Friday, October 3, 2008

The Business of Being Born

I finally picked up a copy of the DVD The Business of Being Born, a film that was recommended to me both by a doula and by a babysitter. It’s a film initiated by Ricki Lake, who found her at-home midwife-attended second birth much more fulfilling than her first standard, hospital birth. In the film, she calls attention to the problems facing obstetric care in the U.S. and seems to promote giving birth at home.

The points she made that I agree with are:

  • Being in a hospital can make one feel like they are on a timeline. I felt this both in the process of giving birth (I felt pressure to give birth before the staff shift change at 7 a.m.) and in the discharge (I didn’t feel ready to go home when they thought I should leave). Having a doula there definitely helped me to reject suggestions (such as breaking my water early on) that would have speeded things up without a clear benefit.

  • Technology is often used because doctors think the high-tech things are cool, not necessarily because it’s helpful to the mother or child. Case in point – electronic fetal monitoring. For more details, check out the good book A Thinking Woman’s Guide to A Better Birth.

  • One intervention can lead to another. I think this is true especially if one isn’t careful. But if you are careful, and especially if you have a trained advocate with you (in our case, a doula) this doesn’t have to be true. I had the epidural, but no pitocin or other inducing drugs (as the movie says is common with an epidural), nor a caesarean. I did have an epiosiotomy, which I didn’t want, but the doctor didn’t give me much of a choice. Soren was a big boy (8 pounds, 10 ounces and 21.5 inches) and I’m not so big down there, so I guess overall I’m impressed I got him out at all.

  • Doctors are not trained in seeing what a natural birth looks like. This I think is unfortunate and I hope doctors who care will voluntarily seek out this experience.

Points I disagree with:

  • While it’s true that the medical establishment can push women into choices they don’t want, if you prepare for this in advance, you are not entirely helpless. I thought having a doula with us helped immensely. Discussions with the doctor were also of some use. I’d asked him about a “birthing bar” which goes over the bed, so instead of pushing lying down, I was sitting up and had something to grab on to. I was ready to do what I could to avoid induction. Unfortunately, the promise made by my doctor to not force me to use electronic fetal monitoring with the epidural went against hospital policy and was not honored. I learned that next time, I’d have to speak to the hospital admin and the anesthesiologist ahead of time.

  • Natural birth is made out to be beautiful and possibly comparatively easy. While I had an epidural, I felt a heck of a lot of the natural elements – several hours before the epidural and everything during the pushing. Most people I speak to who did it naturally usually say that they did ask for an epidural at one point. I’m sure that overcoming that pain makes one feel strong and I admire them for doing so. But the pain is intense, hard, horrible. I don’t think it’s wrong to ask for relief if it’s needed. I also think the film failed to bring up the risk of tiring oneself out from excessive pain, and needing a c-section because there is no energy left to push (I know someone who had this circumstance).

  • I recognize problematic cases are the minority, but I think the difficulty of transferring from home to a hospital at a critical point is underestimated. I live about six blocks from the hospital, an easy 15 minute walk from my house. When I went to the hospital, around six hours after labor began, I was in so much pain I didn’t know how I could possibly endure the ride there. I also had great problems remaining seated. The ride was extremely, extremely uncomfortable. My husband was thanking the stars that I didn’t chose another hospital I was considering one hour away. And I don’t think I was any more than three centimeters dilated. In the film, viewers see a ride to the hospital and it’s not pretty in her case either.

I do like the idea of a home birth. I wish it was possible to have a home birth plus an epidural-like medication. My sister-in-law had one baby in a teaching hospital and another with a midwife in water. She said the second was more painful, but less traumatic.

When I look back on my birth experience, I do feel a certain sense of trauma. It was scary and bloody and painful and I didn’t feel entirely in control. But I don’t know that I could or would want to handle any more pain than I did. And because I was strep-B positive, I needed an IV no matter how I gave birth unless I wanted to put my child at risk. Though the film makes me wonder whether doing without the epidural would have made me feel better at the end, I wouldn’t want to be the place of Cheryl Strayed, the author of an essay in the current issue of Brain, Child magazine. Because she felt an epidural could put her baby at risk, she gave birth at an off-site location and went through 42 hours – 42 hours! – of natural labor to give birth to her just-under-11 pounds baby. Thank God she said she “truly suffered’ during her non-intervention birth, “literally..ripped apart at the seams” or I would really feel like a wimp.

Thinking back on the experience, if I had to do it over again, things I would do the same are:

  • Having a doula or midwife, especially if giving birth in a hospital
  • Having my husband sneak food in
  • Avoiding induction and drugs to speed up labor

The main thing I would do differently would be to speak to the hospital administration and anesthesiologist ahead of time, though I know that wouldn’t be easy. From the anesthesiologist, I’d like to know what the drug combinations are and what effect they will have. Those last couple hours in which I felt everything were probably the most traumatic part (in large part because I thought the major pain was over). From the hospital administration, I’d like to know what rules are and aren’t negotiable. I wasn’t happy to be forced onto the electric fetal monitoring, nor was I happy that they wouldn’t let me have my placenta (it’s my body part and I don’t see why they should have the right to sell it to cosmetic manufacturers). I had wanted to copy the Vietnamese tradition of planting a baby’s placenta in the yard of its first home, so it will always have a place to come back to.

In sum, I appreciate Ricki Lake bringing up the subject. I feel like it’s one that not talked about. By the time a woman looks into these issues and begins to think about it, she’s probably already pregnant and doesn’t have a lot of time for advocacy. I wish the film had brought up suggestions for advocacy, things women can do beyond having a home birth that will ensure greater choice for and respect for women in childbirth.

I think the most critical change needed to improve the care women and babies receive is for the medical establishment to loosen strict regulations (if this means signing something absolving them of any responsibility, so be it), for doctors to learn about how birth works naturally, and for hospitals, staff and insurers to give women the freedom to make their choices and deal with their labor on their own timeline.

I think having a caring person at the side of a laboring woman during the entire labor would be a good start. In Spain, a midwife goes through the birth with a woman in the hospital. A doctor comes in only when needed. It seems the perfect combination of trained support and medical attention. A doula can provide the same support in the U.S., but they might not receive the same respect from the doctor as midwives do in Spain. And you need to arrange for them yourself.

I also think it’s important for women to not be thrown out into the abyss of the unknown after birth. In England, midwives stop by and visit the mother at home several days after the birth. This is done for every family under the national healthcare. The mother is able to ask for advice and assistance. And it’s paid for by public funds because it’s deemed important that infants are well taken care of early on and that mothers are helped in doing this. Because of the realities of the U.S. health care system, the success of these things changing will probably be tied in to the possibility of a nationalized health care system – where people are treated as people and not as profit-making patients.

Just thinking back on the experience of birth, just watching the movie, brings up so many emotions – fear, anger, joy, pain, wonder. There really is something to be said for women feeling a bond with others who have gone through the birth experience. No matter how someone chooses to go about it it’s a life transforming experience.

I feel like it’s so hard to know what to do during a first pregnancy because one can’t know exactly what it’s like or what your individual experience will entail until you’ve been there. For those who have given birth, how satisfied were you with your choices? What would you do differently if you were to do it again?

Writing this post motivated me to look at the video my husband shot immediately after birth for the first time. It took me almost ten months to look at it because reliving those moments was just too scary. River is lying on my chest, I continue to pant and to cry out, even after it’s over. I look at him as a strange, heavy weight suddenly upon me. I say owie, because it still hurts down there and still will for some time to come. In all the photos from his birthday, I look awful – puffy faced, shocked. I also see a photo of him on me and blood and guts still dripping out of my lower region. I understand why the Kyrgyz don’t allow men to accompany women in childbirth for fear that they will no longer be attracted to their wives. I respect and appreciate my husband for being there, for holding up and for still finding me attractive. I think it was enough to subject him and the other people with me to that though. So this video is not of the birth, but within the first hour afterwards.


Anonymous said...

No hospital is allowed to refuse you your placenta. Whomever told you that is 100% incorrect. They can *try* to keep it from you. They can tell you it has to remain on the premises until you leave (in case they need to examine it if the baby gets an infection). But it is YOURS and someone was being lazy when they didn't want to wrap yours up/put it in the containers that are *always* available for hospital placenta travel; they were also lying to you. I am sorry your placenta is gone.

I do want to say, however, that they don't always sell them to cosmetic companies. They are also picked apart to be used for medical reasons. My partner had cancer in her eye, for example, and when they removed it, they had to cover the "hole" with something until the cells re-grew, covering the hole. They used the amnion portion of the amniotic sac (the chorion is the other part of the sac) from a donated (unknowingly!) placenta. (The other option they were going to use was the foreskin of a circumcised penis. She refused that one on principle.)

I highly encourage you to go into your next birth as a separate one from your last one. Your baby might have been in an odd position that caused you so much pain. It is rare that a woman would experience that much pain in two labors; babies shift and move throughout labor *and* birth and it helps when mom is able to move around herself. Suffering is never a good idea and you are right about not being able to push if too exhausted.

Epidurals are great for relieving suffering; water, love, support, position changes, counter-pressure, heat, cold, etc. are great for relieving pain.

Thanks for the review. I did a review myself when my office did an advance screening a year ago. I liked much of it, but had my annoyances with it, too. Different than yours, but the movie certainly isn't perfect... even for a midwife. :)

worldmomma said...

Thanks for the helpful comments. Do you think the pain was more from the positioning than from a head circumference in the 95% percentile? Large heads run in my husbands family, so I'm afraid head size could be an issue in any future pregnancy.