Monday, June 11, 2007

Hospital Births: Are We Set Up for Problems?

A Recent Conversation with My Midwife

Midwife: So, before we finish the appointment, do you have any questions for me? She's always very willing to spend time answering my questions, which I love.

Me: Actually, I was wondering if Kaiser has a list of doulas that it recommends?

Midwife (looking startled): Uh, no. Kaiser doesn't do that.

Me (confused): Kaiser doesn't do doulas?

Midwife: Well, we don't refer patients to them. We can't. It's against our policy.

Me: Oh, okay. (WTF?) Well, no problem. I can just look online I guess.

Midwife (almost apologetically): But I think it's great that you want to get a doula. What made you decide to look into getting one?

Me (opting for the short answer): Well, I am anticipating a natural childbirth and I feel I will need the extra support.

Midwife (skeptically): You want a natural birth?

Me: Uh, yeah. Well, I mean, I think I may end up with one regardless because my epi didn't work during my first birth. I can't assume it will work this time.

Midwife: Well, it's just that most women don't go natural here. Didn't they try upping the medication when the epidural stopped working?

Me: They said it wasn't possible.

Midwife: Did they try re-inserting the epi?

Me (getting frustrated): No, they never tried that.

Midwife: Oh, that's so strange. Usually, they'll try that...

Me: Well, anyway, I just don't want to bother with trying an epidural again. I have no idea if it's going to work so I can't depend on it.

Midwife (leaning closer as if to whisper): OK, well, if you're really intent on trying for a natural childbirth, then I have something for you. I have it locked away in my office. I'll be right back.

Two minutes pass and she returns.

Midwife (handing me a small one-sided flyer): here is the name of a doula that I have heard is good. She also does a class on natural birthing - the Bradley Method. You can contact her. But please don't mention to anyone that I gave this to you. It's like contraband around here.

I took the scrap of paper, feeling like I was doing a deal with the mafia.

Me: Great. Thanks.

Midwife: Oh, and if you plan to go natural, you have to understand something. When you get to the hospital, you are going to be pressured by the nurses to take medications. You have to be ready for that because when you are feeling labor pain, it will be really hard to say "no" when meds are offered.

And it's REALLY important that you pay to take a childbirth preparation class outside of Kaiser. Kaiser's class won't cut it if you want to avoid meds.


OK, so I left this appointment feeling really pissed. Not so much pissed at the midwife, but pissed at Kasier. Pissed at a hospital system that won't allow its midwifes to even hand out a list of friggin local doulas to its patients. At the very least, they could have a one-pager with the name of the certifying organization for doulas so that patients can search on their own.

When I was pregnant with my first son, I didn't even know what a doula was. That certainly wasn't part of the Kaiser childbirth preparation class. They were too busy passing around forceps and a vaccuum so we could see how our kids would probably be extracted from our bodies.

In any case, our conversation brought to light a larger question for me -

Do hospitals get in the way by complicating labor? Does the medical system (for all its good intentions) inadvertently hinder birthing mothers by intervening when it's really medically unneccesary? And at what cost?

**And here I think it's important to note that I think that hospital staff are wonderful, dedicated people who save lives. In an emergency, they would be the ones to provide the needed interventions to save my life and my baby's life. I recognize that and am very thankful for it.

But. I'm guessing that the majority of birthing women are not high-risk, nor do they ever become high risk during the course of their labor. And yet, we are treated as "patients", strapped down to our beds with IVs, offered medications at every turn. And maybe we WANT to take medications and that is our choice (hell, I was shouting for the epidural at the first opportunity!). But on the other hand, are we conditioned to think that we NEED these interventions? And, again, at what cost?

In recent months, I have read that epidurals are associated with stalled labor, increased risk of needing Pitocin, and c-sections for failure to progress. I haven't read all the research on this, but in my personal experience, I saw it (almost) happen to me. Though I didn't end up with a c-section, I was very close to it. And I know that the c-section rate in this country is astronomical. Why?

And I'm also wondering: given the potential risks and disadvantages of epidurals, why don't hospitals more routinely offer pain-relief altneratives and natural coping mechanisms? Like, how about a shower in every room? Or, better yet, a soaking tub for a water birth? How about doulas provided for free, paid by your insurance? How about midwives on staff who can actually BE midwifes and help women prepare for a natural birth? How about a labor room that is bigger than my cubicle? How about birthing balls lent out to all women at their first prenatal visit? I know there are some hospitals that offer some of these, but guess how much of this Kaiser offers? Zero, zilch, nada.

That said, I don't think there's anything inherently wrong with seeking pain relief in labor. At all! I WISH we could have pain-free labors, and heck, I may even ask for the epidural again, but I hope I won't have to. Having experienced Pitocin without an epidural, I'm actually more afraid of getting an epidural now (and having it fail) than I am of trying to do it naturally.

But I'm curious: what are your thoughts on this topic? Do you think that hospitals get in the way of the natural birthing process? And if so, do you think the birthing mother pays a price? Or am I just smoking crack?



Anonymous Smiling Mom said...

I did feel that I had limited options. But I also had a Doula who advocated for me in both births. She was so nice to have. My husband LOVED her because she could deal with my major pain and he could just be there to support me. Good for you for checking out the Doula. Shame on Kaiser for not doing a better job of showing you (and me) all of our options.

10:58 AM  
Anonymous andi said...

Wow, that's terrible. I do think that it's important to offer women choices (obviously, as I love me some epidural action), but that women shouldn't be pressured into getting the meds if they don't want them and that all of the options should be presented. I'm not sure how it works in the states (I'm in Canada), but I imagine that medicated births are advocated because of the extra cash that it means to hospitals. Or am I wrong about this?

Also, if you go into the birth this time with extra support and knowing that you can't count on the epidural, I think you'll be much more capable of handling the pain (I hope...)

12:38 PM  
Blogger bubandpie said...

Wow - I have never heard of a midwife talking that way. I was actually a bit worried about going with a midwife because I didn't want to be pressured to have a natural childbirth. What's a midwife FOR if not support your desire to avoid meds? Isn't she the one who's supposed to run interference and make sure that you're not pressured to accept interventions you don't want?

12:48 PM  
Blogger Lawyer Mama said...

Yes and no. My OB's pratice had 2 midwives that I saw regularly. Both encouraged me to attend a birthing class and provided doula names. By my 3rd trimester it became obvious that I am one of those high risk women and ended up with an emergency c-section after a routine visit and ultrasound. I was so naive going into it. I had no idea really, just how serious the situation was. In hindsight, when I think about it my heart skips a beat because we were so close to losing my son. So, that's just the background that makes it hard for me to look at the c-section topic objectively.

I'm actually a bit appalled at Kaiser though. How could a doula do anything but help? And they shouldn't want to drive women who are going to seek a supported birth away from the hospital like that. How horrible!

1:20 PM  
Blogger ACostlow said...

I totally feel you I live in Texas I did choose to use a midwife however they did not really talk much about natural childbirth. I loved my midwife but wish that I had more options I did end having a c-section. I feel like hospitals do get in the way, I am pregnant with number three and will probably be having another scheduled c-section and that bothers me. I think sometimes that childbirth has become a scheduled inconvenience. I think there is something to be said for letting nature take it's course.

1:31 PM  
Blogger Kyla said...

I had an OBGYN, not a midwife. I delivered in a hospital. I do feel that there were a few times that I wasn't free to make my own choices, or that is was discouraged. Like I wanted to walk during early labor, and not have the monitors on, they reluctantly allowed it, but they said no meds until I hopped back into bed and put on my monitors like a good little girlie. The only med I took was Staydol to take the edge off. For BubTAR I was given pitocin to speed things along, and it made me nauseas and then I had to have phenergan which knocked me out cold. With BubTar, I had an episiotomy. I birthed both children with no epidural.

There were a few things (episiotomy, confinement, pitocin) that I would have liked to have change, but overall it was a good experience. I feel the trade off was fair for me to be in a place I considered safe. The hospital safety net is important to me in childbirth. But many women are coerced into other interventions.

I think it is a thin line, and women have to do their own research to get the birth they desire, whether that means changing to a birthing center, transferring hospitals or OBs, or whatever. There need to be accessible options so we can experience a birth that makes us comfortable, whatever that may be.

PS: World's longest comment, right?

2:48 PM  
Blogger Mommy off the Record said...

Smiling Mom: glad you had good experiences with your doulas!

Andi: Interesting question about hospital profit. I'm not sure of the answer, but I do know that when I was admitted for contractions at 34 weeks with my first son, the Kaiser nurse told me as an fyi that it's Kaiser policy not to stop the labor after 34 weeks because it's not cost-effective. I was floored! I don't consider 34 weeks full term so I was very upset by that. Plus, that may be policy, but why would you TELL your patient that?? Luckily, my labor didn't progress at that point.

B&P: I was also expecting her to be more supportive of a natural approach. In talking more with her, though, she appears to have her hands tied by the system. She even admitted as much to me during my last appointment.

LM: I definitely would make a distinction between c-sections that can't be avoided in emergency situations such as yours and ending up with a c-section due to unneeded interventions during a normal, low-risk birth. That said, I'm glad a c-section was possible for you and everything worked out!

About the doulas, the even weirder thing about the Kaiser in my area is that they actually participated in a doula study for a year or so and had doulas on staff to see if they could determine whether there was a difference in birth outcomes. That was a few years back, though, and currently they don't seem to promote doulas at all. Go figure!

acostlow: congratulations on your third pregnancy and thank you for your comment.

Kyla: I know exactly what you mean about feeling a need for the hospital safety net. I am the same way. I think I might be open to a birth center next time, but I'm still too chicken for a home birth :) Also, I completely agree with your comment about women needing to do their own research to get the birth they desire. I think it's good to thoroughly understand what the hospital/birthing center/OB etc.'s birth philosophy is and then making sure it jives with yours ahead of time (not that I did this!). I am just starting to get that now.

3:10 PM  
Blogger dcrmom said...

I'm shocked by your experience. I had a hospital birth all three times. I used an O.B. the first time and a midwife the last two times. The midwife basically told me that it was a "have it your way" type of practice. They would help me go natural if I wanted that (and I felt they were subconsciously encouraging that route) and if I wanted meds and/or an epi, then I could have it whenever I wanted it.

When I was at the hospital, this was basically my experience. Now, granted, I wanted all the medical intervention possible and had good luck with all 3 epidurals. But I got the feeling that whichever route I chose, I was supported.

I used 2 different hospital systems, for what that's worth.

5:17 PM  
Anonymous Anonymous said...

Wow. Have you made a birthing plan? I made one while preggo with the Beast and they did listen to what it said. I said on it though that I didn't want meds, and so not to even ask me about them...and the nurse came in and said "I see on your birthing plan that you don't want us to ask you about meds, so If you think you need some, let us know." Wtheck? But I never even thought about asking, because I already had it in my head that I was going natural.

5:23 PM  
Blogger feener said...

I agree that it seems the csection rate is too high in this country. I felt lucky b/c i had such an excellent dr. for my first child in NYC, she was ultra conservative and i just felt so safe. I was lucky that all went well and was able to pop my first out without much trouble. however my second was born in NJ and I could see the difference in care right away, less personal, nothing extra, just what insurance will cover. oh and my NYC dr. did not take insurance....hummm

6:20 PM  
Blogger Christina said...

It depends. I had my VBAC in a big hospital, but was never pressured to do anything I didn't want to. I had a very detailed birth plan, had it signed by my doctor, and faxed a copy to the charge nurse at the hospital so they would be familiar with it ahead of time. I also had a doula.

No one pressured me, I had a massaging shower available if I wanted it, and everyone respected my birth plan. It may have been that I just had a good team, but I recommend standing firm about what you want. They can't force you to do anything, and they can't refuse to treat you, either.

I think hospitals can be just fine for giving bith, but you have to know your rights going in.

7:41 PM  
Blogger Pumpkin said...

Coming from Scotland, I had never heard of a Doula until I watched an episode of Frasier....I'm naive I know. However, I had a midwife who was only there to give me ultrasounds....NO-ONE at any point mentioned that they were alarmed at the size my son seemed to be (10lbs!), I had an epidural,gas and air, the works....there was talk of a c-section at one point and then I gave birth and was whisked away to be sewn mentioned that I had been on their 'critical' list and only noticed I had lost half my blood count when I collapsed 2 days later. Now, Scotland does have national health service, and they were good....but I had no real bond with my midwife, didn't have a lot of information going in and had the bejeezus scared out of knowing now what I do about Doulas, I think they're a great and wonderful thing and especially when you are paying for top notch medical care, I think they should be offering you as many different options as possible in regards to the direction you want to go with the birth which should include RECOMMENDED Doulas!
Hmmmm...sorry that was a long comment!

2:34 AM  
Anonymous lildb said...

brilliant stuff, C. I had a much better experience with Kaiser here in p-town re: the offer of natural options during the childbirth classwork, etc. as well as during labor.


yes. it's true. what you've said. it's true. I'm sure in some places more than others.


and I'm proud of you for working to educate yourself and us. you're such an awesome person.


2:52 PM  
Anonymous chelle said...

I have had a baby in Canada and in the US ... in the US it was all about the drugs and making the birth a non-legal, potential to sue situation rather than what was best for me and the baby on an individual basis. No chances, no go with the gut ... it was done by the book.

My nurse in the US ROCKED! Totally supported me, wanted to help me through for a natural birth ... then the woman had to go off and have lunch .. her replacement was evil and I had an epidural by the time my nurse was done lunch!

Get a doula ... a good one is amazing, but make sure she is the right fit for you and your family!

3:10 AM  
Blogger kgirl said...

I don't know what Kaiser is, but I have real issues with the medicalization of childbirth.
Most people I know that chose midwives (myself included) did so because they wanted the care, ability to make informed decisions and options that (overburdened) doctors don't seem willing to give. Certainly my experiences with my midwife, homebirth and aftercare have been nothing short of enviable.
Hope you'll be able to say the same.
Shame on the medical system.

10:42 AM  
Blogger Nadine said...

Hmm. You know, it is exactly the opposite in my country (The Netherlands). When we find out we're pregnant, we're send to a midwife. Only with high risk, you go to a gynecologist. Here, they try to convince you to have natural child birth at home. Pain relief is like a taboo (only 8% of women have them). Epidurals are very uncommon (as are c-sections).

Having said that. I think both ways of pushing pregnant women to a choice is unethical. We should get the pros and cons for both options.

I had a natural childbirth at home. And I hope I that my second childbirth will be there too. It was a beautiful experience.

11:48 AM  
Blogger Mommy off the Record said...

kgirl: Kaiser is a hospital system. I think they are national.

Nadine: wow, the US is so different! Here, it seems like having a birth at home is seen as "risky". I totally agree that giving women all the information to make the choice that's best for them is the best way to go. But I love that the Netherlends helps women achieve a natural chilbirth. That's awesome.

12:58 PM  
Blogger Damselfly said...

I really hope you're not smoking crack with a bun in the oven!

I think hospitals have come a long way, but really, it seems to me a lot of the stuff they do at birth is done for the convenience of the staff and/or the doctor. If you read the book "Birthing from Within," you will be horrified at some of the stuff that goes on. And yet I opted to give birth at a hospital because I feared if there were any complications, that's the place I wanted to be for my baby's sake....

Pick a doula you really click with. Nobody who's had a doula that I've talked to has ever regretted it.

7:58 PM  
Blogger Nancy @ World Wide Rolves said...

I hired a doula who was also a Bradley instructor - and took her Bradley classes. I think it was a great way to get to know her besides our appointments.

I used a Doula with my second and third children. My first was as scheduled c-secton due to complications. My second was an unmedicated v-bac (with Doula!). My third was a c-section after labor (with Doula).

The unmedicated v-bac was the best experience of all three for me.

I do think that hospital policies set us up for problems. With my third labor, my water broke at home and since the baby had been breech for some time we went right to the hospital. Where labor didn't start. The dr on call was cool and let me sit without ordering pitocin, which made my doc unhappy - but oh well. When we couldn't stall any longer and they finally started me on a tiny dose of pitocin my contractions quickly became unbearable, the baby was having distress with every contraction and they decided to do a c-section.

Unmedicated was a much better experience. It's gradual, you work your way up.

Good Luck

12:58 PM  
Blogger Guinevere Meadow said...

Hi! Please don't think I'm eavesdropping on your conversations with other bloggers, but Damselfly and I are real-life friends and she mentioned to me that you were interested in the HypBirth program. I used it, too (we had our babies 3 months apart,) and I'd love to chat with you about it! (She and I had very different experiences, I want you to have all the information possible!) Please email me

JenKSwan (at) gmail (dot) com


3:10 PM  
Blogger Fidget said...

When I had Levi 4 months ago I was the talk of the birthing floor.. I was apparently the only natural birther there in a long time. I had students in my room as well as other nurses drifting in and after I had him the nurses station was a buzz with what had just transpired in my room. GASP a woman who had pitocin purposely opted for no pain meds ??? They were even further floored when I explained that I had my 2nd kiddo that way too.

I would just go to a birthing center but I am high risk b/c of clotting factors and meds I have to take so I cant even walk by one without the staff getting nervous. When I called to inquire about using one they actually laughed at me.

My 1st birth was terrible. It was overly complicated with all sorts of stuff, meds.. ugh everything and almost everything went wrong.

hell this time Levi was having a bit of breathing trouble and they kept him 3 days - 3!! He was fine after 8 hours but they didnt bring him to nurse and he got hysterical so his blood oxygen levels werent good b/c he was screaming so they had to keep him longer GRRRR

um yeah sorry for the novel.. i can just relate to your experience and thoughts.

11:00 PM  
Anonymous Jenny said...

I don't think I could ever go thru childbirth again w/out drugs.

And what's a doula?

7:58 AM  
Blogger Jodi said...

Huh. Interesting debate to be sure. I don't know where I stand to be quite honest. I had c-sections with both my kids. I am very glad that I had that option. 100 years ago I probably would have died in childbirth. I think that it's more your labor and delivery nurse who drives the atmosphere of your birth experience more than anything. At least that's what it was in the hospital where I had my boys. I was in HARD labor for 14 hours with Trent and never advanced or whatever they called it and so I had a c-section. turns out he was 10 lbs 7.5 oz and was trapped in the birth canal basically. i had two different nurses during my labor and I really think their attitudes made the atmosphere in the room. But, maybe not. I think it really depends on the hospital. And I hear bad bad things about Kaiser and HMO's in general....

8:47 AM  
Blogger dodo said...

i think anything that a woman can do to empower herself physically or mentally before birth can only help. whether its a first or subsequent birth. I had a horrific experience at the hospital and only found out much later how endangered P had been in the hours before I was able to push her out. I'm certain that my taking private antenatal yoga classes saved the day after 4 epi's failed to do anything other than paralyse my arms and legs. Hospitals want to process and butcher us like factory food. They undermine our confidence in our inner strength and ability to push the child out without intervention. they can definitely cause complications with their insistence on certain positions or timings. They don't listen. They don't respect us and are intolerant of independent thought.
Stick to your guns! A big report just came out here in UK about the thousands of unnecessary c sections performed in our hospitals every year, just to keep the factory cogs turning at pace.

11:42 AM  

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