Saturday, June 27, 2009

Why I'm not giving birth in a hospital

Let's tackle the hard one first. The United States has the worst maternal mortality and infant mortality of any industrialized country of our size. Don't believe me? Check out The World Health Organization's website. There you can search the mortality rates of every country providing records for every year records are available. There is a LOT of data, but you can select what information you're interested in and whittle it down to a usable set. Or, you can watch Birth By the Numbers. It's available as a bonus feature on the disc of the movie Orgasmic Birth. (Orgasmic Birth is not as much about sexual pleasure during birth as the title might imply. It is more about being open to a range of birth experiences the way we're open to a range of experiences when running a marathon.) Birth By the Numbers is the best laid out, easiest to follow demonstration and explanation of the mortality data that I've ever seen. Other explanations can be found in Business of Being Born and Pregnant in America (both available on Netflix). I won't list any reading material available on the internet at this time because I haven't had a chance to research any of the websites that I've seen and we all know how reliable information on the internet can be.

My own summary sounds like this: When a country's C-Section rate is higher than approximately 15% the frequency with which mothers and babies die also rises. The United States currently has a C-Section rate of approximately 30%. Mothers who birth in a hospital are encouraged to consider a C-Section after a very short period of allowing labor to progress (usually around 12 hours) even though women regularly and healthily have babies after much longer labors. Even worse, rates of C-Sections rise dramatically over the course of the day. A hospital will perform many more sections around 4pm and 10pm than at other times of the day. I am extremely skeptical that there could be a medical reason for this. Many other risks accompany C-sections including infection, scarring, fertility issues, hemorrhaging, etc. While c-sections are sometimes a life-saving emergency surgery, this country has begun using this procedure as a convenient way to be done with pregnancy, labor, and birth.

Having reached my third trimester, I am beginning to understand the frustration that accompanies the end of the pregnancy. I understand wanting to be done waiting, done with the physical discomforts, and the anxious excitement about meeting the little one. But no frustration or excitement is enticing me to consider a risky surgery (that should be used for EMERGENCIES ONLY) that could adversely affect my child's health or my own.

Another safety issue with giving birth in a hospital are the drugs. Various painkillers, antibiotics, labor 'enhancers' and other chemicals are routinely offered to women in labor and are frequently mandatory and require great effort to avoid. Repeatedly, babies have been tested within a few minutes of birth and researchers have found the medications given to the mother during labor present in the blood of the infant. The drugs from your epidural DO transfer to your child. Children of mothers who received an epidural show neurological differences from children who born without drugs for as long as 3 months. I am not suggesting that the differences are great, or even noticeable to someone as untrained as myself, but I do trust that researchers looking at the motor skills of infants know what they are looking at and for. Especially when that research has been peer-reviewed, retested, and validated. Those methods are the reason we call the rules surrounding gravity scientific laws. These are not guesses, they are not theories. Many women are able to give birth in a hospital and avoid a c-section, and even avoid painkillers, but avoiding the rest of the arsenal of drugs used by medical professionals is much harder. Doctors routinely try to aid labor by introducing drugs like pitocin, cervadil, and cytotec. All of those drugs pose serious risks to both the mother and child that are not adequately explained to women before they are administered. Cytotec, for example (explained thoroughly in Pregnant in America) is an ulcer medication that has never been tested on pregnant women. The warning label explicitly and repeatedly states that this particular product is NOT intended for use in pregnant or laboring women. But it is effective, and cheap, and so doctors and hospitals still use it routinely. Even for women who are able to avoid a c-section, refuse painkillers, and avoid these labor 'aides', declining other drugs is difficult, and often involves fighting hospital policy. That is not an easy task while in labor.

We've covered convient but dangerous surgery and misused and misunderstood medications. What about sanitary concerns? I would love to believe that hospitals are the gleaming, sterile place that we all imagine, but that is simply untrue. So many people with so many illness in such a compact space will always breed germs and disease. If you don't believe me I invite you into any pre-school or kindergarten classroom to watch the teachers, aides and janitors disinfect everything they can as often as they can and still have 2-3 kids out sick every day during flu season. I have never seen a cleaning staff in a hospital clean that thoroughly or that frequently, even when I've stayed overnight. There is simply too much to do.

Emotional safety is a concern for me as well. Doctors and medical staff are people very accustomed to being in a position of power and authority. While I do not hesitate to call a doctor or nurse when I have a medical question and need answers, I do remember that they are all human. Humans make mistakes, humans learn things incorrectly, and humans enjoy power. Just this week the American Medical Association was scheduled to vote on whether or not they should begin labeling patients as 'non-compliant'. Such inherantly subjective terminology is asking to be abused. I myself have refused medical treatment on several occasions because after discussing my options I truly believed I was doing what was in the best interest of my health and my life. To be labeled as non-compliant could jeapordize my future health care and could add another layer of frustration to an already complicated insurance climate in this country. Additionally, we have been raised to trust our doctors as authority figures and in our moments of intense emotion and physical exertion we are much more vulnerable to listen passively and do as we're told. I do NOT want to look back on this birth and wish I'd been able to stick up for myself. Or wonder if it could have gone differently, more safely, with fewer interventions.

Over and over and over studies have shown that homebirth or birth in a birthing center is a safe alternative to hospital birth. The only time this is not true is when a hospital or medical backup is not available such as the Alaskan bush. Studies since the 1970's have shown that birth with a trained birth attendant is as safe or even safer than hospital birth as long as medical intervention is available. Homebirthing women regularly pre-register at a hospital and discuss potential red flags with their midwives before going into labor, and agree upon what conditions will necessitate a transfer. Within a hospital, doctors strive to maintian a 30 minute 'decision to incision' time. This means that no more than 30 minutes should elapse from when the decision to section a woman is made to the moment it begins. The birth center in Denver (Mountain Midwifery) reports a transfer time (measured from when the decision to transfer a mother to the hospital is made to the time she is checked in at the hospital) of 8 minutes. Other birth centers report similar successes. Midwives have established relationsihps with hospitals and staff, and are able to call ahead to explain the situation to a trusted collegue as the woman is being transferred to the emergency room. This means that as the woman comes in to the hospital where she has pre-registered, the doctors and nurses are already aware of her current situation, have been able to review her medical history (if provided by the patient ahead of time), and this facilitates a quick decision and swift action. Many midwives even have relationships with ambulance companies to call should an emergency arise to avoid calling 911 and being responded to by a truck full of firemen or K-9 police unit. Both have a valid place in serving our community, but neither is ideal for an emergency birth.

While not something I generally venerate, tradition has a valuable place in our society. As I enter into motherhood, I look forward to an experience shared by women all over the world and from every generation and time. I don't want to recreate environments where as many as 1 in 3 women die in childbirth, but I look forward to full experiencing this life changing event in the simplist, most natural way possible. The way God built me to experience childbirth. To paraphaphrase Ina Mae Gaskin: "God is not a careless mechanic. I am not a machine, nor a defective model. I am not a lemon." My God did not make me defective. And until I have evidence to the contrary, I will not doubt His creation or intentions. I am prepared in case labor does not go the way I expect, and I have faith that my God will be with me every moment.

For the pure and simple comfort of delivering at home, and then being tucked into my own bed to get to know my family. Or at the birth center, for the low lights, warm water in the tub, and quiet intimacy of people I know well helping me to give life and connect with my child.

Over and over again I've talked to women who have given birth and used drugs and they talk about the most intense pain they've ever felt. When I talk to women who have prepared for natural childbirth (really prepared, not just followed orders blindly) and then executed it, they talk about birth being the most empowering experience of their lives. Women who've given birth naturally even describe it as being a physically pleasurable experience. They speak of it the way marathon runners speak of feeling so physically high at the end of a run.

When it comes down to picking a path for my own birth, it's a pretty easy choice. I want to be with those who've never felt more aware of their bodies, closer to their God(s), and empowered in their choices.


Ultimately, I'm doing it for the safety and best interest of my child, my family, and myself. I trust my God, I trust the body He's given me, and I trust childbirth as He's designed it to be. I know it will be hard and that's ok. He will be with me, I will not be alone. He's given me an incredible husband and a skilled team of midwives who've attended thousands of births. I am getting ready to change my life, and I am not afraid.

I'll add resources as I find them or want to.

Someone else's opinion. She links to on of the studies I mentioned.

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