Thursday, January 22, 2015

Why I Gave Birth as Far Away from the Hospital as I Could: A Nurse's Perspective

I am so excited that this is the first post of 2015. It is a guest post from a nurse, a former doula client, and a Birth Boot Camp Graduate! I love hearing her perspective about birth, especially as a medical professional. Read about her amazing birth here. More and more doctors, nurses, and midwives who attend women giving birth in hospitals, as well as those who work in different areas, are choosing to give birth outside of a hospital setting. Why is this happening? There is a documentary currently in production entitled Why Not Home? that explores the answers to this question. Follow them on Facebook. 

Why I Gave Birth as Far Away from the Hospital as I Could: A Nurse’s Perspective

Katy Wentworth, BSN, RN, CCRN

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.

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.

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