Hospital Birth

I enjoy the blogoshphere. I spend a good bit of time reading blogs. Some of the blogs take a more scientific approach to their content, while others include personal stories of birth (good and bad). I sometimes find myself becoming frustrated and saddened though when I read about women's personal experiences when having a hospital birth.

I find it difficult to wrap my mind around some of the horrible birth experiences I have 'heard'. I didn't have wonderful birth experiences, but wouldn't describe them as horrible or bad either. But some of the stories I see on various blogs are almost unreal seeming. There are cases where legal entities were involved in the care of a woman's pregnancy, confining her to the hospital by court order and others where a woman had to travel 5-6 hours from home to have a VBAC (when she had one already at the very hospital that denied her!). Other cases are of hospital births where women were left feeling, at a minimum, dissatisfied but in some cases, traumatized.

I worked as a labor and delivery nurse for four years, in a tertiary center. This meant that we handled high-risk and low risk, shipping out only those whose babies would require immediate surgery after birth. I know bad stuff happens in the hospital. It can be factory-like, unpleasant, women made to feel powerless and not in control of bodies. I don't deny these things.

What I worry about is the focus on negativity around the hospital birth experience. Until homebirth and OOH birth centers are financially and geographically available to all low-risk women, hospital birth is it for some women. It's the only viable option for whatever reason. I make decent money and have health insurance. But I couldn't afford to pay for a homebirth out of pocket! So all the bad press surrounding hospital birth might be disheartening for those who are destined for the hospital as their birthing backdrop. You know how it goes - everyone's quick to share a bad story, but not a good story :p

There are hospitals....and Phoenix Baptist Hospital (PBH) can't be the only one. We midwives at Bethany Womens attend births at PBH and have been there for several years now. I have seen beautiful births - more than I can count. It is possible to have a wonderful, satisfying hospital birth. Look back at the archives for this blog and you will find a small portion of those stories. So this is why I get frustrated it can be good....even great, in the hospital. We do it all the time.

We encourage women to be a partner in their care. It's not our goal to be the dictator. Instead we want to establish a relationship with women and their families. This is the very first step in having a wonderful experience in the hospital. We truly care about our patients. We didn't become midwives because we wanted to be pulled away from our families and work long hours. No, it's about being with women, empowering women, changing their lives for the better. The five of us are very passionate about this. We RESPECT women. And at the end of the day, I think that makes a big difference. I will tell women when doing a consult for prenatal care. Find someone you trust....if it isn't us, I don't care.....find someone you trust, it's critical.

I hate to see women feel alienated by the very fact that they had a hospital birth. What happened to midwifery being about supporting women...all women... regardless of where they give birth? Who decied that it would be impossible to have a satisfying, enriching experience in the hospital? That this could only occur in the home environment? I think that time spent arguing which is better - hospital or home - is time wasted. Time needs to be spent improving options, educating women, improving hospital birth. The birth community needs to stick together. If we had nearly the coheisiveness of American Congress of OB/GYN (ACOG), we'd probably be a heckuva lot further along in our struggles for women's birth rights/rites.

This stuff with women being forced to abide by court mandates of hospital confinement, etc is outrageous and a slippery slope indeed. But it can be better.....and I see the proof of that all the time.

E's Birth Story

I always encourage women to write their birth stories, whether they have them posted here or not. Having a written account of your birth story is such a nice keepsake for years later when details have become fuzzy. I think it's also a nice addition to a baby book. Someday this child will grow up and may be curious about how they arrived in this world. I regret not having written any of my births up - so many little details are lost to me now. And my husband, well, is useless at that sort of thing :p

E was coming in for induction due to having cholestasis (a condition that carries with it a very high risk of stillbirth after 38 weeks gestation). E was actually 38.6 weeks and this would be her fourth child. She had epidurals with the first three and was hoping to have a natural childbirth this time. She was not thrilled about being induced. Fortunately when she arrived that morning and I checked her, she was 3-4/70/-2. So I discussed breaking her water and waiting for labor versus starting pitocin. We both agreed that the ROM (rupture of membranes) was the way to go. I broke her water and sent her off walking.

I left her to her own devices, with instructions to call me when she started getting active. In the meantime I headed off to see postpartum patients and then the office. I checked in by phone a couple times during the afternoon, to be told that she was feeling more contractions and mildly uncomfortable.

I arrived back at the hospital about 5:30pm to find her ordering some dinner. I decided to check her at that point and she was 4/90/-2. I explained that it does take some time for labor to get going after the water breaks. I encouraged her to snack a bit then do some walking. I told her I would go grab some dinner while she did the same.

But then chaos occurred, as it so often does on labor and delivery :) A patient of one of our doctors came up ready to deliver. I was involved with that for about 45 minutes. By the time I finsihed up there, E was getting active. She was no longer interested in eating. The nurse had her get in the tub.

I went to sit with her while she was 'tubbing'. Her husband seemed a little nervous as E was gradually getting more vocal. he sat with other family members in the room. I told E that he was just not used to seeing her like this :) She vocalized her way through each contraction, then rested, even dozing between. At one point she asked me "How will I know it's time?" I told her she would know...her body would just start to push.

Eventually, her husband sat with us in the bathroom. He rubbed her shoulders and poured water on her belly. He seemed to be adjusting to the fact that E's behavior was very normal (I had reassured him several times). He was doing a great job being supportive. At one point she asked if it was too late to get IV pain medicine. I checked her and told her she was 8cms and yes it was too late. She accepted that without any problem.

I encouraged her to change her position in the tub. She moved to her side but after one contraction on her side, she said "The baby is coming! I need to push". We assisted her to the bed. I encouraged her to get in whatever postion she wanted. I re-checked her and she was completely dilated. I told her she could have this baby whenever she was ready.

I had 'warned' her about the ring of fire previously but she was still caught off guard by it I think. She held back a little but then just gathered her strength and pushed her baby right out. We had a bit of a mild shoulder getting stuck, but was quickly relieved and both mom and baby were doing wonderfully.