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Thursday, September 18, 2014

Reply turned post: The Beauty of OB

You often see posts like "Confessions of a Labor Nurse," or "Why You Need Pitocin in Labor" (I think poor Nurse Jenna removed that post a long time ago) and they're supposed to be touchy-feely, feel good pieces that make you come away with a renewed sense that childbirth is such a special time, that your care provider really does care about you and your child and they only want the best for you. Which sometimes comes at a high price, we know. Sometimes an induction, a cesarean, difficult labor and delivery - they all can happen and are often a rite of passage before entry into motherhood. 

It's hard for me not to be cynical about it. But to cut to the chase, sometimes I think the true beauty of OB is that women still want, and manage, to give birth at all after being subjected to the institutional abuses and misuses that are so typical of modern obstetrics. 

That isn't to say I'm critical of lifesaving measures, or that I'm saying, "All cesareans are unnecessary!" I'm more critical of abuse of care and intervention that is misconstrued as good care, when really, it's excessive and sometimes pointless, sometimes causing the problem you're trying to prevent in the first place. 

But I feel like all these posts have an overtone that says, "You should be thankful. Now shut. up."

The author of this article over at Huffington Post is an L&D nurse. I'm not, and I'm not trying to compare my experiences with hers. But as I see so often in these posts, they really don't get to the heart of the matter. They sort of gloss over, or completely miss, whole areas that are often untouched in our culture of women. The idea that women often come home without a baby, or sometimes never come home themselves, is incredibly tragic. No one is arguing with that. Modern obstetrics has saved many lives, both mothers and babies, and yet the place we are in today is proof of how its overuse can taint our perception of things so much we can't see what's really going on. 

Often the women who are missing, shattered or empty, as the writer mentions, are not only the ones who never survive childbirth or come home to an empty crib. They are often women who look normal and whole on the outside, with perfectly healthy children. We cannot discount their experiences and just assume that everything is perfectly normal and right because we can't see anything broken, or lost. If a woman is subjected to horrible treatment in labor, sometimes resulting in physical injury, how many times does an attorney refuse to handle her case if she seeks prosecution? Because she and her baby both appear healthy and happy on the outside? If no one is physically maimed or dead, they don't even want to talk to you. 

The author mentions staying healthy in pregnancy and waiting for active labor as ways to have a healthy delivery, avoiding induction unless for a medical reason. But unless you know what some valid medical reasons are (and more importantly, aren't) anything that comes out of your doctor's mouth is therefore a 'medical reason' and before you know it, the Pitocin is flowing. Staying healthy is relative, unless you're an illicit drug or alcohol user, and even the healthiest, most informed women can still be subjected to dubious care at times. Oftentimes it never seems to be enough. And often has nothing to do with you and everything to do with an impatient, overbearing care provider who is set in his/her ways and refuses to change. 

She mentions the case of a teenage mother who was induced, with no success, and then sectioned. As a result, she hemorrhaged and her uterus was removed. They lamented, rightfully so, over the fact that she would never have any more children. Do they ever lament over how some teen mothers are degraded and insulted because they're young and often unmarried? Or do they consider for a moment that this young mother's complications were caused in part because of the induction, which carries a risk of postpartum hemorrhage? Why do these happy sunshine articles never, ever candidly discuss what goes on behind closed doors, the whispered conversations or blatant remarks when they don't think a patient is listening - or when they don't care if they are? 

Yes, it's great to do all the "right" things in your pregnancy to encourage the best outcome possible. And sometimes, those things happen despite your best efforts. But when you look at these figures, it's hard to see the "beauty" in OB, only the ugly side that makes it seem like the deck is stacked against you. 

For the original graph and accompanying post, click here
Source: Evidencebasedbirth.com,  Rebecca Dekker, PhD, RN, APRN 


4 comments:

Sarah said...

Nurse Jenna's asinine article is still in the clogosphere.

http://lovebeingadoula.com/2010/11/30/why-you-need-pitocin-in-labor/

Sarah again said...

(Although admittedly, the article could have been a very back-handed way of saying "you don't need Pitocin, and you don't need to be in the hospital in early labour." I'm not sure it will always be read that way, though)

The Deranged Housewife said...

Lol Sarah! For some reason I thought it had been removed. Poor girl took a LOT of flak for that and rightly so. And yet, it's a harsh reality but makes it all sound like our fault.

The Deranged Housewife said...

I was going to post a link to my blog about that but forgot. Thanks for reminding me!