I have written before that birth plans are worse than useless and a new study lends credence to that view.
Birth plans engender hostility from the staff, are usually filled with outdated and irrelevant preferences, and create unrealistic expectations among expectant mothers. But the worst thing about birth plans is they don’t work. They don’t accomplish their purported purpose, make no difference in birth outcomes, and, ironically, predispose women to be less happy with the birth than women who didn’t have birth plans.
[pullquote align=”right” color=”#603b35″]The key to a safe, satisfying birth is to ditch the birth plan.[/pullquote]
For example, in Is the Childbirth Experience Improved by a Birth Plan?, Lundgren et al. were surprised to find:
… A questionnaire at the end of pregnancy, followed by a birth plan, was not effective in improving women’s experiences of childbirth. In the birth plan group, women gave significantly lower scores for the relationship to the first midwife they met during delivery, with respect to listening and paying attention to needs and desires, support, guiding, and respect.
The new study is Birth Experience Satisfaction Among Birth Plan Mothers. It was a prospective controlled trial comparing women with and without birth plans.
Three hundred two women met criteria -145 had a birth plan and 109 birth plans were collected. We established 23 common requests. The most common requests were: no intravenous medications (82%), exclusive breastfeeding (74%), and no epidural (73%). The requests most fulfilled were avoidance of episiotomy (100%), erythromycin (82%), and rupture of membranes (79%)… A greater number of requests correlated with meeting expectations less (P=.04) and feeling less in control (P=.04). Having a higher percentage of requests met correlated with having expectations met more (P=.03) and feeling more in control (P=.03).
The greater the number of requests by the mother, the greater the chance that she had a negative birth experience. In other words, it isn’t birth trauma that causes bad birth experiences, it is Birthzillas.
Who’s Birthzilla?
As I’ve written before:
We’ve all heard about bridezillas, the women who are so obsessed with having the perfect wedding that they become tyrants toward everyone else. There’s an argument to be made that many homebirth and natural childbirth advocates are “birthzillas” who justify their hypersensitivity, obsessive need for control, and rudeness to everyone else with the all purpose excuse “It’s my special day.”
Consider:
Obsessive need for control – It’s difficult to imagine anything more obsessive than birth plans. Birth plans, in addition to being useless for their stated purpose of improving the birth, are attempts to plan the unplannable. You might as well have a “weather plan” for the day of birth for all the good it’s going to do you. Birth plans, like obsessive wedding plans, have the added drawback of irritating everyone around you. The need to ruminate on every aspect of the day, and share those ruminations with everyone else is boring at best and narcissistic at worst.
Hyersensitivity – Homebirth and natural childbirth advocates spend a lot of time being angry. The birth is not going according to plan. The hospital staff are not taking their desires as seriously as they take them. The hospital staff are not behaving as instructed. Everything is a slight. Offered an epidural? Have a fit. Labor support not exactly as desired? Accuse the nurses of evil intentions. Baby needs something different than the pre-approved birth plan? Who does that baby think he is? After all, birth is not about the baby. It’s all about, exclusively concerned with, revolving only around Birthzilla.
Outsize feelings of disappointment – Birthzillas are psychologically very fragile and make no apologies for their fragility. Baby needs resuscitation before being placed skin to skin with Birthzilla? The birth is ruined. C-section needed to deliver a healthy baby? That no longer qualifies as a birth at all!
Birthzillas have an outsize view of their own importance, a hypersensitivity to slights, a feeling of being persecuted when the birth does not go as planned, and an imperiousness and insensitivity to others who work with or for them.
Instead of integrating the inevitable disappointments associated with a birth, they get psychologically “stuck.” They experience their disappointments as narcissistic injuries and respond with rage and accusations of persecution. They have no time for and no interest in the feelings of others, and feel entitled to use other people for their own ends.
The ultimate irony is that the behavior of birthzillas often fails to produce the perfect birth. Because of their psychological neediness and fragility, they are unable to appreciate that every change in plan is not the “fault” of someone, unable to accept that unwillingness of providers to follow commands is not a sign of persecution and, worst of all, unable to enjoy what they have.
The key to a safe, satisfying birth is to ditch the birth plan and concentrate on the baby, not the creation of the perfect experience.
Hello sceptical ob, you should consider one thing. A lot of women have gone through sexual abuse. So when they don’t want vaginal exams without their consent, just as an example, then this has nothing to do with dreaming about a great birth. But it literally has to do with coming out of this extreme situation unscathed, mentally and emotionally.
My cousin was sexually abused as a child. She gave birth to four children, between four and ten years old now. She committed suicide last summer, leaving her kids motherless. Women are not just vessels for giving birth and it is important how they are treated during labor. It is also important to make sure they are not retraumatized. Both baby and mommy deserve the best possible care.
“So when they don’t want vaginal exams without their consent, just as an example, then this has nothing to do with dreaming about a great birth. But it literally has to do with coming out of this extreme situation unscathed, mentally and emotionally.”
A tiny minority of women refusing vaginal checks are victims of sexual trauma. And it is standard that they be offered most compassionate care. Meanwhile, NCB loonies are using them as excuse to advocate against ALL vaginal checks. You might want to search this blog for Meg Heket, leader of cult killer HBAC group and her “instructions” to women:
IOW, your argument is as flimsy as it would be to advocate against all security checks on all airports based on the fact that some people have a panic attack when subjected to random pat down search.
Odd that she said ‘without their consent.’ Isn’t getting consent standard? The issue isn’t with letting women know what’s going on and when they’re checking and what they’re checking for, it’s with women refusing them straight up, a la Heket.
Yes it is. And no one does VE on a victim of sexual abuse without consent.
How do you know your patient was a victim of sexual abuse or not?
a) I am not medical care provider
b) because guidelines and standards of care:
“Obstetrician-Gynecologist Screening for Sexual Violence
With recognition of the extent of family violence, it is strongly recommended that all women be screened for a history of sexual abuse (15, 17). Patients overwhelmingly favor universal inquiry about sexual assault because they report a reluctance to initiate a discussion of this subject (18). Following are some guidelines:
Make the question “natural.” When physicians routinely incorporate questions about possible sexual abuse, they will develop increased comfort (19).
Normalize the experience. Physicians may offer explanatory statements, such as: “About one woman in five was sexually abused as a child. Because these experiences can affect health, I ask all my patients about unwanted sexual experiences in childhood” (19).
Give the patient control over disclosure. Ask every patient about childhood abuse and rape trauma, but let her control what she saysand when she says it in order to keep her emotional defenses intact
(19).
If the patient reports childhood sexual abuse, ask whether she has disclosed this in the past or sought professional help. Revelations may be traumatic for the patient. Listening attentively is important
because excessive reassurance may negate the patient’s pain. The obstetrician-gynecologist should consider referral to a therapist.
The examination may be postponed until another visit. Once the patient is ready for an examination, questions about whether any parts of the breast or pelvic examination cause emotional or physical
discomfort should be asked.
If the physician suspects abuse, but the patient does not disclose it, the obstetrician-gynecologist should remain open and reassuring. Patients may bring up the subject at a later visit if they have developed trust in the obstetrician-gynecologist. Not asking about sexual abuse may give tacit support to the survivor’s belief that abuse does not matter or does not have medical relevance and the opportunity for intervention is lost (20).”
http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Adult-Manifestations-of-Childhood-Sexual-Abuse
I don’t live in the us. In my whole life I was never asked about sexual abuse by ANY ob or midwive. Over here, to give birth at a hospital, u go in and meet the staff for the first time ever when ur labor starts. your ob is not involved. It is the ob in charge at the hospital. I suspect there might be similar guidelines here, too, but never encountered them in real life.
As said before, I think vaginal exams are necessary during labor, but the women should always be asked.
Nearly every second woman I know had things done to her without prior consent during labor, which in my opinion is the most vulnerable state a woman could be in and every woman deserves the best possible treatment!
So you don’t live in any developed world country ( guidelines like the one I quoted are standard in all of them, and pretty much the rest of the world too)?
I live in Germany.
Theory and Practice.
Oh great! I speak German so…shall I “do the research” for you, or will you be decent enough to post same/similar guidelines for your country then?
Na dann, das macht das Leben doch leichter. Mir geht es ja nicht darum, ob es den Standard gibt oder nicht. Bringt ja nichts, wenn er anscheinend nicht eingehalten wird. Ist auch gar nicht mein Punkt, aber das scheint hier ja auch egal zu sein. Der bratet mal schön weiter in eurem Saft, die Art und Weise des Umgangs hier miteinander ist einfach unter aller Sau.
1) Just because I speak German it does not change the fact that this is a blog in English language, and that the decent thing to do is to stick with the language everyone in a group speaks whenever possible ( especially when you are spewing insults directed towards that group).
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I am not arguing against vaginal checks.
I’m asking for prior consent. Should be standard, but it’s not.
At my first birth I personally wasn’t asked anything. I was even given vaginal accupuncte without my consent, and some other stuff.
Yes, I agree, any woman who wants a csection should get it.
And general pat down at security or someone messing with a vagina, that is not a very good comparison.
“I was even given vaginal accupuncte without my consent”
Oh please DO TELL.
“or someone messing with a vagina”
You make it sound like random assault in a back alley. VE is a medical procedure performed by medical professionals as a part of standard medical care. Grow up FFS.
Why this tone? I’m not complaining, just saying it does happen.
MY tone? You portray medical procedures as assaults, hide your vagenda behind victims of sexual abuse and base everything on making blanket statements how it happens all the time based on your own anecdotes? And MY tone is the problem here? And yes, you are complaining, all your comments are ME ME ME.
Seriously, if you want to argue against VEs please choose real arguments next time.
Maybe read what I write: I am not arguing against ve.
Oh no, you are just calling them “someone messing with a vagina” and claiming that they are performed without obtaining consent because you are advocating for VEs?
Previous abuse should absolutely be an accepted reason for a C-section if the woman wishes it.
I just hear a lot of NCB-ers telling women that an Empowering Vaginal Birth will be the perfect thing to get them over prior abuse, as long as an OB doesn’t put her fingers down there, and it just seems a recipe for disaster. If you can’t tolerate a vaginal exam – and I definitely don’t judge someone for being in a place where they can’t! – how is a baby tearing its way out going to be a better experience?
There’s nothing good or easy about navigating sexual abuse issues for an expecting woman, but putting it into such black and white categories as VEs Are Ebul and Baby Emerging From Vagina Fixes Everything isn’t helping.
Your quote:”Having a higher percentage of requests met correlated with having expectations met more (P=.03) and feeling more in control (P=.03).”
So, in other words, women whose requests were followed were happier than those whose requests were not followed, and from that you conclude that it is better not to make requests. I would say that was very Zen of you were it not for the ugly mocking photo and the derogatory name calling.
Only if you skip the preceding sentence:
The more requests you make, the more likely it is that not all of them can be met.
Maybe the problem is that a lot of what the women requested are routine interventions, which they weren’t given a choice over. You write a lot about women’s rights to autonomy over their bodies when it comes to breast feeding and pregnancy. You say that they are more than a sum of their body parts. Yet when it comes to autonomy in labour this flies out of the window. Treatment without consent is assault, and if forced upon a woman who has written that she doesn’t want it, then it’s not surprising that she ended up pissed off is it?
It’s not the birth plan, it’s the perceived (or real) lack of autonomy that causes the dissatisfaction.
“It’s not the birth plan, it’s the perceived (or real) lack of autonomy that causes the dissatisfaction. ”
And this is where I blame NCB ideology. They set women up to “want” all the same exact unrealistic stuff. What woman independently comes up with the idea of “I for sure would never want to use a medicine that can make contractions more efficient and increase my odds of having a vaginal birth and a healthy baby”? But 99% of women with birth plans are sure that under no circumstances do they want the ebil Pitocin! What person independently comes up with the idea that “No matter how much I beg for it, I do not want to be given pain relief, even for a situation that frequently causes sensitive genital tissue to rip”? Yet 99% of women have this written into their birth plans.
It’s not women expressing autonomy, it’s women parroting their brainwashing.
It is exactly about autonomy and has nothing to do with NCB ideology. It is about respect for women & their bodies, & true information sharing. If a woman says no, then she means no, even after a doctor or midwife has given her the facts. It’s her body. You wouldn’t say this if a woman said no to sex. There is no difference.
The things many women are including are out of NCB ideology, though. They don’t do enemas anymore, they only shave you if you’re getting a C-section, and no one makes you get any medication. *strongly* recommend maybe, like with my magnesium but I could have refused.
Enemas & shaves don’t seem to be on the list. Routine rupture of membranes, episiotomy and erythromycin are included. None of which have evidence of benefits,although I’m sure you’ll correct me.
I was strep positive, and I didn’t want my kid or me to get some stupid infection. Maybe we wouldn’t have, but I also clean out cuts and scrapes, because why take chances? My membranes broke on their own. I wasn’t cut, I tore. Anecdotal maybe, but sometimes you guys sound like you think these sorts of things happen automatically to everybody.
No, their birth plans don’t refuse the so-called “routine rupture of membranes”, they refuse rupture of membranes at all. Do the NCB cheerleaders tell women how useful AROM is for checking for meconium and helping a stalled labor? No they don’t. With episiotomies, do they tell women about circumstances where they are lifesaving for the fetus? Do they tell them that mediolateral episiotomy can be painful to recover from but that it is proven to reduce 3rd and 4th degree tears in situations where it looks likely? Do they tell them that erythromycin prevents eye infections that lead to blindness? No, they lie to women and say that it will prevent bonding (yeah right, your baby won’t ever be able to love you if it gets a drop of this in its eyes), and that there is no way that precious perfect them could carry something in their sacred yonis that could possibly cause a baby harm.
Women who are brainwashed by NCB don’t remind me of women who say no to sex when they don’t want it. They remind me of patients I meet from a certain hyper conservative background who tell me they won’t be going to college because that is bad for women, that a woman can only be fulfilled by marrying a man and staying home with the children. That her job is to have sex whenever her husband wants it, because being subservient is the True Nature of women. Sure, she’s an adult and she’s choosing it. But that doesn’t mean I can’t critique the subculture that led her to her choice.
Can I just say that my episiotomy was very welcome, at a point where I had been pushing for more than an hour (thank Maude for the epidural) and I’d already passed the 24-hour mark after my waters had broken. I was the fittest I’d ever been in my life during my pregnancy, having run a marathon and two half-marathons: even so I was flagging, and baby was just not coming out.. More importantly, I didn’t want to risk him. He came out two pushes after the episiotomy. So here is anectode +1.
Aand, that would be “anecdote +1” 🙂
tl;dr: I’m glad I kept my options open wrt. interventions.
I had an episiotomy (with my consent) because my son was in distress and we needed to get him out. I have a wonderful healthy son with an intact brain – that might not have been the case if I hadn’t had that episiotomy. I don’t regret having one for a second.
I would think that erythromycin, as an antibiotic, would be given if an infection is present, or the chance that an infection is likely, or already present. If you are GBS positive, different antibiotics are used, so I would suspect that the erythromycin would be used when membranes have been ruptured for hours, maybe days. But when antibiotic use is presented as “unnecessary”, for whatever reason, by the NCB crowd and is to be avoided and rejected at all costs, the doctors and nurses who may need to have a conversation with the mother about needing antibiotics due to a fever and/or other evidence of an infection, the mother only sees it as going against her wishes and birth plan and makes the situation that much worse.
With my hospital birth, at no point did *anybody* do anything I didn’t want them to. It is good to discuss specific concerns beforehand, but how do long lists of demands further respect for your body, exactly?
And my autonomy had its limits, simply because I was in a situation I’d never been before, where the stakes were incredibly high. I needed the experts. There is autonomy, then there is unnecessary, dangerous intransigence
With sex, there’s no third party at risk of harm. Birth on the other hand, involves someone who not only can be put at risk by bad choices, but cannot express their needs. This makes the issue far, far trickier.
It’s also a bit about expectations. If you go in with confidence in your carers, ready to be advised and ready to accept the advice, then that’s positive for everyone.
If you go in with a laundry list of what you will and won’t have, that makes life more complicated.
No one is suggesting treatment without consent is ever good; but not all consent/refusal is well thought out. And it is certainly not right to refuse to consent to care and then jump up and down if the outcome is not to your liking.
Long winded, but I wanted to share my birth plan hilarity. Every pregnancy is different. Every birth is different. Every mom/dad/family is different. The ONLY thing that matters, in reality, is getting to the end and having that beautiful bundle. That’s it.
I just “knew” I wanted an at home water/hypno birth. My husband was a firm believer in the theory that God/Mumma Nature allowed us to develop our brains, gave us the knowledge to use science, and thus allowing us to invent medicines and techniques that make like better/survivable. He drew the line at a home birth. So we compromised. I’d do a hospital birth, use an OB, and get to labor how I wanted.
I took the pregnancy test on Friday, called my OB’s office (I happened to have a yearly girlie appointment that Monday) and told them the nature of my appointment would be changing, and promptly sat down and wrote out my dream birth plan. Yes. I was confident and trusted my body to give birth because that’s what it’s supposed to do. My pregnancy was confirmed at that appointment. Because of my insurance I had to get a pregnancy referral before they could talk pregnancy with me, other than confirming it. I made the first appointment.
She did a trans vaginal ultrasound to confirm and date. One little blob was found. She moved the wand just a tad to check something. I gasped because I saw it before she did. There were 2 little blobs.
My perfect plan went flying out of the window. I told Dr that I didn’t want to have a CS unless it was needed. She said she wouldn’t want it any other way. 🙂 The horror stories you read about twin pregnancies, NICUs, and all the “bad” things that can happen with multiples pretty much made me think I would deliver at 30-33 weeks via emergency CS & that the girls would be in the NICU for months. One extreme to another… As it is, the girls were 38 weeks, I had a CS because Baby A had a big head and got stuck, and we went home after 4 days – not because they needed to stay but because I did. LOL
What’s that saying? “Life is what happens to us while we are busy making other plans”? Or something..
Best laid plans?
If you want to make God laugh, tell Him your plans!
Maybe doctors or hospitals should write out generic birth plans for the patients. That way everyone knows what to expect. These plans should list common reasons why a woman would need a c-section, as well as hospital or doctor policies regarding continuous monitoring, and patient rights. I can be pretty neurotic about some things, and it doesn’t help when medical professionals tell me to just not worry. I do agree that patient written birth plans are worse than useless. I laugh about the one I wrote for my first birth. There has to be a better way for patients to be able to understand what they can expect during a birth.
Now I’m imagining a flow diagram: this happens, then the choices are this or that, consequences are this and that, there are lots of boxes and arrows….the box at the bottom is labelled “mother and baby survive and prosper”.
I *wish* this would happen. I paid to go to an NCT class. I was lucky in that our instructor was not steeped in woo. *Many* women would benefit from demystifying the whole birth process.
It’s funny, I debated about writing birth plans for each of my 4 births but never did. Instead I just asked questions, talked about things with my doctors before hand and made sure I was aware of hospital procedure so nothing surprised me. It was incredibly easy to go with the flow, and my nurses were great. The only concern I had was making sure every single person caring for me knew I had a bleeding disorder, but I didn’t need a 3 page document typed up to share that with the staff, I just informed everyone I had a bleeding condition when they entered the room. I also made sure ahead of time the appropriate blood factors would be ready to go if a crisis came up. Everyone at the hospital was amazing and they offered their expertise in each of my 4 unique births.
I will say that a few of the nurses and both of the IBCLCs at mine were decidedly pushy-to-the-point-of-infuriating about breastfeeding, but in their defense, I was completely determined to do it, so they were somewhat following my lead on that. My experience was much like yours; in my case, it’s that I’m sensitive to latex, but they’ve gone pretty much latex-free there anyway, making that a near-non-issue.
Do your feelings about birth plans also apply to birth plan templates given out by some hospitals? My hospital’s template had boxes to check like: I prefer IV pain medication, I prefer an epidural, I prefer no pain medication if possible; circumcision or no; breastfeeding, bottle, or both; they had a list coping techniques for pain that moms could check off what they wanted to try. …I don’t see the harm in those types of birth plans but maybe I’m missing something. Maybe it’s just a way to make mothers feel more comfortable about birth and their doctor?
The hospital I had my last child in did something similar. I didn’t bother to turn it in, but I think the study Dr Amy is referencing basically concluded that the more requests the mother makes in her plan, the more likely at least some of those requests will not be met, and the fewer requests that are met (as a percentage of total requests), the less satisfied she will be. So, essentially, the longer and more involved the birth plan, the more likely you are to have a negative experience. The templates given by hospitals (usually in a childbirth class or on the tour) are generally very short and to the point, and I don’t see a problem with that type of “plan” (better still, take that plan to your next doc visit and go over it with him/her). A woman who ticked off a few boxes on a template isn’t nearly as invested in everything going according to “plan” as a woman who spent time drafting a four page document covering every minute detail. The former is likey to get more of what she asked for, as a percentage of the total requests made, than the women who wants to micromanage her labor and delivery.
A template or checklist sounds like a great idea: mom gets some info on what options are available at the hospital, doctors and nurses get some info on mom’s preferences. Having preferences on how you’d like things to go if all goes well is A-OK; detailing your perfect “birth experience” down the minute is a guarantee for disappointment.
I think a short, to-the-point, standardized template from the hospital is helpful. That’s what my hospital had when I did my pre-registration. The nurse doing my paperwork asked me and my husband the questions and filled it out for us and it was part of the standard paperwork in my file. That meant it was already in a format the hospital personnel were familiar with. Pretty sure I got 100% of my requests (if I didn’t, it was something I must not have cared about much).
Now see, that right there is a very smart idea. Make it nice and clear and standardized, make sure that communication happens…I like it!
Honestly, that sounds like a brilliant idea, having all that information in one place in the chart rather than mom or dad trying to remember it off the top of their heads/communicate it in the middle of labor to different shifts of nurses, etc. My hospital does some of that, like breast v bottle, as part of the admission paperwork, but nothing that extensive. I might suggest something of the sort to them next time ’round.
That’s what I had. I brought it to an appointment, and we talked over everything. For example, I said I’d ask for an epidural if I wanted it, but I also asked the midwife if they would suggest it if they felt I was exhausted. I think it just helped to facilitate communication. They didn’t keep it, and it never came out of my bag when I went to the hospital.
They say ours get put in our charts.
If my hospital had bothered to communicate with me in that way, I think I would have been happier. I had no idea what to expect from them, because everything in the l&d tour didn’t apply to multiple births. Would have been nice if they had noted that so I could skip the tour.
I think it’s kind of like dealing with defiant toddlers: There are things you don’t want to compromise on, but you also want to provide the toddler with choices in areas that do have some wiggle room. “Do you want to bottle, breast, or combo feed?” should be asked and respected (unless a child has a specific medical need for one or the other). Just like I ask my toddler if he wants to wear the red or the blue shirt to try and prevent him from trying to refuse to wear any item of clothing at all, giving control (and information) to patients can help them feel respected and like their choices are valued even though in some areas they aren’t going to have much of a choice at all.
I just wrote a comment about this. I had two hospital births, and neither hospital did this. My one biggest fear was an episiotomy and a c-section, luckily I didn’t need either. After reading so much in books, and on the internet I had no idea if I could trust that if my doctors did these things it was because they were medically necessary, and not because this is just how they do things. I’m not sure if these types of birth plans would be able to address these types of fears or not.
My hospital asked all those questions at prenatal visits, around 20 weeks I think. Then they go over your answers again at 30 and 36 weeks to see if anything has changed. However I’m lucky that my primary care clinic is integrated with the hospital so that might be why they did it that way.
Looks like according to her previous Disqus comments, Brooke is also anti-vax. I’m sure you all are just shocked to find that out.
So she’s equal-opportunity – she’ll risk everyone’s lives, not just neonates.
Which is exactly why women are seeking out freestanding birth centers, midwives and even having birth at home unassisted. Obviously every woman knows that her birth plan might get thrown out the window but when doctors and staff INTENTIONALLY punish the woman for HAVING a birth plan and ignore her bodily autonomy what do you think she’ll do the next time?
Oh! You came back! Why didn’t you reply to all the posters handing your head to you in the last post?
You are as clever in realizing which mortality rate should be used as you are in thinking that someone PUNISHES the idiots who refuse themselves to death, sometimes quite literally.
I’m assuming that one “poster” tried to hand my head to me and it was you. I dismissed my phone notification because it was like 3 am here. Obviously since you are now bringing it up in a completely seperate post and sarcastically calling me clever I’m made the right choice to ignore you.
That’s why you ignore me? Interesting since you chose to engage with me after declaring to ignore me.
No, Brooke. I’ve long ago given up on trying to educate clever folks like you. I just point out how misguided and self-important you all are. Looks like I was right since you wisely chose to ignore the posters who, with some very good intentions) tried to set you in the right way.
Can you see it, everyone? Everyone who tries to point to parachuters where they’re wrong? They don’t read you. Good thing I don’t try anymore.
I mean I literally get an email notification every response and I got one. So who are all these other posters trying to set me along the right path?
It’s not a question of intentionally punish. It’s that if mom won’t cooperate with any sort of intervention at all until the kid’s heart rate is dropping into the single-digits (no Pitocin, even though labor is stalling and baby is showing signs of needing to be out! No IV fluids, even if mom is obviously dehydrated and isn’t keeping anything down orally! No fetal monitoring, even though the periodic monitoring isn’t sounding good! No antibiotics, even though mom is GBS positive and GBS can translate to some very nasty things for baby! YOU’RE ALL THE ENEMY AND JUST LIKE TO CUT WOMEN!), then she’s more likely to end up with a CS, even though had she gone along with that (hey, let’s see how you and baby tolerate pit, because baby needs out; you haven’t peed in five hours and keep vomiting, let’s give you some liquids, etc) intervention she might have been able to avoid it.
This article isn’t talking about women in emergency situations it’s referring to all women with birth plans, attacking then as being narcissistic control freaks.
Only in your head.
“We’ve all heard about bridezillas, the women who are so obsessed with having the perfect wedding that they become tyrants toward everyone else. There’s an argument to be made that many homebirth and natural childbirth advocates are “birthzillas” who justify their hypersensitivity, obsessive need for control, and rudeness to everyone else with the all purpose excuse “It’s my special day.”
OK sure I’m just delusional…
The phrase is “many homebirth and natural childbirth advocates,” not “all women.”
We’ve all heard about women who are slaves to their beauty, women who won’t leave home unless their manicure is perfect and the roots of their hair don’t show evidently… Their obsessive need to be perceived by everyone as flawlessly beautiful is always justified with “Any woman with a shred of self-respect…”
As a woman who takes care of her nails and franky hates the difference between the colour of her roots and the lengths of hair (that’s why I love dyes close to my own colour most), I can earnestly say I don’t feel insulted. Perhaps that’s because I don’t thin that a broken nail equals a tragedy and I am certainly not closeted home until I can visit my hairdresser but still. It isn’t about me.
So a broken nail is comparable to an episiotomy?
No, because broken nails still happen routinely these days, while it’s been 30+ years since episiotomies were routine. These days you may get one if forceps are needed or in a few other situations, but the overwhelming majority of women won’t even be considered for one.
My OB delivers hundreds of babies per year. When we discussed epis recently, he said that as a practice and at his hospital (one of the largest in the US), they’re almost never done anymore, exception being baby’s heart rate crashes and they need to get kiddo out NOW.
if you ask the lady whose nail blog I follow, YES. She was damn near sobbing during her broken nail repair video.
So do you not think that any homebirth and NCB advocates fit the description of “birthzillas”? Or just a few? How many?
What specifically is it that you take issue with? The word “many”? Or the very concept that any birthing mama is like this?
But that’s just it. Many of those emergencies can be avoided altogether through mutual cooperation and communication. However, birth plan sites, books, and so one have one overarching theme: the doctors and nurses are The Enemy! You have to FIGHT for your birth! If you have an intervention, you’ve FAILED yourself and your baby!
In just the one example, a mom who’s getting dehydrated would accept a bag or two of fluids, she might have the strength to push her baby out, and might avoid a UTI that could cause her temperature to spike.
Instead, the NCBers would have her wait until she’s out of her mind with a totally avoidable fever/dehydrated/low fluids around the baby causing distress because JUST ONE BAG OF FLUIDS will RUIN her birth experience and keep her from bonding. Etc. And then mom gets a CS, when it’s quite possible she could have avoided one if she’d just gotten rehydrated several hours before.
Where are you getting this from?
Most of the baby/birthing books are pro-hospital and medical interventions. The ones that are not are geared more towards birth outside the hospital. Certainly they mention the risks of interventions but they do not demonize the hospital staff.
What a bullshit hypothetical situation. Obviously women are not going to become dehydrated if they are allowed to eat and drink during labor, UTIs are infections caused by bacteria not just dehydration and maybe women wouldn’t get exhausted while pushing if they could deliver their babies sitting up or squatting which open up the pelvis as opposed to laying down.
I don’t know where she formed her idea, but I was taught much the same by Penny Simkin and by my midwifery preceptors. The birth classes taught by many doulas are spreading this information.
“Obviously women are not going to become dehydrated if they are allowed to eat and drink during labor”
Because no woman has ever barfed during labor and been unable to keep food and water down. Oh, it’s all because they didn’t have your ‘support,’ of course.
Not bullshit at all. Have you actually given birth? I vomited my way through labor, because the pain was so nauseating. I can’t even imagine eating and drinking during labor.
Where do you think bacteria from UTIs come from? The ether? They come from being colonized by fecal bacteria, which can easily find its way up the urethra during labor and pushing.
Stop embarrassing yourself.
Disclaimer: I’ve never been in labor. However, I have had cluster headaches. Various doctors told me, in the course of getting those treated, that cluster headaches and kidney stones are about the only pain comparable to childbirth. Therefore, I think it’s reasonable to say that I do, at least, have experience with severe, agonizing pain.
When someone is in the worst pain they’ve ever experienced, worse than anything they can imagine, eating isn’t usually really high on their list of things they’re interested in. During the worst of a cluster headache, all I could do was lie in as dark a room as possible and get through the next breath. That was it. If I thought about getting through even another ten minutes in that kind of pain, much less the 2-3 hours I could expect, plus the 3-4 more cluster headaches I’d get in the next 24 hours, I’d have gotten up off the bed and either killed myself or tried to literally stab a fork through my eye to try to make the pain and pressure there go away. Totally illogical, but that’s what obscene levels of pain and exhaustion (I always got one at about 1 AM) will do to you.
If you offered me food or liquids, I would probably have thrown up at the mere mention of food because I was so nauseated. Not from a stomach problem, but because the pain itself made me nauseated.
Being in agonizing pain isn’t conducive to eating or drinking–thus my mention of someone offering you a snack if you just had your leg cut off. It’s not gonna do a damn thing.
Again with the lying down thing. I literally know not one person, me with my C-section excepted, who delivered lying down in a hospital.
Ironically enough, getting pain relief might make it possible for more women to rehydrate orally. And, as others have pointed out, many women vomit during labor. That’s not going to be terribly helpful in the keeping-hydrated effort.
Um, you can still get dehydrated even when “allowed” to eat and drink. When you are in labor you are distracted and while you may be “allowed” to drink, that doesn’t guarantee that you will remember to, or be able to get adequate intake orally to keep up with demand. Not to mention that you may be vomitting towards the end. For an uncomplicated labor, sure, oral hydration will likely be sufficient (and most providers are cool with that), but if labor becomes prolonged, you may not be able to keep up with fluid needs through oral hydration alone. True story – with my third child I was “stuck” at six cm for a few hours (and yes I was moving freely, my nurses brought me an exercise ball and encouraged me to shower, try nipple stimulation etc… No one even mentioned pitocin) and despite having free access to food and drink, I still got a bit dehydrated. IV fluids were given and I went on to have my baby without issue a few hours later. In a position of my choosing (I happen to prefer side lying, but my cnm was open to whatever would work for me). Sometimes the evil interventions that you are so scared of can actually help make an unmed “natural” birth possible.
And pushing’s not the only thing that causes exhaustion. Labor itself, the process of being in horrendous pain, is exhausting.
A friend had a nightmare 40+-hour labor with her first–prodromal labor for the first 24 or so, in which the contractions hurt as much as “real” ones but weren’t doing anything. Finally got admitted to the hospital. Over twelve hours later, she’d managed to stay “natural” with no pit or pain relief, but by the time she hit 8 cm, was borderline hysterical from pain and exhaustion. (Thank you, CNM practice which strongly discouraged her from having any sort of pain relief.) Not surprising, given how painful labor is and that she hadn’t slept more than 20-30 minutes at a time in the past 36 hours. Got an epidural, slept like a rock for three hours, woke up at 10 cm, and had a lovely baby, pushed in an upright sitting position like most of us did, shortly thereafter.
I find it improbable that she could have found the strength to push that kid out without the rest that the epidural gave her, and I find it similarly improbable that she’s the only mom who went through something like that.
See, the thing is, I was you once upon a time.
I planned on becoming a CPM, and read every damn book on the subject out there. Ina May. “Sisters in Chains.” (Pardon me while I vomit.) “Hearts and Hands.” Penny Simkin. Various midwife memoirs. You name it, I read it. I absorbed it. OBs are bad people who just want to cut women. If you must deliver in a hospital, fight the nurses every step of the way, because any intervention, no matter how small (heplock placed in your hand in case of emergency, for example) will keep you from getting your natural birth, and the very, very worst thing that can happen to a woman is that she get a C-section. Etc.
Then I had three very humbling things happen to me.
First, I got pregnant with a baby who didn’t read all of those books, flipped transverse/breech at the last minute, and wasn’t eligible for an ECV. C-section, here I come. I was genuinely stunned to find the nurses and staff to be, by and large, warm, loving, caring people, who took wonderful care of us. I was stunned to find that a C-section just isn’t that bad–in fact, I shamefacedly admitted that I loved the experience.
Second, I started getting cluster headaches. I was one of the lucky few who responded quickly and easily to treatment, but it took a couple of weeks. I spent those two weeks in near-incessant agonizing pain, pain so bad that I could barely breathe. Even narcotics would only give me an hour or so of relief. That made me rethink everything I’d previously though about pain and tolerance. No one–no one!–should go through that kind of pain, especially when there simply is no reason for it. (It’s been demonstrated time and again, not that the NCB types want you to hear it, that epidurals do not make you more likely to have a CS.)
Third, I had a miscarriage. Believe me, a C-section is not the worst thing that can happen to a mother. Walking out of a hospital without a baby is. And again, I’d been misled by the NCB types. OB’s don’t care. OB’s just want a paycheck. Funny. My OB’s practice got me in for an ultrasound within two hours of my call, and it only took that long ’cause I lived an hour away. That was my OB’s surgery day, but he left his lunch in order to make sure I was okay and talk me through what to expect, and he didn’t charge me a dime for it, either. Cold and uncaring and impersonalized, my foot.
No. It’s like the difference between having a “driving to work plan” that says “I need to get to work safely and by 8 am” and a plan that says “I need to get to work safely and by 8 am but I will only take this 1 particular highway route, only in the right lane, at a speed of between 65 and 69 MPH. Do not suggest that I change speed, even if the weather is bad. I do not want to change lanes to pass a slower driver. I do not want to take an alternate surface street route.”
I bet that my detailed “driving to work plan” is rarely (if ever) going to meet all of the conditions that I included because I am not in control of all of those things.
A birth plan isn’t intended to meet all the conditions but communicate with medical staff what your preferences are for example in this comparison of driving to work that you prefer to leave the house by 7 am and grab a cup of coffee at Starbucks as oppose to Dunkin Donuts, that while driving you like to listen to classical music and if possible avoid major highways and roads with construction.
Oslo the you need to do your due diligence. Map out your route, make sure there is a Starbucks on the way, find out what time they open, check out your local DOT website, or tune into the local news, for traffic conditions. Hopefully you will find that there is a route you can take that meets all of those conditions. But you don’t wait until you are in you car and driving down the road to decide you care about those things, because it may be too late by that time. IOW talk to your doctor about your preferences ahead of time. You may be pleasantly surprised to find that most of what you want is do-able and in the event that it isn’t, you can head off disappointment by adjusting your expectations so they are more reasonable.
Right. I wanted to labor in my own clothes, for example. My OB was fine with that as long as I understood that they would probably get messy. I wanted to rehydrate orally. He was fine with that as long as I had a heplock in case of emergency. I wanted to deliver in whatever position felt best at the time, he was fine with that as long as baby and I were okay and it wasn’t a “you need to get baby out NOW, we lost the heartbeat” situation. Etc.
So what exactly is the point of a birth plan anyway? In an emergency, as you said yourself, the entire plan can go out the window. If we are talking about an uncomplicated labor and delivery, then why can’t women bring up their questions and concerns and preferences at one of the umpteen prenatal visits? If you talk to your HCP like a person and ask ahead of time about hospital policies, different procedures and the circumstances under which they might be recommended (and why), and let them know what it is you are hoping for, so long as everything remains uncomplicated, you just eliminated at least half of the birth plan. The rest can simply be a matter of letting the nursing staff know, in the moment, what it is that you want. If you show up in a good, active labor pattern, are coping well, and let them know what you want or need, (assuming you treat them with respect and courtesy) most nurses with be right on board with you. They really do want you to have a good experience. No, they can’t always make it happen (mom has her plans, doctors have their plans, but Mother Nature is the one calling the shots), but they will certainly try. Now, if you present to labor and delivery with some four page document, most of which is either irrelevant (because it includes outdated things that hospitals don’t even do anymore) or something that should have been discussed with your doctor or cnm weeks, if not months, ago, and a huge chip on your shoulder expecting everyone to be adversarial… Well, yeah, it would be wise to prep the OR at that point.
Plus, all that you talked about with your doctor will be in your notes and the hospital will already have it. I guess for the first time, I had a “birth plan” with my third baby. I talked it over with the doctor about how I wanted to be induced at 39 weeks because I had a precipitous labor and how if we could, I would like to get the epidural before the induction and if not, as soon as possible. Guess what? I had to be induced even earlier for a different medical reason and I got my epidural before pitocin and it was glorious. Now, I was already prepared for running into the hospital and giving birth without an epidural because I know that birth never goes how you plan.
Its a lot different and more work if you plan on having a natural birth.
Why? Two of my friends had completely uncomplicated, spontaneous vaginal births in the hospital (one of them had two). They showed up, Mama Nature was kind to them and gave them small-headed, nicely-positioned babies that moved in good time with low pain, and the babies popped out with no trouble.
Is that the dirty secret of the NCB industry? That if you’re in a good position to have a ‘natural’ birth, you can have it without any of the midwife/doula Product Line?
(The reason I put ‘natural’ in quotes is because true natural birth results in the deaths of many women and many more babies, and somehow I think that’s not the goal for most women…)
How? So you can’t have a conversation with your doctor about a “natural” birth? If I had planned on having a “natural” birth, I would not have had many conversations with my doctor. I would have said, “see you when I have the baby.” Told the nurses I didn’t want whatever and it would have been simple. The nurses asked questions as they went and I answered them. I think those that are set on a “natural birth” make it different and more work.
Have you had a natural birth?
Hey look lady, I have had natural births, and it was no extra work. In fact, it was awful, as jerky midwives like you made sure that I got to deal with my pain by screaming instead of helping me get an epidural like civilized, compassionate people.
Yes, I did. I walked in and had a baby two hours later. It hurt and it sucked. I did not want to do it again, thus the talk with my OB the third time.
Precipitous labor is no joke. 3 hours for me, and I would’ve been happy if they hit me with a 2×4, if it knocked me out and made the pain stop. Saw above that you were able to get an epidural then pitocin–if I have another that’s what I want. A fast labor would be great if I didn’t have to feel it!
Me too. Fast and furious with both, two hours with my son (half hour of that was laboring while waiting for the antibiotics to get in me because I had unknown GBS status). It was scary, the staff with my son’s birth were wonderful and kind to me, I just was hurting and it was moving so fast.
Yes, I could not believe that it actually worked out that way. This was the hardest epidural placement I have had but I was not having contractions to concentrate on. Once the epidural was placed, I did not feel a thing and I could actually watch T.V. and tell my mom that I would rather her wait. My last epidural I had hot spots and I could still feel part of it. And at the end, I got a perfectly healthy and gorgeous little girl. I would have done anything to get her out healthy, but it was great that it happened to make it easy on me too.
You didn’t say “superior”, but I kinda feel like that’s implied.
First most books say to create one, secondly I think if nurses on staff actually read it, it could be helpful, especially in instances where a woman is in active labor and cannot communicate effectively or respectfully. You also cannot expect a woman to know what is or is not outdated or what the policies are for that specific hospital. She doesn’t work there.
I think that is worth asking early on during the hospital tour and as your pregnancy progresses with your doctor. So many doctors hand out birth plan templates now and expect to discuss those during appointments, it’s worth having your doctor help you with your birth plan.
That’s why you talk to your doctor about what SOP is for that particular hospital, not insult the staff by telling them not to tie you to a bed, give you an enema, or shave your pubic hair.
The books also say to talk to your provider, and present you “plan” or preferences early on to find out what is feasible in your circumstances. Talking to your doc or me ahead of time would also help inform you as to what is hospital policy, what is up to the provider, and under what circumstances certain preferences may have to be abandoned. As for the nurses reading birth plans – you do understand that the nurses are often simply carrying out doctor’s orders and/or complying with hospital policy. You absolutely need to discuss things with your doc ahead of time; most things aren’t even up to the nurse. And if you are in so. I have agony you cannot communicate, you probably should consider the epidural…
Me should be mw. Don’t talk to me about your birth plan, lol.
I’m sure you are a very good listener, Toni.
But she’s had how many antenatal appointments at which she could ask what her OB’s standing orders are, and what the SOP is at the hospital.
Also, having a conversation with your provider that starts with “I’d like to avoid pharmaceutical pain relief, how do you think I can best achieve that goal?” is going to be more productive than not having those conversations and turning up in active labour with a 4 page birth plan, most of which her OB could have told her was either unnecessary, or wasn’t realistic.
Imagine birth is a restaurant. If you have specific dietary requirements and want to sit at a particular table, you should probably phone ahead and check out their menu first. You’ll have a better experience than if you turn up and demand they seat you at your preferred table and that the kitchen cater to your demands without any notice or regard to what is actually on the menu and who else is in the restaurant that day.
Yeah, talking to your doctor is never a bad thing. My conversations as I recall them:
“I’d rather not have an episiotomy if I can avoid it.”
“No problem, we don’t do them routinely any longer, but in the rare event we feel that it’s warranted I’ll discuss it with you first.”
“OK. My mom told me the fetal monitoring belts really bothered her during labor; is there any way I can avoid having those?”
“We can absolutely talk about doing intermittent monitoring. But if you are being augmented, we do need to monitor continuously because some babies do not tolerate that well.”
“OK. I don’t know if I’ll want an epidural yet, but can I have one on stand by just in case the pain gets to be too much?”
“Absolutely.”
“Alrightly then.”
Okay, what happens when the patient does all of these things? They talk to their doctor, they tour the labor and delivery unit, and the patient is told that certain things will be available for them, and they will be able to do certain things during delivery. Then when she goes to the hospital to give birth the nurses have no idea what she is talking about, and it ends in a couple of nurses holding the woman down on her back, and using their hand to prevent the baby from being born causing permanent nerve damage to the mother. I’m specifically thinking about the lawsuit at Brookwood Medical Hospital in Birmingham Alabama. Women are not stupid or crazy, and there is obviously a bait and switch going on in many situations. Some of these hospitals are advertising things that they aren’t able to give, and it’s not okay.
I just read an article on the lawsuit and they are claiming the nurses held her down and held the baby’s head in the canal for six minutes (!!!!). That’s a really long time. I find it implausible unless there was a cord prolapse or some other reason to keep the baby put. I think there’s a lot of information missing in that story.
There probably is a lot of missing information, but that’s not my point. That article says that these hospitals are promising natural birth experiences, but the reality is they are not any different from the other hospitals who don’t promise these things. That is not okay. It contributes to women feeling violated when something like this happens that is outside of their control. I find this to be especially bad for a hospital in Alabama where midwives are not allowed to practice at all, so there is no one in the state promoting natural childbirth to even compete with.
I agree with you this much – NO hospital should *promise* a natural birth experience, regardless of how they are equipped. They should be up-front about the unpredictability of labor and birth. The L&D tour that I took (although I ended up delivering at a different hospital) made a big deal out of their tubs and therapy balls, etc, but did not mention anything about IV antibiotics, epidurals, fetal monitoring, etc, made only a passing mention of the OR in a “Hopefully you won’t have to go there” remark. This was a doula that did the tour. It would be much more helpful if they would cover ALL the possibilities, from whirlpool tubs to c-sections, without promising or elevating one over another. Playing to women’s unrealistic expectations is not helpful. Instead, demystify the interventions beforehand, so that if she does need them, it won’t be so much of a shock.
This is from an article about the Brookwood case:
“An ob-gyn who works with midwives, recently wrote a lengthy Facebook response to a hospital’s billboard in Fort Wayne promising “birth your way.”: “To experience your birth your way requires much more than catchy billboards and glitzy marketing campaigns … It requires a birth team dedicated to helping you achieve the birth you desire. It requires a team whose agenda is to serve the laboring woman’s agenda. It requires physicians, nurse-midwives, and nurses, and doulas to put aside what they want or feel is important.””
There are so many problems with this. If the woman’s “agenda” is to experience “the birth she desires” but the doctors “want or feel” that the baby’s survival “is important” they are supposed to put that aside in favor of her “agenda”? Sure, in a fantasy ideal these things would not be in conflict, but in reality they often are. Do we really want to maintain that doctors and CNMs should put aside their medical knowledge and concern for their patients’ health and safety in order to “serve the laboring woman’s agenda”? REALLY?
That’s so totally me. Kicking my legs, screaming it all out, insistoing, “But you promised!” and feeling utterly betrayed.
Of course, that’s a 7 yo me, feeling all betrayed that. 1) I AM sick; 2) The damned car is being repaired because there was a problem last night; 3) The zoo is closed for today because the lion escapedl 4) Whatever reason you might come up with for a kid not to have her promised trip to the zoo.
I’d expect more of a woman grown but hey, who am I to tell her what agenda she should have? Doctors are there to serve Her Highness, not ensure a safe birth. Just like the other doctors will be there to serve Her Highness in the years of treating the preventable injury her baby sustained.
But the article provides no information to support that thesis. It extrapolated from one (clearly not complete) story
And why would they do that?
Are hospitals advertising things they won’t be able to give, or advertising possibile things that just plain don’t work out for that woman during that delivery? My hospital definitely did have a birthing pool. I was even in that room for a bit. Turns out they don’t use it when it turns out the baby is a footling breech and it’s going to be a c-section. They also don’t use it for vbacs, so I never got to use it. It was there though and it wasn’t false advertising to show it to me on the tour.
https://www.yahoo.com/parenting/woman-sues-hospital-for-traumatic-birth-that-201605478.html
According to this article we are seeing more and more hospitals that are trying to do get patients by offering natural child birth experiences, but they are not actually any different than hospitals how have more medicalized births. That is what appears to have happened to this woman who switched to Brookwood for her 4th birth.
That doesn’t really answer my question. Using more interventions and denying the NCB experience when nature steps in and prevents that experience leading to a healthy mother and baby isn’t false advertising.
Brooke “You also cannot expect a woman to know what is or is not outdated or what the policies are for that specific hospital”
Yes you can. You can expect her to stop pulling information from outdated books, and expect her to discuss hospital policy with her maternity team (for lack of a better general team).
This is the point of this post – folks like you are setting up more barriers against effective communication between the mother-to-be and hospital-based care providers, instead of encouraging them to getting accurate, up-to-date information from the actual people would be providing the care.
Encourage discussion, not pre-written plans.
Just how stupid do you think most women are? You don’t have to take a childbirth class to get a tour of L&D, and they will answer any questions that you have.
I did the craziest thing when I was pregnant and wanted to know about hospital policy: I ASKED. Crazier still, my OB ANSWERED MY QUESTIONS. We had actual conversations about my preferences and concerns and all those things!
In fact (I apologize for anyone who’s heard this already), when I was being prepped for my c-section, I requested that he stitch me up rather than use staples. He said I was the first person to ever express a preference. It made me wonder how many times people go in assuming it “must” be one way or another, and get pissed off because they don’t want whatever it is, instead of doing the grownup thing and saying, “You know, I’d really prefer ______ if that’s possible. Thanks.”
Ooh I know, I know! Go to someone who’ll refuse to transfer her if she needs an epidural or medical attention?
Why would someone “need” an epidural?
Also I think you missed that obviously this was a rhetorical question as I answered it in the begining.
Because labor hurts like hell? Because she wants it? Because she said so, and what the hell better reason do you need?
Because after a long, exhausting labor, an epidural and the associated freedom from pain and ability to rest may well give mom the strength to push Junior out?
Maybe instead of an epidural that woman needs encouragement, support, ideas on how to work through her labor. Maybe she needs to change positions, maybe she needs to eat or drink something. Maybe she needs to scream. Or be left alone for a few minutes. Getting hooked up to a fetal monitor, IV and being forced to deliver laying down isn’t going to make labor end any sooner and increases the chances of a woman needing an intervention.
CASCADE OF INTERVENTIONS! I knew it was coming. :p
I’m just glad I didn’t have ‘support’ like you when I broke my collarbone. “Oh, it’s good pain. You just need to be left alone to scream.”
More in a bit, but here’s a thought. The next time you present to the ER with a traumatic amputation/kidney stones/some other pain comparable to childbirth, how would you like it if you were told “oh, we just need to leave you alone. Go ahead and scream, maybe that will help. Morphine? That’s not natural! Want a snack?”
Perhaps Jane from New Zealand has returned for a new go under a new alias. She was spouting the exact same ideas about midwife support being better than pain relief.
I was just thinking that. Seriously, what is up with all the talk about “support”? What the hell is that even? I was a doula and I knew that back rubs and counter pressure only go so far, “support” is highly overrated.
Support is great and wonderful and everyone should have it. The availability of an epidural to help control pain should be part of that support. Pharmacology and (backrubs, cool towels, music, a good book, whatever works for you) aren’t mutually exclusive…
Totally. I just get ticked when yet another parachuter comes in and mentions support like it solves everything and doesn’t include things like epidural and team of professionals in the hospital. ((My mom told me she HAD to have reading material during her labors, her epidural kicked in and she was always pain free but wide awake. She would read her entire labor))
It reminds me of the lactivists trope that all breastfeeding problems can be fixed by “more education and support.”
My husband held my hand and rubbed my back while I began to pass a kidney stone. I was in so much pain it didn’t matter where he was.
I had to run to the bathroom because I was going to start puking from the pain. Then my intestines started to join the fun from the pain. The only reason I didn’t get dehydrated right then and there was because of the excessive water intake to help the damn thing pass.
I was already on Norco 15s and I wanted to shoot myself. I screamed in pain. And I don’t do that. I went years not knowing my entire right colon was tied to my abdominal wall by adhesions and just dealt with the pain because it didn’t seem that bad. This was THAT bad.
If someone told my husband and I that all we needed was for him to “support” me he’d look at them like they were crazy and say he doesn’t want to lose a hand so get the pain killers out now! Never mind he was turning white as a sheet because he’d never seen me in that much pain and was terrified.
It took days for me to recover from passing that stone and for my body to come back down from all that pain. It was exhausting and I certainly didn’t feel superior to anyone. How’s pushing out a six pound human supposed to be empowering when something the size of a grain of sand brought me to such a powerless state?
So I’m over it. The whole pain is empowering thing. Been there, done that, it did nothing to make me better than anyone else. Give me the pain killers.
They usually base that argument on the fact that women who want to give birth in low intervention settings that involve lots of midwife support, such as home and midwifery led units, have high rates of satisfaction. That is, that women who want midwife support and no pain relief so much that they choose a setting that only offers that option are usually happy when that’s what they get. They then try and expand this to the general population, rather than stopping to think that maybe women who don’t specifically choose such settings might not have the same desires and priorities. Maybe women who choose a hospital because they want the option of anaesthesia won’t be quite as happy with cascading midwifery care and back rubbing as women are who seek it out.
Because the argument came up again that if someone isn’t coping well with labor pain, that must mean they need encouragement, it made me think of Penny Simkin. Remember her pain vs suffering meme?
“Women in labor may rate their pain as high but if they are coping well, she may not be suffering. Those who rate their pain as high and their coping as low deserve the attention of the doula, staff, everyone. She is suffering and it’s time to increase all the support available to prevent feelings of despair and abandonment.” That statement must be what is being talked about and it needs to stop being treated like its wisdom. Despair and abandonment? I can see that happening if someone is left alone, allowed to scream and vocalize or offered “distraction” type techniques. The best support is suggesting the option most likely to alleviate the majority of the pain.
All the support except pain relief. I mean, I’ve nothing against the approach she mentions, ONLY for women who want it. There are women who prefer no anaesthesia and want lots of midwife/doula support instead and that’s fine, clearly they should have it. It’s just not what everyone wants and not better or worse than any other way a woman might want to do things.
Yes, one of my obstetrics lecturers showed us a study (I can’t recall which one or it’s quality, eep! Apologies) that basically showed the ONLY non pharmacological pain relief “strategy” in labor shown to be better than placebo was support of a partner. Not water, rocking hips, wailing mantras with the surges.
My impression is that’s because support of a familiar person helps assuage the psychological component of the pain response. Much like how small children can be comforted by their mother, not by “being left alone” or “screaming”
Who are you to tell anyone what they need? How many women have you refused to transfer because you deem yourself better than epidurals, with your encouragement, support, ideas on how to worl through their labours and other cutesies?
And read something other than the garbage your mentors are filling your impressionable head. If you’re able to place the necessity to know if a baby is in distress higher than your ridiculous and unreasonable fear of the imagined cascade of interventions, of course.
Presumably a woman who has been laboring at home has had access to all those things. She’s already been receiving support and encouragement, eating and drinking as she sees fit, moving around, “vocalizing”, being left alone if that’s what she wants. And guess what? If those things help her, she won’t ask for or need an epidural. But for many women those things simply aren’t enough. And it’s not like those things can’t be had in the hospital (I know; I’ve had three unmed hospital deliveries where I had all of the above). But the epidural cannot be had at home.
If mom is dehydrated and vomiting, as in the example above, offering her a sandwich isn’t going to do a damn thing as far as keeping her from getting a UTI.
Also, what IS this “forced to deliver lying down” crap? I keep hearing that from people, and yet, as a woman in her prime childbearing years with most of her friends ditto, I know of not even ONE of us forced to deliver lying down. (Well, me excepted, but I was having a CS at the time, and my totally unreasonable OB insisted that I’d really prefer to be numb from the chest down for that experience…)
This moving around business baffles me. I was exhausted from months of sleeplessness by the time I was induced. I was thrilled to get the epidural and get the best sleep I’d had in months before waking up rested so I could push the baby out in 40 minutes. I didn’t need to be doing calisthenics during labor.
Me too-the contractions worked like a taser on me, all I could do was hold still and moan. The pain paralyzed me.
Quite. Squatting for a few hours would have me howling for an epidural even without any labour pain.
To be honest, I was not “forced” to lie down but I had long sessions of EFM during which I had to lie on my side (hospital was very busy that day and midwife was away most of the time but making sure that EFM is done repeatedly). Also for the pushing I was asked to lie on my back – if I had insisted to stay in another position nobody would force me down, of course, but midwife certainly preferred to have clear view of my lady parts. I figured that it’s in my best interests too so she can guide through pushing and happily complied.
I swear I did everything except swing from the ceiling on a trapeze to try to get my first out! No problems with the nurses or doctor.
My doc will deliver in whatever position her patient chooses. She does not care. She’s delivered women on all fours, squatting, lying on her back, sitting up in bed with supported legs, lying on her side, you name it.
I actually preferred basically lying down for the actual birth part with my second, despite reading all the stuff about being upright somehow being better. It worked.
I found it a lot easier to read my book between contractions when I was lying on the bed. It would’ve been harder to hold my book otherwise. Priorities and all.
UTIs are urinary tract INFECTIONS. To be blunt about it you get one from wiping incorrectly after using the bathroom or by eating meat covered in feces (according to an episode about antibiotic resistant infections on Frontline anyways) not from dehydration. Typically women are not vomiting throughout labor but only during the transition phase. Eat and drinking early in labor can prevent dehydration. How would you stand up or squat during labor after an epidural? It paralyzed you from the waist down.
Not everyone wants to stand or squat to give birth, nor is it necessarily advantageous, despite whatever nonsense is circulating about it in the midwifery world. Some studies have found that it results in the most perineal trauma for the mother. It doesn’t sound at all appealing to me, and what’s more, there is no way I could have managed to stand because I was essentially paralyzed by the pain.
So in case you haven’t caught on by now — Why would a woman need an epidural? Because she’s in pain.
And I’m telling you that’s not the only way to relieve the pain or work through it.
No one here has said it’s the only option, it’s just a very good one.
And I’m telling you that you have no f***ing idea about what would or would not have relieved my pain or made it possible to “work through it.”
What qualifies you to make that statement about another individual’s pain?
My baby was stuck. It hurt a lot. It’s probably because without a c-section the baby and I would have died of obstructed labor, a common cause of mortality historically and in developing countries. I understand it is not a fun way to die and I can see why now just having a taste of it. I guess I could have “worked through it” right up until I died….
A question for Brooke – did anyone here suggest that epidurals should be COMPULSORY? I don’t recall it.
Okay, I know what you were saying here is very, very important but I couldn’t get past the word “stand” in regards to a birthing position.
I mean whatever floats your boat and if it works then it works but holy shit, we’re not giraffes! Standing wouldn’t be an option for me.
*some* women in certain HB circles seem to prefer it.
They also tend, in my experience, to be of the “good moms don’t worry about their sex lives” persuasion, albeit not exclusively so.
Generally it comes up in the context of “You tore during childbirth? Well, that’s because your pushing was directed/you delivered lying down/you delivered sitting but relaxing back to a semi-recline/your OB was hurrying you/you weren’t “allowed” to delivery squatting or standing.”
Then when you dare to say either “My OB was fine with my delivering in whatever position, but I preferred a more typical one” or “but haven’t upright positions been linked in some studies to *more* tearing,” they start harrumphing, insisting that there’s no way your OB would let you do any such thing, or saying “but at least you won’t have a C-section.”
Le sigh.
Depends on the type, there are “walking epidurals” available.
Yep, and first labors tend to last, what? 18-20-something hours?
Having been in extreme pain, I can tell you that the only thing I’d have wanted to do with liquids or food is to, if I could muster the strength and focus away from my pain, throw them at the person offering or pushing them. Not drinking anything for 10-12 hours, just half that labor timeline, is not a good idea, especially when you’re sweating and peeing it out. And not drinking enough means that you aren’t flushing out that system, which leads to a higher incidence of UTIs.
Have you really never heard of a walking epidural? They’re titered to remove the pain but leave a little sensation. Furthermore, even a standard epidural doesn’t keep you from sitting straight upright with support, which is precisely how most of my friends have delivered.
That’s just plain not true. Those are some of the ways you can get them, but not the only ones. Dehydration can be a major contributor.
What? Meat covered in feces? WTF are you talking about???
That is not how you get UTIs. If you wipe incorrectly you can get them, but that’s certainly not the only way.
Don’t you put meat covered in faeces into your urethra all the time? I know I do.
Only when I’m giving birth.
Which brings me to a random thought: I wonder if moms of babies who pass meconium during labor are more prone to various and sundry infections afterwards, or if the amniotic fluid helps flush everything out? ‘Cause from what I understand, fecal matter is not a particularly nice thing to have in one’s Female Bits And Pieces. Though perhaps meconium is cleaner (ish) than your average poop, since presumably everything in it has been filtered through mom’s bloodstream?
(This is what happens when the toddler takes a long nap; Mommy starts very random trains of thought which are allowed to go on uninterrupted.)
That’s an interesting question because meconium gets passed when baby is stressed so if it was after the membranes ruptured when baby is possibly sitting in infected fluid, it could be contaminated with all kinds of bacteria. Otherwise I doubt it would cause contamination because it’s all a closed system until birth.
It’s an interesting thought. Do babies have a microbiome before they’re born? Because where on earth would it come from? I never really thought too much about it, I just thought the kid would be really rapidly colonized by everything it got into its mouth in the world… and at that point, they’d have microbiota in their feces.
I always thought the bad organisms in labor/birth came from the mom – vaginal and fecal bacteria getting into the amniotic fluid from the membranes being broken. But I’d ask an OB!
No, meconium is essentially sterile, much like urine. Meconium aspiration causes a chemical pneumonitis by disrupting the lung lining, which can lead to a secondary infectious pneumonia sometimes.
Well, you’ve got to have something to smoothie if you decide on a lotus birth.
Perhaps I’m a bit of a prude, but kindly pass the brain bleach. *twitch*
No, I think that’s probably fair.
People get UTIs all the time after having done neither of those things. But that’s probably hard for you to process since you believe that you know all the right things to do, and when things go wrong for other people it’s because they’ve done something wrong because they don’t have access to the magical knowledge that you do.
You get UTIs from a variety of sources. A common one for women is having sex, for example. Getting it from meat with feces, like you say, is not very common- that would tend to cause a GI infection- the only way it could cause a UTI would be if you rubbed the meat against your genitals or if you got so sick from a GI infection it got into your bloodstream and seeded your kidneys (and then it technically would be a pyelonephritis).
Love, someone who got their medical knowledge in medical school and not from Frontline.
I know. I’m still trying to figure out this meat/UTI connection. Does Brooke think the GI system somehow connects to the urinary tract? I mean, I’ve heard some weird stuff, but meat covered in feces? That’s just odd.
It’s possible Brooke got a fistula from obstructed labor.
Dammit it you beat me to it!
Have my upvote.
🙂
Well, I guess if you had an ulcer bad enough… :p
I was about to ask if Brooke has a kink we she hasn’t mentioned. The way she talks about letting women scream it out, we already know she’s a sadist.
Brooke – this is an OB’s blog, with lots of clinicians amongst the readership – nurses, CNMs,doctors – GPs, other OBs, other medical specialists.
Not only do we know what “UTI” stands for, we also know the risk factors, the organisms they are caused by, the complications and the treatment.
You might do better to listen rather than pontificate.
I had an epidural for a couple of days after abdominal surgery (not related to childbirth). I didn’t try to squat, but I was by no means paralysed – I didn’t even know it was there until someone came to take it out on the second day.
You know what, I often get UTIs from dehydration – more concentrated urine sitting in the bladder for longer = stasis = breeding conditions for ecoli are more favourable. There’s an actual biological mechanism for dehydration contributing to UTI. THIS EATING POOP MEAT SHIT? none. Ffs.
My sister-in-law, who isn’t particularly crunchy, told me about her sister-in-law on the other side of the family, who got that “wait to push, the doctor isn’t here yet” business from the nurses, which is kind of in the same category as forcing someone to deliver in a certain position, in my book.
Ugh. Did she at least have an epidural in? From what I understand, it’s quite possible not to push if you have a good epidural in, but if you don’t, it’s pretty freaking hard not to if you’re feeling the urge.
Well, I had to labor lying down, but it was because I was on a magnesium drip for preterm labor … not because the doctors arbitrarily felt like torturing me.
You either can work through it or you can’t. Birth is described as primal, instinctual, natural and something our bodies are designed for. If that is true, we would instinctually be able to and be designed for knowing how to cope without any outside encouragement or support. I never had the privilege of getting pain medication during my labors, the first time I had a nurse who believed that I just needed to be encouraged to work with what was going on and do all the things that you describe in your post. It didn’t alleviate any pain but it did waste my time rocking, standing in the shower, moaning and finally screaming for help when I could have been napping or at least being comfortable.
I think its at least worth a shot if you really wanted a natural birth or like me really hate paralysis and IVs.
The question is, what motivates someone to want a natural birth that much? Again, I didn’t have a choice but it’s not like I wanted it either time.
“Worth a shot” /= “Why would anyone *need* an epidural?”
I hate IVs too bit I’m pretty thankful it’s already been placed before I get to a crisis point.
If I’m dehydrated then my normally hard to hit veins become next to impossible for anyone but the most skilled IV placers in the hospital. And there’s usually a bit of fishing involved even with them.
I’d rather have the option already there an ready to go than to wait for when it’s an emergency and time is of the essence.
And you get to decide that for yourself. Not for anyone else. It isn’t your place to decide what is or isn’t worth a shot for other women who originally wanted a natural birth. Your business, mind it.
Paralysis, really? They severed your spinal cord or gave you succinyl choline? I’m willing to concede that different people have different coping mechanisms when it comes to pain and let each person deal in their own way. But those of us who believe in “better living through chemistry” and choose the medical pain relief right off the bat really don’t appreciate the chiding tone of those who embrace alternative pain management.
Studies have shown that epidurals don’t increase the chance of CS. Maybe instead of platitudes and useless advice that doesn’t alleviate pain, women need real facts so they can make an informed decision about pain relief.
And if the person doing the evaluating is blinded, it has no effect on the baby (as it shouldn’t, the anesthetic is epidural for a reason) or on breastfeeding.
That’s as opposed to when the evaluating is not blinded. Funny, that.
What?
I don’t think I could have been any clearer. Epidurals have no effect on the baby, despite certain advocates reporting otherwise when unblinded about whether or not the mom had one.
Also, preliminary evidence suggests that women who have epidural anesthesia reduce their risk of post-partum depression. You tell your clients that, yes?
http://journals.lww.com/anesthesia-analgesia/Fulltext/2014/08000/Epidural_Labor_Analgesia_Is_Associated_with_a.21.aspx
I’m guessing she doesn’t understand what you mean by blinding.
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“I’m in great pain.”
“Well, we have something for that, but I don’t think you should have it.”
Is that the kind of compassionate care they teach midwives? Your patient tells you she’s in great pain and needs relief, and your response is to leave her alone for a few minutes? Nice. Very supportive!
Midwives are compassionate providers. You know that “midwife” comes from “with women.” Which means leaving them alone when they are in pain.
IV’s do not in any way “increase the chances of a woman needing an intervention.” Please explain that odd statement you made.
When fetal monitors lead to interventions, it’s because the monitors showed that the baby was in distress (i.e., possibly in danger). The point of the “intervention” is to get the baby out ASAP so that it is no longer in danger. Most mothers prefer their babies not to be needlessly injured or killed, and that’s what monitoring is for.
No laying down during birth and being unable to move increases the possiblity of an intervention because you are working against gravity and biology to get the baby out.
Who says you have to be lying down or unable to move to have an IV/heplock or CEFM? A heplock doesn’t limit your movement whatsoever, IVs are usually attached to moveable poles, and while CEFM could limit how far you can walk you certainly aren’t confined to bed (says the lady who rocked Ina rocking chair and bounced on a birth ball while hooked up to the monitors). Not to mention telemetry monitors that don’t limit movement at all – tho not every hospital has that technology yet. Pretty much everything you have said is compete bullshit. And the sad part is, you don’t even know it.
As I said in a previous comment, I tried everything except swinging from a trapeze to push out my OP baby. Sitting, squatting, all fours, etc. You know what worked best? Flat on my back, knees up by my ears, and pushing with all my might towards to ceiling.
Imagine that.
All women are different.
You didn’t try the trapeze birth? Then how can you say you gave labor a fair chance?
Every woman is working against biology. We have a reproductive system that evolved in quadrupeds, and a body that has done a half-assed job of evolving to be bipedal.
I was going to bring that up, actually. It was a large part of my biological Anthropology classes when discussing early hominids and that our hips, brains, and knees are in a fucked up arms race.
Narrower hips provide a better angle for the knees to work properly and keep us upright and able to walk. Bigger craniums can hold bigger brains which gave us a cognitive advantage like tool use. But a bigger cranium means the hips need to be wider to accommodate its passage. But wider hips makes the femur meet the knee at an angle that makes bipedal locomotion more strenuous on the joint. If you can’t run away from predictors or run close enough to catch your prey, it doesn’t matter if your hips are wide enough to accommodate a big headed baby with space to spare. You’ll be dead before you get to use them.
Human infants are already born relatively premature compared to other placental mammals so the baby really can’t be born any earlier when the skull is smaller. Losing brain mass to make the skull smaller affects cognition and intelligence and that’s what’s getting humans ahead so that can’t be dropped. But you’ll never survive to reproduce if your hips don’t allow you to walk upright and use your hands to manipulate tools properly.
So through the trial and error of who survived and who didn’t, and I use survive in a very loose sense here since this “solution” still has a high death rate, human female pelvises had to meet in the middle of all turee and end up with almost no room to spare when squeezing the baby out.
I mean, check out chimp pelvises compared to humans.
Humans are like (O) when giving birth with a small margin for error and chimps are like ( O ) oh hey just let that baby fall right out because I don’t employ bipedal locomotion exclusively!
Lucky chimps…
No doubt it’s that chimps just trust birth more than we do, and understand that even if you really want an epidural, you don’t really want one.
What does lying down and being unable to move have to do with having an IV port placed? Even with an actual IV you can walk around. And all the more so if all you have is an IV port.
BTW “working with gravity” as you describe can increase the risk of severe perineal tearing for the mom.
Ah, but you see, Good Moms (TM) don’t care about their sex lives once they’ve had a baby. If they do, they’re selfish.
You might be able to walk with an IV, but can you writhe?
Well, I guess you could writhe clockwise for a bit, and then counterclockwise to untangle the IV line. I’m sure a good doula could let you know when to switch from clockwise to counterclockwise and vice versa. 😉
Is that this Spinning Babies thing I keep hearing about?
Again the “working against gravity and biology” trope.
Pro Tip: the baby is pushed out (or not) by the contracting uterus – NOT by gravity. Some women do better squatting, others do better lying down.
The Cochrane review on birth position and outcomes found an association between the lying-on-back position and reduced blood loss.
And also enhances uterine contractility (study referenced here previously)
Then why does it seem that a number of the home birth/uc videos show mothers who are in some variation of lying on their backs successfully pushing the baby out? Or does it not count as being on your back if it happens at home and is totally *your* choice instead of being in the hospital?
Another example of one lot of anecdata-homebirth activists’-trumping everyone else’s experience.
They say no one should give birth lying down, but if you want to, and there is no doctor nearby, it’s fine!!
But if she wants/requests/asks for one, then she should get one. Or any other form of medical pain relief she wants. Nothing, and I mean nothing, is worse than wanting and needing pain relief and not getting it. And someone making suggestions like ” change your position, lets get up and walk awhile, take some deep, calming breaths, bounce on this ball, rock in the chair, get in the shower or tub, that will work just as well” shouldn’t be surprised when the laboring mother, WHO HAS REQUESTED MEDICAL PAIN RELIEF throat punches them. Smooth muscle contractions are painful, crampy and colic-like and altogether deserving of proper pain relief/management.
I’m sure Brooke gives all of her clients accurate, scientific information about the safety of epidurals when she’s helping them with their Birth Plans.
I used to think like you. I used to think there was some external value to experiencing all the contractions without pain relief. There is no value in suffering. It does not enhance the health of the infant or mother. Pain can be demoralizing, frightening and pain robs a mother of autonomy. There is true value in pain relief.
I’m sorry, what? I gave birth without pain meds by choice, but as others have said, there’s no intrinsic value in doing so – and if I’d decided part way through that I needed relief, I knew that my husband and midwife would *listen* to me. If another woman says she needs an epidural, then I bloody well respect her choice about what’s best for her and that she knows what she needs and wants in the moment.
Are you joking? Everyone in *that* moment of extreme pain wants it to be over right away but if you really wanted a natural birth, wouldn’t it be better to have someone remind you why, not just give you the epidural?
You people really are cold, aren’t you?
Person A: Hey, that guy who was in the car accident is in a lot of pain. Should we give him something for it?
Brooke: No, he just needs to be left alone for a few minutes.
. . .
Person B: Grandma’s pain is causing her a lot of suffering. What should we do?
Brooke: Maybe have her walk around or something. If that doesn’t work she probably just needs to scream.
Oh no, they wouldn’t take that attitude with Person A. It’s only women who need this kind of treatment.
And children. Don’t forget children.
I am being serious. When we were kids, screaming it out was a part of our treatment plan. Because that syrup was evil, Mom had us shout, “Nasty, nasty, nasty!” three times in a row immediately after taking it. That was her way to make us take it at all.
I am thrilled to find out that the “less nasty after you called nasty” stuff is true for grown up women as well. My mom rules!
Not joking at all. I’d much rather that people providing care listen to what I’m asking for and respect that I know my own mind.
No, I think if the pain is too much to cope with through moaning, using hydrotherapy or counterpressure that “reminding” her of anything is condescending. I trust that if someone says “I need an epidural” they know themselves and what they can tolerate.
“OMG this is really bad, far worse than I expected, please get the epidural going!”
“Ooooh, honey, no, remember, you won’t get your Nacheral Gold Star if you have pain relief the NCBers don’t approve of!”
And why does anyone specifically want a natural birth anyway? It’s general because people like Brooke have built up an ideology and industry around making it sound like something worth having.
Yeah but that might mean actually giving them the epidural. We can’t have that, because sinsofeve.
No. Because the why itself isn’t going to accomplish anything. All you get is bragging rights– it’s no more of an achievement than not taking triptans when you get a migraine or not getting lidocaine when you’re at the dentist. Unlike the pain you might experience learning a new dance move or running ten miles, you don’t get anything EXTRA from labor pain– you get a baby either way.
I’ve had four children. One with an epidural, and three without any pain meds at all. With my second child (first unmed birth) it never even entered my mind to ask for pain meds. Because I didn’t need them. With my third child I requested an epidural, IV fluids were started (via the previously placed heplock), but the resident anesthesiologists had a hard time finding the right spot; by the third attempt I decided I didn’t want the epidural anymore, and the attempt was abandoned. In retrospect I was a bit dehydrated, because the IV fluids helped and at that point I was okay with continuing on without meds. With my fourth child I was pretty comfortable. So much so in fact that I didn’t even get to the hospital until ten cm… I really didn’t think I was that far along. NCB is the luck of the draw. I got very lucky. Three times. It’s one thing to hope to not need meds (don’t we all hope that labor is easy enough not to need them??!). But it’s something that can really only be decided in the moment. Denying pain relief to a woman who said she didn’t want it, long before she was ever in any pain, because you want to hold her to a preference that she expressed before she even knew what she was getting into is one of the most cruel, I humane things I’ve ever heard of. Disgusting.
It was my worst nightmare to have someone deny me pain relief in “that moment of extreme pain.” That is why I purposely did NOT choose a midwife. I didn’t want someone to try to talk me out of pain relief. It seems the height of cruelty to look at someone crying in pain and tell them “remember, you wanted this…”
Perhaps you don’t know your own mind, but you need to not assume others suffer from that problem.
No. I did the whole no meds, natural birth (in a hospital) thing, but if I’d decided in that moment that I wanted pain meds or an epidural the only way I would have found it at all acceptable to be told no is if the baby was nearly out.
What benefit is there in sticking with the natural birth over getting relief from pain you misjudged your ability to handle?
No.
No. No way. If someone was suffering severe pain while their broken bone was being set you would never tell them oh it’ll be over in just a minute just stay strong and you’ll get your unmedicated bone setting. A non-sadistic provider would say, ok let me get you some appropriate pain medication since you are obviously suffering.
Birth is the same thing, when the person experiencing pain says it hurts too much I need relief, a provider should be offering appropriate pain relief.
Exactly.
While generally fairly stoic about a lot of painful things, I can’t do dental pain or even discomfort. At all. Period. Partly because of a jackass of a dentist I had as a teen, I admit, but…just can’t do it. I admit this is somewhat irrational, but it is what it is.
My dentist’s response wasn’t to say “oh, come on, this won’t hurt that much.” It was “okay, we have you really numbed at this point. I don’t think you’re going to need nitrous because it’s going to take me one quick pull each on those wisdom teeth. However, if you want it, I’ll give it to you now, and no argument. Alternately, I can give it a quick try, and if it doesn’t work or hurts, I stop immediately and you get nitrous before we continue. It’s up to you.”
As it happens, because he was that honest and willing to give pain relief, I was willing to trust him for that one quick pull–and yes, it was all over before I thought it would be.
See, that’s a caring provider. I couldn’t imagine denying pain relief to a patient if I had it available.
Probably because of your being a decent human being, or something, or perhaps because you prioritize results over process. Madness, I tell you! :p
I must be utterly mad, you’re right! I remember I was at a relative’s labor and I literally had to argue with her mother about pain relief. I called the nurse in and told them my cousin wanted some and told her mom to shut it. So I have no tolerance for people saying no pain relief for laboring mothers.
I like the way you think. A friend did this for her sister, once. Sister was incoherent from pain, sister’s support person was all “I don’t know if she wants an epidural or not,” friend says “Do you want pain meds?” Sister *screams, mostly consisting of the words “hurt” and “pain”* Friend: I’ll take that as a “yes.” Nurse! My sister wants an epidural immediately. How do we go about getting her one?
Twenty minutes later, sister is resting comfortably preparatory to pushing the kid out, enjoying the whole no-pain thing, and glad that her sister knew her well enough to know that if she’s not capable of answering a basic question due to being in horrendous pain, she wants drugs and wants them now.
That’s pretty awesome! My husband kind of did the same thing for me, I was out of my head in pain and mumbled something about maybe thinking of an epidural and he had that nurse in there in minutes setting up for one. Love that man!
Sounds like a smart husband! Kudos!
He really is, for the next baby he was the first one reminding me of the benefits of the epidural and came up with the whole list of pros for me. He’s a good guy and hated to see me in pain that he couldn’t help me with.
It’s like something my Grandmother did when my mom had a particularly nasty dentist and it was too late to stop the filling and take her somewhere else.
The dentist was yelling at my mom and telling her to stop crying because it doesn’t hurt. My grandmother said, “Yes, he’s right. I’m sure it doesn’t hurt *him* one bit” and gave him the burning gaze of Hell for ignoring her telling him to stop far earlier.
Oh,yes. You must be. Don’t you know when a woman is in labor it is the one time that health care providers ( and everyone else) are supposed to give up their decency and humanity to quietly watch anotger human being suffer without even offering relief.
Everybody wants pain relief when passing a kidney stone too. Seriously, does somebody give out medals for having a natural childbirth? Did mine get lost in the mail.
“in *that* moment of extreme pain”
Wait…labor pain lasts…A MOMENT?
In what universe?
No. At that moment of extreme pain I’d take a mallet to the head if it meant pain relief. Not whisperings in my ear about what I said when my body didn’t feel like it was trying to turn itself inside out.*
*I haven’t had children get but I’ve had the wonderful experience of passing kidney stones. If that’s the closest thing to childbirth then just dope me up as soon as I walk through the doors when I do have children.
I’ve never had kids, but I mentioned recently – I had my ancient primp cervix dilated (to nowhere near 10cm, ffs) to put in an IUD, and it wasn’t just that it was painful – it was – but the pain was so deep and so strange that it hit the flight-or-fight areas of my brain like a jackhammer. Why wouldn’t you want to skip that on the day you meet your baby?
That was also the point where I realized I had made a good choice in OBs – I was biting back another yell and managed, “I can’t believe women fit a whole baby through there!” Instead of saying “It’s not so bad” or “You can get through it,” my tiny OB with two daughters said, “We have drugs for that.”
Wait until you have to have it changed out. The removal is …..interesting. But it is fast.
It’s not just delivering the baby. If it were only just being able to get the baby out. If you are lucky, you deliver the baby and the placenta and do not need sutures. What about the moms who need a vacuum or forceps assistance? Manuevers to release a shoulder dystocia? Repair of a second, third or fourth degree laceration or cervical laceration? Manual extraction of the placenta after a velementous insertion? Bimanual massage or rectal placement of Cytotec during a post partum hemorrhage? Or just wanting to be a better witness to the birth of your own baby by being in control of your pushing with an adequate pain relieving epidural as opposed to writhing in pain vocalizing and involuntarily pushing trying to get the baby out as fast as you can. Imagine experiencing any of those scenarios at home without adequate pain relief.
^^^^ This is why exactly why I had an epidural with my second. I wanted to be fully present and aware during her birth and I wanted pain relief already on board if anything went amiss after the birth.
Or maybe the woman is an adult and perfectly capable of making her own decisions?
“Maybe she doesn’t need an education; she just needs to go visit some friends for a while and see new sights.”
“Maybe she doesn’t need control of her own finances, bless her little heart; just let her have an allowance for her clothes and she’ll be happy.”
“Maybe she doesn’t need to vote, she just needs to support her husband’s political choices and throw a tea for his friends’ wives while the men go to political rallies.”
All that is quite as insulting as implying that a woman in pain doesn’t really want the pain relief she’s asking for.
Oh like the decision to give birth at home without an epidural available? If you want an epidural give birth at a hospital with an anesthesiologist.
Ah, so a woman isn’t allowed to change her mind, then?
See, that’s the thing. At the hospital, you can change your mind. At home, especially when midwives/doulas like you physically keep women from going to the hospital in search of pain relief, they can’t. That’s a problem. And it really isn’t possible to make an informed decision regarding pain management until you’ve experienced that pain. You (the “you” in this comment is mostly directed to the general, not the specific you) can think you may prefer certain things, and maybe you will. Maybe you won’t, though, and in that case, you should be able to change your mind when you make a more informed decision.
You might decide, having seen your mom die of cancer, to get a preventative mastectomy. If you do, that’s your right. However, things might change. Perhaps your surgeon wisely says, “I’ll be willing to do this if you really want me to, but please give it a year after your mom’s death before you make that decision.” At the end of that year, you might say “Hmmm. I really like my boobs. So does my SO. I’ve gotten a bit of space since mom’s death, and I think that for me right now, the best decision is to continue doing monthly exams and getting regular mammograms.” And you know what? The specialist’s response to that would be “I understand where you’re coming from; that sounds like a reasonable decision, and I support it,” not “Nope! You decided to have a mastectomy, so you’re having one whether you want one or not!”
I wouldn’t “support” the decision to give birth at home in that I think it’s a very stupid idea. However, I do support a woman’s right to make it, much like I support adults’ rights to make all sorts of unwise decisions without someone else interfering.
“However, I do support a woman’s right to make it, much like I support adults’ rights to make all sorts of unwise decisions without someone else interfering.”
And a woman should have accurate information to make this decision. Not ‘cascade of interventions’ and similar BS.
Precisely.
Aww, KoTB, I thought you knew. I thought you were posting from your rightful place – barefoot and before the stove, doing your best to get pregnant to fulful the only mission you have as a woman – having as many babies as possible, as naturally as possible, before breastfeeding them for as long as possible. (We actually have a folk tale here. It’s called The Hero Who Nursed for Twenty Five Years. Cute, eh?)
The…Hero…Who…
Are you *entirely* certain that the author of “Melanie’s Marvelous Measles” didn’t come up with that one?!
Absolutely. It isn’t exactly a sweet story of attachment parenting since his mom. Was. Not. Pleased. She couldn’t wean him off, so she took him to court. The judges sided with her and drove him off in the woods to be eaten by wolves and other such animals. Of course, once left to fend off for himself, he started heroing. And eating meat.
I’m with mom on this one. Twenty-five YEARS?!?! Wolves sound like the reasonable, mature decision at that point.
(For reference, though you may have gotten it: “Melanie’s Marvelous Measles” is a children’s picture book about, I kid you not, how awesome measles are, how they’re not dangerous, and how evil and nasty and deadly vaccines are.)
Oh I know this one. I grinned when it was taken off from the bookshelves in… Australia?
I enjoyed the reviews on Amazon. All those suggestions of a sequel… Simon’s Smashing Smallpox… Dolly’s Darling Diphtheria… Tori’s Tranquil Tuberculosis…
Somehow, I missed those. *howls with laughter*
Go there and enjoy. All of them are 5 star reviews! The author was royally pranked.
Oh, and while you’re over there, don’t miss the other 5 star reviews, those thanking Ms Messenger for reviving their business – making tiny white coffins.
My husband suggests adding Paul’s Prideful Polio.
Paul’s Polio Paradise?
Holly’s Happy Hepatit B.
Rose’s Rockin’ Rubella?
Laura’s Lovely Lymphoma? Helen’s Hilarious HPV?
Claudia’s Cheerful Chlamydia? Erica’s Excellent Ebola? Carrie’s Celestial Cholera? Alice’s Amazing Amoebic Dysentery? Barry’s Bangin’ Brucellosis? Lana Loves Leptospirosis?
Molly’s Magical Meningococcal Disease, Persephone’s Perfect Pneumococcal Pneumonia.
Magnus’ Magnificent Malaria
=
Now if only we had * that* vaccine already..
Megan’s Magical Meningococcal Disease, Polly’s Peaceful Pertussis, Persephone’s Perfect Pneumococcal Pneumonia.
Bitty https://www.youtube.com/watch?v=931bCc1R1Q0
There are a bunch of Bitty scenes in Little Britain.
Pain can change a plan, that’s for sure. The problem with that is again, you might find pain isn’t really an issue and you don’t end up wanting an epidural. What is much worse is deciding that you don’t need an epidural before you are in pain, choosing birth attendant and birth setting in a way that will support your decision (at home or in a midwifery led birth center) and then really needing the option and facing a transfer when you are at your lowest point. It’s been talked about a lot here, how slow a transfer can be even in an emergency. It can easily take a laboring woman a half hour to be able to get out of a birthing tub. Then there is the car ride to the hospital and the possible situation where a midwife doesn’t have a copy of the chart to send with or requires extra payment to accompany the woman to the hospital. It might be that the hospital she transfers to doesn’t have 24 hour anesthesia coverage, meaning she will be in pain that much longer.
Woah, woah, that’s a dangerous road to go down. Next we’ll be letting them use birth control and vote.
Oh God no, not an intervention! Much better to leave her alone to scream.
Actually, you’re full of it. I was not dialiating because I HURT so bad and was stressing. I got my epi and went from 4-10 in 30 minutes. My daughter sort of just fell out at that point. So yes, it did speed up my labor and prevented intervention by making me relax enough to dialate and not need a c-section. In less than 45 minutes we went from talking about major surgery to me holding a baby because of an “intervention.” Go epidural, go!
No, no, we all know early intervention can’t possibly help avoid less drastic measures later. You must be mistaken.
Or maybe she actually does need the epidural, instead of having any/all of those things forced on her by some NCB loving midwife. I know I needed an epidural because I didn’t get one, and everything I went on to suffer- including intervention that might have been avoided if they’d allowed me adequate anaesthesia so I could rest- confirms to me that I was correct in my assessment of my needs. The person who forced me to work through that list of alternatives you present was wrong.
BullShit. (Sorry for the swearing.) I had an unmedicated birth. It hurt. A LOT. There was no breathing through contractions, there was pain. Just pain. I didn’t even remember I was having a baby until pushing (I think?) because all I could perceive was PAIN.
Have you had a baby?
How about this? BELIEVE WHAT WOMEN SAY. If she says she wants an epi, give her the epi. If NCB/midwives whatever is allllll about autonomy, you need to help women get appropriate pain relief AS SOON AS they ask for it.
Let’s see…I bounced on the birthing ball, was encouraged to take sips of Sprite between contractions, had intermittent EFM, no IV or heplock, pushed in every position imaginable, and emitted primal screams that I initially thought were coming from someone else. Guess what? None of that made a damned bit of difference. Birthing my oldest child was excruciatingly painful, with the added bonus of suffering a cervical laceration because I was unable to control my pushing. I got to have a manual examination of my uterus (midwife was up to her elbows) without pain medication because I didn’t have a heplock, and had a pph that nearly required a blood transfusion (despite getting a shot of pitocin and cytotec rectally).
Please just stop talking. Now.
Or maybe she just needs a fucking epidural and for people to stop trying to tell her that a drink of water will make the pain alllllll manageable.
I *needed* that epidural with my first after 30 hours of very painful labor that wasn’t progressing (including laboring in the pool, which helped, but not enough) so that I was completely exhausted. The epidural meant that I got some rest and was able to push when that time came. Without an epidural I’m sure I would have needed a csection. Oh, and when the OB was elbow deep in my uterus because of a massive PPH, I didn’t need a general anaesthetic to complete all the repairs. I didn’t *need* an epidural with my second (would have been nice, but he came too fast) because I was rested and well able to cope with the pain for the short period I needed to.
I *needed* that epidural with my third though, again, related to a long, somewhat dysfunctional labor (which only started progressing after that epidural) and fatigue.
Every woman is different, and every labour is different. There are advantages and disadvantages to a medical procedure like an epidural. Women should each be given the opportunity to make a truely nformed decisiondecisionto each of their unique situations and should not be pressured or shamed for making those decisions.
If it were any other kind of pain, there would be no argument that “needs to scream” = “needs pain relief”.
The same reason someone “needs” novocaine when they get a root canal. It hurts.
A person might need an epidural in order to stop them feeling the pain of labour. Obviously. Also, I think you missed that I don’t care whether it was a rhetorical question.
“Why would someone “need” an epidural?”
Maybe because she’s going into the OR for a C-section to deliver her breech baby?
Because she’s human and she’s asking for one and her comfort matters.
I’ve cared for many women who wanted epidurals and some women who needed them. For example, a woman being induced for severe pre-eclampsia who hadn’t slept in 3 days. A woman with an OP baby feeling an overwhelming urge to push at 6 cm. Women whose labor has stalled for hours at 5-5 cm and are exhausted and suffering. Get off your high horse.
“Obviously every woman knows that her birth plan might get thrown out the window”
The thing many don’t get is that it isn’t the doctors who are throwing it out the window, it’s Mama Nature. She doesn’t care how many whale songs you have on the MP3 player or how many positive affirmations you’ve done. She’ll kill your baby for no reason at all.
And sometimes you’ll have to explain to 6 different nurses why you are not having an epidural.
So, on one hand, there’s some annoying repeating yourself. On the other hand, there’s a dead baby. Why is this even a comparison?
Because something something something, false equivalency to FGM/Loss of rights/Insert more bullshit here, something something.
Oh horrors! Being offered something you don’t want and having to politely decline multiple times!
How does that even compare with someone in terrible pain not being able to get pain relief?
I worked in a hospital with a large Mexican population. Those women usually don’t want any pain meds and I can’t recall one ever coming in with a birth plan. On admission we always ask what plan mom has with regard to pain relief? Are you planning an epidural? No thank you. We are cool with it. If its a really hard labor we may offer again but if it’s declined that’s fine. The interesting thing is they do tend to be way more successful at not having meds than the women who have been to natural childbirth classes. They are usually just happy to be in an American hospital and are delightful to care for. Really strong families. All generalizations but its definitely not necessary to get so worked up about natural birth to have a natural birth And they don’t get mad when we offer pain relief they just politely decline it.
No explanation needed. Just “no”. Or if you are feeling chatty “No thanks, I’m doing fine”.
I wonder why NCB types are so *afraid* of being offered an epidural? It’s so simple to say no.
That’s how it worked for me.
Ob: I recommend a c-section.
Me: We’d guessed that. I want a c-section.
Ob: You can continue for a bit longer if you want?
Me: No, I’ve been at this for a while and not getting anywhere and don’t feel like that’s going to change.
Ob: Well baby’s doing fine, I’ll fit you in after I finish a hysterectomy.
Me: OK
Nurse: Do you want a pethidine shot while you wait?
Me: No thanks. I’m OK for now.
All said between contractions.
I guess if your labor lasts through six shifts because “no pitocin” is on your birth plan. Or if one’s level of vocalizing is too loud, a nurse walks in and tries to assess what the problem is and asks if you would like an epidural. Then I could see having to deal with six different nurses. But there usually aren’t six random caregivers unless they are assigned to you.
6 shifts…Isn’t that generally 2 full days?
Depending on the hospital, that can be 2-3 days.
It would be three full days at my hospital.
Damn those women for seeing your pain and wanting to help you.
Maybe they heard her screaming it out, ran over, saw no orders for pain killers on her chart and went “Oh my gosh, why hasn’t anyone offered this woman some pain relief?!”
Ummm.
On the one hand, dead baby.
On the other, either having “please don’t offer pain relief” written in the chart or saying “no thank you” a few times.
Totally comparable.
Are you saying that not wanting pain relief medications kills babies? Invalid comparison.
No, we’re saying midwives and homebirths kill babies. Do try to keep up.
If you read the comment thread, you’ll see that Brooke implied that having to explain to a half-dozen different nurses that one doesn’t want an epidural is quite as bad as having one’s baby die due to Mother Nature’s rather sadistic whims. I said that those two situations were in no way comparable.
What in god’s name makes you think that doctors and nurses “intentionally punish” women for having birth plans? That is just so absurd.
Especially in light of the fact that so many doctors hand you a birth plan template now and expect you to fill it out and discuss it with them. I had two things that were really not worthy of a birth plan (Have the best IV person ready, my veins are crappy and keep all family except my husband out of my room during labor) and the rest I wrote “I will see how I feel during labor” because I really don’t know before hand if I want the lights on or music playing.
Exactly. I love, love, LOVE music and have it on all the time. In my birth plan, I had a whole long playlist I wanted going all the time. It later turned out that when I’m in pain, I want as much silence as possible; music takes too much focus when I need to focus on getting through the pain.
Basically, be flexible and be ready to use common sense. Just about the only thing I’ve learned from parenting is to always have a Plan B, because the chances are excellent that Plan A is going to get thoroughly screwed-over by circumstances outside my control. 😉
Maybe because Dr. Amy says birth plans “engender hostility from staff” in this very post.
There are minimalist birth plans that state something like “get the baby out, healthy baby and mom, whatever you need to do to achieve that outcome, great”; birth plans with a few dictates like: I prefer no narcotic pain meds, I would like to wait until I am dilated to at least a 4-5 before getting an epidural, I want to be able to walk and/or change positions during labor, I don’t want an IV but a heplock is okay, and I prefer dim lighting, those type of fairly reasonable requests. Then there are those that go on for pages and pages that read like a spoiled child’s list of things they want and don’t want. I don’t want and IV or a heplock. No fluids by IV and I want to eat and drink whatever I want during labor. No cervical checks, birth ball available in my room, birth bar available in my room, large tub and/or shower to labor in, nobody but my support people are allowed to speak to me, tennis balls for counterpressure if I have back labor, NO artificial lights, just the scented candles I have brought with me, my labor and delivery playlist is to be played throughout my labor, in the order they have been recorded/arranged, no coffee in my room and noone who has had coffee can be near me, as I can’t stand the smell, I want to bring my own sheets and blankets and I want to labor in my own clothes, no directed pushing, I want to push only when I am ready, I do not want to be on my back at any time, delayed cord clamping until it stops pulsing, skin to skin contact IMMEDIATELY after birth and for at least an hour after birth, I want to be present when my baby is evaluated and bathed, anything that needs to be done to the baby will be done in my room or in my presence, no pacifiers, no formula, allow me to vocalize as much as I deem necessary, no episiotomy, I don’t want stitches if I tear, no vacuum or forceps, no hat on the baby, only use the organic, unbleached baby blankets I brought from home for swaddling the baby, on and on ad infinitum. It is tedious trying to deal with and remember all the special requests, er, DEMANDS, of someone who brings in a multi-page, nit-picking, micromanaging document as that. The medical staff have a number of other patients to attend to. They will be as accomodating as they can, but if any question to the mother is interpreted as an affront to her autonomy and dissing her wishes and elaborate birth plan, well, yeah, they can understandably view those type of birth plans as engendering hostility. But it started with the mom who has such a birth plan.
Yup, they get up in the morning and go ‘what evil woman with a birth plan can we torment today?’
Just like snakes wake up wondering who they will bite.
Now, now. Not a fair comparison. The overwhelming majority of OBs,L&D nurses, and CNMs care about their patients and are decent human beings. Snakes, on the other hand, are a threat to all that is good and decent in the universe and should be extinct as a species because AAAAAAAGH SNAKE DIE DIE DIE.
No. Those would be the spiders. ALL SPIDERS MUST DIE……preferaby far, far away from me.
Now you two.
One of my good friends is a very God-fearing woman who hates ants, and is forever poisoning them. She seems unmoved by the fact that more keep coming.
I suggested to her one day that ants were God’s creatures, and she fixed me with a death stare and said ‘not in my house they’re not’.
I’m with your friend.
Also, snakes made it PERFECTLY CLEAR which side they were on from the start; see that whole apple business.
Is this the early pregnancy minutiae thing again?
Around here snakes eat rats, and ants are everywhere-I draw the line at having them inside, though, because they eat things I might want to.
No, it’s a perfectly rational response to the legless menace within our midst. 😉 (Always have hated snakes.)
Awww, snakes are sweet! 🙁
So friends tell me. From, when they’re holding their sweet, cuddly pets, a nice safe distance. 😉
Sweet? No chance. We had a dugite at work the other day. Just nope. I’m now terrified that I’ll step on a snake when I go to my car after work.
My staffy took one of those out when we lived in Hedland, I was rather impressed that he managed to do it neatly and without getting bitten. (I love snakes, just not where my siblings had been playing a little while before)
I had no idea what a dugite is, so I looked if up. Argh! I am going to have nightmares about this snake for a week. Not a snake person here,
Arachnaphobes are really funny sometimes.
So I live out in the Midwestern US in that deserty portion.
My husband is the biggest wuss when it comes to spiders. When he first moved out here and saw his first Mormon Cricket he threw me in front of him thinking it was a black widow. I have seen this man scream in terror at spiders the size of a pin head and yell for me to kill it or make a truce with my dog so she’ll eat it. He typically only tolerates my dog.
I got a new job as an office manager and they wanted to hire my husband as an intern but didn’t have the room yet so they hired him as a kind of gopher while they got the business set up. Run the kids around, go get extension cables, get more coffee, that kind of stuff.
One day he bursts into the office and yells, “We can’t live here! We have to move! Now!”
I think he’s joking and asks what’s so frightening and he says, “You didn’t tell me there were tarantulas here!!!”
I think back and I remember what I said so I clarify, “No, I said that they’re really shy and don’t like to come near the city. Which is true.”
He then begins his story of the tarantula encounter.
He was driving our boss’s van to drive her kids home so they could change for baseball. They live in the next town over and there’s a good amount of nothing but highway and desert brush between them.
As he’s driving he sees this oddly shaped black thing on the highway and he wonders out loud “What is that?” So all three kids have their eyes trained on it too. Just before it goes under the wheels one says, “Oh! It’s a spider!” According to my husband there was then a loud crunch, a bump, and him screaming. And children laughing while looking back saying, “Yup, definitely a spider! Nice hit!”
He is apparently traumatized that we have spiders big enough for cars to crunch and feel the bump while doing so. All I have to say is, “See? They don’t come in the city.”
That was three years ago. We’re still here. Sometimes I consider putting a rubber tarantula under his sheets but then I remember I’m not Satan.
Do you live in the Third Ring of Hell? Be honest.
Well it does get ridiculously hot in the summer…
They keep the rodent population down, which is good. As long as they do it far, far away from me.
Maybe from Dr Amy in this very post : “Birth plans engender hostility from the staff…”
Perhaps people think there might be lots of people working in hospitals who think like Dr. Amy.
Perhaps people should get out more, in that case. Or just ask, which you can do unless of course you’re planning to give birth at home and only rely on those evil doctors if you actually need them.
What a great way to plan a significant life event.
Parents create birthplans with the following directives:
1. Labor in my own clothes no hospital gowns
2. No IV.
3.No continuous fetal heart monitor
4. Let me eat if I am hungry and let me drink if I am thirsty
5.Let me be mobile
6. Let me labor/ deliver in an upright position. Not feet in stirupps on my back.
7. No internal exams, no checking my cervix.
8. No rupturing my waters,
9. Do not offer pain medications
10. No episiotomy.
11. Do not cut the chord early. Wait a few minutes.
12. Place the baby on my belly and let him crawl up to my breasts
13. NO drops in the baby’s eyes
14. No procedures done on baby until after he has first breastfed.
13. No suctioning out the baby
14. Do not bathe the baby until after we have bonded.
I don’t get the “no IV” one. When I was in labor I wanted an IV so that if something went wrong it would be there already and there’d be no fumbling for a vein while I bled to death or whatever. Sure, the needlestick is annoying, but it’s one and done and you don’t have to worry about it any more: just hep lock it and forget it until and unless it’s needed. But maybe it’s odd of me to single that one out among the various difficult requests in the list.
I don’t get it either. Given how long it took the nurses to get an IV going for me,(they had to call in pediatric nurses, who still couldn’t get a vein), had I insisted on not having one and then become an emergency, this would have gotten very bad for us.
Ask if they have anyone nicknamed “the vampire” on staff. If so, get him or her to try for your veins. Alternately, the NICU or chemo nurse.
And if they laugh you off as just thinking you’re special when you say “Please only use the hands as a last resort. I have weird valves or something that no one’s been able get past in my entire life.”
Get a new one. Immediately. Unless you want to feel like someone was trying to dissect your ligaments and nerves. That was some of the worst pain ever and she wouldn’t stop trying to go after it… I don’t know how long it really took but it felt like she was digging around in there for fifteen minutes. My mom looked like she was either going to pass out or take over the placement herself even if it had been over thirty years since her pre-med days.
Definitely ask for the NICU or Chemo nurse like mentioned above if you’ve got crappy veins or you’re dehydrated. They don’t get set on one vein they’re just so sure is going to work.
Alternatively, if someone also works as an EMT, they’ve been good too in my experience. We have a bunch of EMTs that also work as techs around the hospital I go to. A little messier at times but they get it in quick and you barely notice it since they’re use to having to deal with less optimum environments. A nice, non-flailing, steady patient is a nice break for them.
Actually that’s pretty true. I have fairly crappy veins too that tend to collapse for apparently no reason whatsoever.
I’ve had house surgeons, lab techs, run of the mill nurses and doctors trying to get IV lines in me. And the ones who are ACTUALLY the best at it and tend to get it in clean first time (if a little roughly) are the ED nurses. As you said, it’s probably because they have a LOT of practice getting lines in under less than ideal conditions.
That is what I am known as, with the irony being there isn’t a “vampire” for me when I need it.
That was actually my #1 item–I’ve had issues getting IVs placed in the past (which made me super anxious) so I wanted the heplock put in ASAP.
The birth preferences sheet I got was so funny to me. There were checkboxes, and one category was “preferred position for pushing”–how the heck should I know? I was a first-time mom! So I checked them all.
I also said c-section rather than forceps, if possible.
But then, BAM, precipitous labor, and directed pushing in the normal semi-reclined position, haha.
ETA: I already know my birth plan should I have another-epidural, then induction, in that order. And I cut the cord. That was cool.
I think it may be associated in part with people who’ve never had an IV before and don’t quite understand what’s involved. I was freaked out by the idea of one because I thought that an IV meant a metal needle in your vein constantly, like when I gave blood, so if I moved very much or closed my hand or something it would immediately blow the vein–again, like when I donated. It doesn’t help that I’m a hard stick to begin with.
Once someone explained that after the initial stick it was a flexible cannula and not a metal needle in there, so I could move around, use my hand, etc without worrying about blowing the vein and having to have them stick me another 3 times just to find a good one, I was perfectly ok with the IV. I had a sort of nightmare scenario in my head of having a blown IV every couple of hours or something and ending up a mass of very sore bruises. All it took was a bit of patient education, and I and my doc and nurses were on the same page, and I could pretty much forget the IV was even there.
(Yes, I realize this probably sounded ridiculous to the HCPs, but I’m not one, and I’d never had an IV before, so I’m glad they took the time to nicely explain what an IV involved.)
In fact, my “birthplan” said 1) do whatever you think necessary for a healthy baby and untraumatized parents and 2) Be warned that it is really difficult to get a needle in me at the best of times.
I did get an IV with anti-nausea medication, which I was grateful for.
I don’t get that either, in fact if I had been able to discuss the birth plan template with my doctor if would have said that I would prefer a TKO IV to a heplock because I know how crappy my veins are. It took five sticks to get an IV in and that was with me coming in dilated to 9 (unknown GBS status, had to get antibiotics). A birth plan for me would also say “send the best IV starter in, someone who can find a vein in a turnip”. I hated having an IV in my hand but I knew how valuable that IV could become in a crisis.
I wish I’d thought to have that written in my chart, send in the nurse than can find a vein in a turnip. I got 4 sticks then got to have an anesthesiologist called in to do it.
If I hadn’t had a heplock in place, I could easily have died. As it was, I went into hypovolemic shock due to internal bleeding (only noticed because after the babies were born I was on the monitors and someone saw my BP plummet).
That’s why people have heplocks. To save their lives if things go wrong.
1. I have no desire to stain my clothes while giving birth. But I bought a cute set (or three) of PJs to wear after and not one nurse blinked an eye.
2. Would rather have a hep locked IV than not have one in a emergency and need it!
3. Do they know WHY we do this? Yeah, I want it!
4. Yeah, I did this. But I wasn’t supposed to. I was bad…
5. I was until I had my epidural.
6. I preferred the stirrups. Let me have good support when pushing.
7. I don’t think this needs to be done every 10min, but how do they think we will know if the cervix is even dilating?
8. I require ROM for labor to progress. No ROM means I labor longer and inefficiently, increasing my risk of c/s.
9. Why? Because I’m too weak to resist? And if I “give in”, I’ve failed? Bullshit. I loved my Epidurals.
10. Epis aren’t routine anymore and haven’t been for decades. I’d trust my OBs judgement on whether I need one (had for one birth, not the subsequent two).
11. Clamp that cord ASAP so I can donate the precious cord blood! The public bank that got my last child’s was so excited because there as a ton! I hope it will save a life or lives!
12. Meh. Whatever.
13. I don’t want to risk my kid going blind (and yes, I trust my spouse).
14. Meh. Whatever.
15. Meh. Whatever baby needs. It for don’t hurt them.
16. So, like, a few months town the road? Bathe whenever.
My birth plan was always: healthy mom,healthy baby, no peds residents please (I supervise them, could be awkward), and in an emergency, all requests go out the window.
1. You want to doody up your own clothes? Whatever. That said if you do decide on an apidural, you’ll need to change into a gown at that point. I figured why waste time?
2. This makes no sense. At least have a heplock in place. You may or may not end up needing IV fluids or meds, but at least if the heplock is in place, it’s easy enough to administer them if needed… See also number 1 – should you decide on an epidural, an IV will need to be placed. Why waste time?
3. I can understand a low risk, I medicated woman wanting to be let off the leash periodically, BUT you need that good initial strip and to spend some time each hour hooked up to the monitor to be reasonably sure that baby is tolerating labor.
4. Most places will let you do this anyway, so long as you are low risk and not being induced. None of my CNMs or OBs ever took issue with the Gatorade and applesauce I brought with me. If you HCP orders you NPO it’s probably for good reason…. If you want to know the reason, ask.
5. How are they going to stop you from being mobile? If you don’t have an epidural, just get up. I never asked permission to walk around the room. I just did it.
6. Again, just do it. You don’t need permission. With my last baby, when it was time to push they extended the stirrups. I just told them that I would be pushing on my side, and positioned myself that way (from experience this is the most effective and least painful position for me – she was out in three pushes; no one compainned). Discussing delivery positions with your HCP ahead of time could be helpful here, but I can’t see doctors or CNMs having a big problem with different positions in this day and age, assuming you are able to get into and hold that position.
7. Um. You will need to be checked at least once or twice (upon admission, and at least once more before you push – pushing against a cervix that is not fully dialated is a bad idea). I can can understand requesting to be checked between ctx rather than during them, but that can be communicated in the moment.
8. The sometimes membranes will need to be ruptured, and like Gene, I can say that my labors don’t progress as quickly with intact membranes. With my third child I requested AROM because I had been “stuck” at six cm for some time. With my fourth I was fully dialated but did not feel the urge to push until AROM was performed. It’s really not a big deal.
9. No harm in offering or asking what you are planning. If you are coping well, they won’t offer/ask more than once. If you are not coping well, they are only offering because there really is no need to suffer. Labor hurts. They aren’t trying to push you into it getting an epidural; they really just want you to have as positive an experience as possible. Uncontrolled severe pain can be quite traumatic. If you need it, get it. If you don’t need it, you won’t mind the offer.
10. I can understand preferring a natural tear. Most OBs don’t do routine episiotomies anymore, they are generally reserved for cases where the baby needs to be out (now!). If the baby is in trouble, let the doc do an episiotomy.
11. So long as mom and baby are both doing well, there shouldn’t be issue with delaying cutting the cord by a few minutes. Talk to your doc, it’s generally pretty standard anymore.
12. I’m with Gene here – meh. The baby will almost assuredly be placed skin to skin immediately anyway (unless there is a problem). Making the poor child crawl to his supper seems kind of a lot to ask of a minutes old newborn, but whatever.
13. Sign the form relieving the hospital of liability in the event your child goes blind. Done. (Personally I did not refuse the eye goop, but then I also allowed my kids to have the vitamin k shot and the hep b shot; I believe in science).
14. So, like, 20 years or so? IDK how it is everywhere, but I’ve had four kids in four different hospitals (we’ve moved a lot) and I always had “bonding time” before the first bath. At least a couple hours. And that baby doesn’t leave the room without your permission anyway. If they want to take baby for a bath, just say “no thanks”. Was that so hard?
I never wrote up a formal “birth plan”. I just talked to my providers like they were human beings, and let the, know what I wanted in the moment. And being a grown ass woman I never asked permission to get up to use the toilet or walk around or eat and drink. No one freaked out about any of it. If birth is so “empowering” why do these people seem so spineless?
Yes that looks like a lot of birthplans I especially liked the chord as that’s usually the spelling ( i have always wants to ask …are you bringing your guitar?)
That’s awesome! I saw that, too (chord) and assumed it was a typo. If that was deliberate, it makes it even funnier.
Sometimes I just think that all of this can just be summed up as, “When narcissists become parents.” Maybe the reason we’re seeing any of this is just a rise in narcissism and the “need” to feel special and unique. Everybody is a unique little snow flake. Everybody has a bizarre allergy or food intolerance, a special, obscure, undiagnosed phobia and/or behavioral disorder. “Look at me! I’m OCD, afraid of clowns, and am DEATHLY allergic to macadamia nuts – like I’ll go into cardiac arrest if I even know you ate one. I’m breastfeeding my kids and the neighbors’s kids until they start school and posting pictures of myself and my awesome tits online. Oh and by the way I’m also doing this really awesome toxic, palio, gluten-free, free-range, all lemon cleanse. So if you invite me over for dinner, I need to give you my list of can’t eats. Why? Because I’m special, special, SPECIAL!”
I can’t decide if there actually is a rise in narcissism or maybe it’s just an illusion brought about by more media. But, maybe it really is on the rise. Maybe having upwards of a thousand friends on Facebook can make a person feel small and insignificant and therefore need to do more and more outlandish things to say, “Hey, I’m here, I exist and I’m important.” The problem is, it escalates, causing each person to up the ante even to the point of blindly endangering their own children. Anyway, I digress.
I’m not sure it’s narcissism. Lately, I think it’s just the extreme version of the moralization of health. I’ve noticed that these parents tend to believe that there is no genetic predisposition that cannot be defeated through a strictly-controlled diet, herbal remedies, and avoiding “toxins.” Everything must be carefully controlled, and doing anything else is seen as messing up the child.
actually, I do have a weird allergy. To marijuana. It’s not deadly, just annoying (cause any is, not because I’m sad that I shouldn’t have any) ETA: My mother and both sibs have it too.
Bananas for my youngest, and they’re in most baby foods. Thankfully he’s eating normal food now but it was really annoying. I’m unlucky enough to have developed a latex allergy, which is just contact dermatitis, but it’s a pain explaining it to some medical staff. “Geez, you’re sensitive!” Well yeah, and I really wish I wasn’t. Life would be so much easier.
You probably already know this, but keep an eye on kiddo for a latex allergy as well. Apparently bananas and latex are cross reactive.
Kiwi fruit too.
And avocados, IIRC.
Yup! That’s why I buy latex-free stuff, so glad there are more options now days. Thankfully, he’s not allergic to any of the other fruits and veggies that are cross reactive with latex (avocados, kiwi fruit, sweet potatoes, etc)
Latex is evil. It’s a sensitizer. Thankfully, I’ve never been in a lab that had a problem supplying nitrile gloves, but yeah, so many nurses and phlebotomists still use latex…
I freaking hate the nitrile gloves. Really, really hate them.
They sure do, and I hate being a bother reminding them but I have to because the alternative is being even more miserable.
I’m allergic to latex as well. That rash is no fun. I used to be lax about making sure all gloves are LF because it wasn’t “that bad”. Then I had a pap where the dr “forgot”. It was like having a yeast infection, UTI and razor burn all at once. Yeah. I remind people all the time now.
Exactly! It’s ridiculously painful, I hate it.
I have life threatening allergies to three different classes of antibiotics and my skin peels with Chlorhexidine. Not the fun kind of special snowflake allergies!
I don’t have allergies, but my immune system does very very weird things.
I have a weird one too; I’m anaphylactically allergic to all of the amide anesthetics (lidocaine, carbocaine, bupivacaine, etc.), and react even topically. I live with fingers crossed that I never need dental work or stitches. My allergist has not been able to find testable amounts of esters, because they’re not commonly used anymore, but since we can’t test (and I like breathing 🙂 ) we assume they are also not safe for me.
OT completely, but this is worrying me. Can I ask UK folk about fundal height measurements? I am a pathologist and around 70% of the term stillbirths I autopsy are growth-restricted. I usually get sent the antenatal GROW chart with fundal heights plotted and there have been some alarmingly discordant measurements, for example, fundal height plotting along 50th centile all the way through, then baby comes out well below 0.4th centile. I’d estimate about 9 in 10 of my stillbirths that come with a GROW chart have grossly inaccurate estimations (in the middle of doing a formal audit)-not just a little bit off, but way way off.
One of the trends I’ve noted is that 32-34 weeks is a dangerous time-I think that until then the placenta has sufficient reserve to cope with demands, but then the last few weeks when the baby is fattening up the placenta can’t cope any more and gives up. Often these cases show specific placental disease (VUE, PVF, MFI etc). But after 30 weeks, we don’t seem to be monitoring fetal growth as much-the fundal heights aren’t as accurate later on, are they? I think we are failing to pick up IUGR in the 3rd trimester and I think many of these could be rescued by earlier birth. But I only see this from my end, not from the clinical end.
What is it specifically you’re asking?
I’m UK, two recent pregnancies. With my second, I was measuring above the 95th centile at about 28 weeks and was sent for a scan to investigate (no issues, I just appear to have an extremely stretchy uterus). So I was at the opposite end of the problem you mention I guess, but I was glad to be referred for the scan.
Not really a question, but canvassing opinion on the accuracy of fundal height measurements. The vast majority of babies coming my way seem to have significant discordance between their estimated weight and their real weight.
You’re not wrong. SFH is grossly inaccurate.
In this last pregnancy my SFH was >90th centile, but I had serial growth scans because #1 was small…
Of course the serial growth scans put the EFW at 50th centile…
And my son was 6lbs 6oz, which is between 9th and 25th…
At least with the scans we could see a good quality placenta, and an active baby without obvious IUGR, although I think we all knew that EFW wasn’t going to be accurate.
I have a strong sense that someone is going to realise that if the UK really wants to halve stillbirth rates they’re going to have to bring in a third trimester US with UA dopplers.
I hope you’re going to present your audit findings to your obstetric and midwifery colleagues.
I have also had great difficulty in getting a growth scan arranged for someone who was measuring above 90th centile, because she had no risk factors for GDM and a random BM wasn’t elevated. My concern that someone who was 5′ tall probably should have a someone double check the size of her baby fell on deaf ears. If you are in the bottom 10% height wise, your baby should not be in the top 10%. Waiting until you hit 98th centile before you investigate further seems reckless to me.
Thanks for your answer-I was getting the distinct impression that the fundal heights really aren’t accurate and little more than guesswork sometimes. We have a stillbirth working group that meets monthly to discuss each case but whenever I have a case where the baby had significant IUGR that wasn’t picked up clinically my concerns about inaccurate fundal measurements or estimation of fetal weight seems to be poo-pooed.
I’m planning on presenting the findings when we’ve got two years worth of data (two more months to go). But it’s really that complete a picture-I’m sure there are babies out there who were equally under or over estimated and who are doing just fine. I think my cohort are IUGR and struggling, and then something else comes along, like infection or a minor haemorrhage and that tips them over the edge.
What’s fundal height?
“What’s fundal height?”
When they measure your belly with a tape measure during a prenatal appointment.
Ah. Thank you. THey didn’t bother with me, between my obesity and the way I carried the boy, it was pointless.
The top of the uterus is called the fundus, measuring from pubic bone to the fundus gives you the fundal height. It should be roughly equal to weeks pregnant after 20 weeks. So at 38 weeks it should be around 38 centimeters. Thats for a healthy singleton pregnancy.
They never did one on me. Probably because I’m fat.
Interesting. I’m fat too but they did them on me. It’s true that it is hard to do them accurately on fluffy bellies, but another important part is the trend of growth. Say if the number was measuring 2 cm high, but it was 2 cm high each time then suddenly was 4 cm high that would be something that I would have to consult with my referral doctor on (not a midwife, but as part of my scope of practice in a rural area I can do regular return prenatal visits with doctor oversight). That said I am not a doctor and most certainly not your doctor and the things I do in my clinic are the most cautious practices because I am not a doctor.
Maybe the way I carried him played a part, too? *I* couldn’t see the bump until 7 months along and many people did not believe me when I said how far along I was.
I had what they suspect was subtle growth restriction. My daughter was at one point on track to be a ten-lber, but she dropped percentiles, but not enough to be considered actual growth restriction. At 37 weeks when she was stillborn, she was about 7.5lbs. As for fundal height, I was actually behind with my eldest, but she came out at just under 9lbs (alive and kicking thankfully), but she sat very differently and low.
I do appreciate you bringing this up btw – my placenta had two big plaques on it, though her stillbirth cause even with an autopsy is considered undetermined.
I am so very sorry for your loss.
I’m so sorry to hear about your daughter. Placental pathology can be difficult to interpret sometimes-like any other organ it has some reserve capacity (we have a spare kidney, but could manage on 2/3rds of one if we had to), so towards term seeing an area of infarction-dead tissue in the placenta-isn’t uncommon. The placenta is coming to the end of its life, so if you think in terms of it being an 80 year person, there will be scars and battered areas in it even if it still functions, so the odd bit of infarction may not mean anything. We generally talk about percentage of the tissue affected-if the infarcted areas occupy more than 15% of the total placental volume then its usually considered significant. But the site of the infarct is also important-if its towards the middle then its more serious than an infarct at the edge. So generally an infarct may or may not be relevant depending on a host of factors, but I understand how frustrating this can be when you’re looking for an answer.
This may not be related to your question, but I have some doubts about the ability of some UK midwives to plot something on a percentile chart.
Not fundal height measurements, but weight percentiles. I don’t know if our surgery is particularly bad, but every weight dot bar one on my toddler’s growth chart was put in the wrong place, either the x-axis, or the y- or both! I’ve taken to correcting the record in pencil.
I wonder if some things don’t get picked up simply because people make mistakes reading percentile charts.
That’s interesting, I hadn’t considered someone filling the chart incorrectly (that’s what comes of being lab based and nowhere near patients for the last 25 years!). Sometimes my impression is that the curve line of measurements is so smooth and perfect the person filling it in has been influenced by previous measurements and is putting down what they think it is or what it should be, not what it actually is. Not deliberately, but sort of subconsciously. Then again, I’ve seen curves going the other way with measurements falling down centiles but no action has been taken, which suggests that they are measuring by rote and not with an understanding of what its for and the clinical significance.
My birth plan had 5 items: lots of photos (my daughter needed open heart surgery soon after birth, and there was a chance she wouldn’t survive), pain medication, my husband, an IV, and one item I forgot. I got photos and pain meds.
All I really wanted was to take 2 living babies home. Six weeks later, I finally did.
I’m not sure it’s the birth plan per se that’s doing the harm as much as the expectations and feelings of entitlement that go with it. A woman who makes a birth plan is likely to be one who feels more nervous and possibly more hostile to practitioners than one who just makes decisions as things happen. So I’m not sure that just ditching the birth plan is going to help. Other interventions, like better education about the real risks and benefits of specific interventions, might be needed.
As a nurse at the hospital I had my son at in 2009 said:
“The bigger the birth plan, the worse the birth.”
My SIL the ob nurse says that after a page or two they just prep the OR. If the laboring mother won’t let them do anything to help with complications then all you have is the section when things go pear shaped.
I don’t really get the “trust your body” and “trust birth” thing. My doctor has been through a LOT more births than I have, and if it were up to my body I would’ve been dead before the age of 5 (childhood cancer).
I think it can be difficult for women whose bodies have never really previously let them down to realise that trusting your body isn’t a particularly good idea. I did imbibe a little bit of that idea myself during my first pregnancy, and never really having had any previous health issues to speak of it made sense. When your body has always done what it needed to in the past, why wouldn’t it carry on that way during pregnancy and birth? Pregnancy’s not a disease after all. I think for many of us, it takes running into something shit to teach us that particular lesson- that your body is perfect and knows what to do right until it isn’t and doesn’t. And I suppose you had it metaphorically beaten into you very young.
Very true. I also think that the current trend toward “all natural” in all areas tends to encourage the idea that our bodies are magical or special, like they know something our brain doesn’t or something. Certainly our bodies are amazing, but they are machines that can easily fail.
Yes! I am lucky enough to so far have dodged the family cancer(s) bullet. But my first hospitalization was a ten months to remove a large hemangioma (benign tumor made of blood vessels) that covered my back. My second and third surgeries at 3yrs and 6yrs were to correct eye problems. My next one will probably be to fix my wonky knee..Apparently my body did not know what to do about a lot of things…
Yay for modern medical advances!
But then again, Sarah, we also hear about those who insist on NCB after going through issues with infertility. In this case, their justification is “I wanted to prove that my body could do it”
I think that a lot of this is just post-hoc rationalization of choosing NCB, and not a reason for doing so.
Yes, people have lots of reasons for being pro NCB. I didn’t choose one myself, as it turns out I enjoy anaesthesia too much, but I definitely ‘get’ being so lucky, health wise, that you fail to properly comprehend risk.
I had a ‘birth plan.’ I didn’t care too much about what happened, especially as I got closer and closer to labor, but we sort of ‘had’ to fill one out in my childbirth class. My pregnancies both became more high-risk as they went on, because of high blood pressure, so by the end, I just wanted healthy babies and for me to not die or have major complications (I was lucky). But it was kind of nice to feel like I had choices – I didn’t call them requirements or anything, just things I would like to happen, if they could (no epidural until I requested one, for example, because I wanted to walk around)….I wanted my own doctor to be there, which I knew wasn’t going to be possible, but it was definitely a want. Both times I got lucky. Just a little anecdote – I do love this post. Of COURSE you’re going to be disappointed and feel “trauma” (I’m not talking about women who have actual traumatic experiences – like a C-section that goes horrible wrong, or a baby needing intervention out of the blue, or major hemorraghing, etc.) if you have a list a mile-long and you don’t get everything on it.
OT.https://amino.com/blog/c-section-rates-in-america-state-by-state-analysis-new-C-section-predictor-pregnant-women
Ugh. Dr. Amy, please do a post about this crap
I looked at the map for my state. One small city has an outsize “risk” of CS…..of course that’s because it’s the only city for hours and hours to the north, east or west that has surgical capabilities. High risk women live there for their last couple of weeks and low risk women are airlifted there if something goes wrong.
Same thing in my state, the ONE BIG city gets all the big bad stuff and that’s where all the emergencies get airlifted to. Plus looking at their interactive map, they have at least one city incorrectly named and the total numbers of births are way off for at least three locations plus they are missing about 4 locations with hospitals that routinely do deliveries.
Looking more carefully at my city, they have CS rates for zip codes without hospitals. A few might be where some major OBGYN practices are located, so the bills might be from there. But others seem to be indicating hospitals that have been closed for years.
Yep. Locally, the NCB types have made a boogeyman out of one of the hospitals–“they have a 40-something percent CS rate!” Never mind that they’re associated with all the really high-risk pregnancies and have the best NICU in the area, it must be that their doctors are just cut-happy, not that they have a much higher percentage of women and babies who need CSs…
Children’s hospitals are a good example. If you are delivering there, then obviously something terribly wrong and in most cases a section is the only way the infant will survive birth. Doesn’t stop people from freaking out about their high numbers, but for reals, that is just responsible medicine.
Exactly. And yes, this is a children’s hospital–*the* children’s hospital in the state for high-risk moms and babies. So of COURSE the CS rate is high! Oddly enough, a lot of moms with very sick babies would rather have a CS and a live baby than a vaginal birth and a dead baby. Strange, I know…
One glaring issue: They ask women whether they had a previous c-section, but not whether they have any intention of trying a vaginal birth this time around. Most repeat c-sections are planned in advance! And a c-section rate for malposition? Um, again with the planned c-section thing.
It’s like the person who put this together didn’t actually THINK about the data or what it meant. Certainly the author didn’t separate out planned versus during labor, which actually makes it kind of useless for planning purposes.
Seriously, count me amongst the c-section moms who has less than zero interest in ever having a VBAC should I get pregnant again. At my last annual checkup the topic came up and my OB started to hem and haw about how if I reeeeally wanted to try a VBAC and I cut him off right there and said no thanks, I’m only asking because I want to know how quickly we schedule the c/s after finding out I’m pregnant. He looked pretty relieved (I am not a good candidate for VBAC).
I’m another c-section mom who would not even consider trying a VBAC. I’m a poor candidate anyway, but there is absolutely nothing about it that sounds appealing to me.
SECONDING. There are so many things wrong with this analysis….I can’t even.
It’s as if the whole concept of specialisation has passed them by. Complaining about high cs rates in particular hospitals is like complaining about high rates of chemotherapy in oncology units.
(This is a sensitive topic for me… so I may be ranting a bit but I’m tired, have a baby with separation anxiety that I’m struggling to bond with and had too many people tell me that the reason I found my son’s arrival traumatic was entirely my own fault.. health visitors and doctors included).
Whilst I believe that some women are definitely guilty of the above, not having any expectations of fluffy bunnies, the earth moving or any of the things any of my natural birth “friends” claim, did not lead to me having a “safe, satisfying birth”. I was polite, I listened to staff, I discussed options, I’ve had it confirmed from multiple sources including staff that my only priority was my son, I didn’t care what happened to me and yet I’ve been diagnosed with PTSD following a traumatic experience.
In fact my experience was so horrific, if I have any more children I will be a “birthzilla” on steroids to the point that my husband already feels sorry for the Consultant who covers our area and will have to deal with my ante-natal appointments.
Okay, I still don’t want to give birth with dolphins or in a natural spring half way up a mountain but my son’s arrival was so far from “safe”… 81 hours after my waters broke, running a temperature in the 40s, blood pressure best described as “interesting” and pushed to the point of being barely conscious not to mention the flashbacks I ended up having thanks to triggering and unnecessary physical contact that I have zero trust in those meant to be providing care and if there is a next time around, I’m not willing to negotiate on my “plan” which I suspect will have sticking points from the maternity hospital’s perspective. (I’d run it by the commentators here if I didn’t have a good idea what the responses would be).
It’s two way relationship and if you feel you can’t trust your health care providers whether that’s because you buy into the natural birth fantasy or because you’ve been damaged mentally or physically by the birth of a child already, then telling women to let go only goes so far. I’m living proof of the fact that not having a birth plan doesn’t mean everyone lives happily ever after. In fact I’m in therapy at the moment to try and help me get past seeing my rapist (who didn’t father my son.. it’s just that thanks to unnecessary physical contact/not being able to breathe/barely conscious, the only memory I have of his arrival is a screwed up flashback) whenever I look at him. In fact I wish I’d had a birth plan.. I wish I’d anticipated people touching me outside of the usual places a baby can exit from.. I wish I’d been a bitch.. because that might have provided some cold comfort now.
Erin, I’m so sorry.
Your experience was awful, I am sorry that the people who should have been supportive and understanding weren’t.
I am glad that your husband has your back and that you are getting help.
It might be worse before it gets better, but it’ll get better.
What you went through wasn’t disappointment about unmet expectations, it was traumatic and triggering, and your reaction to those experiences is not something you had control over, so no, it wasn’t your fault.
I am sorry you went through all of that, and I sincerely believe that with all your hard work you are going to get through this.
Come and vent here if it helps.
Correct me if I’m wrong but it looks like what you went through wasn’t nearly the same as what this post (and the study) were about. You were entitled to compassionate care and you didn’t receive it. I don’t know if that constitutes medical malpractice but it constitutes something that should not happen in my book. Do not place yourself on equal footing with women who make grand plans for something that doesn’t bother to read them. Your expectations were not out of the scope of what everyone should reasonably expect: a professional manner and compassionate care.
Get better soon!
To be fair, IIRC, one of the things that Erin found triggering was that one of the docs touched her in a friendly way (not unprofessional) during her CS, trying to reassure her. He meant nothing but kindness, and couldn’t have known that that coupled with having a hard time breathing would trigger flashbacks to traumatic experiences.
That is the sort of thing that would be more than reasonable to put in a birth plan: “due to patient’s prior sexual assault, do NOT touch her in X, Y, or Z manner that’s generally professionally appropriate but will be traumatic in her case.” Totally different from “if I so much as overhear you offering the woman next door an epidural, it’ll RUIN my whole birth!!!!”
ETA: of course, that’s leaving aside the gross unprofessionalism of the nurses and midwives who attended her pre-CS, and whose heads should be on pikes outside the l&d unit pour le encouragement les autres. (No, no, I don’t feel at all strongly about poor treatment of women in labor, why d’you ask?)
I suppose I feel that studies like these make it easy for health providers to turn around and say “your experience sucked because you were unrealistic about the whole thing” without looking at what they could do improve that experience. Since my son was born, I’ve met a lot of women who describe themselves as traumatized by childbirth and whilst their stories all vary hugely, lack of communication and lack of control all feature heavily. (Which is why my new birth plan should I fall pregnant again is geared around assuming the whole experience will be a living nightmare complete with insensitive and downright rude staff so fingers crossed I should be fine, worse case scenario it will be as bad as I’ve planned for.. )
For example in the Maternity hospital my son was born at, no one seems to mention c-sections if you and baby start out the right away around and healthy until one of you is half dead so actual informed consent unless you do your own research which midwives running ante-natal classes make a point of telling you not to do is out of the question. You’re told that epidurals are bad and lead to c-sections because of lack of mobility, that tears heal better than cuts, that skin to skin immediately makes or breaks breastfeeding etc etc and so women plan accordingly.
Then everything goes pear shaped and suddenly it’s your fault for having unrealistic expectations even though you were encouraged to have those expectations by people you are meant to trust and who should know what they’re doing.
(and yes, Keeper is correct. The poor anesthetist was simply trying to make me feel better as he felt for me, however despite me telling the midwifes that I’d been raped, no one told him. It was just unfortunate circumstances.. and by the time my husband saw what he was doing, it was too late.
However I do believe it was unprofessional simply I don’t think it belongs in that kind of setting. I was not a child with sore arm or a kitten but a women on an operating table having been pushed to exhaustion and if my husband sitting next to me wasn’t touching me, why would a stranger think that stroking my hair which is a fairly intimate act was okay, especially since he knew nothing about me. Do I think he should be sacked or disciplined for it, of course not but maybe I’m naive but I didn’t and still don’t think that the onus should be on me to go into a hospital and have to tell everyone my triggers if they are outside the normal remit of having a baby because people shouldn’t be touching random bits of me without a good reason.)
I guess Keeper is correct but frankly, I would not have included “no one is touching me except for the business end. No one EVER touches me in a way meant to call me” in ANY plan, not in a hundred years because to me, it simply goes without saying that it isn’t done. Perhaps I’m weird this way. I don’t go to massages because to me, they aren’t relaxing. I never rub my head to relieve a headache. Touching for comfort is OK – but not from strangers, be they doctors or not.
Anyway, this post isn’t about women who are having unrealistic expectations encouraged by the NCBers (some of which have, unfortunately, found their way to the hospitals.) It’s about women who try to shove their NCB agenda into the faces of everyone whose concern is to end this childbirthing business with a healthy mother and child, not “organic” ones.
And let’s be fair, the majority of women we meet online complaining of traumas deem an evaluated baby as one that was “seized” from them, a c-section that didn’t end in a NICU stay an unnecessarian and so on.
A fair point, that. It can be partly a difference in style, too. I’m a very touch-oriented person; touch is comforting. And my OB is also “touchy” in the sense of arm-pats, shoulder-pats, that sort of thing, which I like, but I can quite understand that not everyone likes that. (Also, he didn’t do any of that stuff until we’d known each other a while and had a more established relationship, which I imagine it’s fair to assume you didn’t have with the anesthesiologist.)
And in thinking about it more…hair *is* kind of different from a pat on the arm or shoulder. It is, at least to me, more personal a space than an arm/shoulder. (I also wonder if this is partly a cultural thing, too–in the American South, where I live, we tend to be rather “touchy,” but I’m told that that’s not the norm in the UK.)
I am a l and d RN and I have had a few moms come in terrified from an awful experience. Whether you call it a “birth plan” or not communicating what happened to you is important. Talk to your doctor or midwife, but I also suggest finding out who the nursing supervisor is to let them know how afraid you are. When we have a patient like you we bend over backwards to try to do what you want and help you have a good experience.
Often, when people say, all that matters is a healthy baby, they forget that some moms have really awful experience. While the healthy baby, and mom, are the most important, it doesn’t mean that treating people with respect and compassion isn’t. I really hope that things go smoothly for you this time.
I’m so sorry.
Look after yourself.
Erin I am so so so sorry about your experience. I really hope you get help. Looks like you would have been much better off with a CS after laboring for much much less time. I strongly believe that there is a culture of “vaginal is best” in a lot of places that is actually damaging a lot of women. I really hope you get better care if you decide to get pregnant again.
Erin that’s not birthzilla, it’s MASSIVE AND COMPLETELY LEGITIMATE TRAUMA. The totally logical response to going through something utterly traumatic! And it’s not your fault.
Your temp was in the 40s and your BP interesting 81 hours after your water broke and no one was talking c-section? I had a c-section approximately 12 hours after my water broke when I had a temp spike and no BP issues (as far as I know.) What made them wait another 60 hours? Add to that the fact that you had a significant comorbid problem that no one seems to have taken into account, it makes perfect sense that you wouldn’t trust: your providers weren’t acting trustworthy.
I’m glad you’re getting therapy and hope that the therapist is doing better for you than the obstetricians seem to have. Take care of yourself!
He was eventually born by c-section as apparently I don’t have a pelvis designed for childbirth, however I and my husband who wasn’t so out of it agrees that until they burst into the room with consent forms no one mentioned c-section. I kept asking if things were okay and was told yep, everything was progressing fine, had a student midwife and my husband sponging me down with cold water and a drip with fluids plus paracetamol for hours. By the time they extracted my son apparently I was almost out of amniotic fluid, my stomach had almost completely deflated apart from a baby sized ball at the bottom.
We’re in the UK.. so didn’t see an actual Doctor until my waters had been broken for over 70 hours and the midwives were “protecting” me by not telling me all the facts and quite possibly not telling the Doctors either. I didn’t demand to see a Doctor earlier because I believed what I was being told, I mean why would they lie?
I’m convinced that this sort of thing is why the UK looks bad on basically every health metric compared to the rest of Europe and sometimes even to the US.
When my water broke, I remember thinking “Ok, it’ll be over–somehow–within 24 hours because they don’t let you go any longer than that…”
I’m sorry you got such poor care. I strongly suspect that fear of being treated like you were drives a lot of birth plans.
That is so terrible. My kids were born in the UK in the early 90s, I can’t believe what seems to have happened there in that time. Our midwives would never have behaved so dreadfully.
Your reasonable trust was betrayed.
The more that I read about midwifery care in the UK, the less that I believe that it is a model to which we should aspire. I follow James Titcombe on Twitter, and I am simply shocked by how bad things are. The fact that midwifery’s leadership is completely unwilling to learn anything from the Kirkup Report is proof that too many midwives are giving preference to ideology over safety. Surely they should have called in an OB after your water had been broken for 24 hours. That is just horrid care, and i am so sorry that this happened to you.
Wow, that sounds like an incredibly difficult experience 🙁 I’m sorry to hear you went through that…
As a GP obstetrician (mostly doing caseload work, so I look after my own patients in labour), I agree with this article in general and for most (most!) of my patients I discuss and recommend that they don’t set a birth plan. In general, not having expectations beyond ‘let’s get through each contraction one at a time and deal with things as they happen’ makes for more relaxed mums and less disappointment if things don’t quite go in textbook fashion. Obviously we talk through the different possibilities so I’m not stuck trying to explain instrumental deliveries or syntocinon to someone who’s exhausted and contracting every two minutes, but basically, we aim for safety and flexible expectations.
That said, I do look after a significant proportion of mums who had a really tough experience the first time through as well, and I agree with those who’ve already said that is a different thing from the main focus of the article. Trying to ‘plan the unplannable’ and have every tiny detail specified is not at all helpful during birth, but that’s quite different from working through what caused problems last time, what made things harder, and talking about ways to avoid those things. Usually we’re able to discuss (often at great length) and agree on a plan that balances safety with sensitivity to the parents’ concerns. Sadly it really doesn’t sound like safety was a priority for the staff caring for you during your first labour either. I really hope that if there is a next time, you’re able to find someone who’s in a position to spend the time and tailor your care to your needs. Best of luck…
Within a single century women have gone from writing their wills to writing birth plans.
Good! I look forward to the day when people write their cancer treatment plans and they involve the importance of relaxing music and dolphins while the chemotherapy is going. The overly controlling birth plan is a sign of success, albeit an annoying one.
“they involve the importance of relaxing music and dolphins while the chemotherapy is going. ”
Except it would have to be more like rejecting chemo as an unnecessary intervention, because who dies of cancer? Those oncologists are fear mongers.
“The overly controlling birth plan is a sign of success, albeit an annoying one.”
I agree it is a sign of the success of modern obstetrics. It’s that NCB types see it as a sign of success also– success in standing up to the patriarchy or some such.
Heh. That’s already happening. Mostly people rejecting adjuvant chemo and sometimes getting away with it, if they went ahead with the primary surgery. (Of course, if they survive they credit their diet or herbs or anything but the surgery…)
The Suzanne Somors gambit.
What gets me about the more elaborate birth plans is that half the stuff they demand already standard hospital policy in the 21st century. e.g., At the hospital where I delivered, the default was to hold off on bathing the baby until mom and dad had had some skin-to-skin time. It wasn’t something you needed to insist on. Showing up with a birth plan that went into detail about when your kid could be bathed would just mark you as obnoxious and clueless.
Don’t even get me started about the birth plan templates that still include “I don’t want to be shaved” as an item…
This is in line with my comment below that to a first brush, wouldn’t you want to consult with the doctor in preparing your birth plan? You wouldn’t end up looking so clueless
I don’t want to be shaved. But that’s why I get waxed.
Heck, in my late pregnancy I couldn’t even see down there (let alone care about whether I had hair there or not…).
Jesus Shaves. But I got the laser.
ARGH!! This pisses me off so much! I was directed to a bunch of garbage woo books (INA MAY FOR GODS SAKE) by one of the midwives, CNM, where I was receiving care and because it was a health professional that directed me towards them I thought they were honest and real. Then I went back for another appointment a few weeks later and had a few questions about things that I’d read that would happen during labor. Oh I felt like such a moron when the answer to everything was “no we don’t do that anymore”. That’s when I decided not to bother with a birth plan and just kinda half assed my natural birth stuff and ended up getting an epidural and was very happy about it all. Stupid natural birth woo crap! Literally stupid and completely out of date.
OT, but given that the pain relief discussions generally come back to “No one thinks twice about using it for broken bones” I just wanted to share that apparently some people do. My middle kiddo learned how much gravity loves her after trying to skip a bar while on the monkey bars and ended up with a fairly displaced buckle fracture at the distal end of her radius. The nurse-practitioner and doctors have had so many resistant parents that they were expecting to argue when I was presented with pain management options for reducing the fracture. Given the choice between gas with fentanyl, IM ketamine, and IV ketamine; I opted for IV ketamine as it’s a more controllable option, there’s a line in if something goes wrong, it’s effective pain relief, and it has the added bonus that she doesn’t remember two strange adults playing tug of war with her arm. It would have been cruel to make her sit through that, I think she would have had nightmares afterwards and I don’t want her to fear the hospital. Reportedly the fastest consent they’ve ever had, and thankfully they were able to reduce the fracture without needing to go to surgery.
Happy to hear that surgery was not needed. Quick recovery to her!
Thanks!
Hope she pulls up okay, and it isn’t sore for too long.
Why would anyone argue with pain management for a child. Though my son has a terrible reaction to ketamine, has done since he was a child, involving him being terrified, and trying to fight his way out of the ward/emergency room while projectile vomiting.
My daughter is carrying a plate and four screws after a touch footy incident leading to distal radius fracture, lots of morphine in hospital while they xrayed and wrapped it up, most of which she now doesnt’ remember, lucky her.
Thanks! Nurofen before school and a pillow to rest it on are helping her get through the day. So glad it’s nearly holidays.
“Why would anyone argue with pain management for a child.” – I don’t know, and I will never understand it. I’ve heard it from our dentist, and now at the hospital as well. It really does not make sense.
Your poor son, that would have been awful! She had the vomiting too, but luckily not the other side effects. She was mildly annoyed and slightly irrational – “I want to keep my teddybears!! Don’t take them! Get the straw out! Not my bears.” (straw – cannula, and there were teddy bears on the cover holding it in place) – but pain and trauma tend to do that. So glad your daughter had an easier time despite the need for surgery.
I can think of one reason to argue about pain management. Sometimes, medical providers prefer to use general anesthesia on children so that they don’t freak out, even though it’s riskier than local. In which case, it’s totally reasonable for the parent to say, “My child remains calm in medical situations; use the local.”
That’s true: neither of my kids would have been in the remains calm group, so that never occurred to me.
Yeah. I just kinda felt the need to stick up for my mom there (and maybe to brag about what a freakishly calm child I was). 🙂
Fair enough.
I remembered after I posted that my son-ketamine kid-tried to negotiate for a general when he had to have a couple of stitches in his leg, when he worked out the drip would be one needle but the local would be several. He hates needles. The very kind emergency doc patiently explained that only the first jab would hurt, and I explained that we were there to be advised by the doc not tell him his job. It all went fine, but he still hates needles.
See, that’s way more impressive than my story. I just went along calmly with what the doctors wanted. Your kid actually tries to make medical decisions based on his personal preferences!
It was interesting to watch. Everyone was happy in the end: the boy originally wanted no stitches and then stitches only with a general, the doc was v good talking him through it.
People seriously turn down pain relief for broken bones?
Attempt to turn it down for their kids, yeah. I’m not sure if its a case of “drugs are bad/risky” or if they can’t comprehend the level of pain the kids are experiencing.
That’s completely barbaric!
To be fair I didn’t realise how much a broken bone hurts until a few weeks ago, but why, in ignorance, you would refuse I don’t know.
Unless you know your child turns into a terrified fighter on the drugs, in which case you ask for more drugs to avoid that problem arising in the first place.
I’m a “Give me a double dose of every kind of dope you’ve got” type of girl myself, but my attitude tends to be “If the opportunity to get stoned legally presents itself, why not take advantage?” Yes, I know. Rehab is in my future. No, I’ve never even seen the illegal stuff, let alone tried it, not even marijuana.
I get the impression it isn’t as fun as you think when there is a medical reason for needing it. I’ve never needed anything stronger than what you can buy over the counter, but I wouldn’t hesitate if I did.
None of my immediate family who have needed the good stuff have been very happy on it, though they are a different kind of unhappy than when they are in pain.
Heh heh heh, I’ve done codeine cough syrup for strep throat. The strep sucked, don’t get me wrong, but I actually quite enjoyed the feeling of sedation!
I dunno, one of the happiest memories of my life is getting medicinal heroin during my first, very prolonged birth. It was very much medically needed!
Glad it helped: prolonged labour must be terribly tough.
I’m hoping it’s a good long time before I need any such thing!
I get a lovely loopy high on vicodin, and I only use it when very much indicated (I’ve broken too many bones – it’s perfect for the immediate recovery period from surgery when I have that deep pain). It’s a very personal thing indeed, though. For my husband, it has utterly no effects beyond the purely analgesic (for which it works great); for a friend of mine, it gives her a bad high and doesn’t relieve her pain. Stupid complicated brains.
I did once get IV morphine, and I felt absolutely nothing but the pain relief, no high at all.
I did have pethidine once, it just moved the pain two feet in the air from where I was lying. Most disconcerting.
I remember a lovely experience where I got two doses of morphine, then moved up to fentanyl, then a dose of phenergan maybe, then more fentanyl, then some ativan. My friend with me at the time in the ER said something to the effect that I was so high I was hunting ducks with a net. I don’t remember much except that the fentanyl was effective and asking why I needed ativan since I was being cooperative, the answer was something something panic.
So TLDR, drugs equal blissful pain relief but I don’t remember being high because I was too high to remember.
Meh, my reaction may be atypical, but I found opiates a real disappointment. Plus, constipation is a real…well, you know.
Same! Though, since I have combination IBS, it was interesting to find that even though Endone did nothing pain-wise, it had a positive effect on my gut.
Opiates make me tired but not able to sleep and did not take away the pain.
Oh no, what did you break?!
Not me, my daughter-she was in a lot of pain, and it was awful to see her like that.
Awww! Hope she’s feeling a lot better now. (You’re a great mum)
Well on the mend, plate and screws to come out early next year. It’s one of those things I’m sure we’ll look back at and laugh but it has been really horrible for her. She’s working well on her OT so should get her strength back, she already has full range of motion.
Oh, that’s great to hear!
Or a desire to punish the child for an accident caused by misbehavior.
That too, but I try not to judge other parents by the standard set by mine. It’s simply too depressing.
Poor little one! Glad she got effective pain relief and I hope she feels better soon!
Thanks! I am so glad they offered it.
I did not have time to write a birth plan, but I have to say that even before I got pregnant and I came across one I wanted to write under the line for “who you want to be with during the birth”: the most senior neonatologist on call.
Even before getting pregnant I could not see the need of my husband driving me crazy or my mom driving me even more crazy, asking every two minutes if I was OK, but I could see that someone that could sort out any kind of problem with the baby would be really helpful.
Turns out I got to go inside the OR only with the medical team and it included three neonatologists (with a very senior one). So, actually it was even better than my (admittedly very strange) never written birth plan.
Yes about the neonatologist! All I wanted to know about my hospital was that it had a level 3 NICU. When we went to Hawaii at 26 weeks, I made sure it was the island with the level 3 NICU (Oahu in case you’re wondering). That was my only criteria.
My insurer/provider now wants me to have my next one at a hospital with no NICU. It’s closer to their offices, but further for us bus riders. But, I’m assured, they do have access to one of the top 5 NICUs in the country. THey also have hydrotherapy available! Oh, that’s fantastic. Last time I gave birth down the hall from that NICU. And it’s closer to me, and I knew where the heck it is!! I’m still irritated. Granted, I’m not due until June, so a person can hope for a change.
oh no! i hope they take your wishes into consideration and change their minds!
The hospital where I gave birth last month had a standard birth plan where I answered a few questions. My main request was that I not be offered pain medications. It’s not that I knew I didn’t want them; it’s that I have a terrible habit of saying yes to things I don’t want if asked repeatedly. As it turned out, I begged for an epidural that I didn’t get because there wasn’t time. The baby came in about 2 hours, and by the time I asked for the epidural, it was too late. Oh well.
I discussed the plan (the few things I cared about) with my OB ahead of time. She said my requests were reasonable, but she was very clear that there were no promises in birth. I was very clear that priority one was a healthy baby. Most of my friends with children had extensive birth plans. None of them had the births they wanted. I was perfectly satisfied with the experience and the outcome, but I also went in without an idea of what the birth would be like.
“it’s that I have a terrible habit of saying yes to things I don’t want if asked repeatedly”
Even to having a 17 gauge needle stuck into your back?
Honestly, I don’t know. That’s why I wanted to be the one to ask for the pain management I decided I needed.
If they’d been allowed to offer it then they would presumably have done so before it was too late.
Yep. People seem to think that we push epidurals- we do not. If a mother expresses the wish for a med-free birth, I don’t mention an epidural at all.
I didn’t have a wish for a med-free birth, necessarily. I wasn’t sure what I wanted. What I did have were three different nurses (triage nurse + shift change), each of whom needed to know what I wanted. If all three asked about an epidural like the first did, it would have felt very much like badgering, even though they were just getting acquainted with my wishes. My request had more to do with knowing myself than any particular concerns about the intentions of my care providers.
Since I asked for an epidural almost immediately after being moved from triage, no it would not have made a difference. I was asked by the nurse to wait for the doctor to see how I was progressing before they put in the call for an anesthesiologist. When the doctor checked, I was 3 cm dilated. When they applied an internal heart monitor half an hour later (by which point I was begging for the epidural), I was at 7 cm. The doctor said to hurry the anesthesiologist or we’d be out of time for the epidural. By the time he got there, it was too late. Maybe they weren’t expecting a first time mother to progress that quickly.
You’re really as unpleasant as the homebirth obsessives. I made one request, which I made verbally when they asked about pain management in triage long before the on-call staff saw a birth plan, which I filled out because it was on the hospital’s website. My doctor had no issue with it when we discussed it at an appointment, and the nurse I spoke with at the hospital had no issue either. Now, an armchair obstetrician who wasn’t even there is telling me how much better it would have gone if I’d listened to the opinions of people on the internet instead of working with my own doctors. Fantastic.
Next time I am in labor, I’ll be sure to consult message boards and comment sections on the internet to ensure proper care.