Eh. I’m trying to strike a balance. I’m also failing in that regard. But, for what it’s worth, here’s another birth bitch:
I rarely, if ever, participate in banter on my blog — even back in the day when I was posting nearly every day. But Lucky Candice left a comment on my last post that struck a chord, so much so that I felt I couldn’t just respond to her comment in-line. Thus, this post. Her comment was offered respectfully, and I took it as such. Likewise, my response, in the form of this post, is also offered respectfully. Her comment:
I love your blog - so I hope you don’t mind a bit of devil’s advocate here. Many hospitals offer walking epidurals. You can have walking monitors on or take them off. You just tell the nurses you don’t need or want them. If you write in your birth plan that you want the birth to be more natural, most nurses are really really cool about it. Supportive even. Granted, at the hospital you have to stand up for yourself! You have to be in charge and be firm about your wants. I’ve had all three of my kids in the hospital. My doctors (both of them that I’ve had) have been adamant about the fact that they never do episiotomies. You CAN eat, you just tell the nurses you’re going to and they don’t fight it. I guess what I’m saying is this: if you’re going to have your baby at the hospital and want a natural experience - bring a doula or be in complete charge and make it go the way you want it to. Even with pitocin you can walk around, have a room with a birthing tub, request a birthing ball make sure you get the squatting bar. Hospitals have this stuff. People just don’t use it and don’t “shop around” when it comes to the hospital they’re going to use.
Anyway, that’s my two cents.
I’ve heard her sentiments offered often — heck, even I have echoed them at some point in my life. It all sounds nice and good: advocate for yourself, and you’ll get what you want. Except, it doesn’t work all the time, or even most of the time.
Sadly, it has been my work as a doula that has brought me to this conclusion.
Take for example the case of eating and drinking during labor. Honestly, most of the time I don’t see this restriction placed on moms. But sometimes — most recently included — it happens. And mom says, “I know this is bullshit. I should be able to eat.” And I say, “You know, what happens behind closed doors isn’t anyone else’s business.” Yet, still, mom doesn’t eat. She’s been told — multiple times and quite clearly by the nurses and the doctor: nothing by mouth. The unspoken implication being that she’s putting herself — and her baby — at risk. Does this make her a “weak” individual, unable to advocate for herself? Should the blame be placed upon mom? I don’t think so. The blame — and the shame — is on the care provider: for not practicing evidence-based medicine, for unduly using his influence to force someone into submission, and for putting his own self-interests above that of his client’s. The restriction should have never been imposed in the first place.
Now, about those episiotomies. In the area I practice, I too, can say that most doctors don’t perform them any more. “Oh, please don’t be the one to make me do an episiotomy,” they’ll joke, “I haven’t had to do one in two years and I don’t want to sully my record.” Despite the underlying theme of self-interest echoed by these statements, this is a good thing. It gives me hope, in fact, because even as little as five years ago episiotomies were standard practice. If this protocol can change so quickly, maybe, I hope, others can change as well.
But that doesn’t mean that they don’t happen. “You’re going to tear. I can’t tell you how badly, but you will tear. Or I can cut you cleanly and we can have this baby on the next push.” These are the words mom’s hearing. Over and over again, actually. She’s also hearing from me, quietly, “With each push you’re stretching beautifully. A little at a time, just like nature intended it.” But the words from her care provider hold more weight. They do. Is mom to blame? Or is it the care provider? Shame on the care provider, I say: for lacking patience, for not practicing evidenced-based care, and, most of all, for not listening to mom — who’d clearly told him her preference to tear — and, instead, badgering her repeatedly until she finally submits…to his way.
Monitors — just try taking them off, and watch the fireworks fly. Walking Epidurals — only one of the five hospitals in my area (yes, five) even provide such an option, and you tell me how you’ll be walking the halls with a fine catheter in your back attached to a pump attached to a wall. A really, really nice nurse — one you’ve gotten by the luck of the draw — just might detach it to let you go to the bathroom, but, otherwise…these walking epidurals are a sad misnomer. Birth Balls — you’ll get the only one available if someone else isn’t using it. Squatting Bars — push all you want while squatting, but when doctor shows up to catch, plan on being manipulated into a lying position on your back. Wireless monitors? Again, if you happen to be at the one hospital out of five that even offers such an option, you might get lucky — if the two sets available for sixteen birthing rooms are not already in use. (And, incidentally, the hospital with the wireless monitors is not the hospital that offers “walking” epidurals). And care providers — for every one in a given practice that you show me who will respect your choices, I’ll show you another one in that same practice who operates on an entirely different playing field. Which one shows up on the day you go into labor is anyone’s guess, and that’s an uncomfortable gamble, at best.
So, yes, you can make choices. You can do the research and choose the hospital that has the most permissive monitoring policy, or the hospital with the “walking” epidural, or the hospital with the wireless monitors, or the care provider who you most “love.” You can make all of these choices, carefully and purposefully. But, in this environment, you can’t guarantee they’ll be respected. And, that, in the end, is the problem. You shouldn’t have to fight to be respected during labor. You just shouldn’t.