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Entries in hospital interventions (2)

Monday
Feb142011

Thoughts on "One Born Every Minute"

You can’t Google about natural birth the last couple of weeks without coming up against half a dozen posts or articles critiquing the new show on Lifetime, One Born Every Minute. One of the most vocal was Gina, The Feminist Breeder, who wrote “Lifetime Shows Us There’s One (Unnecessary Intervention) Born Every Minute.” Gina says,

"So I couldn’t help myself.  I took notes the entire way through this train wreck and yelled at the television every 60 seconds.  Here is what I saw, and here (in blue block quotes) is what I yelled at my TV."

Kristen, from Birthing Beautiful Ideas (a blog I’ve never seen before… how have I missed this?) writes in her post Dear Lifetime: It’s not Weird, it’s Normal,

“… I worry about pregnant women and their partners watching “One Born Every Minute.”  And it’s not because I think the show is going to make them want to run out and ask for every birth intervention in the world as if they’re candy.  Rather, I worry that the show will create or even reinforce in women’s minds a pretty bogus distinction between  “What’s Normal and What’s FREAKY-DEAKY-WEIRD-AND-ABNORMAL During Labor.”

I’d considered not watching the series, but since I’ve recently hung up my homebirth midwife hat and picked up my full-time monitrice-doula hat, I thought, “What the heck… how different could it be from what I already know to be true in hospitals?”

Last Tuesday night, I watched both the first segment, “To Medicate or Not,” (the one that had the natural birth couple in it) and the second installment, “Expect the Unexpected”; Sarah left the room. (You can see the full segments in those links.)

It turns out I was right; the shows weren’t all that different from my own personal hospital experiences… as a doula or as a midwife who’s transferred/transported women to them.

I didn’t sit screaming at the TV. I didn’t get high blood pressure from enormous amounts of frustration. Sure, I rolled my eyes a few times (some things said and done were absurd… more below), but, hard as it is to say, I stand behind the “You Buy the Hospital Ticket, You Go for the Hospital Ride” belief I’ve had for years. I don’t know if 28 years in hospitals has numbed me (I don’t believe it has at all) or if my idealistic belief that I Can Change The System has been flushed down the toilet, but I have pretty much given up any hope of seeing massive institutional changes in that area of the birth world.

When I first started, I thought things were so awful –the induction rate, the cesarean rate, etc.- that they couldn’t possibly get any worse. And look! Not only has it gotten worse, it’s gotten horribly worse. I’ve come to the realization that, until we have a 100% scheduled cesarean rate, it can always get worse. Of course I pray for a miraculous change in The System, but I’m just not going to hold my breath anymore.

 So the TV show. I tried to watch it from two viewpoints… one, from a mom who knows nothing about birth and two, from a sociological point of view. Marrying the two, I definitely winced thinking of the messages being conveyed throughout the episodes.

The first was how Blessed (gloriously, exaltedly Blessed) an epidural is. I would swear someone (or many someones) in the epidural industry is paying for product placement in shows like this. I almost sat and counted the number of times “epidural” was said, but decided it was pointless; we all know how many times an epidural is brought up in labor already. And giant pet peeve of mine: “Her epidural,” “My epidural.” Ugh. How did this procedure acquire possessives? Counter that with a cesarean. Rarely do I hear women say, “My cesarean.” It’s usually I had a cesarean.” Are women claiming ownership to the epidural because they can remain more “civilized”… more themselves? Versus a cesarean that very nearly transforms the woman’s perception of herself or, at least, her body? A great topic for someone who studies these things.

Women on the show were so passive. Their bodies doing things they had no knowledge of until someone (or some machine) told them something was happening. “Oh! I’m complete?” I know this is a duh kind of obvious to those of us who know natural/normal birth, but the message is ghastly to those that don’t know any better. It was so funny (not haha), the woman who was on the birth ball, in the shower… she looked so out of place! The same way a woman in a homebirth who did nothing but lie on her back in bed would. Isn’t that just sad?

It’s true, the show capitalized on the friction between Nurse Pam and the natural birth mama, but even in the second installment when there was no natural birth juxtaposition, we could see who the nurses smiled with, who they joked with and who they were the kindest toward: the women who didn’t cause any extra work for them. If a woman needed her belts adjusted because she moved or even if she had “annoying” family members, you could almost hear the heavy sighs as they had to go out of their way to do the task or speak to the family member. Never mind these things are part of their job; if they took an extra two seconds, it seemed an extreme bother.

This is one of the main things I feel I can offer my clients (slight segue), that I work well with hospital staff, helping wherever I can, helping the nurses not have to do things like moving the belts or changing chux or whatever. I’ve spent many a-labor holding the monitor on a swaying, moving mom. This delights the nurse who really doesn’t care if mom’s mobile and rocking, as long as the baby can be seen. I think this was where the natural birth mom’s doula could have helped a lot, by holding the belt on the laboring woman’s belly when she was on hands and knees. If the woman is anywhere near the monitor… on the ball, standing, rocking, etc… why not have her on the monitor so you can get her off without any issue when you want to later? Making the nurse happy AS the woman gets her needs (wishes) met creates a much more pleasant atmosphere and the client has better post-birth memories.

I had a transfer not so long ago and one nurse was initially guarded with me, but warmed up quickly. During the labor and birth, I was encouraged to take a more active physical and even clinical role than I know would have happened if I’d have been Guard Midwife. The birth became a wonderful, empowering moment for my client… her wishes honored and honored respectfully and happily… not just because she was compliant (she refused more than one recommendation), but because everyone was clearly listening to and hearing each other. As I was leaving, the nurse thanked me for all my help and told me it was refreshing to see a homebirth midwife not be combative, that most of the other ones she’d seen have been “bitches.” (Her word, not mine.) I left vowing to repeat this positive experience, that I would work hard not to have my midwife-monitrice-doula interactions be contentious and, somehow, find a way to also help others have a more harmonic hospital birth experience without sacrificing autonomy and self-respect.

I would be remiss if I didn’t mention two incredibly huge gaffes and one smaller one that one of the nurses made. First, when a baby’s heart rate was going down and mom was worried, Nurse Linda, a tiny, older nurse (second segment) told her the baby was just getting used to her lower blood pressure… that she’d had high blood pressure and now it’s normal, so the baby has to adjust. I can only assume this was right after an epidural was placed (can’t tell from watching), but what a stupid way to explain what was happening. The baby’s “getting used to a normal blood pressure?” Geez.

The second thing this same nurse said that nearly had me falling out of my chair in disbelief was when a mom was pushing, had been pushing for what seemed to be about two hours at that point, and as the tiny nurse was showing a family member how the head came down and receded with each push –while the baby was still inside - she casually says, “Oh, that’s turtling.” Uh, no it isn’t. Turtling is when the head is born and then is pulled back up, mooshing back against the perineum. Said more clinically:

“Once the shoulders impact at the pelvis inlet, the fetal head which has already left the pelvis, often recoils tightly against the maternal perineum. This is termed the ‘Turtle sign’…”

photo by Kristina Kruzan

The woman did, later, have a shoulder dystocia, but the turtling had not happened yet. I wonder what the other nurses –and the tiny nurse’s supervisor- had to say about her clinically incorrect remarks.

The third was when a mom was on hands and knees and her sister made a snickery comment about her being “doggie style” and Nurse Linda pipes up, “We prefer to call that knee-chest.” Excuse me? No “we” don’t; we call it hands and knees.

I acknowledge I’m not like a lot of Natural Birth Advocates (NBAs) who refuse to watch these types of shows. Besides watching as an informal continuing education, they are what many pregnant women watch and I like to be able to answer questions regarding what they’ve seen on them. Bloggers and commenters have begged for a realistic (not reality!) show about homebirth, but honestly? I don’t think it’s dramatic enough to show. And don’t we like it that way?

Wednesday
Jul092008

When Dogma Trumps Common Sense

I stumbled onto this blog post from someone who 1) seems to work in a hospital 2) hears great stories from friends who work in a hospital. You decide.

A birth plan, but no immediate mothering skills highlights the image of a rabid natural birth fanatic (and I use the term purposefully) as she moved from her planned homebirth into the hospital after she had ruptured membranes for 7 days and no labor to speak of.

(Those that know, know I also had 7 days between ROM and the birth of a baby, but I was under the care of myself and a sneaky group of CNMs. Don't know how tolerant I would be of another woman acting like I did! It'd need to be on a case-by-case basis, that's for sure.)

N E Way....

So the blog poster illuminates how stupid... er, strike that... ignorant? (not good either)... crazy? (probably a better word) an immobile natural birth advocate can sound when confronted with a change in plans.

(Edited for typos and attractiveness, not substance.)

(Begin quote)

- Her water broke 7 days before she ended up in the hospital. She had gone into a small town hospital (after the planned home birth didn't happen) that was not equipped to handle sections so was transferred to ours.

- She refused a section even though her baby was in DISTRESS; she had a birth plan and a section was NOT in her birth plan.

- She continued to refuse the section even though her baby was in IMMEDIATE DISTRESS because she wanted a natural birth.

- The doctor eventually had her agree to the section, not quite having to "hit her over the head with a hammer" as my friend so elequently put it.

- The baby was covered in meconium when born and even though he had not yet taken a breath she insisted he be placed on her chest.

- Couldn't happen becuase a) the baby wasn't breathing and b) her chest was in the sterile zone.

- They did place the baby on her chest immediately after he started breathing and the nurse stayed with them as the mother could't technically hold him.

- She refused to let the baby go to the nursery to be checked over while she was in recovery and wanted him left with her. As she had no partner and she was still somewhat drugged the ICN nurse had to stay as well, meaning she couldn't see to the other babies under her care in the nursery.

- When she was transferred to the maternity ward she had the baby lying on her stomach and the nurse suggested she lift the baby higher if she was looking to feed him. "Oh no, he will crawl to the breast if he is hungry." The two nurses say that newborns don't actually crawl to the breast and she says "Yes, they do! I saw it in a video." Editing, ya know.

- She refused to have a crib in her room and wanted the baby with her. When the nurse came in to do some bloodwork on the baby, the mom was sleeping and baby was nowhere to be seen. The nurse lifted up the blanket to find the baby with his face down in between her armpit and breast. Baby grey, no heartbeat, not breathing. Nurse rushes him out of room, all the while trying to get a heartbeat and breath. When in crib in hall, heart rate measures 40 (normal newborn in 100-160). If nurse had been 30 seconds later, baby would have been dead.

(end quote)

Even if we looked at the story through squinted eyes, believing some of this is exaggeration, I know this story is true because I have read/heard enough accounts from the fanatics themselves!

When you buy the hospital ticket, you go for the hospital ride.

As I recently said, hospitals have a huge responsibility to normalize birth within their walls, but for crying in a bucket, when there are complications, birth plans should be shredded by the women themselves.

When I have clients that move from home to hospital during their births, anything relating to the reason we are going there for now rests solely in the medical personnels' hands. It's what they're there for!

For example, if mom is laboring and there is lack of progress that sends us into the hospital, a birth plan that says, "No pitocin," isn't going to cut it. The part that says, "No erythromycin (in the baby's eyes)" is easy to adhere to because it isn't related to the reason for the transport.

Make sense?

If you have to move to the hospital because the baby has low heart tones, asking for intermittent monitoring is not only foolish, but dangerous.

Hmm. thinking

My frustration... let's see... part of it is it's embarrassing to have women be so adamently against something when that something can possibly save their lives or their babies' lives... all in the name of "natural childbirth." I'm not talking about the routine crap that goes on in hospitals, but the stuff that is really necessary when birth deviates from the norm.

Just like the hospital treating everyone the same and demanding that they stop doing that, it behooves natural birth advocates to stop seeing every intervention in birth as dangerous and weigh the risks with the benefits. Sometimes technology is fantastic!

The issue, of course, is how can you tell when the interventions are really necessary? So much of it depends on trust and distrust definitely sets the stage when there's mutual antagonism.

Walking in/being wheeled in with an open mind and heart can help tremendously.

Having an advocate... your midwife or a doula... not your partner (who is laboring right along with you) who can explain things to you as they unfold... a person you implicitely trust... someone with the experience to understand the hospital language, the interventions and their necessities... where was the woman's midwife in the above scenario? Was she UCing? (Sadly, it sounds like it from her rigid attitude towards birth and the hospital. Sad because UCers have a reputation that precedes them.)

And finally, believing that whatever happened was supposed to - for whatever reason. Lessons. The baby's choice. Destiny. Fate. However you are able to explain it to your psyche, it's important to integrate the experience so you are able to be a mother and a woman in your life.

None of this means there can't be distress in the experience, that women might not be coping with birth trauma or recovering from birth abuse, but integrating can mean the difference between immobilization and functioning.

Some women have found my The Gray/Grey Messenger: Recovery helpful when overcoming birth trauma.

It's a precarious place... needing to trust the hospital yet knowing many women are bulldozed into interventions they don't want/need.

Even though the medical folks tend to play the Dead Baby Card too often, it really is more important to err on the side of safety for both mother and baby.

I hope the mom in the above post is able to obtain some balance in her reality.

It's all any of us can ask for.