Friday, January 07, 2011

My views on childbirth

Just before Christmas this year, I thought I would try to find the midwife that delivered my son Gabriel so that I could send her a Christmas card. My search sent me to a part of the blogosphere that focused on homebirth and loss. I spent some hours during Advent reading the stories, weeping with the authors and reflecting on all that had happened to me during my birthing years.

When I had a baby the first time, I went into pregnancy/childbirth  as a complete newbie. I hadn't read much or prepared for the birth, other than attending a breastfeeding class and a childbirth class, both given by the hospital. I guess I was naive but I just felt that the hospital, doctors and nurses would do the best for me and would want the best for me. My first experience was simply horrendous. I wrote the birth story here and about my feelings on that here and here.

Mr. Pete and I were first time parents. I was laboring on a small bed in a very tiny cubicle with Mr. Pete at my side. My contractions hurt but I was handling them pretty well. After almost six hours or so of doing this, the chief of obstetrics came to see me. He was an older man and he was flanked by two med students.

He told me that he wanted to check my cervix, which I allowed because I thought I had to. Plus I was interested to know if I had made any progress. In what I took as almost a tone of disgust he said I was only 3 cm dilated. There was no encouragement, no suggestions about what I could do to progress (like maybe walking around instead of being confined to the bed for insurance reasons), in fact there was no discussion at all. He announced that he was going to break my bag of waters.

Now, at that time I had been working as a medical records transcriptionist and even as the supervisor of the department for some time. I was use to being able to talk about problems and come up with solutions. So I started to ask him some questions like, "will this hurt" or "what are my other options."

What happened next still shocks me. I started to ask him questions and tried to engage him in conversation (on my back, undressed from the waist down with his gloved hand still in the vicinity of my vagina) when he said, "NOW" and he thrust his hand with the hook inside of me. I instinctively tried to close my legs and move away from him, but then he said loudly, "God, she's breaking my wrist."

The two med students each grabbed a leg and pulled me apart like a wishbone. In a second I felt the warm water rush over my bottom and legs. He took off his gloves and left. The contractions got much stronger. In fact the next one was excruciating. (I found out later that my baby was posterior, and breaking the bag of waters was one of the worst things to do for a posterior position. This led me to other interventions and eventually to my C-section.)

Mr. Pete stood next to me stunned. He had just witnessed something akin to the digital rape of his wife. I was crying. Crying for being treated with such disrespect, crying for the sudden increase in pain, crying because I wanted to run away but couldn't.

This and the rest of my experience did transform me however. For weeks I resented my baby. It wasn't until I came to realize that he was a victim too that I bonded with him a little better. The experience also transformed me into a sexual cripple. There are almost three years between my first and second child. Part of that is because we did not have sex for almost a year after Calvin's birth. I found out later that that is a normal reaction for women who have been sexually assaulted. It took us a while after that to get back to any semblance of the sex life we had before. Mr. Pete was very patient about it.

I tried to put it behind me. I healed from the surgery, I had a healthy baby, and I never wanted to give birth again. Problem solved. By chance I found the book A Good Birth, A Safe Birth, in the grocery store of all places! I started reading about the interventions and and things that happened to me and realized that it hadn't been all good or even all necessary!  My life and my perspective changed by the time I finished the pages. 

And that's how I entered the world of natural birth and home birth.  I read all types of birth literature about home births, and I was a regular at the local ICAN meetings. I became a birth enthusiast!  A couple of years later I did have another baby, via VBAC (Vaginal birth after cesarean) in a hospital with a certified nurse midwife.

After that successful birth I took some training to become a doula and I was with a friend of mine during her first birth, at the same hospital. When I became pregnant again, I followed my favorite nurse midwife to another practice but because of finances, we decided to try for a home birth.  A few months before I was due, another lady asked me to come and be the doula at her home birth.  This would be my very first homebirth experience and I was very thankful and happy to be asked to participate. I had seen the video this lady's prior home birth, shot around Christmas time, and it looked so magical and peaceful.  She gave birth in the same room as the Chirstmas tree! So I definitely was looking forward to being at her next birth; after having been at prior hospital births, including my own, I wanted to see the differences.

Unfortunately the first homebirth that I witnessed did not go according to plan.  It was a very stubborn shoulder dystocia that required transport of the baby after it was finally born to the NICU.  The baby did survive and in fact I saw her a few years ago shopping with her mom.  She survived and thrived, but it was very serious at first.

Understandably, that made me a little apprehensive about my upcoming homebirth.  I continued to read and study on my own. When the time came, all went well and I had an almost 11 pound baby in my living room in the middle of summer time.  This will probably be one of my top 5 acomplishments in life! You can read that story here.

A few years later I was pregnant again and I knew I wanted another homebirth, but I hadn't been entirely satisfied with my homebirth midwife.  I found a Catholic doctor who did homebirths and I started seeing him.  That was one of my happiest pregnancies.  I enjoyed sharing my faith with him and I enjoyed all my visits out to Amish Country for my prenatal visits.  That birth went very well and my mother was even able to hold the baby after he was born.

Surprisingly I was pregnant six months after that!  I started seeing my homebirth doctor again and I felt really like a professional homebirther by then.  But that birth had a surprising serious complication with a cord prolapse.  I was transferred to the hospital and had a truly emergency C-section. That story is here.

When I became pregnant in 2002, my homebirth doctor was no longer delivering babies. I found another midwife very close to my home.  I liked her a lot and she insisted that I have prenatal care at a local OB practice, which I did.  Yet despite standard medical care and care with the midwife, that baby was stillborn at home at 23 weeks. That story is here.

My youngest child's birth was a planned Cesaeran for a number of reasons.  Mainly, there were too many restrictions for trying for a VBAC.  The OB practice that I stayed with would let me have a VBAC if I was not post dates (all my babies were post dates) and if the baby was under 8 pounds (all of mine were over 9 pounds and two of them were over 10!).  And also since I was still grieving somewhat over my stillborn child, I opted not to fight the system, but just have the Cesarean.  That was one of my better births, and the small hospital that I had her in did everything to make our stay pleasant.

As I reflect back on it all, I wonder why I had all of these experiences. My homebirth doctor told me that in his 25 years of practice he had only seen two prolapses, one of those were mine!  He said he had never had a difficult shoulder dystocia, and yet I had witnessed one my first time observing a birth. 

I find myself straddling between the homebirth crowd and the hospital only supporters.  I think homebirth can be wonderful and safe, but I know it is not without risks. Hospitals can provide good birthing experiences too, but I think a lot of that depends on who is attending the mother, and sometimes that can be a crap shoot.

A father at the grieving/homebirth part of the blogosphere commented to me:


People should be able to choose home or hospital birth, but they need to understand that the preponderance of scientific evidence places the relative risk of their baby dying at about 3 times if they begin delivery at home, all things being equal. I consider intentially mis-educating the public to the contrary once you have been shown the evidence to be malicious, and hope that now that you have been shown the evidence you will tell everyone that you support their right to home birth, but oh by the way, triple the rate of infant death. You will have the honesty to do this in the future, yes?
I don't know about the "triple death rate" but I do think if we're going to "educate the public" we should go the full disclosure route about hospital practices and policies as well.

I guess what I really would like to see eventually is this:
1.  More certified nurse midwives able to attend home births.2.  More birthing centers.
3.  Removing the stigma from home birth parents. Maybe even OB practices or hospital having their own homebirth program!
4.  Better training for homebirth midwives, perhaps like the old-school hospital training that nurses used to receive at hospital schools of nursing.
5.  Better education for parents about what their options are for each procedure and what the benefits and consequences could be.
6.  OBs that are more open to letting a birth happen without being so quick to intervene for medicolegal reasons.
7.  Tort reform.







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