The truth about Cesareans, in video

This video combines pictures and text to express the emotional and physical toll a C-section takes on a woman. It is not just another way of giving birth. We are all glad that C-sections exist when the life or health of mother or baby is at risk, but we are in the middle of a C-section epidemic in this country, with no appearance of it slowing down. In fact, one hospital in Michigan, set to open in a few years, is being built with several more operating rooms than is the current norm, in anticipation of a 50% C-section rate. Many hospitals and doctors now will not allow a VBAC as an option. When a C-section is truly necessary, no one complains. When a mom has what she feels to be an unnecessary C-section, many times she is scarred emotionally as well as physically.

An Epidural Story

I once watched an episode of “The Baby Story” on TLC, in which the woman (a first-time mom) planned on having an unmedicated birth. She took no childbirth classes, had no information prior to going into labor on how to achieve that goal. My sister was like that–just assumed that since women had been having unmedicated births since the dawn of time, that all she would have to do is “just say no to drugs” and it would happen. Little did she know how difficult it would be at the hospital.

Once my sister was admitted to the hospital, she was made to stay in bed. This was supposedly so the umbilical cord wouldn’t prolapse, but the possibility of that happening is extremely small. If the cord doesn’t prolapse when the water breaks, then it almost never does–like one in a million chance, regardless of what the mom does, or what position she is in. My sister was told to lie in bed and be still so the EFM could monitor the baby’s heartbeat. She wasn’t even allowed to get up to go to the bathroom….but they wouldn’t bring her a bedpan when she requested it. So, she unstrapped herself and went to the bathroom, and then the nurse came in and scolded her for taking off the monitor.

In this particular video birth story I saw, the mom is admitted to the hospital, and does everything “by the book.” After a few hours of lying on her back in bed, with a blood pressure cuff on one arm and an IV in the other, she has reached her limit. She so terribly wants an unmedicated birth, but she just doesn’t know how to accomplish it–the contractions are just hurting too badly. Yet, as I watched her, I realized that she did actually know what to do–she just didn’t understand that what she wanted to do was what she needed to do. She thought that she had to follow hospital policy, which included forced bed rest and continuous fetal monitoring. She thought it was best for her baby, safest for her child to stay in bed, unable to move.

Here is what I saw: she was lying in bed resting between contractions, then another contraction would start. She would lie still as long as she could, and then start whimpering and shifting her body around–unable to really move, because of her arms being essentially tied down with machines, and her belly strapped to the monitoring belts. She was valiantly trying to make it through the contraction in that position, which I can say from personal experience is one of the worst positions to be in during a contraction. What I saw was this woman having to force her body to stay in the “proper” position, while her whole being was trying to move into a different position. What she needed was to be off of her back, but she couldn’t do that and do what the hospital wanted. So she chose to be a “good little girl,” and she was in a lot of pain, because she was lying on her back. I was literally yelling at the woman through the TV screen to get off her back. And I could tell that her body was yelling at her to do the same, but she just wouldn’t listen to it. She listened to the “experts”, instead of her body. Now, who do you think was more expert in what she needed for labor–some nurse she didn’t know, or her own body?

After suffering through multiple contractions in that position, she whimpered to her husband, “I…. just…. need………. something.” She didn’t want drugs, remember. She also didn’t ask for “drugs,” in particular. But she needed something to be able to make it through the contractions. This isn’t because contractions are necessarily so horrible that all women need drugs or should take them–it’s because lying on your back during labor is usually about the worse position to be in, and makes the contractions much more painful. The “something” that she needed was sympathy and support from her husband (he was her only labor companion), but even more so, she needed to be in a better position. Her husband, knowing she had wanted to go without drugs, softly asked her if she wanted an epidural. Defeated, she nodded her head and accepted the epidural.

Laborists

A new trend is emerging in certain hospitals that provide maternity care, and it appears that it will spread: the replacement of the OB you chose as your care provider during pregnancy with an OB who is on the hospital staff, and is called a “laborist” (as a specialty) who oversees your labor and birth.

The desire to ensure the presence of the OB of their choice has led some women to have an induction or a C-section, putting their health and the health of their babies at risk. (Inductions and C-sections are both riskier than normal birth, with medical complications as well as death rates being higher than in births that are not interfered with.) Other women are more accepting of “fate” and submit to the fact that their chosen doctor may not be in attendance, little realizing how much their care may differ from doctor to doctor.

Now here we are in the first decade of the 21st century, and the care women receive during labor and birth is becoming even less mother-friendly, less personal than before. With the advent of “laborists,” there is actually a guarantee that women will not meet the doctor who will be making decisions in their healthcare prior to going into labor. Does it bother you that someone you have never met, don’t know, have never had a conversation with will be deciding what medications or procedures you will have and when? If you are educated about childbirth, you may be knowledgeable about certain drugs or procedures that are commonly used in labor but you wish to avoid. Your OB may agree with you on not doing these things, but what is the opinion of this unknown, nameless, faceless laborist who may think that these procedures are preferable?

Do you know how much weight the opinion of the doctor has on the care you receive? Some doctors have very high intervention rates, others have very low rates–even with identical clientele. Why do some doctors think women “need” Cesareans or inductions or labor augmentations when other doctors don’t? If your doctor thinks you “need” a Cesarean (even if another doctor would not make the same call), what do you think the odds are that you will be pressured into accepting this surgery? While you may be able to discuss this with your OB, what if the doctor on call has a different opinion?

To end on a positive note, I can see one area in which having doctors on schedule like this may possibly improve women’s care (although having continuity of care is known to improve the labor experience and birth outcomes). Under the current system, doctors must come in to oversee their clients’ births, which means they often want to speed things up (by augmenting labor, calling for a Cesarean, using forceps or a vacuum to speed up birth, etc.), so that they can get back to their lives–seeing patients during office hours, eating supper with their families, going on vacation, sleeping more than a few hours each night, having a weekend without going to the hospital, etc. Doctors are human too, and want to have time for themselves and their families, and while this should not happen, this can lead them to suggest interventions or even urge a woman to accept a Cesarean when they are not truly necessary, but will be preferable for the doctor or his schedule. I sympathize with the demands on a busy obstetrician’s time, but that is not an excuse for using an otherwise unnecessary and potentially harmful intervention. Under a “laborist” system, the doctor will be at the hospital for a certain period of time, regardless of how long any particular woman is in labor. He will get to go home to his family at the same time, whether Mrs. Smith has had the baby or not, so there will be no internal pressure to suggest something to speed up a normal labor, just so he can go home early.

Why can’t I eat or drink in labor?

(Part 2 of “Why, why, why?”)

Let’s take being denied food and water as a prime example of asking why something must be done, since most hospitals today have that as their protocol. You may actually be already expecting it, and have never thought to question it. But now, ask yourself, “Why should I not get to eat or drink during labor? Why do I only get hard candy or ice chips?” Do you know? Really?

The real answer is that back half a century ago, most women were anesthetized during birth, many under general anesthesia, and anesthesia techniques were not as good as they are today, and many patients–not just pregnant women, but all people undergoing anesthesia for surgery–vomited and (being unconscious) inhaled the vomit. Many of them got sick, and some even died. Modern anesthesia techniques eliminate that possibility; so unless you have an incompetent anesthesiologist, this will not be a problem. Even if it were still a problem, the likelihood of you actually needing general anesthesia is very slim. Even if you need an “emergency C-section,” in most cases, it will be in reality an “unplanned C-section”–there will actually be plenty of time to place an epidural, which will allow you to remain conscious during the procedure. If you are awake, trust me, you will not inhale your vomit.

But you’re in the hospital, and you ask the nurse for some food because you’re hungry and it’s suppertime. “Oh, no,” she says, “you can’t eat in labor.” At this point you can say, “okay,” or you can say, “why?” She will probably say that it is hospital protocol, routine, or procedure, and hope you shut up. Do you say, “okay” or “why?” See–you may think you have been given an answer, but “this is what we always do” does not answer why you can’t eat. You are not a three year old child who cannot understand the reasonings of an adult. Many times, you will find that hospital answers to such questionings are basically the equivalent of “because I said so.” You deserve better. You are an intelligent adult, and should understand the logic behind the request, before just mutely submitting to it. So, in answer to your question, the nurse may say, “Well, you may vomit if you eat.” You can say, “I’ll take my chances–I’m really hungry!” She may still resist–and remember, most women just blindly follow hospital protocol, so this is a learning experience for her, too. She may speak of the danger of vomiting; but as I’ve already shown, the real danger is so miniscule as to be nonexistent. Think of it this way–there is a greater possibility of a driver getting into a wreck and needing emergency surgery under general anesthesia right after he finished his lunch (so a very full stomach), than of you needing the same. Yet there are obviously protocols in existence to minimize the risks of aspiration in those cases, so why should you be any different?

One further question–how do you think your doctor would react if you told him at your next prenatal appointment that you had worked outside all day without eating or drinking anything but a little hard candy and some ice chips? Your body is working very hard–hey, it’s called “labor” for a reason!–and needs fuel to continue. So ask your doctor or nurse why you should fast and become dehydrated at the end of your pregnancy, if it is dangerous during pregnancy. What athlete would compete in an endurance event without proper nutrition and hydration? Labor may last longer than a marathon, and you’re supposed to complete it without food or water?

Why, Why, Why?

Don’t worry–this isn’t some whiny rant post. This is just a reminder of what to ask when presented with something–any test, any procedure, any intervention–during pregnancy or birth (and afterwards, for that matter!). This blog goes hand-in-hand with the informed consent page, so if you haven’t already, check it out on the side of this page.

Have you ever consented to something, and then afterwards wondered, “Why did I do that?” Have you ever felt like you didn’t quite understand a procedure, but didn’t want to seem stupid, so you didn’t ask for a better explanation? Have you thought you understood something when it was explained to you, then later on realized you didn’t know all the facts?

Me too. I daresay everybody has. Nobody wants to appear dumb–call it “The Emporer’s New Clothes” complex.

But the truth is, if you don’t understand, then it’s not your fault for not understanding the explanation–it’s their fault for not explaining it on your terms. It has nothing to do with real intelligence, but rather with understanding their particular jargon. And let’s face it, some folks just like talking over other people’s heads, because it makes them feel superior. It’s time to say, “Enough!”

When faced with anything, just ask “Why?” And keep asking “why” until you fully understand.

For instance, take the flimsy hospital gown they give you when you check in. Why do you need to wear that ugly thing that barely covers you? Would you be embarrassed, if a nurse opened the door suddenly, and a stranger passing by your room saw you like that? There may be a reason for you to wear the gown….sometimes. But why not just let you wear your own clothes? Why can’t you bring your own gown, that is certainly both more modest and more comfortable. In addition, wearing a hospital gown marks you out as more or less their property–you look like a patient, and patients are by definition “sick.” When you retain your own clothes, you retain more of your own power, and people treat you differently. It’s a little hard to retain your dignity, when wearing a gown that opens at the back, and barely covers your front (especially with your pregnant belly).

I could go on, giving multiple examples of asking “why” before any procedure–getting an IV, pain medication, pitocin, etc., but I will refrain. Here are some examples of questions you can ask–repeatedly if necessary–to give you the knowledge and information you truly need: “Why do you want to do that?” “Why do you need to know that?” “What benefit is it?” “What are the risks?” “How will that change my care?” “How will it help the baby?” “I don’t understand how that helps–could you explain it again differently?”

And after you are told of the risks and benefits, and you truly understand why they want to do it, you can always ask for a few minutes to think about it. (If you want to, you can always say you need to discuss it with your husband or pray about it.) There are very, very, very few times when you cannot take the time to think and really approve of something.

It’s not just to be hard-headed or hard-nosed, but if there is no benefit to you from the procedure or practice, then why should you do it, just for their benefit?

Fast Food Birth

I once saw a lady dress it, wrap it up, and stick it under a heat lamp. Think I’m talking about a hamburger? No. This was a nurse in the hospital nursery, “taking care of” a newborn. She wasn’t exactly rough….but she wasn’t gentle either. She certainly did not treat the baby with the same care its mother would. The poor thing was crying–crying for its mother–but was made to stay in the nursery, probably for a few hours. Is that the way you want your baby treated?

Did I witness this treatment back in the 60s or 70s? You know, the era in which women were still routinely shaved, given an enema, put under general anesthesia for the birth, and given a huge episiotomy so the baby could be dragged out by its head with forceps.

No. This was three years ago, when I toured the hospital labor ward when I was pregnant with my first baby.

It would make a nice story to say that this…..not exactly “cruel”….treatment changed my mind to have a home birth; but the truth is, I was already planning one. The trip to the hospital was just in case we had to transfer, I would know what to expect. Although my intention was to have a home birth, seeing how my precious newborn would be treated if I chose to go to a hospital cemented my determination not to go there unless absolutely necessary.

Through the years, I’ve thought of that poor baby, and that nurse, and that hospital. I feel quite certain that this treatment of newborns is not unusual. In fact, I’ve spoken to many women all over the country, or read their birth stories, who have testified of the same thing. Where is the sense in this treatment? The woman labors for hours, many times in adverse situations; she may push for even a few hours, on top of several hours of dilating contractions. Then, her labor culminates in the birth of her precious infant, and they are separated for hours with barely a cuddle and a glance.

Instead of relishing in the bonding hormones that nature so bountifully supplies, the woman is left on the bed, craning her head to catch a glimpse of her child, while strangers hold, clean, suction, weigh and measure it. Then she is given the baby, wrapped up like a burrito, for a few moments, before the baby is taken to the nursery to have the process repeated–more thoroughly because the mother is not in attendance, and cannot hear her child cry out for comfort, while the poor baby bonds with its first bed (a plastic box) or the heat lamp.

This is obviously not normal. Is it beneficial? No. Here is normal, so you see the difference. This “normal,” by the way, is acted out every day in home births across the country. Occasionally, a hospital birth may be this way–some hospitals indeed are more baby-friendly–but a trip to your local hospital’s nursery windows may be quite educational.

The mother labors with her chosen attendants–whether it is husband, mother, friend, midwife. She gives birth and reaches immediately for her baby, who is handed to her and immediately settles down onto her chest. The umbilical cord is not cut, and the baby is probably not crying. Why should the baby cry? He has everything he needs–still getting oxygen through the cord, taking small, uncertain breaths with his untried lungs; is cuddled to his mother so he has not only her heat warming his wet body, but her smell that he is so familiar with. Perhaps a blanket is put over them so that he is kept snug and warm, but he gets the advantage of that skin-to-skin contact, instead of being roughly wiped with a hospital blanket that has been cleaned with harsh chemicals. The mother, in the ecstacy of birth hormones (most akin to post-orgasmic hormones, but even stronger), drinks in the sight of her precious child, while his eyes search for hers, and then he stares at her with a penetrating gaze. Ah, love! Then the baby begins to root, and finds the nipple and begins suckling. Perhaps after a few hours, someone thinks to disturb them, but no one dares to interrupt that first important meeting. You might think that after all the hours of labor the mother would be tired; but typically the post-birth hormones give her a mental “high” that keeps her awake and alert for hours, drinking in her newborn.

But in the hospital, the nurses take the baby for these precious first hours. The mom is left with an empty uterus, empty arms, and empty heart. She is told to rest, but finds it impossible. The baby must be bathed and warmed in the nursery she is told. So instead of being warmed in his mother’s arms, pressed to his mother’s heart–that familiar heartbeat he has heard for the last nine months, smelling his mother’s smell–that familiar smell he has smelled the last nine months, and nursing from his mother’s breast which is comforting to him above all else–instead of that, he is left crying, helpless and alone, under a bright heat lamp, with no one even attending him, or seeming to hear his cry. The nurses have heard too many babies cry to care particularly about your baby. They have their job to do, and must “observe” instead of cuddle this precious bundle of tears.

Hello world!

Welcome to my little corner of the blogosphere! 🙂 I’m very excited to start my own blog, and hope to interact with you through it.

A little about me–my name is Kathy Petersen, and I live in North Mississippi. I’ve had two homebirths, and am a self-confessed “birth junkie.” Since the empowering birth of my first child three years ago, I’ve been interested in all things related to pregnancy and birth, and have recently become a childbirth educator. If you have any questions about pregnancy or birth, just ask me….woman to woman.