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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