AnthroGirl

First off, let me send out a heartfelt thank-you to everyone who has gotten involved in this thread. Your input is so thoughtful and interesting. Second, let me say that I am learning so much both about how some nurses may be feeling, but also that some of the same sentiments coming out of the midwifery and social science literature are shared in the medical field. When I originally brought some of these issues up with my OB (outside of the research setting, in theory, but one is always learning) she was actually ashamed of the c/s and induction rates at her hospital. There are a couple of aspects that I think may be fruitful to come out of this discussion. One of which is something that SiennaGreen and others have mentioned. It is the fear aspect of childbirth that is often instilled throughout the prenatal period. I was speaking with my Massage therapist/Doula about this the other day. There is a fear that has been built around the pain and processes of birth which seems to be instilled in women. Even if it is not actual fear of complication, or pain, it is the fear of losing control. Women are told that they need to be a part of their labor and that they need to allow (or aid) their physicians in maintaining control of the timing and progression of their labors. they are also told that they cannot do this without help, because they are incapable of handling the pain. Sadly, women are taught that they will probably not be able 'handle' most of their labor, so it should be managed, augmented, and pain free. There is a great article called "Giving birth like a girl" written by Karin A. Martin that examines how women feel they are expected to behave throughout labor and birth which highlights how they think they must be nice and sweet and polite. The other theme that is important throughout this thread is that of convenience. It seems that we recognize the inductions and c/s that are scheduled for the sake of scheduling, but outside of an intimate setting like this, there is no such thing as a social induction or c/s. Docs will swear that they are all medically necessary. I have lost count of women who are induced or sectioned at 38 or 39 weeks (or on their due date) because their baby is ENORMOUS and of average size. We know that this is happening, and obviously, from increasing intervention rates and the threads even on this site, women know this is happening, perhaps the questions are not what is going on, but how and why? Here is a question to ponder: What is it about the relationships and interactions between women, caregivers, and bureaucracies (ie administrators and insurance companies etc) that perpetuate and increase practices that are not beneficial medically, socially, financially, or emotionally? How and why do these practices continue at their(increasing) rates? What roles do the women play in the maintenence of these interventions? Docs? Nurses? Hospital policy makers? ect? I think we may be on to something!!!

Thanks Romantic! I really do like Ina May Gaskin's work. Another great author is sociologist Barbara Katz Rothman. She has done a lot of work looking at how situations in a L&D setting are negotiated and how there is often a dissonance between medical practitioners and laboring women.

Midwife228, Thanks for responding to the rampling thread. I hope that you will share your thoughts, creating a research project/question has been really hard for me. Because I am so passionate about pregnancy and childbirth, gender equality, and natural childbirth Iam having trouble focussing on one aspect of a very, very complicated issue!Thanks so much for the congrats, we are very excited! There'll be nearly ten years between baby #1 and baby #2, so this has been a whole different experience for me this time. My provider is actually an OB. I would have liked to have gone with a birth centre and a midwife (no homebirth for me, between 200 lbs of dogs at home and a nearly catastrophic PPH with the last one...) but my insurance doesn't cover birth centers and will only cover 80% of a hospital birth with a midwife. So it is sadly, financial. However, I have the utmost respect for my OB, she is young, and very progressive, or rather regressive I guess going the more natural non-interventionist route. The hospital where I will give birth, although a teaching hospital, has revamped and taken a more mother/baby centered approach, so I am pretty happy with them also, and of course the nurses are great;). As for the doula, I think they are fantastic! I haven't decided if I will go with one yet or not. I think I may, as this is my husband's first experience with (human) birth. A doula may take some of the pressure off of him, as well as some of the strain off the nurses in L&D (1:2 ratio at my hospital). Like I said, any input is wonderful. I am curious to hear what you and other midwives may feel are some of the more pertinant issues surrounding birth (both hospital and other), client practitioner relationships, and processes of prenatal and postpartum care.

"Hospitals ultimately benefit from high surgical rates (higher reimbursement) despite it being a public health nightmare. Litigation is out of control, mandating unreasonable safeguards and resulting in higher intervention. Many feel that if they don't intervene, they will get sued. Others intervene because much of OB culture is based in fear, and some no longer have the benefit of training which encourages supporting the natural development of labor, which sometimes involves patience, and always deserves 1:1 staffing in active labor (nurse:patient ratio)." MamaFeliz, So true! I have heard a lot of these arguments; litigation, the cost/benefit of interventions, the argument that all births are 'potentially pathological', and one of my favorites regarding medicine in general, docs only know what they are taught... They are all so interesting, and I think that they are also inter-related. One argument that seems to pop up in anthropology and sociology a fair bit refers to biomedical culture in general and it has to do with time and standards. That medicine has put life (and life cycles) on a schedule that is relatively narrowly defined. This includes birth, death, aging, illness, and the like. I think the best advice that I have received from my OB and the nurses at L&D is don't rush to the hospital at the start of labor. If you're not here, you can't be timed. But then again, how does that sort of a advice work for a young primip who has little support at home to get her through the early hours of labor? All very interesting questions. As for the homebirth debate... so heated, so emotional. I think it is hard to be critical and maintain a cool head talking about this because the loss of a mother or baby in birth is devastating for all involved. One thing that I find is really interesting is that the obstetric, nursing, and midwifery literature seems to be coming closer and closer in opinions of normal, low risk birth and the dangers of intervention, but the professional opinions are still divided on whether homebirths are a viable alternative. In a nutshell, it's preferable to birth without intervention, but only at a hospital (according to a lot of docs). To complicate issues, I agree with FemmeRN that often women are planning to homebirth not because it is the ideal option for them, and what they really want, but more so because the hospital is what they don't want. They are afraid of losing control of their body and their experience in the hospital. Also very interesting. I so appreciate everyone's replies in here, it gives me much food for thought that I can sit down with and chew on for a while. Of course, then my brain begins to hurt...

FemmeRN, Thank you so much for your response! I too, am fascinated by the homebirth movement, for many of the same reasons. I think that it is a little like second-wave feminism, where the (and I hate this line) 'pendulum has swung' to the opposite pole! I think that it does have alot to do with power and knowledge relations. Your comments on elective c/s rates are very interesting. I have followed a lot of threads here on allnurses and I see that this is of major concern, as well as 'social inductions'. Both of which I find fascinating. Perhaps this is an important area for so many reasons: Who are the women that are electing for c/s? Are they really electing for a section? If so, Why? All interesting questions, I will keep wondering and hope for more input.

Good morning all, After months of lurking and reading hundreds of pages of posts I have decided to come out of the woodwork. I will start by saying that I love this website! I have learned more from the men and women posting on these discussion boards than I have in many, many years of formal education! Now to the meat of this post... I have kind of a bizarre social location, I am a PhD student in medical anthropology and I am an expectant mother (my second, due somewhere around the 1st week of May). It is the latter that drew me here, but the former that has led me to register and post. I am in the process of building a research question/proposal for my dissertation research which I want to be useful. My interests lie in the relationship between pregnant and laboring women, their physicians, nurses, midwives, and other health care practitioners. I am curious about decision making and informed consent; IE how (and why or why not) do women decide to undergo prenatal diagnostics? How do women negotiate the administrative and bureaucratic maze of hospital births? How might help (or hinder, although this is less common) women through this time? These are just a few areas of interest, but as an anthropologist, I think that the most important aspect of my research is that it is useful and practical in the real world. I want to determine what kinds of questions need to be asked that will benefit not just expectant women, but physicians, nurses, midwives, administrators, and policy-makers (not that I'm overly optimistic!). Basically, without input from the communities that I wish to learn from, my questions are pointless. So, finally, hence the post... From reading many pages of allnurses (I even went back 1998, wow have things changed!) I have started to get a bit of a feel for the complicated relationships between docs, nurses, women, administrators, and the like, but I am also interested in chatting with some nurses and others that may be hanging about on this site to get a more personal feel for what people think needs work. So please, please, I'm begging feel free to fire input my way! I have had a dialogue with other academics who feel that women should be the main topic in this research, but I think that misses out on the complexity of the process of pregnancy and childbirth, and to an even greater degree the social aspect of women's health in general. So again, any input is greatly appreciated, and if at all suspicious of my credentials, please let me know and I will fill in any gaps! Thanks, anthrogirl