “in charge” feeling quickly faded. Monkey had trouble clearing out all of the fluid in his lungs and wasn’t crying as loudly as the nurses would have liked. So I barely had a chance to let him latch on to nurse before they took him away. For most of his first hours, I wasn’t allowed to hold my baby boy. Instead, he was in a crib surrounded by nurses and Hubby, where I could barely see him. It was upsetting, and I now wonder if this separation contributed to problems breastfeeding and postpartum depression. The next couple of days of my stay, I was bombarded by doctors, nurses, and a plethora of specialists, each directing me how to best take care of my baby, and some of whom were quite rude. In spite of their helicoptering and my constant requests, I was allowed to leave the hospital without being given the all-important TDaP vaccine. To say the least, I wasn’t impressed with the hospital experience at all, post-Monkey’s birth.

This past weekend, Hubby and I watched a documentary called “The Business of Being Born“, a scathing assessment of what was referred to as the birthing industry. I was uncomfortable watching it, partly due to the fact that Ricki Lake give birth in a bath tub (the images from which may never be wiped from my memory), and partly because home births were pushed so strongly. I believe properly-trained certified nurse midwives can direct many births, without the use of heavy medical interventions that often drive up the cost of delivery. And I don’t like how often cesarean sections occur, especially when due to convenience rather than medical necessity. But do we really want to go back to a time when women and newborn babies lacked the medical treatment they need?

IMO, there’s a more realistic solution that should be considered. We should depend more on certified nurse midwives, in hospitals, for uncomplicated pregnancies. And more hospitals should employ doulas, or some sort of support personnel, to guide women through the birthing process AND postpartum period. These measures are common in other countries, which (according to the documentary) have better rates of maternal and baby survival at much less cost. Furthermore, studies in the US have determined that the presence of a doula is correlated with less intervention and lower rates of cesarean section (ie, lower cost). In the midst of rising health care costs, this might be a good time to consider a safe, practical, and cost-effective middle ground for childbirth, if only we can remember how to compromise.

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26 thoughts on “Improving the birth experience

  1. finally a thoughtful post on this issue! I'm still so angry at DrugMonkey's and generepairs rants against midwives that I haven't been able to post my own personal experience or why there needs to be a change in the how birthing the medical community, which despite its many improvements is very paternalistic

  2. Agreed 100%.

    I would like nothing more than to be able to give birth like my mom did when my sister was born, in a hospital, with a CNM, and me at age 6 in the room. I wonder if you can still do that in Santa Barbara or if that ability is gone even there.

    Right now the choices are GP (since my OB/GYN moved to New Zealand and there isn't another GYN in town I trust… they're all c-section and episiotomy happy) in a hospital without my son or a homebirth with a CNM. None of the hospitals in town take CNM, except occasionally the HMO, but right now they don't have one on staff. And most of the HMO doctors have high c-section rates.

    Also really disliked DrugMonkey's post on the subject (though I think my scathing rebuttal got eaten by her spam filter). I don't understand how some women can take other people's birthing/parenting choices as an indictment of their own. I don't care one whit whether or not she had an epidural, but I'd prefer not to be castigated for not having one myself.

    I actually stayed at home too long doing home labor– almost gave birth in the toilet, but my doula and DH got me to the hospital on time, though not pushing when I wanted to but the OB wasn't there hurt more than any other part of labor (finally the nurse said I could push as soon as she got her gloves on). Next time I'll know that that constipated feeling is not having to use the restroom… Actually next time I've been told I'm not allowed to labor at home since labor is likely to be very short as the first one was only 5 hours from water breaking to birth.

  3. Anyone have a link to the Drugmonkey post? I couldn't find it, and I'd like to read it so I can get in the loop here.

  4. I haven't read DM's post, but it sounds like it would just piss me off, so maybe that wouldn't be a good idea 😛

    I had a midwife and had a hospital birth without any interventions. However, I'm sure I would have thought about them if my labour wasn't so short (4 hours). I had a great experience with the midwifes, and awful experiences with 90% of the hospital staff. Evan was in the hospital for a week after being born, and I had the same experience as you right after labour in that I was barely able to see him for the first few hours. Then we got the run-around for a week about what had to be done before Evan could go home. It was incredibly frustrating almost to the point where I would consider doing a home birth if I ever got pregnant again.

    I do agree that The Business of Being Born is WAY over the top about home/natural births. However, I think they did it that way because the other 99% of the information out there about labour/birth is so swayed to c-section/epidural/etc. that they wanted to compensate for it.

  5. Before Petunia was born, I read a book called “Birth Day” by Mark Sloan. I recommend it highly- it is a fascinating look at the history of birth, and provides a clear, sensible “third way” between the over-medicalization of birth on one hand and the “birth at home is the best way” on the other hand.

    Of course, what he comes down in favor of (access to laughing gas during labor) is not available in most US hospitals. It is standard in some European countries, though.

    With that said, I am fairly happy with my birth experiences, although I think having a doula would have improved the first one. I wrote about this on my blog as I was getting ready for Petunia's birth, but basically I think I was too lazy and my husband was too freaked out to push me to do the things that I knew I should do (like walk around after my water broke but labor didn't start, and change positions after I'd been pushing for more than two hours.) The second one was a C-section due to an undiagnosed breach baby who was also on the large side and I really don't think that was going to go any differently no matter who I had for support.

  6. I remember seeing something from DM on midwives, but I think it was on Twitter. I think he was questioning the safety of home births after Isis posted about her first birth experience and fears about the impending second one. I can imagine the conversation going off course from there, but I can't find a post. Maybe somebody who saw it can provide a link?

    I'm not a fan of home births myself, but I can see the attraction after my first experience in the hospital. Also, my OB and the nurses were wonderful, but I wonder how much of that was due to the fact the doula was there.

    The hospital I gave birth at, and several others around here, provide midwives and doulas (which was the only way we could afford one). I'm pretty sure I want to go the hospital CNM route the next time around. Hopefully this option will be offered wherever I end up. It certainly should be available to anyone.

  7. Does the current climate over medicalize birth? Perhaps. But until recently, pregnancy and childbirth were the MAJOR causes of mortality in women. Now death in childbirth is less common except in the developing world. Yes, I'm an MD, so I may have drunk the Kool aid, but I would rather chance a C Section than a dead baby or a dead me. As a pediatric resident, I saw bad delivery choices (never try to deliver a 14 lb baby vaginally, even if it s the fourth child).

    Loss of control occurs as soon as you decide to take your pregnancy to term. From then on, you are steering a car with a back seat driver whose voice cannot be ignored…for the next 20 years, give or take.

  8. You've hit on something that is bound to get a lot of people going. And against my better judgement, I have to comment as well… There is no one-size-fits-all solution to birth. I find it terribly insulting when people rant an opinion as fact and insist that anyone else is simply irresponsible. Sorry, Dr. Pascale Hammond Lane, I find your comment especially insulting – and simply wrong, baseless. In addition, basic biology should make you embarrassed to equate a full-term baby or a vaginal birth with “a dead baby or a dead me.” It's not an either-or situation.

    My wife, who now works in public health, was a doula for about 10 years. I often heard her say that her heroes were the women who could have natural childbirth in a hospital. Typically, “loss of control occurs as soon as you take your” pregnant ass into a hospital. Microdro, it's understandable that you're questioning the care you received. Birth is such a rare moment – you are both incredibly powerful and totally vulnerable. You have the right to decide what's best for you and your family. And following a birth, the gift of a child is so amazing, that it's easy to forget the things that bothered you (plus, there's a significant biochemical response that tempers your memory.)

    There are good MDs and bad ones. Likewise, there are good and bad midwives and doulas. But a good midwife is trained to do everything that a good OB can do – except the surgery (C-section). And statistically, if you're young and healthy and have had a normal pregnancy, you'll probably have a normal birth. A good midwife knows when a woman should not have a homebirth, or knows if something is going wrong. Yes, things can go wrong, but they can also go wrong in a hospital. Humans have had babies outside hospitals (safely, even) for a lot longer than they've had them in hospitals.

    People who choose homebirth, or midwife-assisted birth at a birthing center are not “go[ing] back to a time when women and newborn babies lacked the medical treatment they need.” They are not misguided, stupid, hippies, new-agers, or any other ridiculous stereotype. They can be anyone. Both our children were born at home – one was even born underwater in a kiddie pool, & both assisted by midwives. I have a PhD in biology, and my wife has public health degree & has assisted some 80-100 births. We're informed, smart. We also live in NYC, where people have no compunction against launching into every birth horror story they know when they hear that you're expecting.

    Our kids' births were incredible experiences, both so different. And I'm so glad we were at home, not in a hospital. After their births, we were able to be together, at home, by ourselves. That precious, intimate moment was not disturbed by the fluorescent glare and sneaker squeak of strangers. But that doesn't mean I think everyone should do that, & I won't condemn anyone who choses to schedule a C-section – even though it I wanted, I could dig up statistics to show that's a bad idea. Birth is an incredible feat of biology – perfectly natural – and magical as well. And I'm glad that my training as a scientist helped me engage the whole thing critically and make the right decision for my family…

  9. MDs sometimes seem to assume that c-sections are completely safe… No major surgery is completely safe. They come with all sorts of complications, infections being one of the common ones (and one that I've known people who have gotten major infections). Multiple c-sections themselves make future childbirth more difficult and dangerous.

    Obviously c-sections are a necessary life-saving technique and we are fortunate that they exist, but they are not 100% safe and they are definitely overused in the US.

    Personally I would rather have a safe quick natural birth with minimal scarring and a very quick recovery time, rather than being cut into unnecessarily, getting an infection and dying, or ending up with a premature baby with disabilities who needs to be on life-support and can't nurse (see, you can be hyperbolic both ways).

    C-sections should be used when they're needed and not used when they're not. That said, I don't really care if a woman chooses to have an elective c-section. It's her body, not mine.

  10. @PHLane (and others who may be lurking): Let's just be clear – I'm not recommending home births, or births in a birthing center. But even my doctors (I was at a large practice and had 10 of them) believed that a birth with as few interventions as possible was the safest. They sat back and monitored me, and insisted that we do more tests before deciding on a c-section when my blood pressure got high near the end. They said a c-section was major surgery, and wanted to avoid it as long as I and Monkey were safe. Many good doctors abide by this rule, but others are trained to act instead of monitor.

    I had a phenomenal LD nurse that stayed with me throughout my labor all the way until she dropped me off in the postpartum wing. She gave me advice on how to breath while throwing up so that I could try to avoid an epidural, taught me how to push with an epidural, talked me through what was happening at each stage, and went to grab the doctor when it was time to push. She even cited recent findings from the LD literature, giving me ideas on alternative pain relief methods. After the doctor arrived, the nurse still did most of the talking, helping me to push, and suggesting ideas to the doctor for how to get Monkey out (he was stubborn, crowned for nearly 2 hours). It was a team effort, and I believe, in my case, things would have gone just as smoothly without the doctor present.

    This is what I'm talking about. An experienced, knowledgeable certified nurse midwife, in a hospital with all the backup systems in the world available at a moment's notice, delivering a baby. While we're at it, staff the hospitals with doulas to make sure women are aware of what's going on around them. It's done in many hospitals already, including at least two where I live, and I think it should be widely available. What exactly is wrong with this?

  11. Absolutely nothing is wrong with this picture, other than adding more people into the room. As long as you are in a place that can accommodate an emergency (not a wading pool in your living room) I'm OK with it.
    And I never said a vaginal delivery equals maternal or fetal death; as someone who delivered her kids vaginally (including the one who died in utero)with minimal interventions (no epidurals), I managed to do what you're talking about with the support of my husband and physician, no midwife or doula present. It can be done.
    Childbirth may be a natural thing that most of the time goes well, but it is an event that has killed and disabled children and women throughout time. Yes, C-sections are risky, but so is pregnancy and vaginal delivery. When you choose to avoid “modern medicine” you open yourself (and your offspring) to all sorts of risks. Those are risks I was unwilling to take.

  12. I'll add that my sister-in-law nearly hemorrhaged to death after a home birth. Maybe it was the CNM's fault, who knows. But I do believe being in (or at least very near) a hospital is best.

    That said, because of the immediate bonding that is proven to be incredibly important for infant care, hospitals should be doing everything they can to improve the *experience* for mother and baby. If the mother is uncomfortable, unconscious, or otherwise incapacitated, bonding won't occur as naturally. This could lead to higher incidences of nursing problems and postpartum depression, both of which can have effects on the child long term.

    It's a delicate balance to measure, I understand. But saying that one extreme is bad, and not making measured improvements from the other direction as a result, is a *HUGE* mistake that should be avoided.

  13. I remember my surprise when I realised that here in the US where I live now there isn't always a midwife to deliver babies at the hospital (as it is in my home country). Granted, most of the reasoning for a midwife there, instead of an MD is probably due to cost (salary) although there is always a doctor on hand if something seems to be wrong.

    Personally, I'd opt for a hospital i.e. close to surgery/NICU in case that's needed. After my nephew got stuck on the way out and had lack of oxygen, in what seemed as a “regular nonrisk delivery” I'm a bit hesitant about the “nonrisk” of it all…

  14. here is the link to drugmonkey's post https://drugmonkey.wordpress.com/2010/12/07/on-homebirthers/ which was full of rude bullshit vitriol that was meant to stir up shit, which is why I didn't wade in.

    this was genomic repairmans post http://www.labspaces.net/blog/1027/Ask_Genomic_RepairMom___Child_Birth which was equally riduculous that someone who has NO training in OB/Gyn or given birth knows anything.

    I'm planning on posting about my first birth experience, the necessary for balance etc.

    @pascalelane. whether or not you want to admit it, the medical profession is a very paternalistic profession. Is it changing? Totally. Are there amazing doctors who listen and use evidence based medicine, who are not bias? Yes. But the dinosaurs and the jackass still are plentiful. Just look how I was treated during my grandfathers passing.

    It is important for woman to be provided the facts. Not opinions, which is what is missing. No extreme is recommended. Just like not all women can breastfeed (regardless of what advocates say) not all women can give birth naturally. Again, facts and best practices need to be developed.

  15. Thanks SM. I feel like there's a lot of misconceptions when the words doula or midwife are spoken. It's just like politics. There are camps on opposite sides of the field harpooning each other with the worst representatives from each viewpoint. Like the last sentence of my post asks – where the hell is the middle ground?

    And I can definitely do without the patronizing bullshit saying that a doula or birthing assistant isn't necessary in today's medical settings. I'm not an MD, and knew very little about what to expect (even though I took the birth classes at the hospital). As great as my nurse was, she couldn't hold my hand every minute of labor. The doula was indispensable for walking me through the process, and keeping me sane. It was an exciting but scary experience that Hubby and I went through – with no family around and nobody that we knew and trusted to guide us. Anybody who wants to make fun of our decision to have a doula there with us (including several people out there in the blogosphere that I have respected and called “friend”) can kiss my ass.

  16. “I managed to do what you're talking about with the support of my husband and physician, no midwife or doula present. It can be done.”
    It could be done… for you. Does that mean it can be done for everyone?

    There are, no doubt, women with excellent physicians who feel that their physician supported them and their decisions and took control when appropriate and did an outstanding job. In which case, I'm not so sure a midwife or doula present adds much (though 'more people in the room' is a pretty minimal problem in most cases).
    The question is, what % of women go through childbirth feeling supported by the physician?

    When you *are* a physician, you often have the information needed to find a good one. Or to find not *only* a good one but one that fits your personal style.
    You often have the privilege (and I use that term very intentionally, with all its connotations) of being treated as more than just another patient. Heck, you even may be more likely to avoid being treated as the 'vessel for the real patient' (which is, hopefully, an uncommon phenomenon. But it's terrible that any women feel that way, and it does happen in some cases).

  17. @becca – that is my point. it is a sadly the number of excellent physicians who support women is still in the minority. Like the science community, it is changing, so you find many women who have experienced patronizing condescending crap. Unfortunately, its not changing quickly enough.

  18. I gave birth to both of my kids with a hospital CNM. One was completely intervention free, the other required a pit drip and an epidural, but I had wonderful experiences in both cases.

    Honestly, it was the perfect blend for me. Low intervention, compassionate care with the high tech medical back up (just in case.)
    I would do it again in a heartbeat.

    I do get strange looks when I say “my midwife” instead of “my doctor” to people who don't know me or my birth story. I am sure scenes from Little House on the Prairie are running through their heads, but it couldn't be further from the truth.

    I honestly think people would not be pushing the homebirth option as strongly if the hospital birthing experience didn't feel like some sort of factory baby farm. The stories I have heard of terrible L/D nurses, docs quickly scheduling C-sections to make it to a golf game, the inflexibility to discuss options such as VBACs or waiting beyond due dates before proceeding to inductions. It comes across as inflexible, impersonal and cruel.

    I didn't labor strapped to a bed, highly medicated or with the feeling that I wasn't in control or unable to make decisions for myself. If my first L/D had been anything like that I would have seen the appeal in a homebirth. Especially having experienced a wonderful first birth, I was even more adamant on getting what I wanted with my second. To me homebirth, or even the push towards stand alone birthing centers is knee jerk reaction against the overly industrialized birth industry, the pendulum swinging in the opposite direction.

    If midwifery were more mainstream and integrated into our ob/gyn system I think the push towards the anti-hospital extreme would not be as strong.

  19. Well said, LM! I never would have considered a home birth before Monkey, but the aftermath of his birth got me thinking. Next time I'm just going to do a lot more research on the hospitals, AND go with a CNM. I'm sure there's something closer to what I'd like around here. It just sucks that it's so hard to have both the safety of the hospital and comfort of a home birth.

  20. I haven't read all the comments, but I want to say first, I really liked the BOB documentary. My husband and I watched it while I was pregnant with Sweet Pea and while it was definitely one sided, it opened my husbands eyes to how great a natural childbirth was. Because of that I was able to have him as a great partner and almost had an entirely drug free birth. I was lucky enough to have a midwife in a hospital. She was amazing! I had planned to have a waterbirth, but because of my Gestational diabetes I was unable to, but got to labor in the tub. I definitely think that we need to have more midwives in hospitals so that people don't feel pushed for drugs unless they are needed.

    I need to have some pitocin to get my contractions closer together, but it was minimal amount and only given after discussion with me.

  21. I liked the documentary too, mainly because it was so interesting to see how peaceful a birth could be. My concern about the heavy push toward home birth by this documentary (and other pro-midwife sources), is that it gives fodder for the anti-midwife crowd. I am such a strong believer that these options be made widely available in hospitals, and I don't believe that will happen if the conversation remains focused on what many in the medical community believe to be the “fringe”.

  22. There's also the option of birthing centers in some parts of the US: attached to a hospital so any needed medical intervention would happen quickly, but staffed by midwives. I have two friends who are both pregnant at the moment. One is using a birthing center, the other a traditional hospital setting with no midwife or doula. The cost to insurance for a standard birth at the hospital is almost double the cost at the birthing center!

  23. Dr. O., I had my booboo in a labor and delivery department in a hospital that was designed as a birth center-type place, with a group practice of CNMs who are fantastically well-trained (one of the first established in the country), . The pre-birth experience throughout pregnancy was the best part of it all, and established my trust level for the delivery part.

  24. I think a birthing center would be amazing, and the idea of a birthing center in a hospital would be fantastic! Now that I've learned from my first experience, It sounds like a lot of great options are starting to become available, which is great to hear about. I'll be asking a lot more informed questions the next time around! 🙂

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