Thursday, May 21, 2009

On Childbirth

I finally got around to watching The Business of Being Born today (via online streaming on Netflix.com btw). I've been wanting to ever since I first heard of it, just a few months before Donovan's birth. By then I had already switched from my OB to my midwife and was planning a natural birth (with, of course, backup plans if needed). In a way I think it's good that I waited this long to actually watch it. I think enough time has passed now since giving birth that I could look back on the experience while watching the documentary, and actually start looking forward to next time-- which has not been true of any other time in these past 15 or so months.

Most of the facts and arguments brought up were not new to me-- the US has a very high rate of c-sections; mid-wives have a horrible name in our country for some reason when they are the norm in prenatal care world-wide; too often doctors make decisions in childbirth that are based more on cost, schedules, and worries over getting sued, rather than the best interests of the mother or baby. And so on. But there were a few things that I had no been aware of, or had not thought of before, that I found extremely interesting.

At one point in the film one of the doctors interviewed wondered whether some of the drugs now being routinely given to women in labor might have some connection to Autism, ADHD, or any of the other disorders and problems that have been on the rise in recent years. I forget what percentage of women one of the hospitals said they gave pitocin to, but it was well over half. There are also at least 10 other drugs mentioned that are routinely given to laboring women to help speed up labor, reduce pain and discomfort, and help deal with the side effects of previously given drugs. How well do we know the long-term effects of thse drugs on women and on their newborns? We have a pretty dreadful history of using drugs in pregnancy and childbirth that only later are found to have devastating effects: two examples include Thalidomide in the 50's and 60's, and in the film they mentioned another drug that was given to women during childbirth in the 90's, that was later linked to causing the uterus to rupture in women who had previously had c-sections. (EDIT: the drug is Cytotec (Misiprostol), given to try to induce labor.)  We've spent so much time and energy trying to find a link between vaccines and Autism, has anyone looked at any of these drugs used in childbirth and looked for a possible link?

As Zach brought up when I was telling him about this, isn't it odd that we take so much care of what we put into our bodies when pregnant, freaking out about the tiniest potential exposure to mercury or listeria, and also are so careful about what the give newborns, yet we bombard ourselves and our babies with all these drugs during childbirth?

(I also always wondered how, when we're told over and over again not to lay on our backs during those last months of preganncy b/c it restricts bloodflow to the fetus, how it makes sense to then labor and give birth in that same position)

The second interesting point was one related to medical care. Childbirth in the US costs 2-3times as much in the US as in most other developed nations, yet our mother and infant mortality rates are mong the highest among that same group. A hospital birth, even a completely normal, uncomplicated one, often costs $10,000 or more. But that same birth at home or in a birthing center will be half the cost, if not less. It reminded me of all the talk lately about our health care system in general-- how we spend so much more than other countries, yet end up less healthy. I don't know if this expands out well to other areas, but when you look at prenatal care there are clearly a lot of interventions used that cost a lot of money, and that 90% of the time are not necessary. It's pretty easy to pinpoint where these are, and it'd be pretty simple to cut these costs while still providing excellent care-- and maybe even with better results and fewer deaths. That's the ironic thing, that most doctors and our culture in general will have you believe that giving birth outside a hospital setting will put you and your baby in greater danger, but when you look at other developed countries where home/birth center births are more common their childbirth-related mortality rates are lower.

Medical advances are, clearly, a WONDERFUL thing. Amazing, awesome, super increedibly great. Lives are saved every day because of the advances we have seen in medicine. C-sections are a necessity and save lives. Epidurals can be wonderful and beneficial to mothers who are overwhelmed by labor pains. Sometimes labor can be so intense that a woman stops progessing because her body is too tense, and an epidural can help her relax and get things going again. However, just because something is good some of the time does not mean it's good all of the time. Certain practices, like the use of continuous fetal monitors, have no medical evidence behind them that they make any difference, yet hospitals use them because they're easier on staff... even if that causes the mother to be confined to bed in a position that's not only uncomfortable but may inhibit labor's progression (meaning she then needs pitocin... and then an epidural b/c of harsher contrctions, while lying down...and so it goes). Our medical advances are great for the small percentage of the time when they are truly needed. The rest of the time, they are not only not necessary, but may in fact be harmful.

One of the things I hope this documentary does is change the public opinion of midwives and hospital-free births. A midwife is not some woman who just comes in with a warm towel and hopes everything goes well. Midwives are trained professionals. They come with most of the same supplies your doctor does, and is trained and prepared to look for any signs of potential complications that may come up. The center where I gave birth was just a few minutes away from the nearest hospital, and my midwife was in touch with the midwives at the hospital so they would know that a birth was taking place and be alerted in case I needed to be trasnferred so the whole process would be as smooth as possible if it needed to happen (I can't speak for sure, but imagine most midwives here do the same). I think it is so sad that most OBs have never seen a truly natural, intervention-free birth. In so much of the rest of the world, the norm is to be treated by a midwife, and the OB comes in only when needed in the case of complications or high-risk pregnancies. This seems so much more common sense.

I could probably go on and on about this topic, but I think I'll stop here. I will mention that Ricki Lake and Abby Epstein (producer and director of The Business of Being Born) launched a new website called My Best Birth, geared to help inform women of all their choices so they can make an informed decision of what is THEIR best, preferred birth scenario. No, we can't plan our birth perfectly and anyone who doesn't realize how unpredictable birth can be is fooling themselves. But you an have a plan, and be prepared. And whether that plan is to give birth at home or in a hospital bed, it should be made with care and consideration, and with all options laid out on the table.

15 comments:

  1. I agree with you. I saw the movie last year and purchased Ricki Lake's book, "Your Best Birth" and checked out her website. It's a must-have for any pregnant woman or woman planning on becoming pregnant.

    I had a home birth with a midwife attending and I am so happy I chose that path. My labor was 36 hours. No OB/GYN would have waited that long for me in the hospital to progress. I would be a statistic falling into the domino effect of pitocin, epidural and probably C-section. Which would have interfered with my breast feeding - which I am happy to say I am still doing at 22 months (although weaning right now).

    It is sad that most Dr's today have never witness a live, intervention-free birth. They certainly have never seen a breech baby born that way! Thanks for posting on this topic.

    ReplyDelete
  2. "However, just because something is good some of the time does not mean it's good all of the time."WHAT???? You mean one size does NOT fit all???

    Regarding drugs, vaccines, and Autism: you make excellent points, but you see, the drugs given during childbirth make the doctors' and nurses' and woman's jobs easier. So we NEED them. Vaccines? They make the baby cry. THEY MUST BE EVIL. So of course the vaccines give babies Autism, but all that crap women put in their bodies while the baby is going through the very traumatic process of being born? Those are A-OK!

    Thanks for writing this. Women need to get this info!!!

    ReplyDelete
  3. I think that a lot of problems could be solved if more mothers would only educate themselves on all the birth options available to them, and then write a very specific birth plan for their doctors. It's easy to blame it all on the system, but personally I think that it should be each woman's responsibility to make informed decisions about her own body and that of her baby. Having more options is not a bad thing as long as those options are thoroughly understood.

    ReplyDelete
  4. Excellent post. I agree with you by and large. But as the mother of an autistic son, I would like to caution you against grasping at that particular straw to condemn drugs given during labor. Scans show that the autistic brain is physically different from a normal one, and functions differently. Exposure to a drug for a few hours during labor couldn't possibly cause those sort of effects. I have Asperger's and so does my son and no one knows why. The possibility of your comments being taken as blaming mothers for causing autism in their children is worrisome. I planned a midwife, natural birth for my son, but his breech presentation indicated otherwise. All of that is water under the bridge now, unchangeable. We play the hand we are dealt.

    ReplyDelete
  5. Laura,
    But how many women even know that these options are out there, to ask about them? I honestly thought the only way to have a baby was in a hospital. I knew some people had babies at home, but I thought they were extreme radicals (the same people who refuse to vaccinate because God told them it's bad) and were doing something terrible for their children because they were denying the newborn the "proper" care of a doctor and a big hospital.

    And who are you going to go to, to ask about your options? Your doctor -- the same person who A) wants to make money off your birth, and B) is going to tell you home births are unsafe.

    Women do need to educate themselves, but first we need to let them know that there is something to educate themselves about. That there ARE other options available.

    Even after Marcy had D at a birthing center, with a midwife, I still thought that was something she could do because she was in Europe, that this option would not be available or realistic here in the US. Now, I hadn't done much in-depth research on the subject since I'm not even pregnant yet, but most women think the way I did. A large portion of pregnant women are also working through the pregnancy, and between a full-time job and the physical and emotional tolls pregnancy takes on your body, how much time and energy are they going to devote to educating themselves when they have to jump through so many hoops?

    Yes, women need to educate themselves about their options, make a birthing plan, etc. But we need to make that information readily available to them, and we need to let them know there is information out there in the first place. Your OB/GYN is not the only way -- regardless of what your OB/GYN tells you.

    ReplyDelete
  6. Excellent points, all you've written. It is very true that very little has been studied in the long term side effects of these drugs. And especially true that women are almost forced to take the drugs.

    What's particularly frustrating is that if you decide NOT to have drugs, you get harassed for "being a martyr." And if you choose a homebirth in the US? You're being a selfish mother who doesn't care about the life of her child.

    As a mom who chose a homebirth in the US, having actively researched all options (I am a scientist and understand data very well), who did have to transfer to hospital where my daughter was born with meconium aspiration and nearly died, I was directly accused of risking my daughter's life and had all sorts of horrible words thrown at me. The reality is, she likely didn't aspirate meconium until the last minutes before birth (which was 3 hours after I left home), that the stressful hospital environment (tho I had a very supportive OB present) likely led to the 3-hour delay in delivery when I arrived. There's really no way of proving any of that, but even the neonatalogist made that assessment.

    I don't regret any of it, even the transfer to hospital which at the time was the right move -she had an off heartbeat for a moment, coupled with a long labor and my clear exhaustion, my midwife felt I needed an IV and her instincts said "hospital". It went back to normal once I arrived, all heart sounds fine and I was 10cm, which is why OB decided to continue with vaginal delivery. If I am no longer high risk (other issues), I will be planning a homebirth again.

    I can't really comment on the potential link between labor drugs and autism, that's certainly a theory not unlike the theory linking them to vaccines (which I believe has been well disproven). I would never blame a mother for taking the drugs, certainly they are told they are safe and have at this time no reason to believe otherwise.

    ReplyDelete
  7. Oh, and FWIW, my midwife charges ~$4000 for a homebirth, including all prenatal care and post-partum visits., compared to the $10,000 for the hospital birth (which is not including the 3 week NICU stay which cost >$200,000)

    ReplyDelete
  8. Pinget--
    I agree, and probably should have put a disclosure there somewhere. My comment was more in comparison to all the hysteria we've seen over vaccines being so evil and causing autism, and wondering why we aren't looking into other possible causes instead (BTW I personally believe the science that shows that vaccines have little if not nothing to do with autism). I certainly don't mean to blame mothers in any way-- they are only making the best choice they can based on what they're told.

    Laura-- YES exactly. Women need to educate themselves. That's why documentaries like these, and the MyBestBirth.com website, are so wonderful. Because as important as it is to educate ourselves, it's really really hard to find that information in our country. We should make it as available to everyone as possible, so they realize that there ARE options for them to consider.

    ReplyDelete
  9. There's also the very valid point that, once in the delivery room, when you're tired, worried, and not able to always think clearly b/c you're, well, in labor, when a doctor comes in and makes a suggestion for an intervention, even if they mean it as an option that doesn't have to be taken, the woman will often take it as the suggestion of an expert and go with his advice. This can partially be solved by having advocates for the mother to help her think through these decisions (husband, friends, doula, etc) BUT we also should work towards a system that doesn't depend on pitocin for every birth or expect them all to progress that the same pace. Women should make informed choices, and doctors should not push unnecessary interventions on them for the sake of convenience.

    ReplyDelete
  10. marcy - that's very true that once you're in that position, women are VERY susceptible to anything the doctor recommends. And often it's presented in a way which would make the mother feel she's risking her child's life if she doesn't follow that advice.

    Re: birth plans, most people I know who had one said the L&D nurses basically threw it out the window... And the reality is, the last thing a laboring mother wants to do is to have to fight the medical professionals to respect her decisions.

    That said, my OB is absolutely amazing on non-intervention births. His philosophy is "this is what you're made to do, you CAN do it without interventions, I'm just here to help in case you need me." He doesn't induce before 42 weeks unless it's medically indicated, he doesn't recommend C-sections unless medically indicated, he doesn't push meds. So there are OBs like that out there, unfortunately he's only one of 2 in his hospital who believe that way.

    ReplyDelete
  11. This is weird, we just watched this 2 days ago! I thought it was fascinating, and will definitely be considering a homebirth for our next, although I felt that way before I saw this as well. I think once you have had a baby in Europe your view on childbirth in the US changes drastically.

    ReplyDelete
  12. This comment has been removed by the author.

    ReplyDelete
  13. Great post! I do want to say that as a first time mom I found it hard to stick to my guns under pressure from medical professionals when labor pains took effect! I DO think all moms should be informed of their choices- the best choice is an informed choice. This info should come from an unbiased source. That Ricki Lake site is wonderful. Also, I didn't think you were suggesting these drugs cause autism-I think you were suggesting we need to be more aware and /or skeptical of drugs we are using during labor that are NOW considered safe. We are drug happy in the U.S and rarely stop to think about the negative effects.

    ReplyDelete
  14. On availability of information: There are any number of books available on the topic. I, myself, read no less than 6 birth books cover to cover during my pregnancy. And if someone doesn't have the money to purchase these books, then they could check out their local library. As well, there is a plethora of information available online, though you have to use some common sense about which sites are reputable. I think that the information is readily available to those who seek it.

    On enforcing a birth plan:
    This is why you should pick a birth partner who you trust explicitly. You need someone who is there for you, knows your wishes, and will stand up for you even when you no longer have the will to stand up for yourself. I had a hospital birth, and my husband (and birth partner) made sure that every staff member who entered my room was given a copy. I did not find that they disregarded it at all. Actually, I felt that my wishes were very well accepted wherever I had explicitly stated a certain desire. It was in the gray areas where I didn't specifically state what I wanted that I wished something different had happened. Anyway, my point is that in the LDR, a woman needs a birth partner who will be her advocate and enforce the desires stated on her birth plan for her.

    ReplyDelete
  15. Laura--

    Yes, the information is becoming more available. And that's GREAT! I hope most public libraries do have copies of these kinds of books, and that people know to look for them. Part of the problem is many people aren't even aware of this whole other set of options and you can't research it if you don't even know it's there. But I think information is becoming more available and public, which is wonderful. It's, once again, why I am so glad to see films like this one being made.

    And I think we can 100% agree on needing to have someone there with you during labor to help you. I'm glad your hospital respected your birth plan so well. I've heard of many, many, many women who had the complete opposite experience.

    ReplyDelete

LinkWithin

Related Posts Plugin for WordPress, Blogger...