Saturday, April 28, 2007

The Way We Give Birth, Part IV

I was very unhappy with the last post I made in this "series". I felt that I didn't say what I wanted to say, I didn't conclude it well, and I rambled on in a very boring fashion. I'm going to try to wrap this up now.

One reason I write so much about this topic is that I wanted to do OB/Gyn for so long. Even now that I am sure I don't want to become an OB, I still find myself emotionally vested in this subject. Before med school and even into first and second year, I pictured myself delivering babies and providing health care to women. One fantasy I had entertained involved opening a hospital-affiliated birth center--some kind of hybrid place next door to (or in) a hospital where women could choose from a variety of labor and delivery options while knowing that medical care was only seconds away.

In reality, I think such a place would be ideal for many women. The hospital I am currently at has an excellent L&D staff of nurturing female nurses who coach women through delivery every day, but I think it's lacking in other ways I've previously described. Each room has a birthing ball inside, but I've yet to see a mother use one, because they're hooked up to an IV and a toco and an EFM and/or they have an epidural. The whole attitude around here is very medical, and as far as they're concerned that's the only way.

I'm fully aware that the residents here are expected to do what they are told, regardless of their opinion on the matter. However, I haven't really heard anyone here say anything about it. I think the majority of residents I've worked with have accepted all this as the right way to do things, end of story. I wish they could receive exposure to other ideas instead of just laughing them off as nonsense. I guess most of medicine has that reaction to ICAM practices, including OB.

I did see an ancient birth technique used the other day. The mother had a tiny pelvis and her baby was wedged in tightly. With each push, more scalp came through her vagina, but it was mostly growing caput instead of true crowning. Her pelvis was so narrow that the chief resident couldn't place forceps, and the caput was too severe for a good vacuum seal. Added to all that stress, the baby was having late decels--the strip looked really bad. Even with her strong pushing, the baby wasn't moving.

The nurse had a few tricks to try, however. When grabbing behind the knees didn't work, and grabbing the ankles didn't work, she pulled out a sheet, tied a knot in it, handed the knot to the mother, and they played tug of war. That worked for a while until mom's arms got tired and the rope kept slipping. Lastly, a pair of handles was produced out of the side of the bed, the mother grabbed hold, and finally the baby was born. I think she pushed for an hour and a half. The baby required some medical attention because of his prolonged birth.

My favorite births have been like the one above--where the best of medical techniques and midwifery skills combine. I realize that life isn't perfect, but if I had my say I'd choose a combination of my favorite techniques. I'll probably want an epidural--I'm a WUSS--but I'd like to try other methods of pain control first. I've always wanted to try water birth, or at least laboring in a hot tub, to see if the pain relief is as great as I hear. I want to labor in a pretty room without a television (or at least with it off--it's so irritating to have BET on in the background in between pushes) with my husband and perhaps my mother with me--not a huge crowd of people.

I don't want to wear some hideous hospital gown--I'd rather find some cheap gown or go naked. I don't want to labor flat on my back, and if I can find a hospital that allows longer time before cutting the umbilical cord, that would be nice. I don't want a doctor who pushes pitocin as soon as I hit L&D, or breaks my water at 2 centimeters dilated.

I do want a doctor who comes running the moment my baby has a late decel, as the residents here do. They are extremely attentive when there's a problem. I do want nurses who are as nice and as skilled as the ones here. I have a feeling that when I have babies, I'll need all the help I can get. I do want my baby put on me, skin to skin, so we can bond and breastfeed and what not as soon as it's born.

So there's my "All God's Chillun" solution to my dilemma of the past few weeks: more combination of techniques, more allowance for mother's wishes, more acceptance of "alternate" techniques, more knowledge of what the proper active management of labor actually entails (we're a little overly active here). I'm comforted to hear from accepting midwives like Frectis and accepting OB's like MWWAK--obviously, there's some hope of reconciliation of both worlds.

Can't we all just get along?

Standard disclaimer: I'm not pregnant. You just can't be on L&D and not think about having babies. It's impossible. All the nurses are pregnant; three residents are pregnant; 15-year-old girls are having babies around here every day. But it's just a thought, nothing more. *reassures panicked husband*


other med student on OB said...

we had a stillborn the other day. saddest thing i have ever seen. afterwards the residents were talking about other similiar experiences they had. one told of a women who was in labor/pushing for over 6 hours to deliver her long dead baby. they said they used every technique to avoid cutting her, including the birthing ball and handlebars from the ceiling. they finally successeded. so they do use those things, unfortunatly I've only seen it in the saddest of cases.

frectis said...

Well thank you for the acknowledgement, it is very much appreciated. We need more MWWAKs and I wish I could be one of her ;) We need AT LEAST one of her in every hospital in America.