Who Gets To Decide

For previously disclosed reasons, I've learned a lot about how babies are born in the last few months. It's pretty fascinating, though I'm pretty nervous about witnessing the process myself come January. But there's a lot of controversy these days about labor and delivery.

There's a lot of concern around about how c-sections in the US are becoming more common and how that might be affecting babies and mothers. The effects on the mother are pretty easy to see. It's a surgery with cutting and stitching and removing large objects from the abdominal cavity, and all the risk that entails. There are a few people around talking about how this could be bad for the baby because they don't get the natural squeezing and the effects that has on the physical development of the skull bones and the physiological development of the brain.

The main argument you run into when researching birth methods seems to be that doctors are intervening in childbirth a lot more than they really should and that giving birth in a sterile, cold hospital isn't good for the state of mind of mother or baby.

There's both statistical and antecdotal evidence of this conclusion. It's a cold hard fact that c-sections are on the rise. It's less clear what that actually means, but there's a fair amount of support for the idea that doctors are intervening too often. Even if a c-section doesn't affect the baby, it's still a procedure worth minimizing just because of the effects on the mother. Most of the people advancing the idea that doctors need to be more hands-off are mothers. And they're mothers of multiple children. It's purely my observation, but most of the people I've heard with this point of view are mothers that had a bad hospital birth with their first baby so go to birthing centers or stay at home the next time.

Rachel did an interview with the REBIRTH blogger, who is a labor and delivery nurse. Here are some telling quotes (emphasis mine):

What are your favorite and least favorite things about your work in labor and delivery?

My favorite things… I don’t know if I could narrow it down. I
love the moment a baby emerges. I’m in awe every single time. It’s just

My least favorite thing is seeing how many women have little to
no options in their care. Actually, that pisses me off.

If you could change one thing about modern obstetrics and hospital
delivery, what would it be?

Obviously, that most women would be cared for by midwives. And there
would be no such thing as “active management” of labor.

There are so many things in obstetrics that are not scientifically proven
to be effective, and research shows in some cases such things (interventions) can lead to worse outcomes.

The fact that these women are asking these questions makes me think that
they didn’t agree with what was recommended or done, but didn’t feel equipped to
say no or ask for alternatives.

I just snipped what I needed, but I recommend you read the entire interview.

To be fair to the doctors, it's understandable to want to be overly careful. After all, it is the lives of children we're talking about here. Not to mention their own professional liability and assets in a litigation happy society. But I've heard so many stories about doctors and nurses pressuring mothers and just riding roughshod over their wishes. It's an easy position to take when you're not the one giving birth.

From a dad's point of view, the whole process is about risk and fear. Risk to the baby and risk to the mom. Risk of a doctor doing something unnecessary but with serious consequences, versus risk of a doctor not being there when he's needed. It's also a matter of trust. Do you trust the skill and judgment of your doctor or midwife to not advise something unless it's really necessary? There are a lot of people out there that think most doctors make decisions about what is medically necessary based on personal liability or solely on the baby's health.

So, to drag this from the abstract to the personal, we had a choice to make when The Mrs. turned up pregnant. Who do we want to deliver the baby and look after her until it was born? She was torn between a homebirth, a midwife, and the ob/gyn she's been a patient of for several years. We ended up compromising by using a midwife clinic affiliated with Vanderbilt. So all her natal care would be by a midwife, and the delivery would be by a midwife. But the birth would be at Vanderbilt Medical Center, and there'd be a doctor and a Natal Intensive Care Unit close if we needed it.

We did visit the doctor, since she had history with The Mrs. And it helped us make our decision. The doctor was brusque and hurried and didn't really encourage questions. Understandable since she has a busy practice, but not really what we needed as first time parents.

So you kind of get an idea of the quandary expecting parents are in. As the father to be, there's an extra little mental adjustment because ultimately it's rightfully her decision to make. I've no doubt that I will be consulted, but in the end it is'nt my decision. And that's hard to get used to.

Thanks to Women's Health News and REBIRTH for helping me get better informed.


Anonymous Rachel said...

Hey, thanks - just saw this post. Did you meet with one of the midwives yet? I'm anxious to hear about your experience with them, if you don't mind sharing.

REBIRTH has a great childbirth ed series on her blog you should check out if you haven't.

11:01 AM, September 20, 2007  

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