Childbirth: a matter of choice?

[skdadl]

Cathie from Canada has a fairly passionate post up this morning that took me a bit by surprise. I see that kuri has already responded.

Since I've never given birth, I didn't say anything because those are Cathie's rules at Cathie's place. But I was surprised by the absolute nature of her judgement in favour of medical control. She says that the doctor's opinion, among other things, doesn't matter, but if I'm following her logic correctly, it is precisely the doctor's control that she is endorsing (because that's the only way you are sure to deliver a healthy baby).

The discussion over at Shakesville (link from Cathie) is interesting too, although I haven't read all the comments.

[shaolin]

Fair enough if she thinks only her baby mattered in that experience, but she seems to be suggesting that it's only the baby that is important in any birthing experience.  She is sounding very similar to the fetus fetishists in that.  I suspect there are a lot of mothers out there who would disagree, and rightly so.

[brebis noire]

Of course, Cathie is perfectly right.
Assuming of course, that doctors are always right, and never ever make mistakes and are always able to predict perfectly what will happen during every birth. And that they also have absolutely no other considerations in mind (and that there is nothing else to consider) besides the delivering a healthy baby.  :roll:  And that mothers are nothing more than baby-carriers, and that no matter what is done to them while giving birth, they will subsequently perform perfectly as lactators and baby-holders.

I had my babies in hospital precisely because I was concerned about medical emergencies, both for myself and my babies, but her tone is categorical, likely because of the shock and surprise she went through in having her baby. So it's too bad she can't see past her own experience.

Just for example, there are very legitimate concerns about how C-sections can negatively affect subsequent pregnancies and deliveries, not to mention the health and well-being of the mum in the days and weeks after birth. It's a bit much to assume that women are only having C-sections when it's medically necessary, and never out of convenience for the doctor or out of excessive caution.

[skdadl]

I understand why Cathie was outraged by the comment from the neighbour -- who was "sorry" for her, I guess because she had a C-section. That was a cruel and stupid thing to say, the sort of thing that sets off rants in me too. But I don't see that that is directly connected to the issue at hand, which is the problems many of us have with some conventional practitioners who are still running on sometimes dangerous patriarchal arrogance -- and not only when they're overseeing childbirth. Most of my medical rants go in that direction.

[Debra]

I wrote to this subject yesterday and reprinted the study from Britain which shows better outcomes from midwife assisted birth. I have also read studies which show that mothers in midwife assisted births have less incidence of PPD.

http://aprilreign.breadnroses.ca/2008/0 ... ur-choice/

What the AMA is doing is trying to call for it to be illegal to birth at home. What then happens to mothers with precipitous birth, young girls afraid to tell anyone they were pregnant or any number of other reasons why a woman may delivery at home including her own choice too. This as I said in my post is just another way of controlling women.

[arborman]

Our kid was born at home (on R's insistence), and we had 2 professional midwives and 2 students present for the birth - 4 medicos right there and involved for 6 hours.  Significantly different than the doctor who pops in while making her rounds.  Not to mention one or the other of them came by for an hour every day for two weeks, and regularly after than for another 4 weeks.

I think people should give birth where they are most comfortable doing so, and in the circumstances they are most comfortable.  I am incredibly appreciative of our midwives and their help, but I have many friends who opted for a hospital birth, and good for them too.  Absolutes applied to personal choices are never good.

[kuri]

Since I've never given birth, I didn't say anything because those are Cathie's rules at Cathie's place.

That didn't stop me. I've been there (literally and figuratively) for enough mothers that I gave myself a pass. Besides, her rule is stupid.

I also sent the link to someone who has given birth and I reckon will have a lot to say.

[Toedancer]

I'm mighty confused. From her blogpost:
the mother's experience, her doctor's opinions, her midwife's opinions, her husband's participation, whether or not she uses drugs, whether or not she uses technology, etc etc -- all of this is completely irrelevant to whether she has a healthy baby or not.

I actually found ALL those points totally Relevant to the kids healthy birth. I needed every one of those points in different orders and back again, round and round we went, to stay focussed and in control.

Having never given birth disallows opinions? Well I had never given birth before, and I had a lot of opinions during my pregnancy.

AMA - patriarchal arrogance go hand in hand. The studies I've read are really too small, but so far they've all come out 50/50, just as safe at home with a backup plan for emerg. Just to add, in H I gave a list of DO NOT's and DO's, one do not was ignored without even a verbal warning, oh we're going to do this even tho it's on your do not list.

[brebis noire]

Funny, there's nothing in there about how doctors who've never given birth shouldn't be delivering women of babies... :?  

I really appreciated that my rotating team of four physicians had all given birth at least once. Though even then I appreciated some of them more than others...I'm thinking it's because even people who are supposed to be as objective as possible still manage to have subjective experiences and opinions.

[vmichel]

I'd agree with her if, after the baby was softly plucked from the mother's belly, it was spirited off to BabyLand where a host of caring angels took care of it for a month while the mother rested.

In actuality you go home after a day or two to care for the baby, and there are serious physical demands placed on the both of you. As Brebis points out, what happened in the delivery affects your strength and healing and your ability to care for the child. So yes, it might make sense to be resistant to an intervention that will ease the delivery itself but make the mother's recovery much more difficult.

There aren't a whole lot of either-or choices in childbirth where you must choose between the mother's comfort or the baby's well-being. That's a sneaky way of framing the issue as "selfish feminists want X."

I will say, though, that as the time comes closer for me I am increasingly irritated and uncomfortable with the focus on my plans for labor and delivery. It reminds me of getting married, and the focus being on all the details of the Big Day rather than on the actual marriage.

I'll use a hospital, and I'm glad I have the option to consent to or refuse certain interventions, and I'm glad that I can have someone in there with me. But guest lists for L&D? Timing the parade of visitors during labor so that X is there for transition but only Y is there for pushing? Bags upon bags of merchandise I'm expected to buy for the delivery? A birth plan that gets down to who says what to who when, and who holds the baby in what order after it's born? Forget it.

Most of all, I am frustrated with the expectation that the delivery is somehow supposed to be a magical, transcendental experience for me and that if I don't do everything in my power now to arrange that I will be missing out. I really don't want the hassle and aggravation of planning my Birth Experience. I just want to have my baby as safely and comfortably as possible and then go home and start taking care of it.

[vickyinottawa]

I kind of get what she is trying to express - that when something  goes wrong in a pregnancy or birth, what kind of birth one wants is irrelevant.  I would have loved a midwife-assisted, drug-free birth, but when Wee G turned breech at 39 weeks, there was really no option other than a c-section.  Even then I never would have expected going into distress after getting the epidural in preparation for the surgery, and then being put under general anaesthetic and missing the whole experience.  It's certainly not what I would have chosen.  But ultimately G and I were both at considerable risk and were it not for medical intervention we may have not survived the experience.  I was so glad of our health care system that day.

The way I would have put it is that unexpected things can happen and at that point your desires are irrelevant.   You can make all the detailed birth plans you want, but ultimately it is out of your hands.  Crap happens.  But what she doesn't get is that even in those situations parents need to have an understanding and acceptance of what is happening - doulas, midwives, nurses and docs all need to ensure that clear lines of communication are there so that parents feel good about having their ideals ripped from them in a split-second.  I think her absolutist approach is unfortunate, but perhaps she has mixed feelings about what was clearly a scary experience and they are playing out as hostility for people who make what she calls "silly" choices.  She may not understand that most people who choose home birth go through it with contingency plans in place and that no midwife would allow a high risk birth to happen at home.  The midwives I know are consummate professionals.

[brebis noire]

I'm as easily put off by the idea that giving birth should be the Ideal Metaphysical Experience as I am by the purely medicalised approach. Most of the time, I feel like each camp is just reacting to the other and that doesn't help to advance real understanding.

My experiences were somewhere in the middle, and I likely just lucked out when it came to available choices. I could've had my second baby at home relatively easily, but didn't, and six years later, that kind of choice seems like a wedding at the beach. A trippy, holistic experience, it might have made for some great memories, but ultimately doesn't have a whole lot to do with how you relate to your spouse (or kid) every day for the rest of your lives.

On the whole, I just think we're very lucky today to not have to deal either with what women had to go through for centuries, what with the atrocious death toll of labour and delivery, or with the overly medicalised experience that was briefly the norm from the mid-40s till the mid-60s or so.

On the other hand, "more choices" doesn't necessarily mean the experience is going to be smooth and without unforeseen consequences - which can result both from the application of non-necessary medical procedures as from not having them.

[pale]

Some people really get in an uproar about this stuff. I have 4 kids. Done this a few times myself.

I wish I had been able to deliver at home. I HATE hospitals. The hospital here actually has one birthing/maternity room in the maternity ward, with no windows. Its just stuck it in any old way. I guess it was a storage closet at one time.
No sun. No light. No way to tell the time of day even. Thats medical science for ya! Women are incubators who we are forced to accommodate when they give bith. Period. cold bastids.

Guess which room they put me in last time? Uh huh.
 
You cannot sleep, its not your bed.....its too narrow to lie with baby.  No window, dog food for food. (literally, serious ongoing issues at the local hospital here)....

wanna talk PPD?
PPD can be deadly. I'm not being an alarmist as many of you know.  
That last time they wouldn't let me out, and I just cried, and cried. It affects everything, and I am sure the babe as well.

Hospitals are for sick people. We always come out with some gawd awful bug.

On the other hand, I'm a bleeder. They hook me up to IV's and get the blood supply ready before you can say....."blood type"...

Me? I have no choice. But many are not in that boat, and can choose. With the level of care available at so many hospitals now, a midwife giving one on one attention can often spot problems a lot better, and get appropriate help sooner than a ward nurse who is so bogged down with a patient overload she misses stuff. (and that wouldn't be her fault either).

Homebirth? nah. I wouldn't. But I'm me, and everyone is everyone else. Guess I could have just said that and been done with it.
:)
4 medication free births. BTW. Heh. Im more skeered of the epidural than the pain.

[vickyinottawa]

after my last epidural experience, I am pretty scared of it too!  If I do get preggers again you can bet your britches I'm trying for a VBAC.

[brebis noire]

I had an epidural for my first, and though it was pretty badly timed (i.e. I was actually ready to push, but also ready to throw myself out the window) it was a huge relief at the moment. Very insidious aftereffects though, both for me and the baby, so I didn't opt for it the second time.

Is the PVAC a pudendal block? If it is, that's what I had, and it didn't work, so I might has well have had nothing. (Demerol was not a good choice either, for the first labour, I think it just slowed things down.)