Tuesday, March 4, 2008

Who is in charge, here?

I feel like I am somehow on a rant that just won't stop. It comes with the territory of being bitter about becoming a statistic. So here's another thing, this also pertaining to this idea that a hospital birth is inevitably tied up in a sea of interventions resulting in a c-section (not truly, but you know what I mean)
Are we not all free agents?
Now I know I am lucky, truly fortunate, to have a really great birthing center at our local hospital, and I have had the same, very fabulous nurse with me for each of my births. So I was given a nice jaccuzzi to lie in, was offered a nice big birthing ball to sit on, and when I of course demanded to be monitored so I could hear that sweet heartbeat they made sure it was a telemetry one so I could walk around, move, etc. I was encouraged not to lie down, was given a squatting bar, this was all very good. I know that most moms are not offered such things.
But rather than steering people away from a hospital, why am I not really seeing much action towards changing hospitals, and first and foremost, educating mothers? Or rather, where can I find the people who are working from this angle? To me this seems really logical. Really, even if you wanted to, there would be many, many moms who could never be convinced to give birth at home. So rather than coccooning up with the rest of the homebirthers, why not work hard to change what's happening in hospitals? To make sure mothers KNOW what might happen, and have the education to assist in weighing and calculating the risk possible to their babies and themselves?
Yeah, I know. This actually is going on. I am missing it, because I am sequestered in this spoiled rotten granola crunching valley where our hospital already IS good and where lots of people have homebirths and where all the people who get epidurals have asked for them, begged for them.
But this is where I want to be. I want to change things from the inside, not walk away from the whole problem. And by saying this I am not insinuating that people who are pro-homebirth are walking away from the problem, quite the contrary, in fact. It's just that while obviously that pro-natural birth community is working quite hard to re-establish birth as normal, and sees a logical consequence of this action as moving away from the hospital in uncomplicated, risk free deliveries, we have already established that I don't share that opinion due to my freaky sensation that all babies in the womb are ticking time bombs, liable to drop dead at any moment.
So anyway, here's my point. We are all free agents. We are all free to say NO. We can say no to monitoring, ultrasounds, pitocin, epidurals, and even a c-section. We can at any point walk out the door. Right? So who is the one responsible for the interventions? Is it the doctor? Is it the nurse? And isn't it also the patient? The consenting patient?
So here's the plan. Once I have successfully trained all the OB's and nurses and midwives and doulas in the northeast US to be really awesomely conscientious and kind and do all the right thing for the people whose babies DO die; AND after I have made sure that every person whose baby dies has access to adequate support networks; AND after I have made sure that all hospitals and homebirth midwives have access to and use excellent photography equpiment, dental-stone castings, beautiful blankets, etc. all this first-rate stuff for memory making; AND after I have totally revolutionized in general the way that perinatal loss is viewed in the obstetrical and nursing community; THEN I will move onto this subject. The patient needs to know what is happening to her. Because she is the one saying yes. So that's the next thing.

5 comments:

Natalie said...

I agree! That is exactly what I am trying to figure out how to do- change the hospitals. HA
Lately, I worry that this is the place that everyone starts, sees that it can't happen, and that's why they move it on to their own territory.
I, myself, am quite a nervous person and would probably be more comfortable in a hospital. But if I got pregnant today, and the choice was between the hospital I used for my first baby and my home, I would probably choose my home. Maybe.
Also- of course we are all "consenting," but we are also already in love with our babies, so if the expert tells us "we need to break your water/crank up the pit/insert IFM/what have you," why would we argue? The first time I mean. Now I hope that I wouldn't be so passive.
But we have been put or have put ourselves (prob. both) in a place of passivity.
I couldn't agree more about the education part- lamaze actually recently had an article about the changing face or childbirth education, and also gives grants to individuals in communities to promote normal (whatever that means to you) birth.
http://www.lamaze.org/Advocacy/BirthNetworksOrganizingYourCommunity/tabid/113/Default.aspx
I really enjoy your blog

Natalie said...

http://www.lamaze.org/Advocacy/BirthNetworksOrganizingYourCommunity/tabid/113/Default.aspx

Jen said...

I think your detailed plan at the end of your post is right on. You are having an amazing impact on the world, Carol, and I am so inspired by you. You ask the really important questions, questions that get right at the root of, what values can we agree on as a society, as mothers, as people who need to grapple with birth and death?

I read this post and then read a bunch of other posts in the blogosphere about the upcoming "Trust Birth" conference-- and I feel jarred and shaken. I am struggling so hard to put my finger on all the elements that are disturbing to me. Certainly the free agency of mothers is one element. The anti-hospital, anti-OB crowd is quick to point out a "culture of fear" as well as cases of pressure, coercion, etc, and I wouldn't dispute that the cultural elements are powerful and real. But what about the corresponding culture/rhetoric/pressure that can come from these same homebirth "get your interventions away from me" folks? Are they not also saying "do it my way"? And when we focus on external pressures from either camp, where does that leave mothers and their conviction in their choices?

I know when I was preparing for birth, the message I was getting from the homebirth folks was along the lines of "Avoid hospitals as much as possible because of the inevitable cascade of interventions." Except what they didn't say was, I was free to say no to interventions, I was never at anyone's mercy. In retrospect I find the statement incredibly DIS-empowering, the opposite of its intent. This is especially clear to me because, due to my active choice to accept interventions, and my astounding luck at being in the hospital at the right time, my baby's life was spared.

Thanks, Carol, for helping me think about these things. And thanks to the other bloggers and commenters as well.

Charlotte's Mama said...

I think it's really a good point, what Jen says. The message of "stay away from the hospital or else you will meet the chain of interventions" is very disempowering. Isn't that kind of as far away from the point as you can get?

Charlotte's Mama said...

I think it's really a good point, what Jen says. The message of "stay away from the hospital or else you will meet the chain of interventions" is very disempowering. Isn't that kind of as far away from the point as you can get?