NieceWatch 2008 and the Medicalization of Birth
Posted by hope on February 12, 2008
My sister, who was due with her second child on February 1, will be induced tomorrow morning. She went for her 41 week check up today and the doctor and midwife got concerned about the heart rate (including a minor arrhythmia identified previously) and insufficient fetal activity. She’s got gestational diabetes, but it is mild so at least up until now there hasn’t been a concern about getting the baby out on any timetable.
The midwife is stripping her membranes shortly and hopefully this will get labor started. Joy is scheduled to be at the hospital at 7:30am at which time they will hook her up to the Pitocin, which can end up stressing the baby more than regular labor. They’ll probably do continuous monitoring given the existing heart rate issue (that is, if my sister lets them), and even normal dips in heart rate during contractions will probably make the L&D staff and doctor nervous. Joy is worried (with good reason, in my opinion) she will end up being rushed into a C section after the Pitocin contractions really kick in.
This is a perfect example of the pros and cons of medicalizing childbirth. On one hand, it is great that we have the pharmacological and technological means to monitor and address potential and actual problems. Modern pharmacy and medicine save countless moms and babies that otherwise would have died or been disabled/injured in years not so far past. On the other hand, the first intervention to address a problem can set off a cascade of additional interventions that might not have been necessary, often resulting in a surgical delivery that could have safely been avoided had the doctor chosen a less aggressive first response.
Maybe more with childbirth than just about anything else, hindsight is 20/20; nobody wants to look back and regret not taking every available step to prevent a stillbirth or injury. Still, when the potential risks are minor or moderate, women like my sister (like I was) who desire a labor and delivery with no interventions end up struggling to sort out what level of risk is acceptable and responsible. I wouldn’t necessarily say it is easier for women who just go with whatever the doctor recommends, but when you have a strong preference for natural birth it can be really hard to decide when your doctor is overmedicalizing and when the potential risk should drive your decision.
joy said
I would say that any women in this day and age that wants a natural birth has the deck stacked against her from the moment she walks into her first prenatal visit. And its an uphill battle the entire 9 months. If you are fortunate enough to have a CNM in the practice…use them. They can be your best friend. I know without ours we would be playing an entirely different ballgame right now.
When you talk with her….she is confident that this thing can happen still with little intervention. When you talk to the DR. he just says “Have the baby now”.
My gut feeling is the baby is fine. Stubborn…yes. Big…yes. But fine. But even a second time mommy who is well read and well informed and confident doesnt feel 100% good when i look at an ultrsound where the baby is not moving around and listen to a heart monitor with a sporadic heart beat. I dont want to jeopardize my babies health….who would. But you start to wonder….which is really more harmful for her…intervening or waiting for nature to take its course?
James DeLoach said
Jay D. here – Leann’s brother.
We thought the same thing about birthing our three. We fought the system (“…and the – law won…”) and the best we could ever get with government run crappy (military) health care was to sneak our midwife in the hospital as a friend. Ours ended up getting in a fight with the Dr who was seemingly DESPERATE to use the pitosin, epidural, C-section and the hedge clippers – he even quipped “everyone needs an epi”. Oddly, our midwife had delivered babies for about 20 years and had known that Dr since he was a teenager had only done 3 epis. He later confessed that it was a litigation issue – if something happens to baby and they did nothing (even if nothing was the best COA) it is too easy to turn into “negligence”. So any action where the Dr is proactively in control is likely to be encouraged (by the hospital legal department). The other confession (from the secretary) after the birth of our first was that the hurry (pitosin, epi, threat of Csection if she did not progress) was that the Doc was leaving on a Golf vacation immediately after our birth so he needed to stay on HIS schedule or pay to have his tickets and tee-times rearranged.
We had an even more nightmarish experience when we birthed the 2nd in the UK though we naiively assumed the UK/EU system would be better. That was a hospital experience straight out of Dante’s Inferno and resulted in us calling the local base and pleading for an emergency exfil from the NHS crappy hospital. Man you know its bad when you are begging for MILITARY medicine…
I see things have gotten a bit better since I hear more and more midwifery (such as your birthblog). Still till they round up the lawyers and shackle the predatory lawsuits, Drs (even well meaning ones) will be pressured to do things not entirely in the interests of the parents and the cute little babies like your new neice.
Congrats Joy and family!