I've been reading and thinking a lot about birth choice this week. I'm a huge homebirth advocate, but also understand that the majority of women want to have babies in the hospital. I just wish that more women who were going to be having babies under the care of an OB in that setting would be more informed about the process. So many of the horror stories I read come from mamas going in completely unaware of what to expect from the birthing process and what to expect from their hospital and doctor. I know people who would read thirty consumer reports before buying a TV but go into labor with no idea what's really happening and just a 'trust the doctor' attitude.
   I'm not saying that all OBs are arrogant scalpel-happy egomaniacs with a god-complex and a total lack of respect for their patients wishes and capability to give birth, but many are. Now, strange as it may seem I don't think that's a bad thing. Personally, if I'm going under the knife, I want the person holding it to be completely sure of what their doing. I want someone who isn't going to be second-guessing themself and wouldn't in a million years be described as timid. Surgeons are supposed to be cocky pricks.

   That's what an obstetrician is, a trained surgeon. OBs are trained in the pathology of birth and are perfectly suited to over-seeing a labor that is fraught with risks and medical issues. They are not trained to attend a normal birth, because why would anyone need a surgeon for a normal birth.
   And as unsavory as it may seem to some, a hospital is business. They rely on turnover to make money. Even hospitals that aren't trying to make a profit still need to treat as many 'paying customers' as possible to stay afloat. That means even if your OB is the kindest, gentlest doctor in the world who wants your labor to progress naturally and allow you all the time you would like, he/she is under pressure from the hospital to get you out of that bed quickly so someone else can get in it. Ca-Ching!
   There's also the issue of liability. One of the most cited causes for the US's sky rocketing c-section rate (more than 30% of births here are cesareans, despite a WHO recommendation of a 5-10% rate as any higher causes more harm than good) is doctor liability. If an OB does a c-section, they can always say that they did everything they could to save mother and baby, even though c-sections are much, much riskier than normal, vaginal birth (the U.S. has a higher maternal death and morbidity rate than most other industrialized countries that more closely follow the WHO's rocommendations). A lot of the time, moms end up with an 'emergency cesarean' because of all of the previous interventions insisted upon by their doctors.
   Say Mama is dialated 5 cm and doesn't make it to 6 cm an hour later so Doc says 'We're going to break your water to get this labor going,' despite the fact that AROM doesn't actually speed labor up, but only makes it feel more intense because Mama just lost the cushion against her cervix. Still not progressing fast enough for Doc ? Well, now that your water's broken baby is at risk for low amniotic levels or infection (especially since they keep shoving their hand up your hooha to see how you're progressing). Let's augment! Here's some pitocin to make your contractions ten times stronger and more painful and one on top of the other. Mama's now in too much pain to labor effectively and exhausted from handling the contractions, so here's an epidural to let her cope and get some rest. Now with an epidural Mama's stuck in the bed on her back so fetal heartbeat can be continuously monitored, but laying on her back is cutting off the blood flow to the uterus and placenta restricting the baby's oxygen supply on top of the super-strong pit augmented contactions squeezing the bejeezus out of the little one, so now we've got fetal distress. Time to cut her open so Doc can save the day!
   It's such a slippery, slippery slope. So much of it could be avoided if women were aware how interventions cause a snowball effect and knew what questions to ask. Doctors don't tend to fully inform patients, though, because what Mama is going to say 'Go ahead' to AROM when the Doc says, 'By the way, this could lead to an emergency c-section or an infection, will make labor more painful, and isn't medically warranted.'
   So, be a savvy consumer. Know your options and know what every procedure they might suggest means and the risks involved. Ask questions and insist upon fully informed consent before anything is done to you. Be aware and knowledgable, because you and your baby need you to be!
02/26/2010 07:36

Preach it!
Very well written, Beki!

05/25/2010 10:27

Wonderful post!!! Adding it to the next Sunday SUrf, and you can count me in as your newest follower.
Would you like to do an original guest post?


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