In a message dated 2/14/2006 9:51:15 P.M. Eastern Standard Time,
[log in to unmask] writes:
The tough birth plans are the ones that tell all about what the mother
does NOT want. They are often rigid. Those are the ladies (I am sorry to
say) who usually end up not progressing and needing every intervention=20=
that they had hoped to avoid. It's cases lke this that assure me that the=
mind is an extremely powerful thing. The mind can completely stop a labor=
Betsy, you are lucky if your hospital has held itself accountable and has
provided true informed consent and all mothers are able to labor as they desire
with the idea that medications are not normal or part of normal and that they
will interfere on some level with breastfeeding. And I agree, if they are
in a hospital where they will not be expected to use drugs, they may have a
different experience. Though, the scenarios you gave were both about when she
would get her drugs and what type of drugs she would get.them. So, perhaps
there are more medicated births than not.
For the record, this is not about Betsy or her hospital. I think she is
speaking from a place of concern and care for her mothers and their babies. She
is a piece of the experience, she is not in control of the experience, and
she also works within the policies and procedures of her institution. What I
read in Betsy's posts is what I hear all the time from nurses and they are
not trying to be unkind. They are also trained, as are doctors, to be prepared
to expect the worse possible situation and to plan for it and prevent it or
manage it. So, in fact, the beginning of the birth journey a mother will
take starts in the classrooms of nurses and med students. When you put together
the training and education experience with understaffed and law suit fearing
institutions you do not have the ideal place for a healthy birth. When you
define birth outcome in terms of living mother and baby you do not have a
healthy emotional experience of birth. The hard part is having all the
knowledge and skills of how to step in and intervene when necessary and at the same
time viewing birth as normal and stepping out of the way of it. Yes, it must
be hard to do. It would be easier if the entire system supported it.
I want to really comment on is the 'birth plan' as rigid. I had a rigid
birth plan. I don't see it as rigid, I see it as informed and educated
consumerism expecting to receive what I want from the place I am paying to provide it.
However, as I do not enjoy the fight while I labor, with subsequent
children I chose to labor and birth at home and I assure you there is a vast
difference in the experience of 'rigid birth plans' if you are home or hospital.
Actually, at home you don't need the 'rigid' birth plan because those things
are a given. What I am saying is the need for a birth plan should be switched.
All women should enter hospitals expecting minimal intervention and if they
want the iv, the monitor, the drugs, the epidural, the separation, the
formula, the medical model of birth they should have to plan for it! If this was
the case we would not be having this discussion at all because social
engineering would have convinced mothers of their strength and power and abilities.
Instead social engineering has convinced women birth is unbearable and they
should feel it as little as possible and the only safe way to birth is with
the management of their doctor....and it is now ever so much safer to have
your baby at 38 weeks and with a surgical incision so we can be sure all is
well. This is a institutional problem, not a parent problem. Who do we blame?
Certainly not the mothers who are trusting their health care system to
protect them and their baby. Why should they have to work so hard to defend
themselves during a time when they should be able to feel vulnerable and protected
by those around them?
When I use the word normal, I use it to mean "biological norm' as in before
mankind created every intervention there is to further birth along. I
completely respect that biological norms sometimes result in death and injury to
mother or baby or both. As Barbara Wilson-Clay says so often when we have this
very discussion--even in normal bad things happen. When I hear her words
and put them together with the new saying I love....when it doesn't happen as
it should, it should happen as it can I do accept the need for intervention in
some cases. And in the instance there is a true danger to mother or baby, I
expect a deviation from the biological norm. I prefer that the deviation
hold to the goal of returning the baby and the mother to the biological norm
as soon as possible. Think of babies being born by cesarean being skin to
skin immediately unless truly medically impossible. That is a out of the norm
situation being given the chance to regain as much of the normal process as
possible. Good for baby, good for mom. No harm.
As long as we talk about choices women should be allowed to make with the
educated choice being considered the hospital managed labor protocol women are
not being given a choice at all. And, is the hospitals still view birth as
something to be managed and intervened with for all women just in case, we
will see women who are choosing a hospital birth but want the biological norm
experience having to have a rigid birth plan. The truth is, within the system
as it is, there are no true choices and if you find out you want something
else, you either fight hard for it and win, fight hard an lose and enter the
birth already feeling defeated, or you stay home or go to a birth center. It
is the rare experience for a mother to enter a hospital and experience a birth
following the midwifery model as shown by CIMS. As one nurse told me, my
clients are so few as to be statistically insignificant. And she is right.
Breastfeeding is the biological norm for baby and mom. It is supposed to be
part of the uninterrupted flow from uterine life to birth. It is not
something a mother should have to ask for. It is not something she should have to
plan for. Every mother entering a hospital should assume that they will be
assisting her and expecting her to breastfeed. If she is going to choose not
to, she should be responsible for making that choice clear. It should not be
the breastfeeding mothers having to fight for the right to do so, it is the
mother who chooses not to who should have request otherwise. Why is it so
simple to see that breastfeeding is the normal against which all other feedings
methods must be judged, but we don't see that the same is true for birthing?
I understand the training and I understand the thought process for nurses
and physicians is completely different from mine as a consumer and as a support
person during labors and the one who hears the mothers tears afterwards.
You are so right Betsy, the mind is a powerful thing, and if women hear support
and encouragement and the assumption of their ability they will indeed find
themselves capable to birth and feed their babies. However, what they hear
instead is the power of the medication, the ease of the surgery, and the
convenience of the induction. Followed closely behind by the breast is best, but
this is just as good and oh so much easier for you.
I know we are about the breastfeeding, but over the years I have come to see
the intimate intertwining of the two---the birth is the beginning of the
breastfeeding experience and the feelings the woman has about her birth will
indeed spill into her feelings about breastfeeding. And that is not even taking
into consideration the physical implications of altering the birth and how
that alters the breastfeeding experience. Perhaps those women Betsy speaks of
who saw their plans for birth dashed to shreds have lost all confidence in
themselves as women and therefore feel unable to breastfeed either....they
thought they could birth, and they were wrong, so surely they must be wrong about
being able to breastfeed...maybe those powers that be are right and formula
is just as good, after all, they had to depend on them to 'fix' their
birth.....and perhaps that will spill over into other areas and will rob them of
other powers they rightfully should be able to own
Recently I listened to Jan Riordan speak about measuring breastfeeding. I am
sure I took away something different from what she was presenting. One of
the things she was discussing was the research that shows how certain things
affect breastfeeding and how they measured it. Specifically one of the studies
showing duration not affected by epidurals. I listened, and thought,
hmmmm....duration until when? Then I thought, how about how hard mother had to
work to get to the duration? When we say studies show something we may want to
think about what they are not showing. They are not showing those moments
after birth or the days after birth. They are not showing difficulties
achieving duration. Then there is always defining breastfeeding itself. How many
of those babies received even one bottle formula because remember even one
bottle matters.
It is all about what you think and feel about women and birth and
breastfeeding. Either in your deepest soul you see this as normal life event and work
to help it go smoothly with as little artificial support as possible, or you
see it as a medical event to be watched carefully for any deviation from the
task at hand. And, then of course there is anywhere in between. I think
that for me I fall squarely in the camp of the first and expect the latter in
only those situations where medically necessary. And I feel just as strongly
about breastfeeding. It is a normal life event, it should happen unless
medically impossible and when it cannot happen something important has been lost.
Something important to the baby and to the mother.
I have been having babies every few years for 19 years, and I have to say
the first two were born in a much more baby friendly environment then I see
today, and it wasn't that great then. I feel like we were just coming into the
idea of normal being normal and then the rug got yanked out from under us.
Not sure why, not sure exactly what started that trend, but it is here. In
my work now I see very few babies born at term without induction. I would say
the majority are induced at 38 weeks, flip a coin for vaginal birth over
cesarean birth outcome. While I was working as doula (pre my newest baby) I
worked with women who did get normal in the hospital, so I do know it is
possible, but they had to ask for it at every turn and they were also smart enough
to have chosen doctors who also believe in normal. Honestly, that should be
the opposite situation. And that is entirely my point. The system is flawed,
the mothers are not to blame and they should not have to ask for what should
be expected.
Take care,
Pam MazzellaDiBosco, IBCLC, RLC
Florida, USA
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