Wednesday, June 1, 2016

Hospital, Birth Center or Home Birth? Part I

In my first pregnancy, there was no question I was going to a hospital to deliver. I knew that the number one cause of death for women historically was childbirth and that infant mortality rates were much higher historically and that was the end of the story, albeit I tepidly dabbled into natural (i.e. non-hospital) births. My main aim was to try to have as much of a natural birth in a hospital as possible (my preferred option was to got to the one hospital in NYC that had a birth center, because I was assured that if anything were to go wrong, the doctors and the equipment were right there - but I was told they didn't take first time mothers). I dragged my husband to yoga partner training and religiously did all the squats and other exercises that my yoga teacher recommend for birth. While my friend gave me a book on doulas and hypno-birth, I didn't favour having a doula because I believed the experience was too private to involve a stranger (albeit ironically the hospital environment guarantees that you will be surrounded by strangers) and I feared that if hypno-birth really worked, I would go into early labour listening to the tape, so I had it in store only for the birth itself. My friends were enamoured by the Bradley Method, but after reading merely a number of pages, I found his tone extremely patronising, misogynist and outright nauseous. I believe I reached the final point when he was comparing women's struggle in labour to the ease of farm animals - not only did I not favour being compared to a ewe, but considering their physiognomy and biology are quite different to ours I didn't see the utility in his comparison. I suppose that there may be something to the fact that other animals labour easier, but other babies are also way more adept than humans. It takes a fowl about 30 mins to stand and it's walking around the same time it starts to nurse, whereas human babies are far more retarded in the pace of their development compared to most animals and can't even sit up until about five months. What other animals do just doesn't seem like the right path to investigate in finding out what is right for our species.

But back to my wonderful first hospital labour. Armed with yoga positions, a list of mantras to listen to and repeat (with the main mantra, which I still favour in bringing me ease and strength is om gum ganapatayei namaha - simply put, to call on Ganesha to remove obstacles in your path - not specific to maternity nor childbirth but very revitalizing), and my trusty hypno-tape, I was pretty confident that my birth would go well and if it didn't, I knew I would be in a place that would keep me and my baby safe (as much as that were possible). Apart from the fact that my son was delivered healthy through vaginal delivery, nothing about my experience was expected or to be desired. First, I was induced and induced by Cervadil which to my doctors' surprise, gave rise to eruptions of contractions without a break leading to their apology and subsequent removal of Cervadil from my system. I was told labour would build up and that you rested during contractions, but I was instead tossed about by a recursive onslaught of thumping tsunamis with intense pain in my back for nine hours. There was no break. My whole body was shaking and bleeding so much that I couldn't do any of the squats, nor did I want to listen to anything I had brought. All I wanted was darkness and silence (albeit my screams and groans regularly pierced this). When my husband decided to use the massage and pressure point techniques he had learnt in our yoga partner class, I backed away - the last thing I wanted was to be touched (except that I was gripping his hand until he gently pointed out that I was about to dislocate his thumb). During this debacle, my IV fell out, but I didn't notice. My husband, growing pale, called for the nurse to come as he saw blood all over the bed. By the end of nine hours, I knew I had no energy to push and caved in and get on an epidural. This allowed my body to stop shaking for two hours so that I could push my son out during a 40 minute stint so he was born at 11:11 am on Hindu New Year's Day. Thank God for the drugs. If it weren't for the epidural, I would indubitably have ended up under the knife. I was also grateful for my OB, who performed an expert maneuvre to get my son's broad shoulders out, which my pushes alone were not progressing. The pain of labour was so excruciating and so unexpected and followed by my three months of nursing in which everything that could go wrong did (but blessedly it was easy street after that) leading to more pain, that I felt invaded and tortured.

This time around, thinking over everything that went wrong - should I have been induced at 39 weeks 2 days when my amniotic fluid had dropped to 4 and my mucus plug had already dropped? Should I have been induced by Cervidil? Should I have been given an IV right away and not been allowed to eat anything but ice chips? Should I have been connected to a machine the whole time when my baby and I were doing fine after hours of monitoring? I started to wonder whether there wasn't more to the argument that the hospital may not be the safest place to birth. I had previously thought that while the experience of having your child at home or in a center was probably much better than at a hospital (provided nothing went wrong), it was not safer and assumed that women that decided to give birth at home or at a birth center did so because they wanted more control over their own birth and that coveted beautiful experience, considering this more important than the risks of themselves and their babies. This pregnancy, I started to wonder whether mothers who gave birth at home or in birth centers were rather of the belief that it were safer. Possibly I had such a horrible labour in hospital in order for the universe to expose my previously held naive judgement (which, as I've experienced in my life time and again, the universe is wont to do).

As always, we start with research and review. The only problem is that it is very difficult to find a non-biased and non-prejudiced analysis as everyone who writes about this issue is writing on this issue because they are proffering a certain view in an extremely polarized debate. If you read what doctors say, you will end up with an analysis that favours medical care and hospitals. If you read what midwifes say, you will conversely end up with the benefits of home births and/or birth centers and the risks of hospital births.  This is of course fairly common throughout all topics, but considering the topic is medical care, it makes it more difficult to comprehend without medical knowledge and experience (which I lack).One must be diligent in sifting through each author's rolling punches of persuasion and carefully arranged facts in the midst of panglossian prose as to their profession invariably followed by terrorising tirades against the other side. The battle between midwifery, which has historically - and still appears to be - female and the medical profession, which has historically been male, is rife and as virulent and explosive as if the Girondists and Jacobins were facing each other on the other side of the aisle.



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