but those of you who are not directly=20=
>
> involved with actual labor management on a regular basis may not have eve=
> r=20
> had the opportunity to work with someone like the rigid mom I have=20
> described above. Even with absolutely no interventions (except=20
> intermittant monitoring) some of these women are confrontational,scared t=
> o=20
> death (which is usually the case), and more important completely unable t=
> o=20
> relax and let their body do the job it has to do to give birth. For=20
> whatever the reason(s), these women's labors just stop. I think that=20
> sometimes these women have invested so much negative energy in
> worrying=20=
>
> about what they don't want (and how the hospital is going to ruin
> their=20=
>
> birth experience), that they have spent little time educating
> themselves=20=
>
> about how they can help themselves and what the actual physiological birt=
> h=20
> process is about.
I agree that these mothers may find it difficult to relax and let their
bodies give birth, but I'm not sure that it is because they are
unnecessarily rigid. I think that nurses and hcps sometimes forget that just
getting in the car and going to the hospital, going through the admission
process, and changing into a hospital gown are all "interventions" and
stressful for most moms. Being in a strange place with scary-looking
instruments and with nurses who are, after all, complete strangers, is also
highly stressful. (I grew up on a farm, and can tell you for sure that a
very good way to stop or slow down labour in farm animals is to bring a
stranger into the barn!) For some women, being in the hospital may have many
negative connotations (perhaps her mother died in this same hospital a year
previously, or perhaps she remembers having a painful surgery when she was
younger, for example). Or perhaps she has just been treated disrespectfully
and with condescension when she came to the emergency room on a previous
occasion, so sees hospitals as a place where she needs to protect herself.
> We once had a diabetic mother lock herself in her bathroom once so the=20=
>
> nurse could not monitor her (and I am talking intermittant monitoring=20
> only). Here is a confrontational mother putting her own baby at risk.
> If=20=
>
> she didn't want any intervention, she should have stayed home. But of=20
> course, underneath, she knows she is at risk and knows she should be ther=
> e=20
> and is scared, but instead, decides to come in and then refuse things. Ho=
> w=20
> much sense does that make.
I think it is crucially important to keep in mind that this woman is an
adult, and has the right to make decisions that are right for her EVEN IF WE
THINK THEY ARE NOT THE BEST DECISIONS. Perhaps, for her, the stress added by
the process of being monitored would put the baby more at risk than not
having the information provided by the monitoring. Knowing that every
intervention (including intermittent monitoring) adds risk, it would seem
most logical to me that we should be trying to minimize interventions for
mothers who are already at risk. In fact, the opposite seems to happen - the
mother who is even slightly at risk gets more and more interventions.
You also mentioned a mother who chose to have her baby receive sugar water
rather than take a blood sugar test first, and commented "this was far less
optimal." I wonder what the reaction of hospital staff is to mothers who
choose to bottlefeed rather than breastfeed - clearly a less than desirable
choice. Are these mothers seen as unreasonably rigid and not having a clue
about what they are deciding? Or is that choice respected?
I think that people who work in birthing units in hospital see the whole
process in a different way. It is their job, the rooms and halls are
familiar and they find it reassuring to have all that nice medical equipment
close at hand. The other staff people are familiar, too, and they know how
nice and friendly they all are. They are comfortable with their routines.
But that's not at all how it looks to a mother arriving in labour. At a time
when she needs to be listening to her body and feeling safe and supported,
she is instead in a strange place, with scary-looking medical equipment, a
place that smells really weird, with total strangers around her. One way to
protect herself and her baby in this environment may be to try to maintain
some control over what is being done to her. This is reasonable, and we need
to respect this.
Teresa Pitman
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