[ruralnurs]

I may be a bit off here but I think that women, those that are having babies need to take some responsibility for how “bad” birth is going with the mean, paternalistic OB doc intimidating her into his demands. I work in a rural hospital and we don’t do a lot of births but we get a variety.
So the woman smokes during pregnancy despite what she is told, we find THC in her urine every time we check, she either doesn’t eat enough to keep a rat alive (gotta keep that figure) or is a non-compliant gestational diabetic, misses several prenatal appointments, doesn’t come to the childbirth classes that I teach (free might I ad with lots of giveaways and food), complains constantly about how she hurts and is miserable and needs lortab to make it through the day, and then walks into the ER when she has had 2 contractions and demands and epidural and IV fentanyl until the CRNA can get there! (And asks if her family can wheel her out side to smoke because the epidual has her legs numb!)
So people wonder why we want to monitor that baby every second and be ready to do whatever we have to.
You can’t have it both ways, be self centered, not put any work into it, expect NO discomforts and have a “natural” birth. I have 6 children, 5 born with no meds, naturally (even had ruptured membranes for 9 days prior to going into natural labor with my doctor’s full agreement) and then on my last I had every problem in the book, and so did baby and an emergency c-sec (and a blood transfusion for me) saved us both.
I live in the middle of now where Montana and I found a doctor that had my same ideals. Don’t tell me in the big cities that a woman can’t find a CNM or doc (often FPs are more holistic than OBs) that has a similar outlook on birth.
We had a perfect baby born here, first time young parents. The baby was a bit dusky at birth, and a sharp RN noticed that at 10 hours of age he was still a bit blue. She alerted the doc, we did an ultrasound and discovered transposition of the great vessels. He was shipped off for heart surgery and it saved his life. If he had been born at home and brought in later he may not have lived.
Yes, things are going south in many ways, but it is not all the medical profession. I hate when I hear “those doctors and nurses”. Almost every nurse that I know that is in L&D do it because they love to help women, and they want to support that woman in the most natural way possible. It is often the whiney, “It’s not supposed to hurt”, “but I want my baby born while grandma is here”, “but I’m 2 days over due”, “but I need to go out and have a cigarette, this labor has me all stressed out”, “but I need lortab to sleep, if I am not sleeping it will be bad for the baby”, “I smoke pot so I will eat enough for the baby and it helps me with morning sickness”, “Its OK I did some meth with the last one and she is just a little bit bipolar and ADHD”………
Let’s wake up and take some responsibility.

[kythe]

Originally Posted by Hopefull2009

Women are n-u-t-s for doing that.

Too many things can go wrong and I really think that a woman who chooses that option should be charged with criminal child neglect if a baby dies/injured due to total absence of medical care during a birth....just like they do with these teenagers that birth babies at home...I see no difference.

These women, if they don't care anything about whether they live or die, then so be it...but they shouldn't put their baby's life at risk just so they can have bragging rights later.

Things like this make me SO angry!!!!

When women choose crazy birthing options like that...it's not about the baby, it's about their ego....which needs to be checked at the door.

I also see some serious potential problems with unassisted birth, but I don't want to paint all UC'ers with the same brush. People's motivations for choosing UC vary greatly, and some are very educated and put more research into their unassisted birth than others do into which hospital they will go to. Some keep emergency equipment on hand (such as for the possibility of rescussitating the baby). It's not unheard of for women to recieve full prenatal care with a doctor, then "accidentally" have a fast birth where they didn't make it to the hospital on time.

Although I personally would not do this, I also wouldn't consider it justified to involved social services in every such case. I also don't assume it to be a selfish decision on the part of the mother. Some women have had negative experiences with practitioners and feel "driven" toward UC because of lack of trust in their providers.

Unfortunately, many UC'ers aren't as responsible and it can give all homebirthers a bad name. I once met a woman who had all three of her babies at home, 1-2 months early each. She doesn't know their exact gestation since she recieved no prenatal care. She believes it was okay that her babies were early since that must be how her body works. She took each baby to the hospital after birth when she realized that they were unable to nurse since they weren't breathing well enough. Her firstborn had a two-week stay, yet she made the same mistake of giving birth prematurely at home to each of her others as well! One would think that most women would learn the first time and seek medical care in the future, but she had read a work of fiction that idealized "natural" childbirth, and she continued to see no problem with giving birth prematurely without medical intervention.

I'm sure this woman is one of the ones you are referring to that more than needed intervention from social services. However, it is stil unfair to assume all or even most UC'ers are this. Many UC'ers are more educated and prepared, and have more constructive reasons for making the choices they do.

[Kiwimid]

i am training to be a midwife in New Zealand and our model of practice is quite different to what you guys have, in fact it is unique to New Zealand. It is based around a treaty that was singed with the Maori people about 160 years ago. We aim to work in partnership with our women, they can changed midwives when they want, and there is an equal sharing of power in the relationship. as far as i know, the only unassisted childbirths we have are the unplanned kind. we have planned homebirths, birthing centers and hospitals and the women can choose where they give birth. the thing that amazes me now is just how foruntane we are here. after i graduate, i can work in a hospital or become an independant midwife with my own clients.oh and by the way......i was direct entry with no nursing background.....come to new zealand...we have a huge shortage of midwives....and the weather is good too!!!!!

[mommy2boysaz]

Originally Posted by Kiwimid

i am training to be a midwife in New Zealand and our model of practice is quite different to what you guys have, in fact it is unique to New Zealand. It is based around a treaty that was singed with the Maori people about 160 years ago. We aim to work in partnership with our women, they can changed midwives when they want, and there is an equal sharing of power in the relationship. as far as i know, the only unassisted childbirths we have are the unplanned kind. we have planned homebirths, birthing centers and hospitals and the women can choose where they give birth. the thing that amazes me now is just how foruntane we are here.

You are fortunate! Unfortunately, in the USA, midwives who want to attend women at home, find it very difficult, if not impossible to find a physician backup (which is required almost everywhere). Most physicians won't do it because they wouldn't be able to afford the malpractice insurance rates they would be subjected to, for something that has been proven safe! Or, the physicians feel too threatened by the practice of CNMs and just plain refuse to work with them.
Also, as a L&D RN, I see too often how difficult it can be for a woman to get the kind of natural delivery she desires in the hospital setting. My hospital is a small, rural one that has much fewer interventions than the nearby bigger hospitals, but without our CNMs, moms would still find quite a bit of resistance to having "too natural" a birth. OBs truly don't want to be inconvenienced.

I also agree that many women in today's society are half the problem. We live in a very self-centered world. We have a generation of girls who have become women and still want everything their way all the time. They don't want to feel any discomfort, or have their schedules interfered with, or "get fat", or lose sleep, etc., etc. (Obviously this is a broad generalization, but a common thing.) I don't know if any of these attitudes would change or not, if these women were educated about the risks to their babies as a result of their mothers' desires for their "needs" being met, i.e. inductions, elective CS, excessive pain meds, etc. My fear is that many women who have this attitude, would still feel the same, even WITH the knowledge that it isn't in the best interest of their babies.

I do believe that many of the problems in our country could be changed with education, however. If women begin to demand care based on their knowledge of what is in their and their babies' best interests, eventually someone will have to listen!
Midwifery care needs to be an option for all women, regardless of location. If a low risk woman desires a natural birth, in a hospital, birth center, or at home, they should have that option, with a trained, educated health care provider! Until that option exists, there will be those who opt to take chances with their lives and the lives of their little ones, by going it alone at home, rather than risk what they percieve to be potential risks associated with "medical" hospital births. It makes me so sad. I anticipate a news story any day now about a lost mama or baby because of an unassisted birth. How tragic and unneccessary!
I do know that the ACNM is beginning a marketing strategy to try to increase the public awareness of midwifery. It might be a cause worth supporting! More info can be found at their website.

[byrd262]

I think that we must recognize that women are going to choose to birth this way whether or not it is accepted. There are systemic issues we have to understand. SOME (I can't speak for all) women choose this option because their only option is a hospital birth. Unfortunately, other, more accepted options don't exist depending on where you live. For example many CNMs do attend homebirth, but they need physicain back-up to do so. Most physicians are not willing to do this. Therefore many if not most CNMs work in hospitals, hospital birth centers and free standing birthcenters (which there are very few). Another option would be the CPM and lay midwife who are not trained as nurses but usually have a lot of experience and/or a formal training through a midwifery school. The challenge here is that these professions are not recognized in all states which can get very tricky. So there is a legal risk for these midwives if they do homebirths where they are not "allowed to." Also, CPMs and lay midwives usually have a difficult time to sustain their business financially because of the cost of travel (for prenatal and post partum) and other expenses. What does this mean? Many non-nurse midwives leave the business. All of these issues lead to a lack of access to women who want a certain type of labor. So, for them their only option is to labor at home.

I also want to point out that the women who choose this option don't just "wing it." They prepare by educating themselves as much as possible and they have a back up plan. Of course there is no substitute for medical/nursing knowledge, however, that knowledge is not always needed.

[mommy2boysaz]

Originally Posted by byrd262

I also want to point out that the women who choose this option don't just "wing it." They prepare by educating themselves as much as possible and they have a back up plan. Of course there is no substitute for medical/nursing knowledge, however, that knowledge is not always needed.

OK, I was with you up until the above quote.
I'm sure many of the women do attempt to educate themselves and prepare a backup plan, but I'm quite certain that some don't. And, they can't possibly educate themselves about every possible complication or issue that may arise.
I agree that medical knowledge may not be needed with every birth, but you won't know you need it until after you need it!
With 10 years of OB experience, I know that the smoothest, easiest labors and deliveries can sometimes yield the sickest or most "depressed" (respiratory-wise) babies. It is usually completely unexpected. I've also had joyous births turn into emergencies when moms begin to hemorrhage after delivery. At times like that, you REALLY want someone with training present! I'm not saying these situations can't be handled in the home, but I do think they need to be handled by someone trained to handle them.

I agree wholeheartedly with the rest of your post. Most of these women just feel caught between a rock and a hard place.
As CNMs, we have to fight to change this!

[scootersuz]

Ok I have to add my two cents worth here. I wanted to have a home birth with a mid wife. I was pregnant with twins and the pg went perfect. My girls were in the head down position, ready to go but I developed Pre-eclampsia quickly at the end. My blood pressures spiked and they decided to deliver early and do a scheduled C section. The fact that I was in the operating room for the c section saved my life. I ended up having a massive Bleed pot because my placenta was deeply embedded in the uterine wall. The delivery went code and they called in two other surgeons. They said if I had even tried to do a vaginal birth in a labor room there was a good chance I would not be here today.
And one of my twins needed help breathing so she was taken into the NICU immediately.

So a at home unassisted birth. Thanks but no thanks. Things can go wrong.

[LLLovely]

I know an RN who recently had her third child at home with just her husband. She had two previous hospital births, both with no intervention, but she hated them. While she is a strong person who is able to advocate for herself strongly, even while in labor which many women can't, she was tired of having to do it.

I don't know that I would do it, but I certainly understand the inclination. Why go to the house of bright lights, have people ask you over and over to insert an IV, have people interrupt you during a contraction with demands of changing into a hospital garment instead of the clothes you brought, disallow you to walk in the hall, have no access to a tub or shower, have no food or drink except what your husband can sneak in, etc?

She didn't want to deal with it and there is only one, yes just one, CNM who does homebirth in her state because of the complete lack of willingness of docs to back them up and lay midwives are illegal there. In her case, there really were no legal options other than hospital or UC. I greatly despise that many women are left with those two choices. I know there are direct entry midwives who do practice illegally in her state, but their numbers are dwindling as well since many of them are CPMs and do not want to risk their certification.

[epiphany]

Originally Posted by Hopefull2009

Women are n-u-t-s for doing that.

Too many things can go wrong and I really think that a woman who chooses that option should be charged with criminal child neglect if a baby dies/injured due to total absence of medical care during a birth....just like they do with these teenagers that birth babies at home...I see no difference.

These women, if they don't care anything about whether they live or die, then so be it...but they shouldn't put their baby's life at risk just so they can have bragging rights later.

Things like this make me SO angry!!!!

When women choose crazy birthing options like that...it's not about the baby, it's about their ego....which needs to be checked at the door.

Do you really believe that a woman who chooses this option is out to her hurt her baby?. That's the kind of reasoning I've heard over and over again whenever a woman resist the medical model of management that's forced upon them - if you don't do what we prescribe, you are unfit mother who is willing to hurt her child.

Please look at the evidence out there on hospital birth, rates of c/section, infection - not to mention the kind of empowerment that is experienced by a mother who feels in control of her own labor before you make assumptions about people as well as facts.

I believe that a woman should have the kind of pregnancy and labor care she wants, and many women choose this option because they don't think that they can find someone who advocates for their beliefs. That is truly sad.

I had a hospital birth that has traumatized me so much, I chose to become a midwife. I wish that I had had to courage to give birth myself so that I didn't have to be at the mercy of the heartless people around me at the time when I was most vulnerable and scared. If I had, I would have been able to hold my head up high and let my courage enter the spirit of my daughter. So now I choose hold another woman's hand in the hop that it will heal me, too.

I worked in an L&D floor before going to midwifery school, and I have heard so many abusive attacks at mothers who questioned their treatment - and it was always the same weapon that you are using - "are you trying to hurt your baby?".

I don't know if you are going to be nurse, but whatever your beliefs, you need to understand how to be therapeutic, and that people just want to know that they matter, and that it hurts the most when you are not treated like a human being. If I believed that an intervention was truly necessary, it never took much for me to convince the woman that it was the right thing to do, and I know that it was simply because she knew that I cared. What bothers me the most about your post is that you don't seem to have a clue about love and support. Maybe that's just from anger and misinformation, but I can tell you tell it is this kind of attitude from the health profession that drives people to extremes.

[LLLovely]

I am headed towards midwifery for the same reasons epiphany mentioned. A physician actually told me, "You can sit here and watch your babies die on the monitor. We don't care if that is what you really want."

I had several physicians lie to me about the statistics of risk surrounding my choices and about the risks and benefits of many medical procedures. I had a physician strip my membranes, not just without my permission, but without even asking or telling me he was about to do it. I had a physician tell me that I didn't know how to push a baby out and I couldn't do it unless I listened to their experienced voices. (She had never birthed a child of her own.) I had a physician tell me that there was, without a doubt in all circumstances, a higher risk to breech delivery than to a C-section.

I absolutely understand what drives women to choose unassisted childbirth. The vast majority of them have no other choice that doesn't land them in a hospital, and so many women are scared to death of what happens in hospitals because they have experienced it previously or know someone who did. In my ideal world, low-risk women will be able to confidently, legally, and with adequate medical backup choose homebirth. My goal is to be a part of that solution.

Kudos to epiphany for being able to speak on this topic so eloquently. Her astute observations about the role of nurses as supportive caregivers, rather than judgmental "yes men" are right on the mark.