Showing posts with label Hospitals. Show all posts
Showing posts with label Hospitals. Show all posts

10.20.2008

Labor Nurse's Perspective on Birth Plans

Check out this post on birth plans from the Rebirth blog. She brings up some important points about why birth plans are so often treated with derision.

What resonated most with me was this:

And then I've seen very inflexible birth plans that request things like no fetal monitoring (absolutely impossible in the hospital) which basically ask for things that are better for a home birth. These types of birth plans I have no problems with in regards to what they want or not want, but often scratch my head wondering if these couples have taken into account that they are giving birth in a hospital. As much as I feel continuous fetal monitoring or even IVs are not necessary in every birth, some hospitals have environments, protocols, etc that don't "allow" for this. I really think those who want to avoid all interventions look into alternatives to birth sites because the second you step into a hospital you give up some things, like complete control. I wish this wasn't the case, and try very hard as a nurse to let women know about informed consent and choice, but there are very few hospitals I know of that go with any request a woman has.

It's so important that women realize what is and is not realistic in hospital birth. For more on this, read You Buy the Hospital Ticket... You Go for the Hospital Ride. Giving birth in a hospital is different than giving birth at home. Wonderful, fabulous, and low-intervention births happen every day in hospitals, but they are still hospitals. Why would you go there if you basically want to have a home birth? Walking into a hospital in labor and announcing that you reject all its care is a recipe for disappointment -- and possibly a terrible birth experience, because your expectations and reality will be so different. Why set yourself up for this?

If you're planning a hospital birth, find out what the standard procedures are. Then talk to your doctor and your doula about how you are work with any aspects you want to avoid (i.e. a saline lock instead of being hooked up to an IV). Going in with realistic expectations -- and a realistic, well-researched birth plan -- will greatly improve your odds of having a satisfying experience. And isn't that what we're all looking for when we write these plans?

7.03.2008

The Void that is Postpartum Care in America

I just started reading a most phenomenal jewel of a book called After the Baby's Birth by Robin Lim. Two quotes just from the preface and opening chapter have struck me:

"...I came to see more clear how my sisters in the West could expect little or no postpartum care or support, either from health-care providers or from friends and family. The modern lifestyle, embraced by the West, sought after and imitated all over the world, has so fractured families that postpartum women today accept and expect to be isolated. [bolding mine] I wonder at a culture that decades ago put men on the moon, yet chooses to ignore the most significant life passage of women." (xi)

"All too often, the only postpartum care an American woman can count on is one fifteen minute appointment with her doctor, six weeks after she has given birth. This six week marker ends an arbitrary period within which she is supposed to have worked out most postpartum questions for herself. This neglect of postpartum women is not just poor healthcare, it is abusive--[bolding mine]particularly to women suffering from painful physical and/or psychological disorders following childbirth." (4-5)

In cultures across the world, newborns and postpartum mothers are viewed as sacred and in a vulnerable state of being of both body and spirit. As such, they are nurtured and cared for. I suspect that now that puerperal fever is largely a thing of the past due to a better understanding of germ theory, more sanitary practices, and antibiotics, that as we lost some of the physical vulnerability of this time period (mercifully, the vast, vast majority of women in the West survive postpartum), we also lost respect for the spiritual and emotional vulnerability.

There are many interesting, beautiful traditions for postpartum women across the world. "Warming" the mother is common to many cultures. Some bury warm coals under the postpartum woman's bed. Some women are to sit on a fire warmed rock every morning, and it is also common to place a warmed rock on the woman's abdomen. There are taboos revolving around certain foods, and it often requires that the mother consume only warm liquids like tea and soup. These practices not only warm the body, but the soul. Touch is also a familiar component to these rituals. In some cultures the responsibility falls to the midwife to come give the mother a massage or rebozo treatment designed to "bring the bones back together." In others, the mothers or grandmothers of the postpartum woman provide this life affirming touch. In America, we too have our warming ritual, if you are lucky enough for someone to bring you a warm blanket after birth. The difference is, whereas the aforementioned traditions go on for weeks, women in our culture are "cared for" (and I use that term very loosely) for a few days or less.

Today I was reading a post on a message board for moms from the mother of a 2.5 week old who was feeling overwhelmed, sleep deprived, and isolated, looking to reach out to other mothers. She got some wonderful suggestions, but what stood out to me was the comment from one poster that said "If you are feeling depressed, don't worry, there are many antidepressants compatible with breastfeeding." While this is certainly true, and I would never ever advise against someone going on such medications if they feel like they need them, it made me wonder if we are handing prescriptions out to women who are really seeking encouragement and camraderie. Much as a laboring woman asking for drugs is sometimes actually asking for more support from those around her, I can't help but feel like we are ignoring a mass of women when we hand them a pill instead of loving guidance and help.

I have been working as a hospital doula now for 2 weeks and have spent a few shifts shadowing another doula on the mother baby unit. What has been eye opening for me is how little rest these women are getting in their very brief stay at the hospital. I have seen mothers drifting off falling asleep while they try desperately to pay attention to the presentation of how to put together their breast pump. I have seen a mother who had a cesarean not 12 hours earlier whose hospital phone rang no less than 5 times in the 15 minutes we visited with her. This same mother was distraught and exhausted and told us she had had visitors all day long. These mothers are also struggling to get to know their baby, learn how to breastfeed and recover from birth which for many also means recovering from major surgery. What I have also noticed is while these rooms may be brimming with stuffed animals and flower arrangement, I have yet to see a care package for mom, a stack of magazines or her favorite food or drink. The focus is on coming to see the baby, and respect for the mother and her passage is lost. It is no wonder we have a whole generation of women suffering alone through isolation, a sudden, crushing loss of identity and postpartum depression.

What can we do to improve the state of postpartum care in America? I believe it's obvious we need better medical care including at least one home nurse visit in the first 2 weeks after birth. For a greater discussion of this, see Ina May Gaskin's article "Masking Maternal Mortality" in the March/April 2008 edition of Mothering magazine. But aside from that, what can we women, birth professionals, mothers, sisters, aunts, grandmothers, and friends of postpartum women do to help fill this void? And what can the postpartum woman herself do to create the support system that is so sorely lacking for them?

First, I believe we need to address the early visitor issue. Everyone loves to see and hold a new baby. But again, we are talking about women who are in the hospital for 24 hours, not getting to rest because the nurses are checking in on them and their babies every few hours, learning to breastfeed which can be highly challenging, and often recovering from surgery. We wouldn't expect to go see Aunt Sally 4 hours after her appendectomy, and the same respect should be given a woman who has had a cesarean. I propose that no visitors come to the hospital the first day, and if they do, be limited to immediate family and the closest friends for less than an hour. Remember, in most hospitals rooming in is standard, and these mothers are not going to get a full night of sleep. There will be plenty of time to meet and cuddle this wonderful new blessing once the new family is settled at home.

How can the postpartum mother enforce this? Some tips are quite simple. Don't call anyone while you are in labor except for those you want with you either at or immediately after the birth. When you do call to let family and friends know you've had the baby, tell them you will be happy to see them once you get home. This alerts them to the fact that you are not inviting them to the hospital. What about those who will show up anyway? Tell your nurses to mark you down as "do not announce" and they will not tell anyone you are there. Let them know you would like your visitors cleared through the nurse's station and have them place a sign on your door when you are resting/feeding and prefer not to have visitors. Please realize this is not a hardship for the nurses, they actually like to limit your visitors. It is their job for you to have a full, speedy recovery, and they realize that you resting is the best way to get that. They will not mind at all being your gatekeeper.

I realize this all probably sounds harsh. But I assure you that once you have given birth, you will understand more of what I am saying. And I will also tell you that the most crucial time to your postpartum healing is 8 days after birth. The more rest, relaxation, and general being taken care of you can arrange for, the quicker the rest of your recovery will go. You are not denying people access to your baby. You are ensuring that you are healthy enough to care for him/her in the very demanding weeks to come.

Birth professionals, I implore you to impress the importance of these 8 days on your clients prenatally and encourage them to set forth the rules I have suggested for postpartum visitors.

This post will continue with more tips on how to build your own network of postpartum care, but for now I must sign off!

6.16.2008

Hospital Water Birthing in Syracuse, NY!

Check out Kristen Oganowski's VBAC, hypnobirthing, hospital water birth story. Hers was the first water birth at Crouse Hospital in Syracuse, New York. Her birth from the perspective of her doula, Chris Goldman follows Kristen's account. This is a wonderful, inspirational birth story, but even more encouraging are the comments following both articles that indicate hospital waterbirth is on the rise in Central New York.

One of my favorite parts of the article follows. KUDOS to Dr. N, a shining example of what OB's can and should be to birthing women today:

"And then he [Dr. N, Kristen's OB] turned to my nurse and said, "Well, it looks like you aren't getting her out of the tub!" But then he took the time to tell her the following: "Look at how beautifully she's doing. Look at how natural and normal this is. She's pushing on her own, and no one is yelling 'PUSH' in her face; no one is counting for her." And you know what? My nurse started to get really excited about this birth."

4.07.2008

Doctor, Did You Wash Your Hands?

From the NY Times:
Despite national campaigns encouraging patients to take an active role in improving hospital safety, many patients aren’t comfortable asking doctors challenging questions about their care, a new report shows.


As much as we talk about changing the culture of birth in this country, and as much fault as we sometimes find with hospitals or obstetricians, nothing will change with our healthcare in general, or birth in particular, without consumers asking for that change.

Why do we treat doctors as authority figures? Why are we afraid of making them angry or disappointed in us? Why would we rather sacrifice our own or our children's health than risk offending? They do not naturally have that power or authority -- in fact, consumers hire their care providers. We have the right to receive the information we need, as well as the care. Would you tolerate it if your mechanic was snippy or evasive if you asked a question about a recommended repair on your car? Would you keep going back to that mechanic, and recommend him to your friends?


“Patients need to feel they can ask questions that may be perceived as challenging without causing offense to those involved in their health care treatment,'’ the study authors wrote.


Women, if you have ideas about how you want to give birth, you must communicate with your doctor. If you're afraid to ask questions or make your intentions known and stand by them, it's not realistic to think you'll get the birth you want. And if your doctor does seem offended when you ask a question, isn't that an excellent sign that s/he isn't the right care provider for you?

In addition to it being part of your own health, dealing with your care team is one of our first acts of parenting. Now is an excellent time to start advocating for your baby. Start with asking questions!

4.03.2008

April is Cesarean Awareness month!

Promote Cesarean Awareness and tell a birthing family you love about ICAN and check out their fancy new website!

A friend of mine just had a baby, and the Cesarean rate of the women in her childbirth class was 57%. These were all first time moms who now have the choice between an elective Cesarean and all its attendant risks with their next births, or a VBAC which is increasingly becoming less of an option with many mainstream care providers. Mothers attempting a VBAC face the physical barriers and restrictions in place at many hospitals, as well as the emotional hurdles that come with attempting something widely regarded as "more dangerous" by the medical community and society at large. (for more information on the REAL risk comparison of VBAC vs. repeat Cesarean look here)

This problem is epidemic and it affects us all, whether we are birthing women or not. 57% of women in this class were told they couldn't birth their babies. This is startling, and wrong. It will not stop until we do something to stop it. ACOG is telling us the rising Cesarean rate is due to more overweight and older women getting pregnant and ignoring the other major issues like their own fear of litigation. It's up to us. We cannot know the possible effects that a large Cesarean rate could have on humanity at large. What we do know is that it has the potential to obliterate the confidence and feminine wisdom of an entire generation of women. Women deserve the opportunity to give birth vaginally without fear!

Pregnant women, what can you do to help reduce your risks of Cesarean? This is a short, quick and dirty list. I'll be posting more Cesarean prevention tips throughout April.
  • Consider an out of hospital birth if you are healthy and low-risk. Both birth center and homebirth midwives have dramatically lower Cesarean rates than their hospital counterparts.
  • Hire a doula. A doula can help you navigate the childbirth system and teach you how to ask the right questions to decide whether intervention is appropriate or not.
  • Read EMPOWERING birth stories. Don't watch "A Baby Story" or shows that focus on "baby emergencies". Try both of Ina May Gaskin's books for a start. Focus on what your body is capable of instead of what can go wrong.
  • Take a GOOD childbirth class. Consider an independent instructor. These classes often cost more but they are worth it because you're not going to be fed only what the hospital wants you to know. ALACE and Birthing From Within are organizations to consider.
  • Turn that breech and try to prevent the odds of back labor with a well-positioned baby. This offers no guarantees against back labor, babies move throughout labor, but it's healthy to try! Do yoga, and check out Spinning Babies for more tricks and techniques for turning both breeches and posterior babies.
  • Stay home until you are in ACTIVE LABOR! Simply getting to the hospital too soon skyrockets your chances of Cesarean. More on how to know "it's time" later...
  • Choose your care giver wisely. Ask good questions, and expect them to give you open, honest answers. If you feel like they are being evasive, press harder. Don't put your care giver on a pedestal: you are the ULTIMATE expert on your pregnancy and baby, and they work for you. Don't be afraid to look elsewhere for answers or second opinions. TRUST is essential for a good relationship with your care provider. Another note on care providers: if your OB is known as "THE best C-section doc in town"...there is probably a reason for that. And it is more than likely because s/he performs a lot of them. Find out why.

4.02.2008

Risk

When I'm talking about choices in birth, I've found the subject consistently turns to risk. What are the risks of home birth? What are the risks of hospital birth? What is the safest possible way to have a baby?

The fact is that risk is an inherent part of life, and birth is no exception to that. There are situations in which being in a hospital is very desirable when you're giving birth. Isn't it wonderful that we have that option, and the benefits of all modern obstetrical technology, available to us when it's needed? On the other hand, the mainstream medical community doesn't seem eager to discuss the risks of giving birth in a hospital. It's painfully ironic to me that midwives are stereotyped as superstitious women who walk around the house burning herbs and chanting, when in fact many -- if not most -- of the procedures in your typical hospital maternity ward are based on fear, ritual, and lack of evidence.

We all have to choose the risks we're comfortable with. Personally, I'll take the risks of birthing at home, over the risks of birthing in a hospital. I feel I'm much more likely to experience the risks of unnecessary interventions in a hospital than I am to face a true emergency at home. I only wish for all women to have the option to make their own choices without bullying, superstition, or manipulation.

This lovely post from Rixa at The True Face of Birth provides a great summary of the risks of VBAC and elective repeat cesarean. What a breath of fresh air! We cannot keep disrespecting women and their babies by refusing to provide them with enough information to make the right decisions for them. If a woman has had a cesarean, her next delivery carries risks -- it's insane to pretend that repeat c-sections are risk-free.

Women are empowered when they can make their own choices, not be pushed into what ACOG would like them to do. If both choices carry risk, we need to make sure that women can choose the risks they're most comfortable with. Is that really so much to ask?



PS A more specific look at some of the risks of home vs hospital birth coming... someday. I promise!

3.23.2008

"Epidurals Are For Tolerating the Hospital, Labor Is The Easy Part"

What a great quote, from this blog entry about a mom's recent second birth.

Having a natural birth in the hospital is a huge accomplishment! Women really do deserve a trophy for it. A drug-free labor at home or in an independent birth center is (comparatively) easy.