Thursday, December 13, 2007

Rethinking childbirth

This evening’s screening of “The Business of Being Born” (at 6:30 at the Columbus Public Library) should be worth the trip.

I’m stuck at home alone with the boys tonight so I won’t be there. But I’m eager to see the documentary, with Ricki Lake as executive producer – not because it contains some footage from Lake’s home birth, but because it’s garnering attention as an exposé of the state of maternity care in the U.S. (ABC News Australia called it “The Inconvenient Truth” of Childbirth, according to the film’s Web site, where you can also watch a preview of the film .)

As a preview to tonight’s screening, I interviewed LaGrange doula Kristin Pittman (via e-mail and phone) about her own experiences giving birth to four children and now supporting other women as a doula. Read the interview in today’s Ledger-Enquirer here.

Kristin offers a fascinating look at a range of childbirth experiences through one woman’s eyes. Although she had hoped to have all of her children naturally, her first two births wound up being medicated hospital births (and both led to hospitilizations of the babies within their first week of life), her third child was born naturally in a hospital with an obstetrician and a doula assisting, and her fourth child (now 21 months old) was born in an inflatable pool in her bathroom at home (with the assistance of a midwife).

There wasn’t space in the print edition to include the stories of her first three births, but they are well worth reading. Take a look -- and pass her story along to any mothers-to-be you know so they can think ahead about the sorts of choices they may be faced with in their owns labor and births.

Kristin's first birth story:

My desire from my very first pregnancy was to give birth naturally, with as little intervention as possible. I have always believed that women were perfectly designed to give birth, and our bodies will do just what they need to do if we trust in the process. There are, of course, times when medical intervention is necessary, but it’s my belief that it should not be used routinely, as any intervention into the normal process of labor and birth comes with risk, and can interfere with what the body is naturally doing.

In my first labor at the hospital not all of the staff was supportive of my desire for natural childbirth, and my confidence was quickly undermined. My first nurse’s response, when my husband informed her of my plans, was “Oh, first baby huh?....You’ll see…” I had a
very difficult and slow back labor, with a posterior baby. After many hours of laboring and terrible pain, I started giving in to interventions and pain meds. Every intervention seemed to come with another, and I ultimately delivered my baby girl with the assistance of forceps. She had a pretty rough transition and was not very alert and responsive and was taken immediately to the nursery to be worked on. Right before discharge we found that she was not only very jaundiced, but dehydrated as well. We ended up having to admit her to Children’s Hospital (in Akron, Ohio) the night after we brought her home due to her dehydration and jaundice, where she stayed for 3 nights. I felt confident that Cadence’s troubles were due to the many interventions, drugs and her difficult labor and birth. I also believe that if I had had the proper support, my labor with Cadence may have not been so difficult. If I had had someone who knew (which the nurses did) that my baby was posterior and suggested to me that there were things we could do to facilitate her getting into a better position (and things that we SHOULDN’T do ~ namely break my water ~ which would exacerbate the situation), things MAY have gone very differently. A doula would have been wonderful for me during that labor. At the time, though, I really didn’t know much about doulas.

Her second birth story:

In my labor with my second baby, I was again coping very well at home and actually coping well at the hospital…until my OB arrived. He had been called in (at around 2 in the morning) for another patient, next door to me, who had been slowly laboring all night and suddenly went from 2 cm to complete and baby flew out! Needless to say, he missed the birth. Since he was there, he came into my room to check on me. I had not even been officially admitted yet, because I was still in the “monitoring” stage, seeing if I was progressing, before deciding if they would keep me there or send me home. He decided to check my dilation and as he was checking, he asked the nurse to hand him a “hook.” I knew immediately what he meant ~ the amnihook, to break my water. I said “No!” The nurse started telling him that I hadn’t even been admitted, and that my birth plan said I did not want my water broken, etc. He asked for the hook again, she hesitated, I screamed “NO!” ~ and he proceeded to yell at the nurse, tell her “I’M the doctor!” and go into a tirade about how he “HAD” to break my water because of some scenario (both my husband and I believe he said something about the cord). So as I’m saying no, my nurse reluctantly hands over the hook, doctor breaks my water, and there is meconium. What does the doctor say? “See? That’s why I had to break your water.” (Never mind that he couldn’t have known about the meconium before breaking my water…it was just a convenient excuse after the fact. We will always believe that he was (a) fired up after missing a patient’s birth, and (b) ready to just get my labor moving along and done since he was called there in the middle of the night.) He had scared me to death -- made me think something terrible was wrong and that my baby was going to die. So here I was, traumatized, crying, and a very basic part of my birth plan had been violated. This baby was also posterior, but up until this point the back pain hadn’t been near as bad as it was with baby #1. When my water was broken, however, the pain intensified dramatically.

A few minutes after this incident, my OB came back in the room, sat down next to me, held my hand, and told me something along the lines of “I just want what’s best for you.” And then he said: “Don’t question me in front of the nurses.” I was so traumatized at that point that I was speechless. I once again asked for an epidural because I was so overtaken by the sudden intensity of the pain once my water had been broken, I couldn’t get focused again.

Once again, my posterior baby remained posterior…and maybe if his water had stayed intact, and I had been able to use position changes (if I’d had support from someone to assist me in what to do), he would have been able to turn and have an easier labor and birth. Micah was delivered with the assistance of vacuum, and he aspirated his meconium. It’s possible that he would have aspirated anyway, but I will always wonder if his water being broken before it was time contributed to it. It’s also possible that his difficult birth and his position coming down the birth canal could have contributed to him swallowing and aspirating the meconium. Micah was transferred just hours after his birth to the NICU at Rainbow Babies and Children’s Hospital (in Cleveland, Ohio) due to the meconium aspiration. He required some oxygen that night and observation for the next few days.

Her third birth story (with a doula, this time):

By the time I conceived my third child, I knew I wanted a doula for my next birth. I needed someone who would provide that continuous emotional and physical support, with her trust in the process of normal birth, along with knowledge and experience in natural childbirth. I was more dedicated than ever, after having two newborn babies hospitalized, to doing what was best for my babies (and myself) and doing everything in my power to minimize risk. And I knew I needed someone by my side who could “hold the space” and assist me in following my body’s cues and allowing it and my baby to do the work they were meant to do. As much as I love my husband, and as wonderful as he is during labor and birth (and all other aspects of parenting), it’s a difficult role for a husband to “doula” his wife. Husbands are emotionally invested; it’s difficult for them to see their wives in pain. It’s difficult for them not to worry. They are distracted by the enormity of this huge life event. A doula is there ONLY for the mother. She does not have the distractions of monitoring and medical tasks or an emotional stake in the event. She can remain focused and objective at all times. There is great power in women helping women through childbirth.

So I hired a doula. She made all the difference. She came to my home as soon as I was ready for her to come during my labor. The moment she arrived and placed her hands on my back, I felt a sense of real calm come over me. We labored at home for several more hours, until I decided that I was ready to make the transition to the hospital. Once I got into my room in the hospital, I was able to get in the labor tub and relax for a bit. While in there, I felt lots of pressure and knew my baby was coming down. I did get out of the tub and up onto the bed in a kneeling position to give birth. Hannah came flying out! (Anterior!) She was born less than an hour after I got into my room.

I believe that the difference in Hannah’s labor and birth were due to more knowledge and more support for my plans and wishes. I was free to move the way I wanted and do what felt right, with no tension around me or pressure to have this intervention or that…no timeline. Hannah was able to maneuver into just the right positions for her journey through the birth canal and her birth. Her water remained intact until she started coming out (when I was in the tub). This made a difference in her position and in my level of pain.

After Hannah was born, we had no health issues with her. She had no drugs in her system, and she had a very gentle birth.

Here Kristin discusses some of the positive aspects of home birth AFTER the delivery of her fourth child, Ethan (now 21 months old). See the print edition link above for details of the labor itself):

I was allowed to hold my baby immediately (my husband put him right on my chest) and stare at him and touch him, as my husband exclaimed that it was a boy! There was no one to take him out of my arms and rush him into an isolette under bright lights to “examine” him while I sat empty-handed, longing to hold this life that I had carried inside me for 9 months.

My children were able to see their new baby brother immediately (I had meant for them to see the birth, but at least a couple of them had fallen asleep by the time he was born ~ 11:15 p.m. ~ but we did wake them up right away to come see him), in their own home…They all got to hold him and have pictures taken and then they got to go to sleep in their own beds, with Mommy and Daddy and new baby brother just down the hall.

I was able to climb into my OWN bed with my baby and initiate breastfeeding immediately. I was allowed to wait for my placenta to come in its own time as well, with no tugging on the cord (and no early clamping of the cord). I got to clean up in my own shower and again climb into my own bed, with fresh sheets placed on it by my midwife and her assistant, while Daddy did his own bonding.

My midwife’s assistant made me a sandwich to eat shortly after the birth, while my husband and I relaxed in bed with our newborn. We were given plenty of time alone with our baby. When we had said goodbye to our midwife and her assistant, we settled into our own bed and had a peaceful night of rest, between feedings of course, with no interruptions from strangers. The next few days were so comfortable, being in our own home, our own bed, with our whole family together, and close friends and family visiting here and there.

Another question that didn’t make the print edition:

Do you have a sense, in the work you’ve begun to do as a doula, that more women are beginning to seek out natural childbirth or home birth experiences?

I do believe more women are seeking natural childbirth. At a time when we are seeing our nation’s c-section rate rise each year (preliminary data for 2006 shows a rate of 31.1%, up from 30.3% in 2005), I think more women are looking for ways to not only stay out of the operating room, but to simply bring their babies into the world as safely as possible.

And here Pittman shares her wishes for all women (a nice note to end on):

What I wish for all women is factual information, informed consent, informed refusal, respect for the laboring woman’s wishes, no agendas, no coersion. No more putting mothers and babies at risk in the name of hospital policy dictated by malpractice insurance carriers, as a result of our litigious society. Women deserve options and the freedom to give birth the way nature intended and freedom to listen to their bodies and do what their bodies are telling them to do.

Learn more about the movie and watch a preview here.
Learn more about BirthNetwork – in Columbus or in your area

Other resources:
Childbirth and Postpartum Professional Association
DONA International, a doula association
Childbirth International
Association of Labor Assistants & Childbirth Educators
BirthWorks International

For more information about Kristin Pittman’s doula services go here.

Leave a comment and share lessons learned from your own labor/birth.


April said...

Thanks for your thoughtful interview and blog entry about the movie and the births. I just saw a list of countries rated by the quality of their healthcare systems and the U.S. was #37 on the list, below many developed countries and even some developing countries like Costa Rica. The state of maternity care is certainly a good exhibit A for this huge problem. A friend of mine was just telling me how birth is handled in her native country of Holland. Every woman has her babies at home unless there are exceptional circumstances or complications when she would go to the hospital. Then, the country's health care system provides a nurse who comes to stay with the family for ten days after the baby is delivered, to help with taking care of children, household and be available as support for the new parents. Can you imagine how lovely that would be, especially as first-time parents?

Annie Addington said...

Strange isn't it, that we pour so much money and so many resources into giving women in the U.S. high-intervention hospital births -- only to wind up with worse outcomes for mothers and babies than in many other countries where more effort, and less money, is directed to helping women give birth more naturally. I think we could learn a thing or two from Holland -- and many other countries as well.