Sunday, August 29, 2010

Interventions: Guest Post from Emily Murphy

My pregnancy was more than something that just happened to me. It was a journey--a journey that has led me here today, passionate about birth, at peace with my body, and regrettably, disgusted with our system of maternity care here in America. I began this journey just as any other young, fist-time mother—with the idea that I would deliver my baby in a hospital, under the care of an ob.  Although I was hoping for a natural childbirth, I never thought that I would have to fight for it.  But the more I read about maternity care in America the more horrified I became.  In America, where 28 countries have lower maternal mortality rates and 41 countries have lower infant mortality rates, pregnancy is treated as a life threatening, emergency situation, and because two lives are involved it is doubly dangerous. In America women are wheeled into emergency rooms, whisked off to an LDR, hooked up to every machine imaginable and left waiting in peril until the doctor is able to deliver the baby. The doctor saves the day! Good thing because the mother needed an emergency C-section; her baby was in distress.  But how did baby come to be in distress?

What is so frightening about the use interventions is that one often leads to another, which leads to another, then another, and soon you are traveling that slippery slope to a c-section.  You go into the hospital too early, your labor stalls and they administer pitocin; pitocin causes those super-contractions, making labor more painful for you so you need an epidural; the epidural slows your labor because your uterus relaxes, and more pitocin is administered.  This mega-dose of pitocin causes the baby to go into distress, which is picked up on the fetal monitor and you are wheeled off to the operating room.  So really, in the words of Marsden Wagner, they had to use in intervention to rescue the baby from the intervention. Where in the world does this system make sense?

 Well the answer is obvious—and since in America pregnancy is seen as an illness and the mother as a patient, the doctor is left with the burden of a perfect outcome every time. And how else can a doctor ensure this unless he/she has control of all aspects of birth? Thus, the intervention. Now, although I believe that the c-section and other modern interventions can be incredibly useful as life-saving technologies, I believe that they are grossly overused. In fact, the use of some interventions has become so common that they are actually considered routine procedures (the use of ivs and continuous fetal monitoring, for example).  Some other interventions are not considered routine, but are used so often that many nurses and obs do not know what to do without them.  These include the use of labor inducing drugs such as Cytotec (which, by the way, is not FDA approved for pregnant women), labor enhancing drugs such as pitocin, and the epidural.  And some interventions are actually on their way out because they have been shown to be counterproductive/useless.  Examples of these are the pubic shave and the episiotomy (although many obs still use episiotomies routinely).   All of these procedures are simply that—procedures.  Why does something that is a natural process need a procedure? 

The more I read about interventions and what most interventions lead to (the C-section), the more I realized that I needed to be proactive in how I would achieve my natural childbirth.  I wrote out my birth plan and proudly took it into my next prenatal appointment.  The answers I received from my ob were not what I was hoping for, but at least she was honest. But, I was not yet completely discouraged—that happened when I went on the hospital tour. 

The tour was basically a run down of all hospital procedures: when I was suppose to come in, how I would receive an IV and a monitor, when I could get an epidural, how long my labor was allowed to ‘stall’ before they would administer pitocin and break my bag of waters, what position I was allowed to be in while I pushed, how long I was allowed to push before they would call for a C-section, and did I mention that I was allowed an epidural? It was all too much. 

At almost 30 weeks, I left my ob and sought out the care of a midwife.  With my midwife I did achieve the beautiful natural childbirth I was hoping for.  Would I have had the same natural childbirth had I remained with my ob?  Could I have slipped past all the intervention hurdles the hospital had ready to throw at me? There is no way to tell.  What I do know is that I did not want to give control of my body up to a doctor who, if I was lucky, would have spent a total of 3 hours with me, and that there is no one in this world who is better able to deliver my baby than me.   

Friday, August 20, 2010

Birth Records

A few months ago, I wrote that I wanted to review my birth records with the midwives to better understand what led to my cesarean. Well, today I did it. I went over my chart. Talk about emotional!! I am pretty much a wreck right now. In fact, when I was walking to the car afterward, I managed to lose the parking ticket you need to get out of the lot at Magee. I had to go back inside and get the valet to print me a new stub. (Luckily I had not lost my receipt)

Anyway, I also wrote about this chart reading on my personal blog, but wanted to share some of my thoughts and talk a bit about what was in that record. For one thing, it never said "emergency" or "elective" in reference to my c-section. It was just a bunch of paragraphs with headers like "indications for cesarean."

The first paragraph matched with my memory. It detailed my progression and effacement and stuff. I was happy to see the words "progressing normally" even though I wasn't opening at the prescribed 1cm per hour timeline OBs like to see. Of course, I should expect midwives to know that opening is allowed to take longer than that!

Then, the report began to talk about my son's heart rate and I was both shocked and relieved to see how low it was for how long and what measures they had taken to bring it back up. I learned about all sorts of things such as intrauterine resuscitation, the fact that it was a full 10 minutes from noting a heart rate of 40 BPM until they began operating, and also that they had given me a drug called terbutaline.

I need to read more about this drug, but apparently it slows down contractions. In the end, I asked the midwife about my deep, dark fear. At the center of all my "what-if" fears had been the memory of someone asking me a question: do you want this procedure? It seems as though I must have said yes in the operating room, but of course I didn't want it AT ALL. For months, I agonized over what would have happened if I'd said no.

The midwife today told me that there had not been time to seek written consent for the surgery and what I was remembering was likely the doctor obtaining verbal consent for the procedure. Very different from me having a choice about it!

I feel a lot of closure after having that discussion. I feel, finally, that I really did all I could to avoid surgery and that my midwife did all she could to avoid me having surgery, and even after that, the attending OB did all he could to avoid it, too.

I could spend the next year trying to figure out why my baby's heart rate dipped and he didn't drop, but I no longer feel like I need to do that. Today was a big day.