Thoughts in Pregnancy and Childbirth

Friday, August 03, 2007
(I wrote this @ 1AM last night when I was extremely tired, and am hesitant to post it, but Landon thought it might be beneficial to someone out there, so here you go).

I'm sure you've all been there--those times in life where you're stretched--forced to see something from another point-of-view. My recent stretching experience has been the result of venturing personally into a previously unexplored territory: the world of midwifery. Because of my personal beliefs about giving birth, I realized after going through prenatal care with an OB-GYN, then giving birth in a hospital setting with nurses and doctors whom I had never met (my OB-GYN wasn't on call that night), that the way I wished to give birth would be nearly impossible in a hospital. There are just too many routines and protocols, and I don't know about you, but I don't know if there is enough paper to write a birth plan to address each and every one, and even if there were, I don't know if anyone would even read or honor it. The whole environment for me was counter-intuitive. My experience of giving birth in a hospital setting led me to more seriously explore a home-birth with a midwife. I knew from the time I came home from the hospital that I would give birth differently the next time around. I've read many books on the subject of giving birth naturally; here are a few:

The Thinking Woman's Guide to a Better Birth by Henci Goer
Diary of a Midwife: The Power of Positive Childbearing by Juliana van Olphen-Fehr
An Easier Childbirth: A Mother's Guide for Birthing Normally by Gayle Peterson, PH.D.
Baby Catcher by Peggy Vincent
and the classic Spiritual Midwifery by Ina May Gaskin

I always felt like I would be a perfect match for giving birth with a midwife, as just about 100% of what I believe on the subject has been written about in books like these. What I'm learning as I go along is how little I really do know. Growing up, I was only ever exposed to western medicine, and I actually know very little about naturopathic medicine. I failed to realize that by stepping into the community of midwives meant also stepping into the world of natural medicine and practice. In many cases, I've been thrilled with natural remedies for pregnancy ailments, as my prior experience had been recommendations by MD's to use Tylenol or to "hang in there, because it won't be long now...(code for deal!). For the most part, my experience with midwives has been a learning experience. I don't know much about herbal remedies, so have been pretty receptive to trying them out (and they've worked--I haven't had to suffer in pregnancy nearly so much!), especially during pregnancy when you are so limited in what medications you can actually take. However, I have been surprised at how far I am from fitting in as well with this community. Like I said, I thought I would be a perfect match, and maybe I am, but there have been many instances where I have realized I have my foot in two camps: giving birth naturally (midwifery), but wanting all the prenatal screenings and tests (western medicine).

I'm a pretty analytical thinker, so believe me, I give each and every test a lot of thought and consideration before forming an opinion. My midwives are definitely conservative on what tests they recommend, and most they feel are unnecessary. They provide information on the tests, then leave it up to me to decide what to do. Other than the AFP, which I declined due to its high false positive rate, I have wanted every screen, mostly to alleviate my anxiety about whether or not everything is progressing normally, but also to prevent some potentially negative outcomes during pregnancy/childbirth. Even though my midwives are fine with whatever I decide, I think deep down I want to feel like what I decide is what they would recommend, and this is not the case. For example, they tend not to recommend testing for gestational diabetes unless the woman is showing symptoms for the disease, because the screen has many false positives, which means women have to undergo a 3-hour glucose test in addition to the 1-hour glucose screen, and neither test is pleasant for the woman to undergo, especially considering most women go through them unnecessarily. This is a different practice than what I am used to. Most hospital-based physicians recommend the gestational screening as a standard part of prenatal care, regardless of the situation. Presenting them as standard screenings, rather than optimal, has left me, as a patient, to feel that they are necessary in order to have a healthy pregnancy. As an aside, I do realize that much of western medicine is fear-based medicine. The desire to prevent leads many people to undergo unnecessary screenings or to worse yet, get a false positive and live in weeks of turmoil over the health of their baby before they undergo a more invasive & diagnostic test. As an example of fear-based & preventative medicine, I was told after being in labor for many hours that I needed Pitocin in order to speed things along, or the baby COULD go into distress and I'd end up having a emergency c-section. The baby (Samuel) wasn't in distress, and never did go into distress, but the Pitocin led to an Epidural, which didn't work, but forced me to remain on my back due to hospital policy, when many other positions would have been more optimal with a baby Samuel's size, which led to an Episiotomy, which led to many, many months of pain after the birth. These interventions were unnecessary, but were nearly forced upon me by nurses and physicians that led me to believe that if I did not agree to them, dire consequences could follow--mainly the health of the baby could be compromised.

I don't know if this makes any sense, but I'm feeling stretched in my way of thinking. I think I've become used to the doctor telling me the proper course of action, and me going along with it. The way midwives practice is that they give information that contains both the benefits & the risks, then ask and strongly encourage the patient to make the decision for themselves. In a lot of cases, this means the patient can make a decision that the midwife might not recommend, but will support. This means it's about me making decisions about my own health & pregnancy, not someone else. Bottom line, this is what I want--I want a birth where I'm in control, because I really do believe that my body is made to give birth and can do so without intervention (as long as I am healthy & the pregnancy is normal).

To get where I want to be means going through some mental stretching, however. This is my pregnancy, my birth, my baby...and everything that goes along with those things are my decisions to make. I do appreciate that I'm supported by my midwives no matter what I decide, but I have to admit, I'm not used to making my own medical decisions...not used to viewing those who oversee my medical care as advisors who advise...and advice is just that--take it or leave it. I really can create for myself an experience that is unique to me. So, I'm learning...growing...changing...and this is uncomfortable for me, but it will lead to a positive outcome.

I had a dream the other night where nurses strapped me down in a hospital and despite my screams of protest, jammed an IV Pitocin-drip into my arm. I was not in control, and my birth experience was not my own. No one listened to my screams. I was silenced & faded into nothingness while everyone around me handled my birth the way they saw fit.

Another dream of mine involves going into labor and running away into a deep forest where I'm all alone and far from anyone. There I give birth alone in a peaceful and quiet place.

Overall, it's been a bit frustrating for me to feel like I don't fit into the model of western medicine, nor completely into the model of natural medical practice, but I'm trying to take the good in both fields, and put them together to fit my particular desires & needs for maternal care. I think that for me, this stretching process, which entails sifting through information & doing research, will lead me to be an even more confident person, trusting my decisions despite what is recommended to me. I believe this will lead me to give birth without fear, because my confidence and peace is based in myself, not in others.


Sarah@mommyinjapan said...

It's so hard to plan a birth, isn't it? There are so many factors that can complicate things at the last minute or else nothing out of the ordinary happens and then all the worrying had no meaning. I've given birth four times and each time there was a different set of circumstances that made things interesting but the one thing I hated about giving birth in Japan was the lack of options. Epidurals are hardly ever offered and they haven't quite the concept of different labor positions, etc. When I delivered my second baby, I was literally strapped down to the table. Fortunately she came out within 5 minutes of being strapped down but still, it was very irritating.

After all of these experiences, one thing I've realized is that soon those memories fade away but I get to keep my wonderful baby and that's all that really matters to me.

Anonymous said...

WOW Karli!! You have really, really, really thought about every little thing. I just had my kids and didn't think everything out loike you have. It is good to do some/your home work but I think you are stressing yourself out Karli, about worrying about everything turning out alright.
I think that is why you are having the dreams you are. Subconsciously you are going over and over everything.
Basically you HAVE set everything up to 'be' the way 'you want it' so don't worry Karli. It will be alright. You did "GREAT" when Samuel was born!! I was very proud of you!! I know what you mean about some of the unnecessary things done-- it has been that way with me and some was done that way with you but you are so educated on it all now that you know what you want and what you don't.
You just need to rest and trust God to be in control and enjoy your last few months of pregnancy!!
Love you,

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