Archive for the ‘Improving Maternity Care’ Category

The Best of Both Worlds

One of the most common questions I’ve heard posed by those who oppose home birth is this:

“Which is more important to you- the birth experience? Or the baby?”

It implies that mothers who choose home birth are irresponsible. That they care more for low lighting, eating and drinking, and romantic photographs of labor than having the possibility and convenience of immediate medical care. That they are making the choice to birth at home as a trade-off- “Well, I understand my baby might die, but I really like my house better than that cold, sterile room.”

Of course those women who chose home birth cringe at the accusation. We love our babies just as much as those who chose the hospital. And home birth moms cry out that it’s not just the experience that draws them to home birth-it’s also the medical advantages that home birth offers.  It’s the lowered risk of hospital-based infections, the probability of faster, easier labor, the less likelihood of unnecessary interventions that can cause even more problems. They challenge the idea that the hospital is the safer place to be for low-risk mothers.

And both sides pull out studies. Both sides pull out horror stories or anecdotal evidence to support their own position. It seems that either you risk a life or you compromise your healthy, calm labor experience.

But I challenge you all.

My question is, why can’t you have both a beautiful and safe birth experience in either setting?

Why can’t home birth midwifery be legalized in all 50 states so that it wouldn’t fly under the radar, creating unqualified providers and dangerous birth settings?

Why can’t there be standardized training for those legal home birth midwives so that all mothers can get the safest care available?

Why couldn’t there be traveling OR units for cesareans at home in a true emergency, as one birth blogger suggested?

Why not require OB’s to have more training and experience with completely natural births? How about having to witness some home births before beginning practice?

Why not allow a mother to have a “home birth in the hospital?” All it would require is to allow a mother to labor freely under midwifery care, just as she would at home- only just down the hall from OB’s & the OR as needed.

Why can’t OBs provide the quality and continuity of care that mothers love when hiring a midwife- longer appointments, a holistic view of woman’s health, having the same doctor from prenatals to birth to postpartum care?

Why do money and legalities rule our health care decisions?

Why doesn’t the minority have the same opportunity to birth naturally and safely, just as women have the opportunity to birth with pain medication and/or in a more medicalized environment?

And why can’t these things change?

I know many of my hopes are only far off dreams… things that seem impossible now. But in reality, why not?  Why can’t we live in a world where we can have the option of more natural and peaceful hospital births, or the opportunity for a qualified home birth care provider for every woman who wants one?

Most of these ideas aren’t even on the horizon yet. But hey, a girl can dream, can’t she?

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Five Reasons Why One-on-One Maternity Care is Awesome!

In just about every hospital setting, one nurse is assigned several patients to keep an eye on (in our hospital its about 1:4), and there are usually only a few OBs on the floor (in ours, only 2), depending on the size of the hospital. Most women never get to experience the joys of one-on-one care during their birth. This is not the fault of the mother or of her providers- rather, it is simply the fact that hospitals can’t really afford that type of care. But, if you will, imagine with me for a moment the potential rewards of continuous individual care during labor and birth…. Why would one-on-one care be so great?

1) The mother is more likely to relax around her provider. Let’s face it, strangers can be nerve-wracking, especially in a situation such as labor! Having the same person there allows mothers to settle in and feel more comfortable.

2) The mother is more likely to be heard. When a provider has too many clients, he/she is not able to give the mother the time she deserves for questions and concerns.

3) The mother is more likely to have her basic needs met quickly. More ice? An extra pillow or blanket? Help getting to the shower? When nurses are in and out of the room to tend to other patients during labor, mothers often have to wait for assistance for longer periods of time.

4) The mother is more likely to receive extra non-medical care. When a provider isn’t concerned about having to rush off to other patients, he/she may have more time to encourage the mother, help her shift to more comfortable positions, etc.

5) Problems are more likely to be caught quickly. When machines are watching the mother instead of the provider, it is more likely that a) the machines will not function properly and will  miss something (e.g. loose EFM, shifted blood pressure cuff, etc.), or b) the machines will “catch” something that’s not really there (e.g., EFM picking up mother’s heart rate instead of baby’s, etc.). A provider who is dedicated to the mother, on the other hand, can diligently watch for any signs of trouble- either by making sure that the machines function properly, or by using more low-tech methods of care.

I know it’ll be a long time before  this type of care is feasible in most hospitals… but hey, a girl can dream, can’t she? What other reasons for one-on-one care can you think of?

Saturday Morning Quote: Join the Minority

“Examine your own views toward the medical caregivers you have dealt with in your life- not just OBs. Korte and Scaer [authors of A Good Birth, A Safe Birth] classify medical consumers by the amount of control they hand over to their caregivers.

  • On one end of the spectrum are patients who totally relinquish responsibility for decisions about their bodies to the medical authority. A group of consumers closely related to the relinquishers are those who want to know what’s going on but still don’t want to make the decisions. Most consumers of medical care in North America lean towards these two views.
  • On the opposite end of the spectrum, a very few consumers opt out of the current sytem altogether, using self-perscribed regimens for healing, without ever consulting a mainstream medical practitioner.
  • A small minority of consumers are somewhere in the middle. They enter into a partnership with their caregiver or view the relationship as one of professional and client, as opposed to patient. These people want to have an active voice in their health care, They view their physician as an advisor who has expertise they can integrate into a plan for health. Join this minority.”

Natural Childbirth After Cesarean, Karis Crawford, PhD, & Johanne C. Walters, BSN, RN.

The Birth Survey

I’ve seen The Birth Survey referenced many times across the web, but I didn’t take it until last night. This survey has potential to be a fantastic tool for use in improving maternity services across the US. The makers of the survey wish to bring “Transparency in Maternity Care,” so that all women have access to information and feedback on various providers, hospitals, and birth centers in their area.

The objectives of the Transparency in Maternity Care Project read as follows:

Objective 1
Annually obtain maternity care intervention rates on an institutional level for all fifty states.

Objective 2
Collect feedback about women’s birth experiences using an online, ongoing survey, The Birth Survey.

Objective 3
Present official hospital intervention rates, results of The Birth Survey, and information about the MFCI (Mother Friendly Childbirth Initiative) in an on-line format.

Objective 4
Increase public awareness of differences among maternity care providers and facilities and increase recognition of the MFCI as the gold standard for maternity care.

The Birth Survey included questions about my prenatal, labor, delivery, and postpartum care by any and all providers that saw me during these times. Its questions tracked quality of care, intervention rates, availability of comfort measures, breastfeeding support, circumcision rates, and my satisfaction with my providers. 

I discovered after taking the survey that I could search for any provider in my area to view feedback provided on him or her by other women. Additionally, I found resources for searching birth statistics such as method of delivery, VBACs, birth weights, intervention rates, etc. in each state and each hospital or birth center. I found that 1,011 out of 2,727 total deliveries at our local hospital were c-sections in 2009 (that’s a 37% c-section rate!). About 34% of those cesareans were repeat, and only 21 VBACs were reported for the year. Wow!

This information should be widely available to women choosing maternity care providers and birthplaces. Please take The Birth Survey to share your birth experience, and have all of your friends do it too! It only takes a few minutes, and might help make big steps towards improving maternity care.