Monday, October 29, 2007

Lots of readers, few votes :p

I do encourage all of you to think about your feelings about the way birth is approached in the US, and cast your vote. If you don't see an option that fits your thoughts and feelings, or if you otherwise want to comment, feel free to do so on this post. :o)

10 comments:

Kermit~the~Frog said...

None of your options fit for me. Women should be better educated about their birth choices, but should still have the freedom to choose the birth they desire, even if it's one I feel is fraught with intervention.

Doreen said...

The second option would probably fit you best. You know, the "room for improvement" being better education. :o) It still gives women the choice to have a medically managed birth, the way it is routinely done here. Though I know that even in countries where a midwifery model of care is widely practiced, some women still choose a more medical approach. Though education plays a big role. I think the more women research birth, normal birth, and their options, the more they would move away from intervention. A friend just emailed me a link to a blog about this very topic, and I'm going to blog about it as soon as I find some time to read more.

chicagosapp said...

Women should be better educated about their choices, and obs and nurses should be better educated about what a normal natural birth is. The vast majority of the births they attend are major medical events, due to their own interventions. They should know how to avoid them instead of pushing pitocin and other things to make the birth "go faster" for their own schedule. Some obs are great, just sitting back and letting you go at your own pace. So none of the answers fit my view either. There is vast room for improvement, mainly in the education of the doctors and nurses who attend birth. A major overhaul of that system is definitely necessary.

Doreen said...

L, actually, everything you just described would happen if we moved to a midwifery model of care. Fewer routine interventions, care providers who are willing to be with you throughout much of your labor, and who are trained to handle problems as they arise. The sheer nature of the training and education OBs and nurses receive makes them view birth as a major medical event, an emergency waiting to happen. Midwives, on the other hand, view birth as the natural event it is, and are trained to handle emergencies as they happen (by either transferring to a hospital if the birth takes place at home or the birth center, or calling in an OB should the emergency exceed her scope of practice). And, depending on where you are, generally midwives can still attend a birth even if the woman chooses an epidural for pain relief. Once you get into inductions and the like, however, risks to mother and baby increase significantly, and OBs are generally asked to handle those births. I don't think switching to a midwifery model of care necessarily means that it would limit women's choices. If anything, it would give them more choices, as they would be more educated about their options. Rather than turning OBs into midwives, why not give midwives more freedom to practice, encourage women to see them, and reserve OBs for the times when problems arise (or a woman more or less moves herself into a higher risk category by choosing medical intervention)?

miranda said...

i loved my epidural too much to go straight midwife if i ever have another baby. but i definitely think that there should be a greater emphasis on midwifery for those who don't want the intervention, and that there should be greater acceptance by society and the medical community of this effort...

maybe one reason they don't like it is that midwifery is less expensive? it doesn't put as much $$$ in their pockets?

Doreen said...

Oh Miranda, don't even get me going on that one. Go to my "41" post and check out the links to some of the movies that are coming out. The whole business aspect of birth is a whole post to itself...

Hanna said...

Hey I voted now :p

I really think the majority of our problems would be solved w/ a midwifery-model of care; reserving OB's for high-risk pregnancies.

It would be LOVELY to live in a world where first-time moms were being educated about their bodies, labor, natural relief measures for pain management, etc. I feel sad when I hear a woman who hopes to deliver unmedicated being scoffed at with "Oh, you say that NOW, but you'll be BEGGING for an epidural in transition." Take away her fear and she'll never even think about medication. THAT is what midwives can do for us. NO MORE FEAR!

Doreen said...

Amen, Hanna. It's amazing what an intense and empowering experience giving birth can be. I never realized that until I had my 3rd child. :o)

chicagosapp said...

Thank goodness I was somewhat educated (finally) by the time I had my 3rd. But again, I have to say the medical training system is what needs to change. Even though I knew what I wanted and what to expect, the complications at #3's birth would have necesitated a midwife handing me over to an ob. And if it was almost anyone else, I would have ended up with c-section. Luckily, I picked a good one who even though was worried and wanted to intervene more than he already was, let my body try first (with minimal interventions). OBs need to be educated so that when they do get some complications, they start slowly with intervention rather than take a quick ride to surgery. I think in your view, a midwife would be seen as the ONLY natural alternative and the ob's would be seen as mostly as surgeons (even more than now) and there wouldn't be any middle ground. There needs to be a middle ground for those of us who choose a natural birth but have complications arise during birthing. OBs MUST be taught better about the consequences of intervention.

(this is bringing back fond memories of Kevin's birth, makes me want another!) Love ya Doreen!

Doreen said...

L, I think OBs are perfectly aware of the consequences interventions can have. The reason they use them is not necessarily because they are safe, but because they feel they can "counteract" should something happen (ending in c/s in the worst case scenario). No matter how many classes OBs take on natural, normal birth, in the end, they are still surgeons. All too often, they feel the need to "save" women from birth, and the pain so often associated with it. There are a few good ones, who are willing to be patient, and you were very lucky indeed. The reason why we need a midwifery model of care is to cut the rate of interventions in the first place (making complications less likley). And just because a midwife has to hand over care doesn't necessarily mean the woman will end up with a c/s. Sadly, I think a lot of what happens these days depends on how comfortable OBs feel when it comes to litigation. OBs pay astronomical amounts of money for malpractice insurance. I think one of the reasons they are so quick to use interventions is to cover their butts. Because, hey, if something goes wrong, at least they did everything they could have done. I think most OBs are aware of the fact that they are not practicing evidence based medicine, but don't hesitate to use interventions to protect themselves. And then there's the convenience factor, as well. After all, scheduling inductions and c-sections makes for a nice work day, whereas waiting for natural labor is quite unpredictable. Do I think high risk women should still be able to try for a natural birth? Absolutely. Do I think OBs should be more patient, and more willing to let nature take its course? Absolutely. I guess I just don't see how a midwifery model of care for the majority of women wouldn't provide a "middle ground", as you call it. In fact, I think OBs seeing women successfully being cared for by midwives, and seeing lots of normal, natural births, would make them more likely to intevene less even in high risk scenarios.