Monday, March 3, 2008

And again

I am having a week of devil's advocacy. It's not to support any position that I am really picketing for, with signs and all, but just to encourage thinking around the issue. Nothing truly is black and white, is it?
So is it really succumbing to a culture of fear to perhaps make a cautious choice to save the life of a child? Because how would it feel if you decided to go "out on a limb?" Say you are the doctor, and you are at a birth, and you are seeing plummeting in the heart rate, and you are a little concerned. The nurse points this out to you, and you are a little worried. Maybe the patient is aware, and maybe she isn't. Maybe she's very into having a natural birth, and maybe she isn't. But either way, once you are concerned, you have two choices. Act conservatively, or wait and see.
Say you decide to wait and see. Then you see further decels. It's not life-threatening right now, but the labor is kind of slow. The patient really doesn't want a c-section. Neither do you, really. But you are concerned.
So do you act conservatively, or wait and see?
Let's say you wait and see some more, and then suddenly, without warning, the patient feels a flurry of movement, and then the heart stops beating. Completely. You put her on oxygen, lie her flat, turn her on her side, call the anesthesiologist. Now there is no choice to be made.
The baby is delivered 14 minutes later, with a nuchal cord wrapped tight 3 times. The peditrician tries for 27 minutes to rescusitate her. The attempt fails.
So don't you wonder, then, what might have happened if you didn't wait and see? And wouldn't that just make you want to NOT wait and see the next time?
And, just so you know, that mother would then be like all the rest of us in that club, who can look back to the very moment when something really conservative could have been done to save her baby, but wasn't in the name of letting things progress as they naturally would. (For me this would be the thought that some "crazy" doctors don't let patients go beyond their due date. Imagine! If my doctor had been one of those, I would have an almost 5 year old girl playing pet shop in the living room right now)
The thing I always like to kind of have a little laugh about, and this is in regards both to childbirth and also to vaccinations, which I have never brought up on this blog, is the third world. So I'm imagining these women in Africa, whose infant mortality rate is very high, whose maternal mortality rate is very high. To them, the ability to have access to the kind of health care we do would be a dream come true, and for many infants and mothers, a potential lifesaver. Same goes for vaccines, these moms line their kids up, anxiously awaiting the vaccine for the disease that might have killed their sister, or mother, or other children. And here we are, all wealthy and privileged and so completely vamped out of the real world that we snub our noses at the very things that were invented for the simple purpose of saving lives. (I realize, of course, that it is far more complicated than just this, but I do sometimes feel so ashamed of this attitude of privilege)
I also feel disgusted by how removed from the natural world we also are, so I really would hope for some kind of glorious compromise, which I have not figured out here.
And all of this, everything that I wrote, is not necessarily representing what I really think is right or true, but just things I think we should be thinking about.
When you have actually had your baby die, and be dead in your arms, you really do see things so very differently. The choices sometimes, to me, seem so much more logical. I just don't see how anyone, ANYONE, doctor, nurse, patient, and for god's sake THE MOTHER, would want to take a risk! A chance! Do you have any idea what it feels like to have your baby actually die? To actually never get to keep that baby you were growing all that time? To have to plan a funeral and to make phone calls to tell people that that long awaited life has been extinguished? I think that we are so removed from reality sometimes that there are a lot of moms out there who really don't even REALIZE that this could happen to them. That their baby might actually be almost dying during the birth. And guess what? Might actually die.
It is such a fucking let down to become a statistic.


Anonymous said...

I hear you. I remember being in an early doctors appointment with my first pregnancy... my doctor, who I was very fond of, asked me if I had any particular ideas about how I wanted pregnancy and labour to go.

I said, "All I know is that I don't feel comfortable with the idea of homebirth - it wouldn't feel right to me, in my gut."

She nodded and said very calmly, "During my residency I worked in obstetrics. I can't tell you how many times I had to run - not walk - down the hallway to save a baby or a mother. The difference is minutes - and it's just not worth being away from help, if you need it."

I couldn't agree more - and that was ancient history, way back when I was still untouched and arrogant and oblivious.

That said, my first labor was a mess of intervention. I just wish there was a happier middle ground - what I would consider ideal would be a hospital setting with a midwife.. with a more holistic, natural approach, but with all the resources at immediate reach.

Anyway, great post. You're right - disaster has a way of changing how you see the world.

Birdie said...

You are really good at saying what I am feeling so clearly...

I just don't get why anyone wants to take the risk that I once did. It was a tragic choice that ended horribly. It was an unfair choice, a selfish unfair to Birdie.

listen up homebirthers....ITS NOT WORTH THE RISK, YES RISK!

Awake said...

Lately, I'm drawn to the discussion of birth like a moth. Reading, researching, watching THE documentary. Going back and forth with my lovely husband. I've had a post on this in "draft" form for awhile now, not quite sure how to say what I want.

But I love how you put it out there. Force us to think of what we don't want to face. Doctors with (shocking!) actual hearts and souls. The real dangers that could be present. These are things that can (and should) be discussed. Without judgment, but to encourage thought.

Charlotte's Mama said...

Yes. You are absolutely right. Things should just be out there. The truth. I was shocked when I gave birth to charlotte. People had told me my risk for Downs, my risk for CF, my risk for heart conditions. These were all in the thousands. Nobody told me I had a one in ONE HUNDRED chance that my baby would be born dead FOR NO REASON. Yes. that is the number. One percent. That is big.

Jen said...

Thank you for this post. I think it is all too true that some moms don't realize, or perhaps don't allow themselves to realize, that babies can and do die. I am feeling increasingly agitated by some statements I've read recently by homebirth advocates, even seemingly innocuous statements like "most births are normal and uncomplicated." And what about those other births? They don't really spell it out.

In theory, when someone weighs a risk, they generally consider at least two aspects: how high the risk is, and how devastating the consequences. Of course, first you have to be *informed* of the actual risk and consequences, but let's assume you are. Even if the risk was fairly low (and as you point out, 1 out of 100 is not low!), wouldn't most people, knowing the real potential consequences, be highly motivated to avoid the death of a baby?

What level of risk are people willing to accept when there are lives at stake?

What is going on in the birthing world?

Nicole D said...

I understand your stance. I REALLY do. I read you often and can see, hear, feel, taste, and smell the anguish and anger in your posts.

I have been privy to a few babies who were born still for their own reasons (or no reasons at all). It is heartbreaking - and the mom's always look for a why, a when, a what if, justifying their anger, their hurt, and looking for a place to settle their heartache and blame - often justifiably.

BUT- I can tell you - from also working with home birthers, there is STILL less risk for a healthy low-risk woman to birth at home and have a healthy living mom and healthy living baby than at a hospital.

What an ideal world it would be where a woman would not be pressured, would have unflappable support from her birth team, and be able to have as safe a hospital birth as a home birth, with ALL medical emergency equipment there at the ready JUST IN CASE... but too often women do not get that support, cannot find that support and have no choice but to have a less safe hospital birth or a safer, though not as ideal, home birth.

There is another side to everything.

In a perfect world.

I am still, oh so sorry for your loss and hurt.