Wednesday, October 8, 2014

Options in Childbirth: Does It Really Mean What You Think It Means?

Just over a year and a half ago, I spoke at a VBAC information event at Dixie State University. To my surprise, the labor and delivery hospitalist along with a nurse or two showed up. The hospitalist and one of the nurses asked several questions - unfortunately while I was in the middle of my presentation - of which some I clarified, and some of which I disagreed. What stuck with me more was something she said a few times - she said that hospital birth can be just like home birth, if women just ask for it to be so.

While I will wholeheartedly agree that sometimes, with a midwife who does not respect autonomy, home birth can be just like hospital birth in some ways, I cannot agree that hospital birth here in our small town, can be like home birth for whomever (low-risk) asks for it to be so.

Why do I disagree?

1. Dixie Regional Medical Center does not allow for complete refusal of an IV line - they are adamant that women receive a hep-lock just in case an emergency occurs.

2. DRMC does not allow for water birth. You may labor in the tub, if you happen to get into one of two rooms with a tub, but there are no exceptions for birthing in the tub. I know of a doctor who tells his patients that he cannot force them to get out, but what he does not tell them is that the tub can be drained in 90 seconds, and the nurses will drain the water immediately.

3. It is hospital preference to break the amniotic sac (water) within a few hours of admission for all patients - and is often presented as a benefit (can speed up labor, etc) without giving patients full disclosure of risk, which also includes a subsequent time limit since they worry about infection after the protective barrier is gone.

4. I have heard of some fathers/partners being able to catch their own baby, but it is rare and certainly not encouraged. You need to have the right doctor, and the right circumstances in order for this to happen.

5. You will not be able to eat and drink freely without either sneaking food, or repeatedly defending your right to do so.

6. Achieving a successful VBAC (Vaginal Birth After Cesarean) depends on so many factors, that the odds seem nearly stacked against many women. IF circumstances line up perfectly - right size baby, no blips in prenatal care, right doctor who is not only 'VBAC friendly' but actually VBAC supportive (HUGE difference), right pregnancy week, right amount of time in labor, zero variation in how baby sounds during labor, etc - you might just end up achieving a VBAC.

7. You are highly unlikely to have a full hour, completely uninterrupted, with baby immediately following birth. Right doctor, right nurses, right circumstances...maybe, if you're adamant and repeat your wishes often.

8. You are unlikely to be able to refuse routine checks and tests on baby, without receiving information about how risky it can be to forgo. (I personally cover tests, options, etc prenatally and don't need to ask again after the family has done research and made a decision).

9. Depending on the season, your children are not likely able to be present for the birth.

10. Intermountain Health Care has a policy in place which bans photography and video at the time of birth. It is my understanding that you are allowed to photograph or video tape before and after, but not during birth. This is again, something that can vary widely. Some doctors allow it (there's that pesky word again - allow), others strictly reinforce the policy. It will also depend on the nurses in the room at the time of delivery.

I am not vilifying hospital birth. I am incredibly grateful for the technology and skill of hospital staff, when a hospital birth is medically warranted or chosen. I needed the hospital with my last baby.

What I am saying is that a simple statement, such as, "hospital can be just like home for those who ask", is risky. It may give women false hope, only to find that there was much fighting for this simple right, and/or the right doctor, right nurses, right circumstances.


Brenda said...

This was the very main reason we did an HBAC with you. You knew exactly what we wanted and didn't push us. I HATE all the stupid pushing and bossiness a hospital has! Very much love this. Nicely written.

Christine Fiscer, Birthkeeper said...

Thank you, Brenda. And I just read of your loss - my heart breaks completely for you. I know you have plenty of good friends and family, but if you need anything, please let me know.