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- Using the Hospital as a Safety Net

Last Updated: 9/24/2012

Teaching childbirth education gives me the opportunity to work with many couples planning a hospital birth.  Almost all of these couples are first time parents.  Most of them want to have a natural birth, mostly for the safety/health of their baby and secondarily for the aspect of the empowering experience.  Almost universally when I ask why they have not considered a homebirth, they will say, "I just don't feel comfortable for my first one, JUST IN CASE something were to go wrong, I like the security of being close to medical assistance.  THIS TIME we'll use the birth center or the hospital and if everything goes okay, THEN NEXT TIME I'll stay home to birth."  Next I will ask, "Well, what IF?  what COULD go wrong?" The biggest worry is that the mother won't know if something is wrong and the baby will die.  She expects that the hospital staff WILL know and will intervene to stop that from happening.  The hospital has the equipment to monitor the baby with electronic fetal monitoring to see how the baby is doing.  The problem with that is using that technology doesn't produce the results of improved outcomes for mothers/babies.  It DOES, however, increase the likelihood of a surgical birth.  

Most of the time, if there is a problem near the end of pregnancy or during labor, the mother will know.  She will have a sense of impending doom and a nagging feeling of being unwell that she cannot shake.  Mothers who have experienced stillbirth will say, "I knew something was wrong, I knew he was slowing down and wasn't moving much BUT I TOLD MYSELF I WAS JUST BEING SILLY, I WAS WORRYING ABOUT NOTHING."  Instead of listening to her own intuition, she will squelch it and try to assure herself there is nothing to worry about.  She may call her doctor or midwife and say the same, and be reassured that babies slow down when they begin to run out of room.  In reality they don't slow down in frequency of movement, but the characteristics of their movements will change.  Where there may have been lots of swift kicks and punches it may change to rolls and stretches.  I encourage a woman to listen to her own intuition.  If she feels like something is wrong, then keep making noise until she is heard.  Likewise, if she feels nothing is wrong, then don't allow herself to be bullied into testing or other unwanted procedures just because of dates or provider nervousness.  Liability may be a reason for a provider to insist on a test/intervention, but it is NOT a reason for a mother to agree to one.

If you are told, "You cannot keep laboring like this because your baby is going to get in trouble, we have to pre-empt that and get him out now." that MAY be true, but it also may NOT be true.  Just because it is a long labor does not mean the baby will not tolerate it.  If he's tolerating it now, you have every reason to believe he will continue to tolerate it. Having a labor continue for 2-3 days (or even longer) is not dangerous as long as both mother & baby are tolerating it well.  If mom is able to continue receiving nourishment and rest, and baby does well by continued movements and reassuring heart rate patterns then that mother is well within reason to continue until something changes or her baby is born.  Time alone does not increase your risk.

If your water has broken but your contractions have not started, there is nothing ominous about the 24hour mark. "At term, 50% of pregnancies complicated by PROM will go into labor spontaneously within 12 hours, 70% within 24 hours, 85% within 48 hours, and 95% within 72 hours in the absence of obstetric intervention."  As long as you allow nothing in the vagina (no VEs, no sexual activity, no douching, no IEFM) there is no increased risk of infection.  Your risk of infection begins when you allow something to breach that barrier. You can safely monitor yourself for signs of infection and for continued reassuring fhts and baby movement.   

As long as both mother and baby are doing well and tolerating the wait, and as long as you do not put yourself at risk of infection by allowing anything into your vagina, it shouldn't be a race against the clock.  You are well within reason to wait until one of those things changes.  A healthy mother and a healthy baby will tolerate a wait.  You are a reasonable person to insist that your provider tell you what the risks are to waiting it out, and to ask to see any research that is cited.  If you are told studies show....XYZ.....your provider should be willing to tell you WHAT study, or WHAT reference he is relying on.  If he says "liability"  then you know it is NOT about you/your baby.  You can draw your own conclusions what it IS about.

If you were a circus tight rope performer who was putting your faith in the safety net 

while practicing that would be understandable.  If you fall, the net catches you, you can get up and try again.  The ability to stay on the tight rope depends upon your strength, agility, skill and probably part chance.  If you practice enough, you will probably develop adequate skill that will keep you from falling.  But...WHAT IF...WHAT IF your safety net had a large hole in the bottom of it?  WHAT IF when you fall into it, you roll right to the bottom and fall out of that hole?  So you are using this net, and you know it has a hole in it...but some people are able to catch themselves on the edges and NOT fall through the hole.  SOME people do just fine if they fall "just-so".  Yet, you feel better using that net, even though it is damaged and doesn't work all the time.  IS THAT then a RELIABLE safety net?  NO!  It isn't.  If you are counting on that safety net, then your confidence is in something that is not worthy of it.

The FACTS are that MORE than one out of three women will have a surgical birth by entering a hospital for her birth.  Some hospitals may have a slightly less chance but many have an even greater one.  Whether you have an interventive or surgical birth has as much to do with the place of birth and the provider you have chosen to attend you as it does anything to do with the mother/baby.  The probable need versus the reality of what actually happens doesn't match up.  You have a greater risk of infection, of every other intervention and the slippery slope that a good many mothers wind up sliding to the bottom of.  Hospital birth is risky. The hospital is NOT a safety net for a normal birth.  You might be one who walks out with a satisfying experience.  However, considering that up to 6% of women that experience a vaginal birth come away with PTSD.  The numbers are even greater for those with cesareans.

Homebirth an Annotated Guide to the Literature.  The literature speaks for itself, the results are in.  Homebirth is as safe, or even safer for the average low risk woman.

A new Cochrane review was published recently (Sept 19, 2012) that states "Observational studies of increasingly better quality and in different settings suggest that planned home birth in many places can be as safe as planned hospital birth and with less intervention and fewer complications."   

So the results are IN...why do we keep studying this and arguing this?  Why don't we instead, study WHY is it so stinking hard for a woman to GET/HAVE a natural, unhindered birth in a HOSPITAL??  Why aren't women's wishes honored?  When a woman says she doesn't want an episiotomy or immediate cord clamping, why do many OBs ignore them?  Why do they PUSH epidurals and other pain meds?  Why do they disallow water births?  Why do some OBs refuse to go into the birth centers for their patients.  For that matter why do we call the woman a "patient" when she is not even SICK?

It turns out that most people do not even NEED a safety net for their birth.  One expert, Marsden Wagner, former director of women's and children's health for  the WHO  stated in the Business of Being Born, "If you really want a humanized birth, the best thing to do is get the hell out of the hospital."  

You may FEEL more safe by going to a hospital to birth your child, but in the absence of medical need, if your feelings are based on a farce, why are you just listening to nay-sayers?  Please, do your own research and soul-searching and NEVERMIND THEM!

Additional Resources:  

Thinking Woman's Guide to a Better Birth, Henci Goer,

Electronic Fetal Monitoring is not necessary for low risk labors BMJ.pdf

Grant A, O'Brien N, Joy MT, Hennessy E, MacDonald D. Cerebral palsy among children born during the Dublin randomised trial of intrapartum monitoring. Lancet 1989;8674:12336

http://midwifethinking.com/2010/09/10/pre-labour-rupture-of-membranes-impatience-and-risk/

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