Tuesday, October 16, 2012

Fighting For Your Birth

"How can I get what I want from my birth when my hospital has a policy against it?"

"What if my doctor says I need to do XYZ but I don't want to?"

"How do I get my doctor/hospital to let me....?"

These are all questions I hear constantly from women preparing to have a birth slightly different than the induction/assembly line/epidural/birth that is common right now for women.  Many women want to birth in the hospital but they are afraid of what will happen.  They wonder if they will be strong enough to stand up to the system.  They worry about getting what they want in what is sometimes perceived to be a hostile environment. 

I see a lot of different responses to these concerns.

"It's your body.  You get to make the choice."

"Say, 'I Do NOT consent'."

"You are in charge of your birth."

"Get your doctor to sign your birth plan."

"Hire a doula."


These answers are all correct.  In fact, I have told COUNTLESS women the same things. 

But....

I think sometimes we talk about choice and empowerment and doulas when we really should be giving women a few words of warning and letting them know about the REALITY of birthing within an institution. 

So I am going to tell you the truth (according to me.)

Here are some other truths that you deserve to know about birthing in a hospital.  (I am not saying you shouldn't birth in the hospital.  It is the best choice for many people and many births.  But we need to be realistic about it.)


#1-  It is difficult, if not IMPOSSIBLE to buck hospital policy. 

Every nurse, every doctor, every midwife, EVERYBODY who works there will be versed in their policy.  They have jobs.  They sign contracts.  They want to keep their jobs. 

Let's say for a moment that the hospital policy is that EVERY woman gets an IV.  And you don't want an IV.  You find this out when you talk to your care provider.  He tells you, "Everybody get's an IV."
You assure him that you will be unmedicated and so it won't be necessary.  There are a lot of responses your care provider may have to this.  Most likely he will say that it is "policy."

Pay attention.  This is your chance to....

FIND ANOTHER HOSPITAL.

Seriously.  Find another one.  It might be a drive.  It might be inconvenient. 

It will most likely be worth it.  

Another choice you have is to birth in that hospital ANYWAY.  You can do all of the above.  Refuse consent.  Get your doc to sign your birth plan.  Take a doula with  you.  (Please remember though that your doula can not make choices for your or your baby and will be very unpopular very quickly if she tries to boss around the staff that actually works there full time.)

You MIGHT get away without that IV.  More power to you if you do.  That is fantastic and I mean that.  BUT- think about what that will involve for a minute.  Getting out of NOT having an IV that is hospital policy means that you will be FIGHTING FOR YOUR BIRTH every step of the way.

Now you need to ask youself a very honest question:

Do I want to fight for my birth while I am in labor?  SHOULD I have to fight for my birth while I am in labor.  CAN I fight for my birth choices in between contractions?  How effective will those contractions be if I am fighting with staff in between them?

Because the reality is, if something is policy and you manage to CHANGE IT- just for YOU, then you will be fighting for it every step of the way. 

Are you HONESTLY OK with that?

#2-  It is really hard to stand up for you birth choice IN LABOR.

So let's say for a moment that you decided to go ahead and have your baby in this pro IV hospital.  Your doctor told you that he was OK with you going without the IV and he signed your birth plan. 

Now, WHAT IF your doctor isn't there for your birth?  Most docs and midwives in hospitals rotate call.  This is standard care in the USA.  Unless you get lucky or sign up for an induction to ensure that your doc is there, you are playing roulette with your birth.  That is just a reality.  Are you comfortable with that? 

You deserve to answer this question honestly and realistically.  It is your birth. 

So you are in labor, at your hospital and, for the sake of argument, let's say that your doc isn't there.  The nurse says, "We need to get your IV placed!"  (Now remember- she isn't a mean person!  She is just trying to do her job and do it well.  And part of her job is getting you your IV.)

You inform her that your doctor (who isn't there) told you that you didn't need an IV.  He even signed your birth plan.  You proceed to show her the birth plan.

There are a lot of responses she could have to this, ranging from, "OK!  No problem!"  to "I hate your guts, problem patient, prep surgery."

But let's say that she mentions that....

"Well, we want to keep your baby and you safe.  And if you don't get an IV and something goes wrong, and we try to place an IV when everything is going bonkers and we can't find your vein, then those precious minutes could really hurt your baby.  And we want a healthy baby."

Now remember two things- 1) You are in labor and don't feel like arguing or talking.  Neither does your partner.  It is easier to just give in.  2)  You also value a healthy baby.  Somebody who is trained to help you get that healthy baby just told you that this procedure is needed in order to make that happen.  In fact, they made some very good points.

Are you still going to refuse that IV?  (Or ANY other intervention that you didn't plan for but which was hard to argue against in labor or which could impact the safety of your baby but was just being done because of policy?)
***
In the end, I realize that sometimes women don't have a whole heck of a lot of choices when it comes to birth places.  Sometimes we are limited by insurance or money or a variety of other factors. But TRY to find a hospital that is more friendly to your wishes and respectful of you. 

Now- if you need to or choose to still birth in this hospital, you may want to be somewhat realistic about the kind of care they give.  Some things might be worth fighting for.  Others, not so much.  Be honest about these choices.  I don't really think it is fair to the hospital or the doctor or the nurses to be MAD at THEM after your birth when you knew full well what their policies were and you just expected them to change- just for you.  That isn't how life works and it sure as hell isn't how hospitals work. 

Remember the other stuff too.  You CAN make informed choices.  You SHOULD hire a doula.  You ARE strong enough to say "No, I don't consent to this procedure."  Find your voice.  Be strong.  Get the birth you want.  But please, also be realistic about what you are asking.  And be honest withourself about how easy or hard it will be to FIGHT in labor. 

Fighting is totally contradictory to good labor.  In fact, when I am in labor is one of the only times that everything my husband says doesn't make me a little irritated.  It is the magic labor hormones.  They even make me less argumentative. 

If you disagree with something- try to be polite.  Kind but FIRM.  Act like a good parent with a hyperactive toddler.  It is your birth.  Making enemies doesn't help it.  Bring cookies if you have to. 

I have to be honest now.  I had a GREAT hospital birth with my first baby.  I did consent to a few things that weren't in my "plan".  An IV was one of those things.  An episiotomy was another one of those things.  I don't regret those choices.  I consented.  I made the choice.  I was and AM fine with that. 

But when I found myself pregnant again in a different state where the hospitals were NOT as good about choices (all those near me required constant monitoring, an IV, staying in the bed, supine pushing, and had high c-section rates) then I simply chose not to birth with them.

Don't get me wrong- I KNEW I could do it.  I had already birthed naturally.  I knew when I was close to pushing.  I could have waited and gone in at the end.  I was opinionated. 

But I didn't want to have to FIGHT for my birth.  I wanted it to be peaceful.  I wanted to feel safe going to my birth place when I wanted too, not worrying and sitting in the parking lot.  I wanted care providers to support me and my choices.  I chose a birth center birth with a CNM.  It was wonderful  and I didn't have to fight for my birth at all.  But this post isn't about birthing outside of the hospital- there ARE hospitals who practice mother friendly care.  FIND ONE.  Give your MONEY and your BUSINESS to a hospital that is respectful of women and babies but still has lifesaving equipment available.

Birth in a hospital that you can trust to advise you when an intervention is NEEDED, not just when it is policy.  

Good luck ladies.  I know these are hard choices and will have different answers for all of us.  You can do it. 


5 comments:

Marisa said...

Hi! I'm a new reader (and a natural birth junkie) and I love your blog. I'm pregnant with my second baby, and I live in a different part of the country than I did with my first birth. My first birth was very similar to yours; even though it didn't go exactly the way I had hoped, it was still a positive experience. I was fortunate enough to find a hospital that was committed to keeping their c-section rates low, didn't force unnecessary interventions, and the doctors/nurses/midwives were very respectful of my wishes, and I never felt that anything was forced on me.

Unfortunately, we had to move due to my husband's job, and we are now in a city where all the hospitals have very high c-section rates (around 40%), the doctors favor early inductions, and the more I learned about the hospital the more I knew I would have to fight for my birth plan every step of the way. My husband and I had a long talk about it, and I knew that route just wouldn't be for me. We found a wonderful freestanding birth center about 40 minutes away, and I am going to have my baby there with a midwife. I was a low-risk pregnancy with my son, and there were no complications during delivery. I'm once again considered low-risk, and I'm confident that I made the right choice going with the birth center.

Anyway, sorry to turn this into a novel! Keep up the great posts! :)

Alanna said...

Oh, my goodness, it's like you were there in the room with me when I had my third kid. After the accidental home birth, my husband made me promise him that the next baby would be born in a hospital. AND IT WAS JUST LIKE YOU SAY HERE. Fighting for EVERYTHING, starting with me trying to refuse the IV. The doctor (who was just some monster of a woman on call, not the OB I'd been seeing who I quite liked) finally got that one in by spending a full hour consenting me at three in the morning (yes, while I was in labor) and then demurely mentioning that, "This is why you need the IV." while the nurse slipped it into my wrist. I couldn't believe it.

The whole rest of the labor was one battle after another, culminating in the doctor and nurses yelling at me that I couldn't possibly push on my hands and knees because "they couldn't see the baby" that way. I was in the middle of pushing and they were all yelling at me!!!!! The doctor finally asked me to at least lay on my side, so as I tried to comply with that, she grabbed my leg and flipped me onto my back right as my son came out.

I never want to give birth in a hospital again.

And I'm going to re-post this on my own blog for everyone who thinks I'm crazy for wanting a different experience (ahem, my in-laws) to see.

Thank you for writing this. You are so dead-on it's not even funny.

Mama Birth said...

Thank you and CONGRATS Marisa for finding a place that would work for you! So glad I did that with my second! And Alanna- that sucks- and I simply cannot believe that is considered acceptable care. Gross.

Refrigerator Memories said...

Thank you for this! I'm having a home birth with a midwife for our third child due in April. Hospital policies are the biggest reason for making this switch. I don't want to have to fight for what I want. I regret not fighting harder with our second child and gave in to an induction despite in my heart knowing this was not right.

Hope said...

I'm 36 and hoping to become pregnant within the next year (first time). My husband and I live in a very isolated rural town which has a county hospital with a 27% c-section rate. I haven't heard very good things about this hospital re: natural birth. There are no doulas or midwives practicing in this area. I feel very nervous that the doc will want to induce and/or c-section given my age. We are 2 hours' (very rural) drive from the nearest city.

My questions would be: what is an acceptable c-section rate, in your opinion? I'm willing to drive, but how far is too far to risk? My parents live in a very large city about 5 hours drive away--I'm considering the idea of staying with them toward the end of the pregnancy and using their local natural birthing center staffed with NMW's. What do you think?

I feel nervous because it seems as though we won't be able to make many choices at all--even though we know what's best for me and the baby. Thanks for any thoughts...

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