Sunday, January 10, 2010

Are we advocating for Choices or The Choices we would make?

You are sitting at your favorite in-door play area with your little one, talking to another mother who frequents the spot. She just had a baby and you are super excited to hear about the birth. She begins to tell you that at her 38 week check-up her OB said the baby was measuring big (oh boy, here we go), and so an induction was scheduled. Of course she remarks on how the doctor said it was safe and she was full term, so she agreed. By this time you've kept that smile on your face, but are feeling you could easily continue this story for her. She goes on.

At 6am (why are those things scheduled so damn early in the morning), she arrives at the hospital, does the paperwork, changes into the gown, blood work, yada, yada, yada the doctor comes in at 9am. Wait, why did she have to come in a 6am? Oh well, you keep nodding. The doctor decides because she a multip (she tells you admitting she didn't know what the hell a multip meant, but didn't ask either) and already dilated to 2cm that he would break the water and start a low dose pitocin drip. You nod at her, but your heart drops inside.

So she talks about how as soon as that pitocin was put in she is deep pain. She kept wanting to get up, but the nurse kept telling her no. She says the nurse said the best thing to do was to get the epidural, but she would have to wait until she was 4-5cm. Of course, she thought that was pure torture, but she made it. She got the epidural and everything was copasetic. She tells you how she was playing cards with her husband, chatting on the phone, and it was hard to believe she was actually in labor, because with her first baby, she didn't get the epidural until she was 8cm. Wait, why did she get the epidural at 8cm? Never mind that's a whole different story.

So, by now it's 7pm and she has been stuck at 7cm. You nod, ready for what you've known was coming. Yes, you guessed it. Decels! The doctor tells her that he will give it one more hour. Wow, a whole hour really? And by now your friend is getting really scared. She says she didn't know what to do, but understood that the doctor knew what he talking about and decided to try and relax and pray.

So the prayers worked because in an hour, she became fully dilated. You perk up again, happy to hear that she wasn't sectioned! But wait, baby is hasn't moved down the birth canal. Oh, yeah, she's been laying her back this whole time. So after 2+ hours of pushing it's c-section time because after all, that is a big baby in there.

So you ask. How big was she? When the mother tells you 7lbs 8oz you force a smile and say she is so precious, because, what else can you say?

So you ask your friend how she feels and she says good. She is just happy the baby is healthy, and nothing bad went wrong. She completely understands that those things happen, and that's why she chose to birth in the hospital with a doctor in the first place.

When you re-tell her story to your group of natural birthing advocates, the first thing you say is, How do I tell her that her c-section was unnecessary? And therein lies the conundrum. You don't, because quite frankly, did she ask you? Telling her that is tantamount to telling her that her choices were wrong. She doesn't feel that way and it certainly isn't anyone's place to try and convince her otherwise.

Almost everyday I read something like this from one of my colleagues and associates and I am frustrated on two levels. I am frustrated for the women who got put through a system that doesn't always have the best of interest of her or her child in mind; and I am also frustrated by the advocates that seem to forget that it's not about changing a person's mind. It's about educating women, giving them all the facts so that they can make the best choice for them and on a bigger level it's about bringing change to that system.

I would ask myself if I were the woman listening to the mother's birth story; Did I offer up information, advice, resources to this woman while she was pregnant? Did I talk to her then and really listen to her? If you did, in the end, that's all you can do. It's her choice. If a woman makes a choice to be induced, knowing the dangers of induction, it's still her choice. Just as it the woman who chooses not to be induced, or to have a home birth or an unassisted birth. Are we really advocating for choices, or just the choices we would make?

19 comments:

  1. I think this is the real crux of the issue. To say you are an advocate of choice means you advocate for all women to make their own choice even if it is not the one you would make. We must empathize with where they are comming from in their knowldge base and emotions. We take their choice away when we tell them too late what the other choices were and why they would have benifited them. Most women will look for answeres durring pregnancy but after the birth they need reasurance that they are good mothers making the best decisions they can for their babies. We must support them in this hour of need (not negate their feelings and choices) if we are to gain the respect to educate them durring their next quest for information.

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  2. I think this is a very important issue. I just thought i would add that in this situation the women was not given a choice, not really. She was given incorrect information (inductions are safe beacause she was full term for example). Im not going sit down and tell her she made the wrong choice, but it gives ME a chance to learn. I can not expect a mother to be able to make an IMFORMED choice if she is not getting all the imformation. Pregnancy imformation is the key. We cant 'save/help' everyone, but we can help a few throughout our career.

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  3. I completely agree with you Mixy. That's why in my post I mentioned talking to the woman during pregnancy. In this scenario, the mothers were acquainted during her pregnancy so there may have been some opportunity or maybe not. But you are right, we can't save or help everyone, but we can certainly learn from other women and their experiences.

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  4. All I can say is that I SO feel you. Been right there many times. The title question is so important.

    I think they key thing is, as you said making sure as much information is available and accessible as possible. I know that I feel awful any time a woman feels regret at past choices simply because of her lack of knowledge at the time - but we ALL do the best we can with the information we have at that moment.

    So if that's what the mom did, as I think most moms really do, then there's no reason for regret. Just more informed choices in the future. And that's where we come in!

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  5. great post. very much captures the point. i try very hard not to make individual women feel bad or defensive for their individual choices. the point really is to get the information out there so women can make informed choices even ones we may disagree with. also timing is key. while it may not be horrible to discuss tactfully that the doctor may have provided misleading info...right after birth is prob not the time to do it. a year or two down the road...esp if the mom is considering another pregnancy...perhaps. of course tact is important. i would prob use myself as an example in this case focusing on where the doc mislead me despite the fact that i felt well informed and educated.

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  6. I think what it comes down to is the system. When did having a baby become so complex? Are women really do different than 100 years ago? 200 years ago? The system keeps changing. their rules keep changing. Their policies keep changing, yet women remain the same. traversing the system has become mind boggling...is this intervention safe or risky? Is it true I can't birth a big baby bc a machine predicted its weight to be such and such? I continually keep asking "does this make sense?"

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  7. WOW, is all I can say. I'm learing more and more.

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  8. I so hear where you are coming from with this. When I was apprenticing, we were doing a 1 week postpartum for a gal who had an uneventful home birth (as in, there was nothing to tell, cause everything went great!). Several of her girlfriends were there visiting with their babies and had a lot of questions about home birth. All of them had given birth in the hospital, under the pretty standard protocols.

    One gal in particular piped up and said something about how she had two c-sections because she had a narrow pelvis and her babies wouldn't have fit, according to her doctor. I asked her how big her babies were and she said something like 6lbs something for both of them. I just smiled and nodded, but inside, I was seething. Of course, I didn't know all the facts and she may have been one of the small percentage of women in the world with a truly contracted pelvis, but even then I knew that this woman would have had to have a DEFORMED pelvis to not be able to birth a 6 pound baby.

    What do you do? It's so hard. I don't want to make women feel bad, but at the same time, I want them to be informed. UUGGHHHH...it's often a hard place to be in.

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  9. Ugh!!! Yes, this is the very reason (as well as my own story that went very similar with my 2nd child and why we've UC'd the last 2 and the one about to be born will be UC'd too)that I have became a natural childbirth educator. If we can reach women before they are duped into this situation by these doctors who get paid more to cause problems perhaps we can hear about more gentle births and better recovery. A lot more breastfeeding and a lot less post partum depression too.

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  10. This happens all the time to me since women want share their birth stories with a midwife. I have yet to come up with wording that doesn't make me worry that I'm offending her. The only thing I can think to say these days is, "Well, listen (big gulp), there was a cascade of interventions at your birth, right? You know I'm a midwife, and I have to say that professionally, I am upset when I hear about these typical hospital experiences most women have because most of what they do is truly unnecessary in the normal process of birth. Now, for all I know, you may be happy with your experience, but if you were in any way unhappy with the process and you ever want to talk through it with me to further understand the differences in why the medical model manages it the way they do, and why the midwifery model accepts the birth process a different way, I'd be happy to talk to you about it." Sigh...

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  11. Its hard. If a woman wishes to inform herself it is very easy via the internet. but doing that menas taking responsibility for the outcome, good or bad. If you "do as your told" then someone else is ultimately "responsible" (even if the choice to do so was theirs).

    Not everyone wishes to take control of their own birth and baby. For those women, you just have to hope they meet with humane and caring birth attendants.

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  12. But we should at least TRY to educate people. My best friend is not speaking to me right now, all over the fact that her textbook from decades back, tells her that a fever alone will end in death if you don't regulate it. All parents need to learn about fever and why it occurs. Fever is your friend and to stop it or regulate it when the child is handling it just fine...is just wrong. Yes, febrile seizure do occur in a number of people, but the person will not seize until they die. That is what they believed in the 18th century. We know better now, so why is everyone so terrified of fever? Because they are not educated on this topic, that's why. I don't care who gets mad at me, but pushing my choices is not my agenda, educating is. Keep up the good work, this blog is awesome!

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  13. Obviously the mother in this story was making her "choices" based on incomplete or inaccurate information. This isn't something that should just be accepted. Even if we give information, we can't compete with what the doctor says. The doctor is the "authority." That's why we have to step up our activism. This isn't a matter of personal preferences. It's like breastfeeding and formula. One choice is definitely better than the other.

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  14. I have been in the position of the woman you are describing. A first time mom, extremely scared and very trusting of my OB. Had I been more informed beforehand things might have turned out differently and I wouldn't have had a c-section with my first child. It was my responsibility to research everything. I felt I knew all my options. I chose a great OB who was highly recommended. No one I had talked to had even mentioned a midwife through my entire pregnancy. I had no support from family or friends when it came down to the birth. Dr said baby was going to die if we didn't agree to a c-section. I felt I had no other option. When its your child's life in your hands even the most educated woman looks to her OB to help her make the best decision.

    Was I in the wrong for agreeing to that c-section? I do not feel I was. I was happy that my daughter was alive and healthy, but that wasn't enough to comfort me for what I felt that experience robbed me of. I was afraid to even get pregnant again. I was afraid I would never experience childbirth as mother nature had intended.

    Now, I have personally experienced two totally different births. The c-section with my first, and a HBAC with my second. I tell everyone both stories. I may not change anyone's mind about what they will or won't agree to during birth, but I hope my story has opened their eyes a little more. Open your arms to that woman, and don't judge. She may come to you during her next pregnancy and ask for advice or support.

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  15. I have been in the same position too. If I knew then what I know now I would never have allowed myself to be put in that position. I don't believe my baby would have died if we hadn't had a c section. There was no emergency. It was 6am and my doctor had to get to work. I had been in induced labour for 13 hours and I didn't fit in with their charts. I was not informed of the side effects of a c section and I was not given a choice.

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  16. I have to disagree with the comment about how easy it is for a woman to find the information... um... not so easy. When you are in an area that calls natural childbirth, going without an epidural, the information is not so easily gathered. I'd never heard of the term 'natural child birth' really... I thought, it's birth... it's all the same. I knew I didn't want the interventions (went into labor naturally 2 weeks past dates)... but how was I to know that I was gonna be 'scare tactic'd into things I didn't need. I knew what a doula was & tried to find one... but only one registered doula in the area I was in AND SHE WOULDN'T RESPOND TO MY EMAILS OR THE EMAILS FROM ANOTHER DOULA WHO REFERRED ME TO HER - the other doula was too far away to take me on as a client. So seriously, where was I gonna get the information? Sure, google it... but google only works if you know what you are looking for. Besides, I don't know if you realize how much worthless crap is on the internet, but I don't take anything that has only come from the net as fact... and you think if I'd found the unnessacerean page back then & asked my doc about it he would have backed it up? So, seriously, don't be so quick to judge women because 'the information is easy to access'... no it's not... even if you find it... you still have to find actual real life people you trust to help you sort through what's crap & what's not.

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  17. I'd like to say that this post "hits the nail right on the head." When I read it I could not help but want to cry. I came a crossed it just researching counseling for mothers who have had a previous traumatic birth, and it almost sounds like what I went through. If I knew what I know now about pit, I DO NOT think that I would have just as easily let someone else control it (and me) like I did.
    I of course did not get the epidural and I did not have a C-section, so it is different in that way. I really wanted to have a natural birth (and on top of that I really was afraid of a needle going into my back, not that they cared). So to be brief, it did not go the way I had wanted it to. And what made things worse, is when it felt as though they cared more about getting me on tract and my daughter out (because I was stuck at 9 1/2 cm for about 30 min or so, and not able to move because they would not let me ) and less about what I was feeling and trying to tell them. Why did they have to be so cold and informal? Why did they not say anything when I told them that I felt like I couldn't breathe? And I must tell you that the day and night before I did not sleep at all because of how uncomfortable I was having on and off contractions ( also arriving at 7 in the morning and starting all of that so early did not help). Now that I think about it, so what if I was stuck for a little, maybe my body needed a break. They did not have to up the pit even more and force me to do something that could have happened on its own if they would have let me be for a while. All I can say is that I hope it does not happen again. Because after I had my daughter I can truly say (with a heavy heart) that I did not like her for about 6mths. I loved her YES! But looking at her and holding her at times (then) would bring all that pain and feelings of violation back. Then one day I realized that it was not her fault, she was only trying to be born. After that it was a little better, but I began to hate myself for being so selfish and not thinking of what it might have been like for her and what she herself was going through at the time trying to come into this world. Things are a little better right now I have learned to just deal. I can say that I would NEVER take back having her in my life but just change how she came into it. She truly is the best thing that has ever happened to me. She is going to be 2 years old in Sept. and I cannot wait. I just hope that I can find what it is that I am looking for before the next one comes (because there is a possibility that I am pregnant again and I am scared to death of it happening twice, since I want to have a natural birth). So maybe this time I am able to better handle what might happen and never have to hear (what seems like women all over have been told by either their doctor or someone they are close to) "be happy you and the baby are fine". "You got what you wanted in the end, No epidural." Why is it that it seems as though doctors have become what I like to call "too doctorized" and "less humanized" with their patients? How did we get to this point? Hopefully something will change soon, to where doctors will encourage more women to do natural labor and give them the true facts on things and their options. Maybe they can even take it as far as learning methods of more natural labor so patients can choice which birth they feel is right for them. I just wanted to add that if anyone has information to help me with my anxiety about my situation. If they could please e-mail at lilspyder21@comcast.net and let me know I would greatly appreciate it.

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  18. Hello, I do not agree with the previous commentator - not so simple

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  19. Thanks for writing about this - I think that it is so important to support all birthing women, and respect where we end and where they begin. Beautiful article!

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