Strollerderby : hospital birth

Are You a Good Candidate for Hospital Birth?

Miriam Axel-Lute — Wed, 11 Mar 2009 18:30:00 GMT

It's always nice—and often informative—to try a little role reversal to reveal unstated assumptions. So I have to admit I'm tickled by the concept of Gloria Lemay's post "Are You a Good Candidate for Hospital Birth?", a checklist that includes items such as:

Must not be scared of needles.
Must not be claustrophobic or uncomfortable in confined spaces.
Must be able to go for long periods of time without eating or drinking.
Must be happy to share a bathroom with others.
Must enjoy sleeping on a mattress covered with plastic.
Must accept the possibility of contracting antibiotic-resistant infections.

Any given one won't apply to every hospital birth, it's true. (If I were writing it, I would have adapted things a bit, such as saying "Must accept a high likelihood that your written birth plan will be ignored" rather than "Must accept your written birth plan will be ignored," for example.) But that's really no different that the way many people phrase things like when asking you if you really want an out-of-hospital birth.

So while I wouldn't use it as is in a childbirth education class, I'm happy to see a little offense as the best defense, especially when doctors are pushing back on attempts to expand midwife care.

Hat-tip: Citizens for Midwifery. Photo by la_cola_de_mi_perro.

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What's a 'Laborist' and Why is She At Your Birth?

Madeline Holler — Mon, 09 Mar 2009 19:56:00 GMT

Go home and go to bed, OBs! Stay in the margins, skilled midwives! There's a new birth attendent in town and she's coming to a hospital near you.

Or, perhaps, she's already there.

In an effort to fill the void of obstetrician-gynecologists who have stopped delivering babies, hospitals are increasingly staffing "laborists" or "OB specialists" to attend the births up in Labor and Delivery. Maybe one attended your recent birth?

These laborists are, indeed, doctors themselves. They just don't have their own OB practices, don't pay astronomical malpractice insurance and typically work only part time -- maybe a weekend shift or a few nights a week.

Some hospitals think having laborists fill in during birth will make giving birth in the hospital safer since they can be with the laboring mother from the time she arrives at the hospital. Laborists also won't suffer sleep deprivation, since their shifts are defined. The fact that laborists will attend the births also means OBs won't have to cancel the morning's appointments to rush to the hospital. So it's win-win ... for doctors and hospitals!

But let's focus on the mom for a sec. Is it fair that after doing all her research and getting to know her OB over nine-ish months that she should show up on the big day and be greeted by a perfect stranger? After discussing her birth plan, hopes and dreams, should she have to go over it all again, presumably between contractions? What about philosophical clashes between the pre-natal OB and the laborist? Is this the final step in the McDonald's-ization of L&D?

The woman featured in this Boston Globe article on laborists was pleasantly surprised by her laborist and all the attention she got while in labor. She says she had never spent so much time with a doctor. And this was BEFORE she even began pushing out the baby. What's interesting to me is that this woman wasn't even told a laborist might be there attending her birth. That would bother me greatly.

I'm all about midwives and homebirth, but I've had a hospital birth and I do kind of like the idea of (1) someone attending the birth who's pulling a shift and not anxious to get home and (2) a doc who is well-rested and not burned out on birth.

Is a laborist for you? Is this any different than getting care from a large practice of OBs who share responsibility anyway? Or does this make you want to hug your midwife a little closer?

Baby-Faced Boy Becomes a Father

The Trouble With Wanting a VBAC

Photo: Boston Globe

Mother Sues OB Who Said She "Deserved Pain"—And Gave It to Her

Miriam Axel-Lute — Fri, 02 Jan 2009 22:00:00 GMT

Catherine Skol, former Chicago cop and mother of five, is suing her OB for abusive treatment during the birth of her fifth, nine months ago. If you've heard of the case, and the arguments that she's "just suing over rudeness" and should quit it because she's going to make malpractice rates go up, I suggest you go here, and read the details of the allegations.

I don't suggest you read it if you are pregnant and about to head into a hospital delivery however.

According to the suit, defendent Scott Pierce, who was filling in for the Catherine Skol's primary OB, was so incensed that she hadn't called him before heading to the hospital (an instruction her main OB had never given her) that he decided she "deserved" pain, refused an epidural, put her in intentionally painful positions, insisted she push before she was sufficiently dilated, kept telling her she was going to hemorrhage, wouldn't give her enough anesthesia before stitching her up and told her husband to "hold her down" instead, and talked loudly and crudely on a cell phone about an abortion in the room. There's more. It's truly astounding, in a nauseating kind of way.

(Confidential to "Linka" who called Skol a wimp for complaining about not getting her pain meds: I'm no fan of routine epidurals and had my kid with none, but I would never claim to know out of context when one was appropriate. And I'd like to see you get stitches for a severe laceration on your vulva without anesthesia, not mention all that other crap.)

As much as I've heard plenty of horror stories about OBs and their attitudes, I have to say that this is a category all its own, and sounds to me like the sort of extremely aggressive behavior that arises when people are on something illegal or are having, shall we say, certain brain chemical imbalances. Not that there aren't people out there who are just that awful, but they don't generally keep a job like doctor very long.

In fact, his behavior bothers me less than the commenters who say that because she and the baby are physically healthy, she should shut up and deal. Aside from being cruel, the behavior described was dangerous. If it's anything like she described, he should have his license revoked. People sue all the time for doctors failing to prevent problems they couldn't have prevented—that's one of the reasons our c-section rate (and malpractice insurance) is so high. Here's a case where the doctor was actually in the wrong rather than just getting the blame for a tragedy. This is what lawsuits are for.

Photo by Bloomsberries.

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Mom Says Hospital Fouled Childbirth—Twice

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U.S. Birth Centers in Danger of Closing

Miriam Axel-Lute — Thu, 18 Dec 2008 21:00:00 GMT

Everyone likes a best of both worlds solution, right? For many pregnant women, birth centers provide just that. For low-risk pregnancies, they are a comfortable, calm, non-hospital atmosphere in which to give birth. They often have pools, and kitchens for family members to cook in. They don't separate mother and baby after birth, but check vitals right there. And yet, for those uncomfortable with birthing at home, there are also a staffed and equipped medical facility, usually quite near a hospital and with established transfer protocols in place. They are often crucial in rural areas where hospitals are few and far between.

And yet, after 20 years, the federal Medicaid agency has all of a sudden begun to refuse to pay for them. (Why? Do they prefer to pay tons more for a hospital birth?) The agency claims there is nothing specifically in any legislation saying that it's a covered cost. (Ah, I see. Bureaucracy strikes again.)

This is not merely a case of the poor getting screwed either notes the American Association of Birth Centers. Other payers follow Medicaid's example, they say. Basically, if the law isn't changed, pronto, freestanding birth centers will be fighting for their financial lives. Many are already suffering from refused payments.

There is a chance to clarify the law when the SCHIP bill passes, but it has to be done before the Christmass recess, so AABC is asking everyone to call their congresspeople and let them know that this is in fact important—a no-brainer even (but perhaps you oughtn't to use that phrase).

Photo from Alma Midwifery.

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Today Show Says: Doulas Get in the Way

Miriam Axel-Lute — Mon, 24 Nov 2008 18:30:00 GMT

Despite having been exceedingly happy with my own home birth, I know birth location is a very personal choice. When I have friends who are planning to give birth in a hospital, I don't go home-birth evangelical on them. I just have three words: "Get a doula."

A doula, or labor assistant, is a trained birth attendant, but not a medical professional. Their role is to provide support for the laboring woman—reassurance, massage, etc.—and her partner, and also to be a patient advocate when needed, not inserting their own opinions, but understanding what the parents want to happen under certain circumstances and sticking up for it. How many OBs read birth plans these days? Breastfeeding, circumcision, pain relief . . . In these days of understaffed hospitals, it's good have someone keeping track of you, your needs, and your decisions.

The extra, consistent support makes a difference. In fact as far back as the 1970s, all sorts of clinical studies show that the presence of a doula reduces complications and c-section rates and improves mothers' feelings about the birth outcomes. Sounds perfect, doesn't it? A nice middle ground in the birth-location fight, a win-win situation? DONA International, a group that trains doulas, was hopeful that that was the message that a recent Today Show segment on doulas would spread.

They, and many others who have used doulas, were dismayed to find that instead a huge amount of the segment was devoted to a doctor who wanted to emphasize how doulas get in the way, inserting their own (non-doctorly!) opinions, and arguing with doctors. Her hospital has actually banned them. I have to wonder if they had any hard numbers on birth outcomes that contradicted the larger clinical studies, or whether they just don't like being challenged.

If it had just been her inclusion that was the problem with the segment, I would have disappointed but understood that it was coming from the twisted meaning of "balance" that operates in journalism these days (i.e., "We must find one extreme opposing viewpoint, even if it's a lie or represents only 2 people out of the whole world"). But the host and resident expert were also astoundingly snotty and condescending throughout, full of smug phrases like "buyer beware" (You know, unlike choosing an OB) and "this is a luxury for most women" (You know, unlike an increased risk of major abdominal surgery, which is just fine) and "Make sure they know they're not there to get in the way."

Yes, doulas are not medical professionals and shouldn't be trying to act as such. But as this stunning article points out, unfortunately, laboring women often need someone adovcating for them, and it shouldn't always fall on the partner.

Interestingly, the text article on the Today Show's site is very different in tone and content, and much more positive.

DONA hasn't issued an official response yet, but it's planning one. Its supporters are, not surprisingly, already asking people to write in and complain.

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Home Delivery Only for Pizza?

Adrienne Martini — Sun, 29 Jun 2008 19:30:00 GMT

Let me be upfront with my bias -- I'm not pro-homebirth and I'm not pro-hospital birth. Frankly, I can see both sides of the argument. In this fight, I am Switzerland; especially since my baby birthing days are done. Still, the recent bumper stickers passed out at the American College of Obstetricians and Gynecologists (ACOG) really pissed me off. What did they say?

"Home Delivery is Only For Pizza."

Seriously? Are they docs that threatened by the practice of homebirth that it required a snarky bumper sticker? Apparently, yes. So their biggest fear is that the 1 percent of births that take place at home might grow to a whopping 2 percent? Are you kidding me?

For a well-balanced take on the topic of home v. hospital births, this Baltimore City Paper cover story, which is where I found out that ACOG tidbit, is a good place to start. For a personal account of what it's like to break the law by giving birth, the 'derby's own Ms Holler wrote an essay about her illegal delivery.

As for me, I'm going to go walk until I don't want to smack someone. At this rate, I might end up walking to Vancouver.

Photo credit: Michelle Gienow

Are Hospitals Bad for Babies?

Karen Murphy — Sun, 03 Feb 2008 18:27:00 GMT

About the last thing you'd want to hear when planning an upcoming birth is that the place you're going to give birth in? The hospital? May be one of the worst places for your baby. Yikes.

But a new (small) study looked at 388 babies born in a teaching hospital in the south of France during most of 2005. Of those 388 babies, 116 were affected by a total of 267 "incidents", defined as anything compromising the safety of the baby. That's almost 30%! And here's why:

Most of the incidents involved babies who had low birth weight, were in the hospital for an extended time, or had an IV line or breathing tube or were on a mechanical ventilator. In short, these were the babies who were subject to more handling by hospital personnel, and therefore were at greater risk for "incidents." (yes, that word bothers me) In addition, these are the babies who already may be somewhat compromised, in a weakened state, etc, and so are more susceptible to problems and "incidents." Plus, this was a teaching hospital, which implies that there's a level of learning involved (and therefore, possibly, a greater risk for mistakes).

But a large number of the "incidents" involved medications, dosing errors, etc. And it's admitted that pediatric medicine has a long way to go with newborns, who seem to be a science all their own and can't be treated, necessarily, as older babies are.

And, it's fairly common knowledge now that anybody spending time in a hospital these days is at greater risk for developing infection. (Did I hear that a little handwashing could help with this?)

So here's the bottom line, in my opinion:

Babies who need medical intervention do belong in hospitals, but it's a double-edged sword. Babies who are healthy (and everybody else) should stay out of hospitals (home birth, anyone?) beyond the necessary.

Oh, and medical science has a long way to go.

Photo: www.mcmasterchildrenshospital.ca

Unassisted Birth -- Help Me Out

Madeline Holler — Wed, 09 Jan 2008 22:46:00 GMT

When I read stories about women who opt to give birth at home allllll by themselves -- no help from a midwife or a doctor or a staff of nurses -- I think to myself, "can you blame them?" I know, I know, a lot of you are thinking these people are just trying to be heroes or adhere to some kind of radical hippie code that shuns any relationship with established authority. Or you think they're narcissistic idiots who put their own childbirth dreams above the health and safety of an innocent child. Homebirth moms get that kind of talk too.

But I think all that's wrong. Quite wrong.

Pregnant women in the U.S. are in this totally weird position where our reproductive rights are, on both ends of the conception and pregnancy chronology, narrowing quickly. State judges, with the eventual help of the Supreme Court, are shrinking options on the early end of the spectrum. Doctors, hospital administrators, and insurance companies and legislatures (who make midwifery a crime) are taking away choices at the latter end.

Let's focus on the latter:

More than one third of all childbirth in the U.S. results in surgery -- a c-section. Some are, of course, necessary (but, like, 10 percent). A tiny percentage are the "too posh to push" variety and not indicated, but allowed (and hey, it's your choice, I won't stand in your way.). More are the "once-a-c-section-always-a-c-section," variety and then the rest, a significant number, could probably have been avoided all together.

It's the last two that, I think, push women to go the DIY route. In loads of hospitals all over the country, VBACs have been banned. Doctors and midwives are not allowed to do these vaginal births after ceseareans because of some studies that say there is an increased chance for uterine rupture in VBACs. Which may or may not be true, but that chance of which they speak is actually quite small. So what do you do? Avoid the hospital.

And avoidable c-sections? There a loads of ways to decrease one's risk of being pushed to have a c-section, but many can't be done in the hospital. Get in a tub, move around, stay off IV fluids, don't get hooked up to continuous fetal monitors, blah, blah, blah. They were in the birth plan! But the pressure! Look at what the quoted doctor has to say:

"What women need to appreciate is that the few hours of labor are the most dangerous time during the entire lifetime of the soon-to-be-born child," said Dr. Frank Chervenak, Chairman of Obstetrics and Gynecology at New York Presbyterian/Weill Cornell. "Because of this, I would argue ... all soon-to-be born children have a right to access immediate Caesarean delivery, and women who are denying this right are irresponsible."

So what do you do in your next pregnancy? That's right. Avoid the hospital and that attitude toward pregnancy and childbirth.

What about the child? Well there are risks to childbirth and those risks play out in different ways in each of the settings a woman might want to give birth in. Don't think women and babies don't die after childbirth in hospitals, which is NOT saying death in the hospital is certain and likely. Just like it's not certain and likely at home or unassisted.

What I'm trying to say is that women/patients/clients want what they want. Because there are so many possibilities. So many ways to do it right. So few ways that make it wrong (smoking crack comes to mind -- but who am I to judge?) Yet hospitals, midwives and doctors only allow for (without battles) a certain range of them. And that's fine for them and their jobs. But not fine for some women. So some women opt for birthing centers with midwives or doctors, or homebirth with midwives or (the few remaining homebirth) doctors. And some women opt to go it alone.

Unassisted birth is not for me, but like I said, who can blame them?

PS: Is it me or is that a fake belly on the woman in the picture? Just asking ...

Photo: ABC News

One Doctor, 24 Hours, Bunches and Bunches of Twins

Madeline Holler — Thu, 29 Nov 2007 00:02:00 GMT

Wasn’t I just saying that twins are the new black?

Exhibit B: a doctor in Wisconsin clocked in for a regular day of rounds and wound up delivering not one, not two, not even three sets of twins in one 24-hour period. But …

Four! Count’em four sets of twins, plus one sadly underwhelming singleton (I bet her mom loves her though). All in the same Lacrosse, Wis., hospital.

The doctor’s shift started out very quiet, like all catastrophes and great events do. And then the first couple called in very active labor (sidenote: you can tell the reporter doesn’t have kids, because he wrote “and very active labor,” but I digress). Then another couple would come in as the previous twins were delivered. One after the other – what good babies!

Toward the end of the shift, one final mom hatched her lone child. By then, the staff was doing this with their eyes closed. (Not really.)

The doctor said he couldn’t remember attending the births of two sets of twins, much less four, in a single day. All the moms are well, all the babies are fine, including the third set of twins who were born seven weeks early (and, incidentally, while their father was on a deer-hunting trip. Ahhhh, Wisconsin.)

So what, big deal, you say, you nasty cynic! Well it was. Proof? The doctors, the parents and all those babies were featured on the Today Show with Matt Lauer. And you thought the world stopped when your babies were born!

Babies Are Expensive, Hospital Edition

Karen Murphy — Mon, 29 Oct 2007 11:32:00 GMT

I'm pretty sure that none of us are having babies in order to make money (are we? if you are, I'm not sure I want to know you), counting on future income or whatever. In fact, most of us accept the fact that kids are pretty much a loss financially. A pretty big one, too. And the cash drain begins before they are even born! (Isn't parenting fun?) So why it's news that babies cost money, I'm not sure, but here it is:

Babies cost money. Oh yeah, we covered that. Having a hospital birth? The average cost for that in the U.S. is $7600, including prenatal care. Not that it's all out of your pocket. Your average expense is only about 8% of that if you're privately insured.

Interestingly, the cost for women on Medicaid to give birth is less than that for women who have private medical insurance, though the prenatal care expense is about the same. Hmm. (Can you say, "There's something wrong with this picture?" And on Medicaid, the average out-of-pocket expense is only 1% of the total cost. Hmm again.

Care to draw some conclusions from this information? Here we go:

1. Blah blah blah U.S. healthcare system.

2. Blah blah blah gouging by U.S. health insurance companies.

3. Home birth blah blah blah.

There. Are we all clear on that?

Hospital Rooming-In or Baby Nursery? (They Both Suck)

Karen Murphy — Mon, 22 Oct 2007 11:28:00 GMT

By the time my third and fourth children were born, I was firmly in the camp of having the babies room in with me in the hospital. It seemed, at the time, to be the most natural thing to do, as close as I would ever come to the still somewhat alien energies of a home birth. After all, people have been giving birth for centuries in all sorts of circumstances, and certainly in most of them, babies have remained with mothers in those precious hours and days right after birth. And research seems to agree with that premise, though I have to tell you that having done it both ways, there are problems, as I see it, with both.

I polled the Strollerderby bloggers who kindly reminded me of aspects of each choice, rooming-in and using the convenient hospital nursery, perhaps a parent's last time ever to be alone again for twenty years.

Mike just wanted to watch the game and have some peace while those pesky nurses brought the baby in every hour, claiming she was hungry or something and clanging carts and poking and prodding. He would have escaped down a sheet ladder had he thought of it in time.

Kelly wishes she had taken advantage of the hospital nursery to get at least a few precious hours of sleep, because her child hasn't slept since.

And Rachael missed her twins terribly, having sent them on to the nursery at a nurse's recommendation. She suggests having the baby room in but sleep with daddy, which to me seems to be the best of both worlds but does require the participation of a willing partner.

While supposedly studies show that mothers DON'T actually get more sleep when the baby's in the nursery (I have issues with this premise), they do show that rooming-in is better for babies. Babies who do so generally stay warmer, cry less, have lower amounts of stress hormones, and gain more weight than babies left in the nursery.

And while I get all that, and got it enough to make it my choice, I still think that it depends on circumstance. If there's been a particularly difficult birth for instance, it's not like we typically come equipped these days with a doula or enough family to care for the baby while mom gets her strength back, in which case resting up a bit for a day or two before going home with a newborn may be the best option.

Which did you choose, and how did it work out for you? Would you choose differently next time?

Pregcellent: You Couldn't Pay Me Enough To Have a Home Birth

Kelly Mills — Wed, 10 Oct 2007 19:01:00 GMT

There's a thing in the Daily Mail about the pros and cons of home birth, and it's all pretty darn pro. I can see that. I mean, you get to avoid the unnecessary birth interventions that can happen in hospitals, and if you want to have your baby at home, you'll probably be more relaxed in that environment. I have some friends that went this route very successfully. I fully support the right of women to give birth at home or in a pool or a treehouse or wherever they feel most comfortable, with the exception of rush hour traffic.

That said, even though I was probably the recipient of some unnecessary medical interventions (when I went in for my prenatal visit a tech said my amniotic fluid was low and they induced my labor, but it turns out it probably wasn't low at all) I'd still never be able to give birth anywhere but in a hospital. Because I am an anxious person. Even though the chances of something going wrong are slight, I don't want to be a 15-minute drive away from a team of physicians and a good NICU. Shoot, I can't even leave the house without a box of bandaids in my purse. I did not have a beautiful, comfortable, meaningful labor. Was that because I was at the hospital? No, it was because my labor hurt like an unholy motherf*cker. As it turns out, I had back labor, which probably ought to be named "all-over-body agony" so I was glad to give the anesthesiologist a sloppy wet kiss on the mouth. So while I respect the miraculous, home-based birth experience of others, for me the only miracle came at the very end. If there's ever a next time, I just hope someone will knock me out with a club.

Chiming Lullaby Marks New Births At Ohio Hospital

Karen Murphy — Tue, 05 Jun 2007 15:07:00 GMT

Aww. I hope this marks a trend, because I think this is a sweet idea: a Cincinnati hospital began a program not long ago where a short bit of "Brahm's Lullaby" is played for every birth through the ringing of chimes on the hospital's PA system. Not only does it serve to commemorate a new life, welcome the new baby, and to make the parents feel a bit special, but it also allows the hospital staff, doctors, and nurses to take a second and recognize their own part in the ongoing circle of life that's so present in a hospital setting.

The downside, of course, would be for those parents not bringing a healthy baby home, either through stillbirth or adoption or time in the NICU. Those are difficult situations no matter how you look at it.

Still, the connection felt by new parents every time a chime sounds, knowing that yet another birth has taken place and knowing that they share that remarkable moment with other people unknown to them yet so close by, has got to be amazing.

Strollerderby : hospital birth

Are You a Good Candidate for Hospital Birth?

What's a 'Laborist' and Why is She At Your Birth?

Placentas Washing Up in Illinois Sewer

Baby-Faced Boy Becomes a Father

The Trouble With Wanting a VBAC

Mother Sues OB Who Said She "Deserved Pain"—And Gave It to Her

U.S. Birth Centers in Danger of Closing

Today Show Says: Doulas Get in the Way

Home Delivery Only for Pizza?

Are Hospitals Bad for Babies?

Unassisted Birth -- Help Me Out

One Doctor, 24 Hours, Bunches and Bunches of Twins

Babies Are Expensive, Hospital Edition

Hospital Rooming-In or Baby Nursery? (They Both Suck)

Pregcellent: You Couldn't Pay Me Enough To Have a Home Birth

Chiming Lullaby Marks New Births At Ohio Hospital