Sunday, October 28, 2007

What I've been Doing instead of Blogging

I’m sorry for the lack of posting. Every day I get up and turn on my computer and think, ‘I should really blog about something today.’ And then I stare blankly at the wall and think nothing at all. And then life sort of happens for the rest of the day.

I’ve been slowly reflecting on my hospital stay, in a vague way. For instance, it occurred to me after coming home, that the reason I was in such a rotten mood leading up to labor and delivery was not because of all the wretched hormones, but rather because I was really honestly and truly afraid of the experience I was facing. The first baby, of course, represents the unknown, and one has every right to be nervous and afraid of that which one knows not. But I was surprised to be experiencing fear in advance of this fourth time. But really, its more justifiable, I think, to be afraid of that which one knows. I was dreading, terribly, the machines, those bands around one’s tummy to monitor the baby, the weird and uncomfortable bed, the blood pressure machine. All of it combines to set you in a twilight of space, not anything like normal life.

Most particularly not like normal life because of, essentially, the partial loss of control over one’s own body and circumstance. Of course, it’s not a total loss—one can say what one wants and doesn’t want, one can call for the doctor. But one, that’s me, doesn’t. I don’t generally call out. I go along quietly and don’t ask enough questions, all the while boiling inside at the relaxed and calm manner of the nurses. I’d rather they weren’t calm. If I’m freaking out, I’d like them to freak out with me. The calm soothing tone, voice, body language all drove me to distraction.

In advance, I feel sorry for the people who will have to drag me to a hospital if I’m ever really sick.

But mostly I’ve been feeding the baby, running around in the car to a thousand appointments and errands, cooking lunch for a hundred visitors come to see the baby, and soothing the fragile tempers and feelings of all my little children who love their sister very much but are having to reorder their lives and routine to make space for her.

And I’ve been praying quietly about this whole unknown concept of ‘maternity leave’. I think I needed it Before giving birth, when I was so anxious and wanting to hide under my bed and not face anyone. Now, tired but happy, I probably still need time off, but I don’t want it. I want to get back into the thick of things and sort out the Christmas Pageant, seriously catch up on making Materials for the Atrium, reorganize the church office, and read a book without falling asleep.


eulogos said...

You must have known when you wrote this that there was someone out there-me-who could not resist reminding you that birth does not have to involve bands around your tummy to monitor the baby, blood pressure monitors, strange and uncomfortable beds....

Six Petersons were born healthy without any of the above.

Just saying...

Mrs. Falstaff said...

Yes - and many babies lives were saved because of the above. Why take a chance? I didn't care about that, anyway, because I was off in la la land on laughing gas.

eulogos said...

mrs falstaff...

I think you are probably speaking out of a general trust in the medical establishment rather than out of any study of this subject.

The study of this subject which I know best is somewhat outdated now. New ones have been done with similar results, but I will cite the one I know.

This was done by statistician Lewis Mehl together with his wife who was a midwife.
1000 low risk women planning home births were carefully matched with 1000 low risk women planning hospital births. They were matched by any risk factors they had, by age, education, and ethnic group. The home births were done about 20%, if I remember correctly, by doctors, mostly old GP's who still did home births, and about 80% by midwives, mostly direct entry midwives as there were few nurse midwives trained at that time, and few of those were doing home births. The birth outcomes were then compared in many particulars. A woman who planned a home birth but wound up in the hospital because of a complication in labor was counted in the home birth group. (I believe this was about 8% of the group who planned a homebirth, which is a pretty constant statistic is these studies.)

There were no maternal deaths in either group. Two babies in the hospital group died, one baby in the planned home birth group died. This was not a statistically significant difference. The mortality outcomes were essentially the same for both groups.

However on the way to these outcomes the hospital group had way more C sections, way more forceps deliveries, way more babies needing resuscitation, the mothers had more episiotomies(cuts in the perineum) to deliver the baby, and despite that, (or perhaps because of it) way more third degree tears in the perineum.

Certainly not every woman could deliver at home. There are medical conditions which identify either the mother or the baby as high risk. Most problems which arise during labor allow time to transfer to a hospital. Are there very rarely some situations which arise during home births which need such fast intervention that there is no time for hospital transport. Yes. However some of these situations also occur too quickly for the hospital to react in time. And hospital birth practices cause many problems which wouldn't be encoutered at home. All obstetric analgesia and anesthesia involves some risk to the baby. Restricting the mother's mobility slows labor. Not allowing a mother to eat in long labors is a stressor which can cause fetal distress, and IV fluids are not a perfect solution to this problem. The strange environment of the hospital slows and stops some women's labor and requires artificial stimulation of labor, which makes for stronger contractions, which are in themselves harder on the baby, and which are certainly harder on the mother, leading to more use of obstetric analgesia and anaesthesia, which always involves some risk to the baby. Good doctors use these interventions carefully and minimize the risk but don't eliminate it. Bad doctors use them less carefully and harm babies, or cause unnecessary fetal distress and C sections. In general the presence of the emergency back up system always there in the hospital allows doctors to feel safe doing things which have an inherent risk factor involved...such as inducing women who are not overdue rather than letting labor start naturally and proceed at its own pace.

Good midwives don't put themselves out as midwives until they have skills, and they accept clients whose problems are within their skill level and refer the rest to other practitioners, including doctors. There are bad midwives who take risks just as there are bad doctors who take risks. Birth itself cannot be guaranteed to be 100% safe anywhere, with any birth attendant.

But studies show that home birth with an experienced and skilled midwife is safe for low risk mothers amd babies.

In many places, however, it is hard to find an expeienced and skilled midwife who does home births. Nurse midwives find it hard to get insurance that hospitals will accept which will also cover them for home births. Some states allow and certify direct entry midwives who have several years of training and a certain number of births under a certified preceptor, but New York is not one of them. That makes home birth here difficult to do. I was lucky to have my last child here with a Certified Nurse Midwife during the time that her insurance still covered her for both home and hospital. That was 18 years ago now. There are under the radar midwives doing home births in the area but one would have to work to find them, and then do a lot of research of their references to feel certain one had found a safe provider. I am not saying this is an easy alternative to follow, but I did it myself back in Maryland and was very glad I did. I myself could not handle the loss of control of the situation which hospital birth involved.

I know my opinion is not a common or popular one but I did a lot of reading and study before I came to it. Susan Peterson