9.16.2010

Childbirth is a Feminist Issue

Now that I'm in my third trimester, the looming doom of labor and delivery is weighing heavily on my mind. I suppose part of that is simply fear of the unknown. The other part, I'm sure, has to do with our culture's portrayal of childbirth as painful and traumatic. Nobody looks forward to pain and trauma, least of all me.

Also, I have been in Research Overdrive mode. One of my coping methods has been to obsessively seek out and digest as much information about childbirth as possible. This is both good and bad. Mostly good. I try to be as informed a consumer as I can about most things.

Going into this whole pregnancy ordeal, I blindly had faith in my doctor's and the hospital's obstetrical competence and the sincere belief that they would both be doing everything in my, and the baby's, best interest when it came time for labor and delivery.

Then, when at a mere 20 weeks, my doctor casually mentioned that I may need to be induced due to a "big baby", my first red flag popped up. A tiny, but nagging, red flag. Up until that point, I hadn't done a whole lot of research and had been mostly convinced by mainstream media articles that becoming pregnant while I was overweight made me a "bad mother". My child isn't even out of the womb and already I'm a bad mother for not being in peak physical condition before conceiving!

This, of course, only made me feel guilty and insecure, and even though my doctor never once brought up my pre-pregnancy weight in any context - negatively or positively, I was feeling judged and ashamed.

But, when appointment after appointment, everything with me and the baby came back perfectly healthy in every way, I started to think 'Fuck That!' to those who use horror stories and scare tactics to shame large women. And that's when I began getting serious about becoming better informed.

I learned, among other things, that induction leads to a c-section the majority of the time. I also learned that the majority of inductions are not necessary. I learned that fetal weight estimates are just that, estimates, and they are notoriously inaccurate.

Daniel and I watched the documentary "The Business of Being Born" with eyes wide open. This is a great film produced by Ricki Lake and I highly recommend it to anyone - even those who are not pregnant or even never intend to get pregnant. It's just a really interesting look at our obstetrical healthcare system.

In 1965, the c-section rate in the U.S. was 4.5% of all births. As of 2007, it's risen to 31.8%. A lot of this insane increase has to do with unnecessary interventions during labor and delivery. I would say the rise in unnecessary interventions is three-fold: 1.) hospital profit (and that's a big one!) 2.) our overly litigious culture, and 3.) women's general lack of confidence in their ability to give birth.

Obviously, there are some instances where interventions are absolutely necessary life-saving measures and thank god we have them for those instances! But those cases are a lot fewer than we might think.

Doula what?

Pretty early on, I knew that hiring a doula would be a good idea. I had only ever heard of a doula about 4 years ago when the pregnant wife of one of my co-workers was talking about her labor and delivery preparations, her desire for an unmedicated birth and the role her doula would play. For the record, at the time, I thought she was NUTS to be preparing for a "natural" childbirth!

So, what's a doula? To oversimplify, she is a trained and experienced labor coach and advocate. She is knowledgeable and informed about all possible interventions and makes sure you know the pros and cons of them before giving consent. She guides you in developing a birth plan and makes sure it is followed by your practitioner. Perhaps most importantly, a doula provides continuous one-on-one labor and delivery support, guiding you through pain management techniques and just generally making sure you (and your partner) are comfortable. She brings confidence, peace-of-mind, and reassurance to the table.

After a slew of emails and interviews, Daniel and I decided to go with Dee. Dee the Doula. She spent an hour at our house (which flew by), and when she left, I immediately felt more calm and happy about labor and delivery, and my pregnancy in general, than I had felt up to that point. We hired her the next day.

Meanwhile, my doctor visits have been raising more red flags, and my trust and faith in my doctor and the hospital to allow and encourage an unmedicated, no intervention birth, has been waning daily. So, we are looking into perhaps switching care givers, from my doctor to a midwife. Tomorrow we have a consultation with the Midwives at Vanderbilt. I know this may sound kind of nutty, but midwifery isn't just a childbirth practice belonging to the Middle Ages.

For low-risk pregnancies (That would be Me! So fuck off fatty-haters!), midwifery is a safe, healthy childbirth choice that encourages and facilitates unmedicated, low intervention labor and deliveries. Also, while many midwives will do home births, the Vanderbilt Midwives only birth at the Vanderbilt hospital. This actually comforts me because if something were to go wrong and I needed a skilled surgeon at the last minute, one would be immediately available. I'm not brave enough or confident enough to attempt a home birth! So, we'll see how the consultation goes tomorrow afternoon. Fortunately, Dee assured us that she was comfortable and confident working with either care giver (although she did have a high opinion of the Vandy Midwives).

My point is, and I do have a point amidst this rambling post, is that I've done almost a complete 180 in my views of pregnancy and childbirth since first seeing that blue line on the pee stick. A LOT of women, especially women of size, are too often railroaded when it comes to childbirth. We are fearful and uncertain about our ability to give birth, we are underinformed about the drawbacks to many of the "routine" interventions, and we allow the system to bully us into, what are for many women, negative and traumatic birth experiences leading to post-partum depression, lactation issues, and a sense of failure.

Of course, having absolutely no experience with birthing a child, you may be thinking I'm talking out of my ass.

I'm aware that there are women who have been perfectly happy with the hospital care they received - c-section or not. I also realize things don't always go as planned, which is why I want to do everything possible to make sure we get the birth experience we want. As Daniel says, we're just removing obstacles - whatever happens, happens.

Remember my co-worker's wife who wanted the unmedicated, no intervention birth? She had the doula, she and her husband had taken natural childbirth classes, but their care giver was an OB at a large, prominent, for-profit hospital. After 30 hours of labor, it was recommended to them that she be induced with the synthetic hormone pitocin to speed up the process. At that point, the baby was NOT in any distress. The mother was tired, but not in unmanageable pain (they used hynotic pain management techniques). They trusted their doctor. The pitocin drip caused distress in both the mother and the baby, and an emergency c-section was necessary for a safe delivery, much to the tearful disappointment of the parents.

Was the intervention unnecessary? Possibly. My grandmother labored for 72 hours before giving birth to a 9lb.- 2oz. baby, and while that's not an ideal situation, I would take it over major surgery any day.

12 comments:

Jackie said...

This is an incredible post and absolutely in line with ALL of my hypothetical, if-I-have-a-baby-sometime musings. You go, Cathryn! I hope your labor & delivery is everything you hope for it. I am rooting for you!

cathryn said...

Thanks Jackie! :) And seriously, if you haven't seen The Business of Being Born, check it out. I'm also waiting for my copy of the book Pushed to arrive. A couple of the doulas I talked to highly recommended it.

mom said...

I think it's great that you and Daniel have done your research and are getting as prepared as possible. Sounds like you have all the bases covered. It should be a very cool experience for all three of you.

HeyBetty!! said...

birth is absolutely a feminist thing! Glad you've come to realize it and are marching at the head of the charge!!

Mars Girl said...

Cathryn, if it's any reassurance, my friend Sarah had a doula and midwife for BOTH her children and she had them both naturally without meds. I thought she was kind of a hippy nut when she first told me about it, but after her second baby, and then talking to her this summer, I'm convinced I'd go that way too if I ever had kids. Would you like her email address to ask her questions about the birthing process? I think she's really honest and positive. She actually made me think that while painful, it's not a horrible process. I think our society uses too much pain reduction medication when it's really not necessary. You're SUPPOSED to feel the pain of childbirth to know when to push! (From what I understand the pain only comes in waves.) I've never been a fan of any pain meds... whenever I've been prescribed narcotics for pain, I rarely take them because I dont like how they make me feel.

Anonymous said...

Hi Cathryn,

Glad to see you're thinking ahead. I was one of those women induced for a big baby. Turned out okay (ie no surgery, no long-term damage), but I don't think I'd want to be induced next time. I'd have pushed harder (get the pun?)to wait one more week, if they hadn't estimated an 8 lb., 14 oz. baby (plus or minus a pound -- and he ended up being 8 lbs.). It was the fear of pushing the big guy out of me that led to our induction decision. We can talk more sometime . . . unless you have heard too many stories already. Hang in there!

Janelle

cathryn said...

mom - I think the more we know, the more my fears and uncertainties dissipate and my confidence in our ability to give informed consent increases. Which makes me more calm and relaxed :)

boty - Yeah - I just didn't realize how "corporate" childbirth has become. It's kinda scary.

MG - That's awesome! Sarah is my heroine :) And yeah, if she wouldn't mind sharing her birth stories with a complete stranger, I'd love to email her!

Janelle - I can never hear too many stories! :) While the fear of birthing an 8 lb. 14 oz. baby is a compelling reason to go for induction, knowing that the women in my family have routinely and successfully given birth to "big babies", makes me less intimidated. But we'll see how it plays out :) I'm so suspicious of fetal weight estimates. lol

Rachel said...

I had two births. My first-born, a son, was induced because he was 10 days past the estimated due date. My daughter came early. If I could do it over again, I would not be induced. In my experience, the labor pains were so much more intense from the induced birth and they were unbearable when I was only about 3 or 4 centimeters dilated whereas with my daughter they didn't reach that point until I was about 7 centimeters dilated. Plus with my son, we got an infection and had to have antibiotics and I think that is becuase after I was induced they had to break my water.

cathryn said...

Rachel - I've read that labor pains from induction are often much more intense. Interventions, whether necessary or unnecessary hold higher risks of complications like infection - at least that's what I've read :) Thanks for sharing your story!

Alison said...

Last Thursday I visited the Birthingway College of Midwifery in Portland, Oregon. The organization I work for gave them some money to digitize some of their original thesis projects. Anyway... if you could see this place, I think you would be even more confident about your decision. Midwives are very well-educated people.

I think Heidi's friend Sarah told me her birth story the very first time I met her :) She's a west coast hippy nut of the nicest variety.

Donna said...

Hi there, finally catching up on the blog. I'm definitely not at the baby stage yet, but after having my stomach surgically opened this summer and having to go through all of the healing, I think you're making a wise choice. I'm no wuss when it comes to pain (remember shopping the day of my emergency appendectomy?), but that abdominal incisions are no fun, so if you can avoid the c-section and do things on your own terms, I'm all for it!

Aimee said...

Hi Cathryn! I'm the "very preggo friend in Illinois" my buddy Squatlo mentioned in your Eviction Notice post (hilarious, btw!) After reading this post, I had to comment because I so completely agree with everything you've written. I'm pregnant w/ my 2nd and was very much pro-natural child birth w/ my first 3.5 years ago. I was 6 days late, had gestational diabetes, and delivered a 9 lb 6.7 oz boy naturally. The only intervention I had was a half dose of Stadol b/c after 21 hours of labor and 3 hours after my water broke, i still wasn't completely dilated. No pitocin, no water breaking, no epidural, and it was not easy fighting off the "recommendations" despite the fact my OB new our wishes.

As a result, we searched around for a new OB after discovering I was pregnant, which is an ordeal in and of itself because docs take the "if we accept you as a patient" approach, as opposed to the allowing the patient to determine if we accept the principles/philosophies of the doctor. However, we did find one we very much like and is very supportive of our preferences...though they all find a way to cover their butts "if the baby or mother is at risk".

I watched Business of Being Born at the beginning of this pregnancy and wow, what an eye opener. Sadly, midwifery is practically illegal in IL, and they can only operate under an OB, and the only ones close to my area work out of a hospital at which I wouldn't have a thorn removed from my finger, let alone give birth. So, that was out, though I totally support the option and wish the "system" would get its head out of its arse and worry about something more than the bottom line.

All of this to say, in summary, GO YOU! and your family!! I hope you had a wonderful birth experience, and sincerely hope your little guy got out in a timely fashion. ;) I'll check back later for an update. All the best...Aimee