Thursday, May 27, 2010

Smoke Screens

Recently, I read a blog written by a birth expert, , (I know, what else is new). It was about how to avoid unnecessary interventions while in labour. I remember a couple of years ago listing these intervention avoidance strategies to a client. My first client. But several births later, I have come to realize that no matter how much knowledge you have before going into a birth about the risks of certain interventions, no matter what you have written on a birth plan, it is ultimately in the hands of the caregiver. Often (not always) a woman in labour feels out of control and is looking for reassurance and guidance. If a caregiver suggests an intervention to her while she is in this state, chances are, she's going to agree. Dads/birth partners are also in a state of stress looking for ways they can help mom and eagerly accept (and urge the mom to accept as well) suggestions from care providers. An experienced doula is less susceptible, being as she has witnessed women in labour and is comfortable with movements, sounds and occasional bouts of fear of a woman hard at work birthing a baby. That is why choosing a caregiver that is right for you is so important, right? No, it's not. Type of caregiver, yes. But when it comes to GPs and OBGYNs if you choose one you are potentially choosing them all. There are some fabulous MDs out there, and many women I have talked to have told me, "Oh I thought about having a midwife, but I love my family Dr." Then after their birth: "My Dr. wasn't the one on call, I had some guy I hadn't met before." Also, your Dr. isn't the one taking care of you during your labour, a nurse is, maybe 2 if there's a shift change. If s/he is busy (which happens a lot because nurses are often understaffed and overworked) you may only see them every 15 minutes for a 2 minute interval. Dr.s get all the recognition, but the nurses are the ones responsible for you the majority of your labour and birth. Your Dr. wants to be at your birth, but it's just not the way the system is set up. So some women get their Dr. who knows what is important to them. They get a Dr. that they are comfortable with, with whom they've built a mutual respect. That is wonderful, but there is a chance that when you get to the hospital you will be taken care of by strangers. It is a well known fact that the adrenaline/epinephrine that is released when a woman is stressed, inhibits the production of oxytocin, the hormone responsible for uterine contractions. So in essence, labour complications can be caused by being uncomfortable with your caregivers and surroundings. Where I live, the only way to guarantee that you will know the caregiver that will take care of you during your birth is to acquire a midwife. Midwives do homebirths and hospital births and should a complication arise that necessitates a surgical birth, the midwife simply calls in the Dr. and remains by your side (even in the OR) until a few hours after the birth. Where I am midwives are free, though if you live in an area where they are not, ask yourself this: How much money was/am I willing to spend on my wedding? How important is the birth of my child compared to my wedding day? Midwives cost much less than your average wedding.

Back to my original train of thought. Are the popular suggestions of : Hire a doula (which I recommend highly, but do not expect that in doing so you will avoid interventions) Write a birth plan, Share the birth plan with your caregiver, take a hospital tour and look at the birthing facilities intervention statistics (each MD will have a different intervention rate, so it all goes back to not knowing who your caregiver will be) , just smoke screens? Do these suggestions just (falsely) give women the impression that they are in control of their births? Is writing a birth plan going to change hospital policy? Is asking a hospital statistic going to lower the incidence of unnecessary Cesarean sections? No, it is not, especially if you live rurally and you don't really have a choice about which birthing facility you are going to. Childbirth education can help, but only if it is a course based on building confidence in a woman's ability to birth, not a course on this is what is done in a hospital.

What will reduce the use of unnecessary intervention? Get a care provider who is guaranteed to be at your birth (midwives are the only caregivers where I live that can guarantee that). Encourage your friends and family who have had poor hospital experiences to speak up and out, to write the Hospital Administration and the local Physician's College. Write to your government, demand that you have more access to continuous prenatal, perinatal and postnatal care providers. But most importantly, tell everyone you know; No. Getting a healthy baby is not all that matters!