Why I Gave Birth as
Far Away from the Hospital as I Could: A Nurse’s Perspective
Katy Wentworth, BSN,
RN, CCRN
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| Photo shared with permission |
In
American culture, modern medicine is king. We put complete trust in our
physicians and nurses because of course, those of us in the medical profession
have sworn to “do no harm.” Thus, it stands to reason that with all of the
education, money, and resources being poured into the medical field in our
country, that hospitals are naturally a safe place to be. We should be able to
assume that all patients are always in good hands. Of course, this assumption
is applied to maternal/fetal care without question in our culture. We assume
that hospitals are THE safest place to give birth, both for mother and for
baby. However, as both a nurse and a proud mother, I assert that hospitals are
in fact the worst place for a healthy pregnancy. Between high infection rates, the
high likelihood of unnecessary intervention and subsequent complications, the lack
of mother-baby bonding time, a loss of autonomy, the frequency of sentinel
events, and other hospital-specific problems, healthy mothers carrying healthy
babies should stay as far away from hospitals as possible for birth.
In
order to explain why hospitals so frequently apply some sort of unnecessary
medical intervention to a laboring mother, I need to describe the mentality of
those of us who have worked in the hospital for all of our professional
careers. Nurses and doctors want to fix things. This is why we went to school.
We enjoy taking sick people and making them better. In fact, this is why I
specifically chose to work in critical care. I enjoy being able to work with my
hands to cure people of illness. Naturally, as birth began to move into the
hospital setting in the 20th century, hospital workers applied this
desire to fix things to the process of labor. After all, we had to do something with all of this education. We
assumed that we could take a natural process like labor and actually improve
it! The uterus contracts by itself? We can make it contract faster, harder, and
longer! A woman’s body may naturally tear to allow the baby’s head to pass
through the birth canal? We can make a large surgical incision instead! The
doctor doesn’t have time to watch a laboring woman all day? We invented
continuous fetal monitoring, where an entire labor can be watched, contraction
by contraction, on a screen outside of the patient’s room! These interventions
have become the standard of care for the birth process in the hospital and are
accepted in our culture as “the way things are.” In fact, “In the United States...
- 30.2% of all babies are born via
cesarean surgery
- 41% of mothers get induced.
- 76% of mothers have epidurals.
- 94% of mothers have electronic fetal
heart monitoring.
- 85% of mothers are connected to an IV line during labor
- 25% of mothers have an episiotomy."
The figures for U.S. birth statistics above are taken from the Childbirth Connections' Listening to Mothers Survey II
conducted in collaboration with the Harris Group. Center for Disease Control,
2005 preliminary data
These statistics show that medical intervention has become accepted as
normal in the American culture. But what is wrong with this? The problem lies
in the fact that labor itself is what we call a “positive feedback loop.” This
means that it is a natural process that feeds on itself to become more and more
intense until it eventually resolves itself (through the birth of a baby in
this case). A positive feedback loop needs no assistance or intervention; it is
the body’s own process and, if allowed to continue naturally, will effectively
result in its own resolution (i.e. labor results in birth). Labor is in fact
only one of many examples of a positive feedback loop in the human body, but
the idea is simple: do not interfere with this already-perfected process. In
the medical field, however, we have a hard time sitting on our hands. Like I
said, we are “fixers.” So, we invented Pitocin to intensify contractions.
Unfortunately, these artificial contractions often result in decreased oxygen
for baby, which causes fetal distress, necessitating emergency C-sections. We
invented epidurals for pain relief, which subsequently slow the labor process,
again resulting in fetal distress, necessitating C-sections. We apply
continuous monitoring to laboring mothers, which confines them to bed, which
slows down labor, resulting in fetal distress, which again can require a
C-section. The irony is evident: our technology, although intellectually
impressive, when applied to an already-perfect process, becomes a curse. Pardon
the slang, but as the old saying goes, “If it aint’ broke, don’t fix it.”
So, in order to avoid all of these interventions and complications, a
mother can just refuse certain treatment, right? Honestly, it’s not that simple
in the hospital setting. Becoming a “patient” inherently puts a person into a
somewhat powerless role. Nurses and doctors take care of the patient,
administering tests, monitoring, and medication as deemed necessary, in order
to make the patient better. If the patient refuses something that is seen as
necessary for their care, hospital staff will try to either find ways around
the patient’s refusal or try to convince the patient to change his or her mind,
for their own good. The same holds true in Labor and Delivery. I hate to be brutally honest, but as
healthcare professionals, we truly do believe that we know best…always, and in
all things. While we may know best sometimes, as discussed earlier, we clearly
are not smarter than the body’s own naturally-occurring systems and regardless
of what we think we know, we simply do not have the right to exert our will
over the patient’s. Sadly, however, women who walk into the hospital in labor
do not know their rights as a patient. They freely submit to the will of their
physician and sign away their autonomy. Thus, they become at risk of
unnecessary medical intervention. Women
are told how to labor, when and for how long to push, when they can hold their
babies, even when they can breastfeed! Of course, this is all for the good of
mother and baby…so we believe. This is the problem with hospital birth: the
mother fails to feel any sense of control in her labor process; she is told
what to do and thus, has absolutely no sense of empowerment in her birth (a
time, by the way, which should be the absolute pinnacle of pride in a woman’s
life). When a woman’s autonomy in birth is lost, she is robbed of the richest,
most gratifying experience that I believe a woman can enjoy. In fact, a mother’s
perception of her birth and the way in which she is “allowed” to birth affects
her and baby even after labor is over.
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| Babywearing Shared with permission |
The first moments after birth are a critical time for both mother and
baby. Naturally, a baby needs to feel close to its mother; they have been
literally connected for nine months, and upon being born, a baby needs to feel
the warmth and security of its mother’s skin. Even hospitals are starting to
admit this as truth. Many advertise that they encourage early “skin to skin”
but this essential bonding time looks very different than what you might expect
during hospital births. In the hospital, several things take place in the
moments immediately following the birth of a baby: the baby is stimulated to
breathe, the umbilical cord is clamped and cut, the baby is thoroughly
assessed, often away from the mother, and finally after being assessed, the
baby is wiped down, diapered, swaddled and given a tiny knit hat before being
handed back to mom (after mom receives sutures if needed for tearing or
following an episiotomy). All of this activity can interfere with both
mother/baby bonding and even with early breastfeeding, as “skin to skin”
encourages a baby to take interest in the breast. Honestly, despite the fact
that all of these things can be delayed or done without interfering with
bonding time (i.e. assessing the baby while baby is held in its mother’s arms),
we as nurses and doctors prefer to do it our way for the sake of convenience
and routine. We get set in our ways and become convinced that doing things
differently would be an unacceptable inconvenience. In this, we prioritize our
needs over the needs of the mother and baby.
Another downfall of this interruption of bonding time is that it can
actually cause harm to the baby. An often not-realized fact is that this is why
hospitals have a “transitional nursery” even for healthy, vaginally-birthed
babies. In this nursery, babies are bathed immediately, vital signs are taken,
and blood sugar is monitored. The most commonly treated issues in this nursery
are low blood sugars and low body temperatures in the newborns. Of course, this
is an expected outcome when a baby is rushed off to take a bath and spend time
away from mom instead of being snuggled up at the breast, eating. The fact is
that when a baby is handed right to the mother upon delivery, and is kept warm
and encouraged to breastfeed, the baby will not suffer from low temperatures
and low blood sugars. This is a hospital-specific problem. Again, this is an
example of interventions doing harm. It is an example of interventions
necessitating further intervention. Once the natural process of labor, birth,
and bonding is interrupted, it is a slippery slope into the realm of actual patient
harm.
Reading this, you may think that I must hate hospitals. This is certainly
not the case. As a nurse, the hospital is my livelihood. Without the hospital,
I wouldn’t have a job. I do, however, hate what we in the hospitals have done
to maternity care in the US. Even if you overlook the overwhelming infection
rates in the hospitals (the CDC estimates that 99,000 deaths occur each year as a direct result of hospital-acquired infection and the sentinel events that occur in
relation to maternal/fetal care (i.e. the case of two babies being accidentallyswapped at a Fort Bend hospital last year), you are still left with the fact that
hospitals take away the beauty of natural birth. While I do believe that
hospitals are absolutely wonderful for those who are ill, we have to remember
that pregnancy is not an illness. A woman enjoying an uncomplicated pregnancy
is not sick and does not require a hospital. She simply needs a safe and supporting
environment that allows her body to do what it was made to do. This is why I
chose to birth outside the hospital and why I hope that I’ll never need to
deliver in a hospital for any of my future pregnancies. This is why at 28
weeks, I broke up with my OBGYN and sought out the care of a midwife. This is
why I encourage any healthy mothers with healthy babies to stay as far away
from the hospital as possible.