Saturday, July 30, 2016

Reasons to choose a Natural Labor and Delivery

First off I want to apologize that it has been a week since my last post. Being a mom of two is crazy! This post was also difficult to get right, I rewrote it a number of times. Enjoy!

This post will be all about the things that helped me choose to have a all natural labor and delivery, and all the risks of having a medicated birth. These risks made me want to have a natural birth even more.

There are a ton of benefits to having a natural L&D. Some of them are, a shorter labor, easier and quicker recovery, less chance of tearing, more alertness, and many more. Women’s bodies were made to give birth. Women have been doing it for thousands of years and we didn’t go extinct. For most women being pregnant is not a serious medical condition, and giving birth needs very little medical attention. Pregnancy is normal. Who decided that we needed so much help from obstetricians? Obstetricians are trained surgeons. Why do surgeons need to deliver all the babies that do not need to be pulled out via c-section? Obstetricians are trained for surgery not for normal L&D.

One of the first pictures of me and Rosalie.
During Rosalie’s L&D (Rose's birth story), I was most comfortable when I hung off RJ’s shoulders. When I was laboring with Heather (Heather's birth story) hanging off RJ’s shoulders was the most painful, I preferred leaning over something. Rose and Heather came out in completely different positions, My body could tell me that better than any doctor could. The pain felt during labor and delivery is important. The pain gives the mother signals. I needed to change the position and the shape of my body, so my baby could make its way out easier. I was most comfortable in the best position for my baby. When an epidural is administered all those signals are gone. The position of mom cannot be changed to help the baby come out. The mom’s body will suffer more stress because she cannot feel what’s going on.

I’m baffled that more people do not come to this conclusion. After doing a bit of research it just seemed to make common sense to me. That said, more women who cannot deliver vaginally and need Cesarean sections do exist in our world. For example, women whose hips aren’t wide enough, or moms with serious medical conditions. Women with difficulties during childbirth would have died before c-sections were readily available. Nowadays those women and their babies are saved by science and amazing doctors. Their genes get passed on so more and more women who cannot give birth vaginally exist. This is amazing, I am so happy how far medical science has come. Women who could not become mothers in the past, now have the chance. But it does mean slightly more women need c-sections, but not nearly one third like it is today.  

One of the first pictures of Heather and me. 
If you are a mom who could not give birth to your baby or babies vaginally, you are just as much a mom as anyone who did. You are a mom no matter how your little one came out. You still suffered 9 months of making a baby from scratch in your body too. Just because you didn’t get to shove it down your hoo haa pooping and screaming (both mom and baby) doesn’t mean you’re less of a mom.

About halfway through my pregnancy with Rosalie, I was trying to decide what type of birth I wanted her to have. I found the film, “The Business of Being Born”. After watching it I did tons and tons of research and came to the conclusion that I wanted a drug free, low intervention birth at the hospital. I wanted a birth at the hospital because, we expected nothing would go wrong, but if something did I wanted to be as close as possible to the resources that could save me and my baby.  

“The Business of Being Born” addresses a lot of the issues about the healthcare system here in the U.S. and how unhealthy it is for pregnant mothers. I would definitely recommend watching it if you have not, it is available on Amazon. It is a great start if you have never thought about natural birth before. There are a few issues in the film. One of the bigger issues is it heavily encourages home birth which I don’t think the U.S. is ready for yet. I think this because of certain laws restricting midwives and how they can work. There are two major type of midwives. Certified Nurse Midwives (CNMs) and Certified Professional Midwives (CPMs). CNMs are actually Registered Nurses (RNs) with a specialty in catching babies. They have gone to nursing school and medical school, and are very well trained. CNMs are very very good at what they do and the majority of the midwives shown in the film are CNMs.

The problem is here in Georgia and many other states CNMs must be under the supervision of a obstetrician. They can only practice in a hospital. In New York where the film is set, it is legal for CNMs to practice without the supervision of an obstetrician. Which means they can run their own practice and deliver wherever they want to. The film doesn’t explain this very well, and here is the BIG problem with that.

Certified Professional Midwives (CPMs) can deliver at homes in Georgia. CPMs and CNMs are not comparable in any way. CPMs have very little training. I could become a CPM in the matter of months. In order for me to become a CNM I would need to go to years and years of schooling. CPMs tend to be very holistic, and suggest things like shoving garlic up your hoo haa to prevent transmission of group B strep (insert eye roll here). When it comes to the life of me and my baby I want someone who has been properly trained. Sadly, currently here in Georgia and many other states that is only available at the hospital.

“The Business of Being Born” also misrepresents a few facts. For example at the beginning of the movie they present this fact, “Midwives attend over 70 percent of births in Europe and Japan.” They do not explain the difference between the two types of midwives. In Europe CNMs are the only midwives who exist and attend that 70 percent, the film doesn’t clarify and is somewhat misleading.

Here are a few of the many risks of medicated labor and deliveries.

Epidurals are very common. Epidurals make pushing more difficult. They increase the possibility of forceps or a vacuum being needed to help deliver the baby, and those increase the risk of tearing. Epidurals require you to stay in bed attached to the Electronic Fetal Monitoring (EFM) machines. Being able to move around during labor helps labor be shorter and easier. My labor with Rose was about eight hours long after we got to the hospital. With Heather my labor was 2 hours. For many years it was assumed epidurals increased the risk of c-sections but recent studies have begun to show they might not be directly related.

A risk many people do not think about is Electronic Fetal Monitoring (EFM). EFM watches and records the baby’s heart rate as well as the mother's contractions. It is used because it supposedly helps identify problems in the baby’s oxygen supply. Drop in heart rate sometimes means the baby is not getting enough oxygen. That is when doctors swoop in to intervene. Studies clearly show that being too dependent on the monitor and not the mother can cause unnecessary interventions.

There is direct evidence that Electronic Fetal Monitoring increases the chance of c-section (source ). There are two different types of EFM, continuous, and intermittent. Continuous means that the machines will record continuously. In most hospitals this means staying in bed strapped to the machines. Some hospitals have wireless systems, but they are still quite cumbersome. Intermittent electronic fetal monitoring is when you are strapped to the machines for 15-30 minutes out of every hour. Both continuous and intermittent increase the chance of c-section the same.

There is a better option, it is scientifically proven to actually help mother and baby not cause unnecessary c-sections. It is called Intermittent auscultation. Intermittent auscultation is when a doctor uses a handheld doppler or fetoscope to listen to the baby’s heart rate, during a contraction. While the doctor listens he or she should palpate the mother’s tummy and uterus. This is recommended every 15-30 minutes during the first stages of labor (5-10cms dilated) and every 5-15 minutes during the pushing stage. This is used at home births, and at birthing centers.

In the article I found all my information about fetal monitoring (source, same as above), they mention a study where women were randomly assigned EFM or intermittent auscultation. “Women in the continuous EFM group were 1.7 times more likely to have a Cesarean and were slightly more likely to have a forceps/vacuum delivery when compared to the women in the intermittent auscultation group. Women in the continuous EFM group were also more likely to require pain medication.”

This is the biggest issue in hospitals. Women do not know the risks and they do not know they even have a choice. During my L&D with Rose I had continuous EFM for a while, when labor started to pick up and get more difficult I need to move around. Every 10-15 minutes my nurse would come in and hold the heart rate probe on my belly. I refused to get back into the bed so she came to me. This was probably unofficially intermittent auscultation. Heather’s L&D was similar. In triage I had continuous but we weren’t there long (it’s probably impossible to avoid at least at my hospital). After we were admitted my nurse wanted to hook me back up to the machines. I pretty much refused and said I needed to pee as an excuse. My labor ended up progressing so quickly they never got strapped back on. My nurse ended up holding the heart rate probe in place for the last hour of my L&D. I think that probably qualifies as intermittent auscultation too. She didn’t like that too much but my midwife didn’t care. My midwife knew Heather was coming now, and if something did go wrong I could push her out faster than anyone could prep me for a c-section. Read Heather's entire birth story here.

A while back I read an article about EFM and physicians interpreting the same data differently (I cannot find the article). One set of recordings was shown to two doctors. One thought the mother need a c-section, and the other thought she should continue pushing and possibly need assisted delivery, but both her and the baby would be fine. In actuality the mom delivered a healthy baby vaginally, with no interventions.

Many hospitals still use EFM for liability reasons. When a baby does die or has a complication during L&D it’s very horrible but does happen. The hospital wants to make sure they are not responsible. Having hours and hours of EFM helps them stay safe from lawsuits. Preventing lawsuits is not a good reason to do something. Especially when that something is not healthy for mother and baby. There is no difference no matter what monitoring is used in baby mortality, Apgar scores, or admission to the NICU. Some babies have health complications whether they are monitored one way or another. The problem is there are unnecessary risks associated with the fetal monitoring used most commonly in hospitals. Something is seriously fucked up (excuse me while I go take a deep breath before I lose it on all the heath corporations in this country!)

It is very possible to have a home birth type experience in the hospital. This is one of two posts. The next will contain instructions how to do it for yourself!

Thanks for reading!

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