More women choosing to give birth completely by themselves

Parent Cafe
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LOL - this cracks me up. Ob’s can be so funny sometimes. Okay with tearing. geez.</p>

<p>Schmoomcgoo - Birth plans - I had one for each child. I don’t think women do them anymore - they just get the epidural. Sadly, we are back to assembly line birth.</p>

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and some will say labor must start within 24 hours. With my second the midwife broke my water in the office and sent me home - that would be unheard of today.
A close friend of mine labored at home for 4 days with her 4th, of which 36 hours were with ruptured membranes. Her daughter is an Ivy grad.</p>

<p>Sadly, most the reasons for so many interventions are for convenience - not the health of the mother and baby.</p>

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<p>^^^^Many interventions are in place to avoid liability; a sad result of a very litigious society. Many potentially great OB’s avoid that specialty because of the heavy malpractice insurance required and the potential for being sued and blamed for bad outcomes.</p>

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<p>He was pretty good natured and matter-of-fact about the whole thing. He came into my room to discharge me early the next day and I asked if it might make my recovery easier to spend another night in the hospital (as my friend had done with her second birth and she claimed it did). He responded, “No. If you stay here they’re liable to confuse your baby with a 4 pound black baby.” (Mine was an 11+ pound white baby.) What a nutjob!</p>

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<p>“Of course, we’re not likely to hear from anyone who opted for a home birth and had a very bad outcome…”</p>

<p>Nor from anyone who got an antibiotic-resistant staph infection following an unnecessary C-section in a hospital, even though that scenario only occurs in hospitals. It is at least as common as an equivalent bad outcome resulting from a professionally attended, low-risk home birth. The science says the lowest-risk women don’t need to be in the hospital unless that’s what they prefer. If you do prefer it, that’s a good reason to go, but there’s no research supporting the idea that it’s safer.</p>

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<p>Hanna,</p>

<p>Amen. Low risk women who have been carefully screened by a professional can give birth at home safely. One important criteria both the OB I saw with D1 and the midwives I saw with D2 used were that the baby’s head be engaged within the pelvis before labor begins in the case of a primipara or near the beginning of labor with a multipara. When the baby’s head is engaged it is highly unlikely that there can be any kind of cord accident during delivery.</p>

<p>The nurse-midwives that I know are very careful in screening women. For example, they will not deliver a breech baby vaginally. They will attempt to turn a breech baby to a head down position, but if they cannot turn the baby or if the baby turns herself back to the breech position, the backup OB is called in and a C-section is performed. In the past many breech babies were successfully delivered vaginally, but it is seldom done now. Frankly, since almost no OBs or midwives have experience delivering breechlings, I would not want them to attempt it with a baby of mine (or more realistically, my grandbaby).</p>

<p>I was a volunteer with La Leche League for nearly 13 years and have heard many, many birth stories. The majority were from moms who had hospital deliveries, though I have several friends and acquaintances who had home births. All of the home birth moms had very positive outcomes, including a few whose midwives recommended going to the hospital. Sadly, I’ve heard many awful tales from mothers who delivered in hospitals and who did not do their homework. That is, those who left everything in the hands of the almighty OBs. I believe that it is a big mistake to treat doctors as gods. It is important to arm ourselves with knowledge and take some responsibility for our own health outcome. </p>

<p>I have found that the women who had the most positive births were the ones who chose their medical team carefully, discussed their options well before the birth with their OBs or midwives, and put their wishes into a written birth plan. It is so important to choose one’s medical professionals carefully. Ask what percentage of patients have C-sections. If the OB routinely does episiotomies and you would prefer not to have one, you need to know. Of course, there are no guarantees that any woman will have an easy, picture-perfect birth, no matter how much studying and planning she does. However, I would want to know how my doctor or midwife handles complications. For example, if labor is slow to progress will mom be encouraged to get up and walk? Will mom be offered the opportunity to take a warm shower or bath to help her relax? Will she be offered nourishing food during a long labor? Most importantly, will the doctor be patient or will he immediately want to give the mother a pitocin drip? I would find another doctor if the person I was seeing was unwilling to have a frank discussion with me regarding common labor and delivery scenarios.</p>

<p>I do find it very sad that a major driving force in our nation’s high C-section rate and many other unnecessary interventions in the birth process is the high rate of litigation. For reasons I have never been able to fathom, many nurse midwives in this country are unable to get liability insurance unless they practice under a doctor’s wing. Because they deal with low risk women and women who tend to be more educated than average, they statistically have better outcomes than OBs. I do not have the statistics at my fingertips, but I recall reading in quite a few sources that midwives are sued at a tiny fraction of the rate of OBs. I would think they would be MORE insurable than the average OB.</p>

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<p>I had an episiotomy with the first and was quite happy tearing with the next three – much easier to heal from those tears versus a deeper cut. I requested no episiotomy after the first birth. </p>

<p>Re the decor, etc. – I posted earlier that my first was born in what could have obviously been turned into a surgical suite and my DD was the first baby my OB delivered in an LDR room – he and DH spent most of my labor reading directions to all the new gadgets in the room while I occasionally waved “Hello, woman in labor here”. I was in the same major medical center and had access to everything I had the first time. But my point is this – along with the decor, and the birthing bed, and so forth, I encountered a changed hospital culture around the birthing process from the first birthing experience. I think the decor, the LDR room and so forth, set a tone that this was a family experience, even if it was in a medical setting, and I felt far more empowered to say, “I want to try this position” or whatever, than I did the first time. It sent a message, and the fact that the hospital was set up to handle the baby’s initial care in the LDR room also meant they understood the importance of the family bonding with the baby, etc. I guess I see the change in decor as a metaphor for a change in attitude towards hospital births. When my youngest two were born, my kids were allowed to come in right after – it was a changed culture. To me that’s the ideal - to be in a top-flight medical setting for an emergency, but to also be in a medical setting that understands that, most of the time, childbirth is not a medical emergency and that it is an experience that should be oriented towards the family.</p>

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<p>Ah. Excellent. I hadn’t thought of a written birth plan, but that’s a great idea.</p>

<p>Being the daughter of a doctor (“The most impoartant thing I learned from medical school,” says Dad, “is to stay the hell away from doctors”), I’m extraordinarily picky about my doctors. If I’m not absolutely deliriously happy with them, and if I don’t feel as though I’m an important part of the medical team that’s treating me, I’m changing. Being in Houston, I’m really lucky… All of my docs except one are professors at Baylor Medical School and practice at Baylor Clinic. If I need anything surgical done, I go up to Dallas to my dad’s hospital (he’s chief of his department) and liberally announce to anyone and everyone that I’m his daughter… I’m incredibly thankful that I have the amazing luxury to do that, and great insurance to back it up. (I try to spread the wealth around as much as I can… Even LTS was offered second opinions and medical muscle via some PMs we exchanged.)</p>

<p>I won’t have that luxury if my husband and I move out-of-state before we have kids, so the idea of a written birth plan is comforting. DH already has specific instructions to deck anybody who tries to give me an episiotomy, and to inquisition anybody who tries to give me a c-section, but having it in writing is better.</p>

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<p>And regarding this… Having just been on the design team for the new Texas Children’s Hospital Maternity Center, and currently being a contributing member of my design firm’s Healthcare Community of Practice, I’ve got a unique perspective on this… This is actually what hospitals in general are moving towards. They want to be less medical-y, and hospital design has become less functionality-driven and has started paying more attention to how to blend patient experience with the state-of-the-art. It’s fun to see how things are changing.</p>

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<p>Regarding “choosing your birth team,” many (if not most) OBs practice in groups–sometimes large groups, and it is common to run through all the docs during pre-natal visits and then end up with whoever is on call when you deliver. Over 20 years I had 7 deliveries in 5 different hospitals, one home birth, (+ 2 miscarriages) prenatal care in 5 different states/big city/small town–my birth attendants were: a family practice resident, a family practice doc in group of four (I did get “my” doc), a certified nurse midwife, my husband alone (3 missed deliveries–two by solo OBs and one by OB in group of 10.)<br>
My seventh child was delivered by an OB from a large group who would have been my last choice (I didn’t like his personality/manner.) However, he did make it to the delivery, and looked good in the pictures (we called him “Dr. Hairspray”). </p>

<p>Most OBs spend a minimal amount of time with the patient. You’re paying for someone to “be available” to do a C-section/deal with emergency, if necessary. It would be much more useful if you could choose your nurses! (I had some wonderful ones, and a couple awful ones. . .) Don’t get your hopes up about bonding with the doc, or even getting a doc you like for the delivery. You will be shocked at how impersonal, and yes, “assembly line,” it all can be–even with the “best” group in town (or especially, since the more popular a group is, the more patients they have, and the less time they have for you). I sincerely hope this will NOT the experience of any young women reading this, but, well, just be prepared.</p>

<p>My impression is that most docs roll eyes at birth plans. They tend to want to be in charge, and coming with your own plan tends to paint you as an “uncooperative” (inexperienced) patient who is trying to tell them (experts) what to do. . .(One OB kicked me out of his office because I didn’t want to do various tests.) Also, they know that the birth process is unpredictable, and have seen many plans go out the window. Most docs don’t like anything different–for example, unusual delivery positions (I had 5 of my kids in a kneeling position, 1 in a sitting position–the first two were on my back with episiotomy like they did back in the late 80s.) Some docs were open, some skeptical–some brought in students to “watch this weird thing. . .” I’m happy I missed the era of shaves and wheeling down the hall to the delivery room, which some of my friends who gave birth just a few years earlier (mid 80s) had experienced.</p>

<p>BTW, I did appreciate the nicer birthing suites, if I got one. (I was once parked in a storage closet for a couple hours. . .) Not essential, but more comfortable.</p>

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<p>Atomom,</p>

<p>What you said about OBs rings true. That’s why I recommend midwives to families who’ve asked for my advice!</p>

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<p>I CHOSE (twice) to get the epidural. I never felt like it was assembly line and it worked for me.</p>

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<p>All three of my OBs have been fantastic… (Then again, the first was a friend of the family, the second was a professor at Cedars-Sinai, and the third was a professor at Baylor… and all of them were women and mothers; I don’t know if that makes a difference but I suspect that it does.) All three of them were <em>very</em> difficult to get a first appointment with, but if you planned things well and were willing to wait six months for that first appointment, then getting a follow-up was a breeze. First thing I do when I move is get established with a new set of doctors so that when I need them, I’ve got them.</p>

<p>If a doctor scoffs at a birth plan, then they’re scoffing at my preferences about my body and my baby. I can’t imagine any of my three doctors I’ve had doing that. Chicken and egg, probably… if they scoffed at my preferences, they wouldn’t be my doctors for very long. I have no qualms about firing a medical professional.</p>

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<p>While I agree that the OB field probably reflects the litigation trend more than most specialties, as a critical care RN, I can tell you that litigation (or fear of) is driving up the cost of health care in all fields. Go to an ER with what will eventually be diagnosed as a mild problem, but expect your bill to be shockingly high due to the numerous amounts of tests/procedures, some of which are painful, expensive, and unnecessary, but ordered nevertheless by doctors who are trying to demonstrate that they have covered all bases in the diagnositic process. While it’s prudent to be thorough, some doctors go way beyond thorough and I believe some of this behavior is fear-driven.</p>

<p>I am a hands-on type of nurse who is often frustrated with the amount of paperwork and/or computer documentation which takes me away from patient care. Most of this documentation of even the most trivial of tasks on the unit is a response to litigation.</p>

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<p>For what it’s worth, it happens in all fields. In engineering, 90% of the specifications I write (and print copies of for every bidding contractor, killing a small forest in the process) are things like “Trash must be hauled offsite and disposed of in accordance with local regulations” because of litigious little sleights of hand that some contractors have used in the past in order to wrangle more money out of the owner, who then turns around and sues us. (“Trash must be hauled offsite” came from one contractor who dumped all of the construction debris next to the owner’s brand new building and then said, “Well, you didn’t specify that we needed to throw the trash away.” Add-services request!)</p>

<p>Some days I think that the only ones making money any more are the lawyers… And even then, only the consciousless ones are really prospering.</p>

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<p>During both of my deliveries, I never felt like I was at odds with the doctors. My first son was six weeks preemie, and I was scared to death, so anything they wanted to do was fine with me. My second was “only” four weeks early and we had anticipated that. I felt strongly that the doctor was on my side. We were both aiming toward the same outcome: a healthy baby.</p>

<p>I still see the doc who delievered my second son, 20 years later.</p>

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<p>I assume that you meant “conscienceless.” Regardless, was that really necessary? Kind of a cheap shot, I think. But lawyer-bashing usually is.</p>

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<p>Oh, crud. I <em>did</em> mean conscienceless. I would imagine that someone consciousless wouldn’t be making much money at all, sadly.</p>

<p>I apologize if it came across as such; I didn’t mean it as lawyer-bashing. I just know that my lawyer friends (most of my high school and many of my college friends went into law… one of them is truly the most good-souled person I know, and I specifically thought of him as I was writing that to try and make sure I wouldn’t offend anyone) haven’t gone through round after round of layoffs this year (we’re on round 5 this year). A couple of them have had trouble finding jobs, but they’re all employed now, whereas I’ve got engineer friends who have been out of work for a year or more. It wasn’t intended as lawyer-bashing… more wistful sour-grapes/the-grass-is-greener… That, and frustration with legal red tape and litigious mentalities (usually of non-lawyers) that I’ve been battling at work lately.</p>

<p>I apologize, lawyers. No hard feelings, truly.</p>

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<p>I had my first baby in '84 in the hospital and it felt like the dark ages even then. I sincerely hope it’s better now. One of the things I objected to was how powerless and infantilized the hospital made me feel. At my first visit with the midwifery practice for my second, I was amazed because I was told to weigh myself and enter the number into my own chart. I felt like I had been given the keys to the kingdom. It was such a strange feeling of empowerment that I actually wondered if I was really allowed to do it.</p>

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<p>Nrdsb4 - you are partly right, IMO. Sure OB’s behavior is driven by the legal profession - however, many routine, invasive procedures have their roots in “laziness”. Routine episiotomies are not driven by mal-practice. If mal-practice was such an influence then women would not be given drugs like demerol and vistaril routinely and pitocin would be used rarely.
The need to make delivery quick, painless and convenient is the driving factor in many procedures.
OB’s have led many women astray - they give them drugs to shut them up and wonder why they don’t make progress in labor, they require that women be hooked up every second during labor and wonder why it is taking so long, they make a “little cut” to cut 20 mins off pushing so they can get to the next laboring woman.</p>

<p>mousegray - yep imagine that a grown woman is able to weigh herself and record it in her own chart! my midwife has us check our own urine too.
At my postpartum visit after my third, the midwife gave me a copy of my own medical record from the birth. It was really neat to read through it and make sense of what happened.</p>

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<p>Uh, wow. Okay, let’s also acknowledge that a lot of drugs are given because the Moms have asked for them as part of their “birthing plan.”</p>