August 23, 2007

Deep Thoughts...by nurse lochia

I've been reading a lot of posts recently about hospital births and it is a far cry from what mother nature intended. Inductions for bogus reasons, schedule c-sections for 1st time moms for LGA and the baby comes out 7 lbs., continuous monitoring, internal monitoring, epidurals, catheters, episiotomies...I could go on. All of these are done under the pretense that birth is unsafe and a laboring woman shouldn't be left alone to labor and deliver as her body intended. Yes, there are exceptions and there can be some horrible outcomes from complications surrounding pregnancy, labor and birth. But the majority of people seem to want this. The last weeks of pregnancy are uncomfortable so people want to be induced. Labor hurts like hell and people want an epidural. Almost everyone around here is on continoius monitoring. The fetal monitor strip is like a god. If the baby doesn't look good, its off to the OR for a c-section. So people think is safer to be monitored constantly, even though research states over and over that all continous monitoring leads to is more intervention and surgical births (c-section, forceps, vaccuum). Recently a patient had a c-section for a fetal heart rate averaging 60-70 for about 30 minutes. (the nurse taking care of her was busy admitting someone and no one apparently noticed the strip for 10 minutes.) She was rushed back to the OR, delivered and the baby I guess was screaming before he was comletely out of the uterus. So you wonder, was the c-section needed? I wouldn't have wanted to wait to intervene and find out, but the questions are still there. There are people who are very strongly for the interventions and those strongly against them. I find myself wondering where exactly I stand. I love a natural birth. The kind where mom comes in, actively laboring, moving quickly into transition and the she delivers without monitors, without an IV and sometimes without a MD. I hate when some nurses shout at the mom "DONT PUSH" when she's crowning and the MD isn't here. I refuse to do that. There isn't a damn thing you can do when that head is coming out and the mom's body is telling her with every cell in her body to bear down. Who am I to argue with that? But on the other side, I also like having the interventions available. For example, a mom came in awhile back for decreased fetal movement. Slapped the monitor on and the heart rate was flat, in the 90's with frequent dips down into the 60's. Oh, she wasn't in labor and was only 33 weeks. We had her prepped and delivered by c-section within 20 minutes of having turned the fetal monitor on. That baby had a knot in the cord and was dying. Apgar scores were 1, 5, 7. The cord pH was so bad that we weren't sure how exactly this little guy made it. (He is, by the way a healthy toddler today as I work with his mother.) As much as that experience was frightening, I will admit and you can call me a monster, but it was also exciting. It was the rushing around, the adrenaline rush and the feeling like you helped "save" this baby. Now I never want or desire any kind of emergency like that. I would much rather have the rush of a laboring mother delivering quickly before any interventions can be done. Maybe its the past experience as an ICU nurse that made me an adrenaline junkie, I don't know. My birth experiences make me think about this issue all the time. With this pregnancy I get to decide to VBAC, or I could c-section. I prefer the vaginal delivery, would refuse induction, would like to move around and such, but like the epidural. I keep trying to envision going into labor, staying home until I cant take it and then arriving at the hospital in transition and having to deliver without an epidural. And right now, my plan is to delivery vaginally. But, sometimes, I think maybe I'll just have a c-section and not labor. (the Labor nurse in me screams NO everytime I think about this, but it still an option.) I don't know why I consider it because even a VBAC is safer than a c-section. I've seen comments posted that c-section is safer because of uterine rupture, but whose to say that the uterus wouldn't rupture without any uterine scar? A nurse I work has only seen 1 ruptured uterus and it was on a 1st time mon with no uterine scars. Anyway, I've rambled enough. I guess when it all comes down to it, I think we do WAY TOO MUCH INTERVENING in childbirth, but I like knowing there are interventions availabe if needed.

2 comments:

kristina said...

As a doula, I see this post as really great work. :) You are preparing internally for your birth, examining not only what you want for your childbirth, but why. You look at your fears and your past experiences with childbirth and see how one might be affected by the other. I think it is so important that you are being honest with yourself about what *you* want, not just what you think is right. I think you will have a terrific labor.

AtYourCervix said...

You are very right, we have way too many interventions in birth.

Way too many inductions too!