Tuesday, August 12, 2008

This night, August 11th, In the darkness by the fire.

We are gathered around in the living room. There is a tall, stone hearth, with rounded stones and a wooden mantle, the fire is warm. A smooth, square pine trunk stands in front of that, there are six feet on top of it, four bare, one with flip-flops. On an old stump, a cutting from an ancient oak tree that was cut down forty years ago stands the television. We are watching the Olympics on television. There is something so cozy about this scene, there are five of us, gathered around the fire first, and the television second, watching these athletes competing twelve hours and halfway around the world away.
We are watching television more as background, and for the mostpart of this time we have been engaged in a hot discussion of healthcare in the US. My entire family is Canadian, my sisters and I are the only members of our entire extended family on both sides who have dual citizenship with the US. More by default and habit than by choice, the three of us have all ended up living in the states, and so it’s always fun for us to get into a good, hot chat about all the things about our fair (or not so fair) nation that could use a good fix. Tonight it was health care.
Now I shalt not go into the entire conversation, but there was one area that stood out to me, and it reminded me of this age gone by on this blog, and a rant I had going for some time which hasn’t reared its head in quite some time. It was this assumption that Americans have (and of course, yes, Canadians have it, too, but this was in the context of our American health-care conversation) that everything, EVERYTHING, can be fixed. Everything with your body can be fixed.
At the support group I run, we talk about this almost every month, the utter disbelief that we feel that whatever it was that caused our baby to die, it was either undetected or somehow, for whatever reason, unfixable. Somehow, all along, we had been gently led around by the hand with blinders on, made to believe that all of science and technology could solve almost any problem. But this all had failed us, and we all had a dead baby, or maybe even two, to prove it.
My mother talked about how many orthopedists find patients shocked to hear that their injuries will never be pain free. Even after bone crushing disasters, it is an assumption that people have that the doctors can fix this: if it is fixed, it won’t be hurt. Then she went on to talk about how in Holland, almost all babies are born at home, and there is virtually no pain medication used: patients expect that to give birth, one must feel pain, and in addition, one must bite ones lip and endure pain. So different from the concepts we have. And in addition: one of the lowest infant mortality rates. Oh, so kind.
So this returned me to the conversations I am always having, elsewhere and at times here, about hospital births versus homebirths, and how desperately I wish there was a way for women who were not as educated, as self-assured, and as bossy as I am to give birth in hospital, where all the life-saving mechanisms are on-call and in place, but without this vicious slide of watching the clock and induction and epidurals and pitocin and water-breaking and intravenous this and that and all things otherwise unnatural and, in some cases, unnecessary. I can’t bear it that so many women are left feeling helpless and defensive, their hands tied as they are led to believe they are doing what’s best for their babies, and in some cases they are, but in some cases they aren’t. I wish there were a way to turn this cycle around, to act truly in the best interest of babies only, to eliminate some of the peripheral antics that can take place, and to just focus on this beautiful end result, with confidence and truth.


Rixa said...

"how desperately I wish there was a way for women who were not as educated, as self-assured, and as bossy as I am to give birth in hospital..."

A few things I think have real promise, that could benefit all mothers and babies and that could help erase this silly divide between hospital and home birthers:

1) The Baby-Friendly and Mother-Friendly Childbirth Initiatives. The Mother-Friendly one will be much harder to implement--more controversial in some ways, since it really challenges the status quo of a lot of obstetric management--but really it's what we need to have good hospital births.

2) Freestanding and hospital-affiliated birth centers in every city. My little sis had her last 2 in a hospital-affiliated birth center (but more like a freestanding one--in a separate wing, writes its own policies, and is certified by the national birth center association). She loved it. Of course there aren't a lot of these around, but consumer demand and pressure can do amazing things. The reason that fathers became allowed in delivery rooms, that we changed from the separate labor-delivery-recovery-postartum rooms to the combined LDRP room, for example, is solely because of consumer demand. These changes didn't come from doctors or hospital administrators, but from parents who demanded it and threatened to vote with their feet if they didn't get it.

3) Hypnobirthing/Hypnobabies/etc...this has tremendous promise, I think, for helping women get into the mental (and thus hormonal) headspace that you can easily enter into in a home birth environment. Frankly, it's one of the things I think has the possibility of rescuing hospital birth from where it's heading. I would love to do a RCT of the effectiveness of Hypnobabies (which seems to be the most effective/successful of the available programs). Ah, got to get the dissertation done first!

4) Decriminalizing home birth midwifery. I am concerned with the climate of home birth in a lot of states that leads midwives to have to abandon clients at the ER door, or that might keep them from transferring sooner because they fear harassment of themselves or their clients. Plus I would hope that if home birth were to become less "underground," we could have interested medical students follow around midwives for a while, attending prenatals and births. It would be so good for med students to see how birth unfolds in a woman's own environment, and I think a lot of them would probably alter their own practice style based upon this exposure.

5) Doulas can help, although I have reservations about how doulas too often become enablers of a broken system, delaying change rather than enabling it. (Fascinating reads on this topic are in Jennifer Block's "Pushed" and especially in Barbara Katz Rothman's "Laboring On.") But, there was a recent RCT of doulas working with first-time middle class mothers who had partners/husbands with them during labor (unlike earlier studies that looked at low-income women without family/partners accopanying them in labor).

From the abstract:
"The doula group had a significantly lower cesarean delivery rate than the control group (13.4% vs 25.0%), and fewer women in the doula group received epidural analgesia (64.7% vs 76.0%). Among women with induced labor, those supported by a doula had a lower rate of cesarean delivery than those in the control group (12.5% vs 58.8%)." More at:

So it seems that especially for women facing an induction (needed or not) doulas make a huge difference in cesarean rates.

Well, I'm sure there are lots more ideas out there!

Rebecca said...

I think hospital birth has gotten a somewhat bad rap...mainly because those who had bad experiences are more vocal than those who might have done just fine there. I had to convince my OB/GYN long before delivery that I wanted to try labor without an epidural. "But, like, 90% of women get them," she said. "Not me." Being bossy about your own birth starts way before hospital. I am happy to report that, while I was induced at 41 weeks, it was a plain and simple birth and I do not, for one minute, regret any of the hospital experience. I have had to apologize time and again on message boards for defending hospital birth but it has its place and you are right-- if we cannot make all women educated, self assured and bossy like us, we do need to re-educate hospitals.

Sara said...

When I first read this post, I started getting into my own homebirth/hospital birth rant in my head, but I didn't have time to write.

So I walked around with your post in the back of my mind and the idea that jumped out at me was this idea that everything can be fixed. It is true.

I had been writing earlier yesterday about Henry getting so very sick just two weeks after his surgery. I was shocked. When we found out about the hole in his heart, we were told that most such holes fix themselves. When we found out the hole was worse than we thought, we were told that it was fixable by a practically routine procedure (sure it involved stopping his heart and cutting his chest open but it would fix things), with a high success rate. And then we could expect things to be normal. We could deal with developmental issues, but healthwise we felt like he was going to have a clean slate. So when, two weeks later, my baby was on a ventilator, I was stunned and I was angry. And I was scared. Up through two weeks post surgery, I believed that my baby could be fixed because I was told so. Then nobody knew what was going on. We were in what is considered one of the best pediatric hospitals in the country and nobody could tell me what was wrong or how to fix it. Then they began to tell me that they may not be able to fix it--that my baby might not come off the ventilator, he might never come home. I could not be led around blindly anymore with assurances that everything would be fine, but I couldn't accept that. I had to believe that my baby would live. It was almost as if I would will him better. Up and down, up and down we went with him--looking good, looking terrible, but through it all I continued to believe we could fix this. He could live. He could live a normal (though maybe with oxygen and lots of meds) life.

We brought him home after three months. We were there only about 24 hours when he started to get sick again. I think by that point I knew he was not truly fixed, healthwise. He was better, but it was precarious.

I know that everything can't be fixed. That's why this pregnancy is so scary for me. My doctors ask if I have any questions. Yes, one: Will my baby be OK? The problem is no one can answer that. I have declined some tests, anxiously awaited results of others, but part of me knows none of it matters. Maybe everything will be fine. Maybe something will be broken, and if it is maybe it can be fixed . . . maybe not.

kate said...

Yes, what you said.