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Natural Birth
magpie1127
member
Thoughts on modern birth from my mom, an OB nurse
magpie1127
member
Hey ladies,
I'm not pregnant (not even TTC yet), but I have studied womens' health issues for a while (I'm a journalist, and womens' health is one of my favorite topics to write about). My mom has been an ER nurse for more than 30 years. Recently, she accepted a position in an OB unit. This is her first time working in an OB setting, so she doesn't have any prior exposure to the recent natural/home birth movement, other than the fact that she knows a few women want natural births.
I was discussing her new job with her the other day (I had never mentioned the modern natural birth movement to her, because I didn't want to offend her). She said something like, "I am so surprised at this hospital! You wouldn't believe the amount of inductions! These doctors just induce for their own convenience, and so many women don't mind it." She reflected the same sentiment about scheduled C-sections, as well. She even went so far as to voice her concern that the hospital was acting illegally. She mentioned that the federal government has laws against inducing/performing cesarean sections when it's not medically necessary, but that doctors get around those restrictions by making up health risks.
I was so stunned. Since I'm not currently prego and haven't really looked into c-section rates for myself, I had a feeling that BOBB and other documentaries were biased against hospitals; but here was a pro-hospital medical professesional (an older woman who'd never seen BOBB or heard about things like AP) having the same reaction to the medical system that so many women have had after watching documentaries and noticing all their friends' inductions and cesarians. I just found it very telling that my mom (who'd had a c-section and an epi at different points throughout her childbearing years) would independently notice how flawed the system is without any prior exposure to a naturopathic philosophy.
She works at a well-known hospital in an upper-middle class community in the Midwest.
I'm not sure where I'm going with this, but I just thought I'd share!
This discussion has been closed.
Re: Thoughts on modern birth from my mom, an OB nurse
I have to say I'm not surprised at all. I have seen BOBB and Pregnant in America and while I do believe that they have an anti-hospital bias in general there are figures that these films offer that you just can't make up. The cesarean rate in 1975 was 7%, it's 30% now. Certainly there can't be that many more births that require it, it's just more convenient for the doctors. Also, the number of babies born Monday through Friday vs. the number born on the weekend is shocking.
So many women just blindly follow their doctors recommendation because they don't know any better, they don't take the time to research the procedures being pushed on them. My midwife applauded my desire to have a natural birth. She said about 60% of women just want go in on their own schedule, not have to feel anything, and leave with a baby.
Haha, that's awesome! We live in Chicago, too (in Lincoln Park). I'm in love with Roscoe Village. I want to move there ASAP!
We live in Northcenter, so pretty close. Roscoe Village is great, Lincoln Park is nice too though! I love that Farmer's Market they have near the zoo.
Hopefully, her being aware of these things in the hospital will make her a great nurse for mommies trying to go natural, or avoid as many interventions as possible.
I was induced and had an epi with my first and hated it!! The whole process sucked, so now I am preparing for a natural hospital birth. After watching BOBB, I just nodded my head the whole time because I've been one of those women getting interventions that I now know really wasn't necessary.
I am not surprised to hear this! When I was in labor and was checking into the hospital DH and I were amazed at the other women in triage. Out of the 5 occupied triage rooms I was the only one in active labor. I know this because the other couples were laughing, talking about food and family visiting while I was concentrating on contractions and moaning/yelling!
Yesh, shiz is messed up. Is she in Chicago? If so, I think I can guess what hospital she's talking about...
You should read "Pushed" by Jennifer Block (and have your mom read it, too!). Having been through two hospital births (one c/s, one VBAC), it's tough out there. I was lucky with my second son, but it definitely could have been a RCS if we didn't currently live in a city with good VBAC options.
DS2 - Oct 2010 (my VBAC baby!)
I bet you and I are thinking of the same hospital.
Your mom sounds awesome
Interesting that you mention the socio-economic class of the hospital--I noticed when looking up c-section stats by hospital in my area (Chicago) that the affluent areas had sky-high rates and the lower-income areas had much, much lower rates. I think there's a tendency to say "they get better care in more affluent areas" but I think there's something else going on--that areas where patients have awesome insurance are more likely to have docs going for elective or medically wishy-washy sections whereas they'll hold off if they aren't sure they'll get compensated accordingly. Hi, yes, I know I'm jaded...but honestly.
I tend to think as well that obstetrics has so thoroughly medicalized a natural process that it's having to assert itself in these ways to stay relevant--if only the births that *needed* an ob had one. instead of being attended by midwives or other non MDs, a lot of people would be out of a job.
No, my mom works for a hospital in Wisconsin . . . but I'd love to know which hospital you're referencing, in case I get prego while living here!
Prentice/Northwestern.
I went to UIC midwives for my VBAC, and sschwege had a great experience with the Swedish Covenant MWs. West Suburban MW group (they are in Oak Park) is also really good.
DS2 - Oct 2010 (my VBAC baby!)
On your first point: you notice correctly. My DH is an MD who did his training in some of the wealthiest and poorest neighborhoods of NYC. The better insurance you have, the more likely you are to have interventions. And how do you think suburban hospitals are paying for those private rooms and family "birthing suites" or whatever they call them?
On your second point: There is a bit of an OB/midwife turf war. However, on the whole, we're actually facing an OB shortage in this country, not a surplus. No one is in danger of losing his/her job. Still, I predict that as healthcare reform pressures hospitals to lower costs, and higher malpractice premiums and low reimbursement drives many med students to other specialties, we'll see new interest in the midwifery model. The question is: have we hit bottom yet?
Thanks for the extra info! The turf war saddens me (and happens in pretty much any mainstream/alternative medical context--too bad). I love when OBs and midwives can work together--seems like an ideal situation that happens far too rarely. I do wonder, though--if only pregnancies and births with complications were attended by OBs, how many would we need? I have a feeling that shortage would resolve itself...and we'd have a midwife shortage instead lol! And you're right--I know OBs who have left the field already because of the malpractice premiums. Not the best situation for healthcare professionals or patients, unfortunately.
bfp#4 3/19/2014 edd 12/1/2014 please let this be the one!
beta @ 5w0d = 12,026! u/s 4/22/14 @ 8w1d it's twins!
That was the hospital I was thinking of too. I do know someone from my Hypnobirthing class who had two water births there, but her labors were pretty quick and complication free. She did say that even though she requested no pain-meds in her birth plan it was hospital policy that the anesthesiologist had to come in and tell her what was available, he only came once, but pretty ridiculous!
I think I'm less surprised, but I love your mom's perspective. I've only given birth in the hospital once and once in a free-standing birth center, but it seems that there were a lot of natural-birth-smart nurses in the hospital my first time (even with the the ward being focused on a high-risk/multiples births). Plus all the CNM at the birth center had been nurses that delivered at hospitals or did rounds at hospitals before opening the birth center so it seemed like there is a core group.
Oh and I've heard it from 3-4 midwives that there is a shortage of CNMs in the medical system similar to OBs. I'm thinking the OBs and CNMs have a lot of on-call hours that are unpredictable compared to other specialties - maybe that's a reason for the shortages?
...baby #3 is here...
This saddens me, a little bit. I would love to have a nurse that would step up and give me this kind of information! I hope she didn't lose her job; she sounds like she is a good nurse who cares.
My doctor says she's all for natural birthing, but made sure to mention that she'll push medications should the need arise. I was a little bummed at how much she talked about it, and I really hope my DH and I are able to stand up for ourselves when the time comes.
There's an OB shortage because it's a pretty crappy job. Low pay relative to other specialties with the same amount of training, high malpractice premiums, constantly on call and just general high levels of dissatisfaction. OB was probably DH's least favorite rotation in medical school and he said it was because everyone he encountered was deeply unhappy.
The same is probably true for a CNM, compounded by state regulations that make it difficult, if not impossible, to practice outside a hospital setting and the nationwide nursing shortage in general. The highest paid advanced practice nursing specialty is anesthesia and I bet the numbers reflect that.
All that to say: as much as we're on the let's blame doctors bandwagon, there are flaws up and down the healthcare system.
I was going to say the same thing. I wish I had a nurse like that at the time of my c-section/induction with my first.
While I am not completely shocked by this, I have to say I have encountered multiple pregnant women who have done nothing to educate or inform themselves on labor and what they will be going through - one woman said to me she wanted every drug she could get and that is what she told her doctor. While I try to go out of my way to respect people's wishes with regard to labor & birth, this type of attitude sickens me and I am sure it is something doctors deal with more than we know.
This saddens me, too--that women don't inform themselves and then, often, have outcomes they didn't expect or that disappoint them. At the same time--are doctors doing anything to inform women? When a woman says "I want an epidural and all the drugs I can get! And can you induce me early?" I think it's a doctor's responsibility to lay out the risks and benefits of these kinds of interventions--and from what friends have told me, many don't. I had a friend whose dr told her to skip childbirth education class of any kind--this tells me he doesn't *want* informed patients. He wants easy patients who do what he says.
The Illinois Department of Public Health (IDPH) and CDC have picked up on this epidemic and is taking a close look at hospitals and provider practices. Besides the obvious risks that would come with inductions and C-Sections they are looking at C-Sections having been performed because they have a higher rate of reimbursement, the risk that C-Sections place on blood banks, as well as the fact that there is a shortage of medication used in anesthesia jeopardizing the health and well being of others. Hospitals in the Chicagoland area have had to cancel non-emergency surgeries because of low blood supply and/or shortage of medication.....not necessarily due to elective inductions,c-sections. Hospitals outside of the city....advertising their birth suites, dinners for two after delivery, manicures, and massages over there care in some cases have C-Section rates close to 40%. The Chicago Tribune has had a couple of articles recently about C-Sections and failure of hospitals to support/encourage VBAC but sadly they were smaller articles in the middle of the paper.
I delivered two babies at Prentice and plan to do the same with this LO. I had a wonderful experience at Prentice but I think that has a lot to do with the fact that DH and I were educated and assertive as well as the provider that we selected. We received nothing but support and encouragement regarding our decision for unmedicated births and minimal interventions....I had nurses squatting on the floor with me so DH could take a bathroom break. Anesthesia does come in and talk to you but again they were respectful of our wishes. I work in healthcare (not at Northwestern or Prentice) and know that one of the main reasons that they continually ask people about pain management is that it is something that hospitals are evaluated on (never report a 4 or higher if you don't want to be offered drugs) as well as the fact that patients are not always truthful and wait until the last minute to disclose important information. DS's birth was uneventful....I could have delivered him at home but DD was another story. DD came out blue with the cord wrapped around her neck twice. She had difficulty breathing. Having previously expressed our desire to keep the baby with us at all times the NICU came to us. They evaluated DD and identified that she was safe to stay with me and they continued to come down and check her until we left the hospital.
Women need to do their research on the provider they select....we ask for referrals for hairdressers,plumbers...why not research an OB or MW? Any provider should be open to dialogue about c-sections, inductions, and other interventions...run if a provider will not provide their statistics. We should be outraged that hospitals think that we are more interested in the features of a birthing suite over the care that we receive. This issue deserves far more attention than it is receiving. I don't know what it is going to take for that to happen but this board is a good start.
Here are the 2010 stats for Illinous C-Sections....I can not find 2011....https://www.theunnecesarean.com/blog/2011/12/4/illinois-cesarean-rates-by-hospital-2010.html
Yeah - I read the 3rd trimester board, and one woman who has already decided she wants meds had her OB call her and tell her to cancel going to the HOSPITAL birthing class - where, in my experience, they go over all the possible intervention options - because he didn't want her to get "talked out of her epi".
Whatever - I get it, some people don't want to feel any pain and/or are scared. But I think going into something like this without even knowing what could happen or what the potential outcomes are just shows either real ignorance or total denial, not sure which. I live in Madison, WI, and I think this happens to a city that is more progressive than most, but I still run into women who are like "shoot me up, I don't even want to remember it." Nice.
What's wrong with not wanting to feel pain? In the throes of transition, all my ideals went out the window and if I hadn't been screaming my head off in a car stuck at a standstill in Manhattan traffic, I might have caved and got drugs. Who knows. And that was for a quick, uncomplicated labor and delivery. Would I do it again? Yes. Do I judge the other side? No way.
The issue is not that most women opt for drugs. The issue is that we need better drugs that still allow freedom of movement. The issue is defensive medicine and outdated hospital policies. The issue is that we shouldn't rush inductions before 42 weeks. The issue is that we overuse Pitocin and continuous fetal monitoring and then create "medical emergencies" that would have otherwise never existed.
But wanting to give birth with minimal discomfort is NOT the issue. The epidural is not an evil invention that we all need to be "educated" against.
Well said. You couldn't be more spot on with that 3rd paragraph.
I totally agree with you--I don't judge anyone who chooses to minimize pain during delivery. But when I say women need to educate themselves, I'm not saying they need education "against" epidurals or anything else, but that clearly many doctors are not following evidence-based practice as you so rightly point out (overuse of Pitocin, outdated policies, defensive medicine...the scary and very true list goes on). How do women know this unless they educate themselves and take a stand for themselves? In an ideal world, the medical community will change. But it's not ideal right now, and my heart breaks for friends of mine who trusted their doctors, chose not to seek more information, and had poor experiences. If they'd trusted themselves, too, and learned more, they might have had better outcomes, or at least felt more confident about the way things went.
It's not women's fault that these things are happening, but we can still be part of the solution. Education is empowering.
Woot! Marking off my Natural Birth board Bingo card: "Mothers themselves the reason for the high c-section rate ".
Tell us, do you think they make crappy mothers, too? I really want to get a BINGO!
DS2 - Oct 2010 (my VBAC baby!)
Hey, guess what? I "trusted myself" and learned/researched/took a shitton of classes when I was pregnant with my first, and I still had a c-section! I did everything I was supposed to, and I still got screwed over by my midwives (who had a very low c/s rate). I was angry about my c-section for the first year after it happened, but now that you mention it, maybe I should have just "tried harder", and I would have been more "confident in my choices" and my crappy outcome.
I was agreeing with you for most of this thread, until that crap you just spouted up there.
For about the one thousandth time, individual women are not to blame for the current maternity care crisis.
Nechie122, very very well said.
DS2 - Oct 2010 (my VBAC baby!)
As I said, I get it if you don't want to feel pain or discomfort - who does? That is not where the perceived "judgement" lies. I guess if you want to say I am judging people, well, I am judging that they are not very intelligent if they fail to ask simple questions about what will be happening to their body as a result of some of their choices.
I think it is ignorant to assume there are no consequences or risks to those decisions, and as has been pointed out, unless you do your own research, no one in the hospital is telling you this as they get paid per procedure AND are under god only knows how many government "guidelines".
If you go into ANY medical situation (other than an emergency, obviously) don't you ask questions about what the possible outcomes could be? For some women, they are comfortable with those, others are not - that is their choice. This thread was sort of blaming medical staff for not educating moms to be, and I was simply pointing out that there are moms to be that don't ask one question about what will be happening to them, and I think part of the responsibility lies with the individual.
Sorry to disappoint you, but you made quite a jump from what I said to "Mothers themselves to blame for high c-section rate". The thread is discussing why medical professionals don't do more to educate women about the options/risks, and I was pointing out that there are people who prefer "blissful ignorance" when it comes to the ways that their own bodies function and the possible outcomes of their decisions. Whether or not they end up having a surgical intervention is not the issue. The fact that I find this type of attitude disgusting is my personal opinion, which I believe I am entitled to.
If you read my post, you would see that it has nothing to do with your situation. I would NEVER suggest that every woman who had a c-section "deserved" it or that it was "her fault"--in fact, I would never suggest that ANY woman who had a c-section was at fault. Crap will still happen and we can still get screwed over--and I do believe that all choices are valid ones (I'm not trying to judge anyone on, say, electing to have a c-section). You did everything you could--and I'm really sorry it ended for you the way it did. I was sharing specific instances in which friends expressly said afterward "I wish I had known more--I didn't realize it would be this way." They didn't realize until it was too late that maternity care is broken--and they are the ones saying "I wish I had known," not me.
But I firmly believe we can help the situation by doing exactly what you did--it won't always end the way we know it should have, but at least we KNOW. Like I said, you don't have to be part of the problem to be part of the solution, and that's where I believe women and maternity care are right now.