Where are the "normal" births?

JeanettePNP, MSN, RN, NP · Oct 5, 2010

Can you give more information about the demographics of the birthing population? Are they young/teenaged moms? How educated are they about pregnancy, labor and delivery? How prepared are they for childbirth? What percentage are getting epidurals? Internal monitoring? Also, when you say thing start to crash suddenly, what kind of things are happening?

blueindigo79 · Oct 5, 2010

I can totally understand. I worked l&d at a baby factory in nyc and was horrified. I started wrking there versus other hospitals bc there were midwives but only medicaid pts saw the midwives. How are birhs at home or at a bithing center safe? Bc moms are allowed to walk, fewer unnecessary interventions, no inductions, intermittent monitoring etc. They have better outcomes (csection,'episiotomies) than the hospitals. Look at the stats at The Farm in kentucky'amazing. Hang in there!!

l&drocks · Oct 8, 2010

It is called the medicalization of pregnant women. Women who are pregnant are treated as if there is a problem, not as healthy women. Pregnancy is thought of now as an abnormal state of being.

CEG · Oct 15, 2010

It's the interventions in the hospital setting that lead to the complications. Inductions, pitocin, AROM, etc. Also electronic fetal monitoring is not evidence based- it contributes to a higher c/s rate without improving outcomes. Homebirths reduce the risk of all of those interventions as well as infection and increased morbidity from things like episiotomy and c/s. Try to think of how many "non-normal" births you have seen where there wasn't some interference before something went wrong. Even iv fluids are an intervention that causes problems (hemodilution, slows down labor)...

BluegrassRN · Oct 28, 2010

You're probably going to have to go to a very small hospital or completely outside of the hospital (birth center, home births) to see a lot of normal births.

StarrySkies · Oct 28, 2010

I was a doula and childbirth educator before I was a L&D RN and let me tell you- there is a huge difference. Have you ever attended an out-of-hospital birth? Without that experience, you really can't compare. Nearly everything that we do to women in the hospital disrupts "normal birth". Heck, just being in the hospital can slow down labor, affect her fear level, and cause complications. Starving women, denying them liquids, denying them freedom of movement, starting IVs, continuous EFM, et are all considered to be "normal" in the hospital (ie- not an intervention) but all of these things ARE interventions and do affect the course of the labor. Let alone the actual interventions that we do! AROM, internal monitoring, hanging pit, pain meds, epidurals, et (some have their place) but all immediately increase the risk of the labor. Lets talk about pushing... In the 50 or so out-of-hospital births that I have attended I have NEVER seen a woman choose to deliver on her back. Yet, that is the only way that I have ever seen an OB deliver a pt in the hospital. I did see a CNM deliver in side-lying once though. How many dystocias happen because of maternal positioning during the 2nd stage? A LOT IMO. Now, lets talk about expectant vs active management of the 3rd stage. There is some new research that makes this inconclusive, but what I will say is that at my hospital they routinely cut the cord right away which leads to a lot of pale babies. I never saw a baby born so white until I started working as a LAD RN. I HATE having to call NICU to do an IV bolus on a baby- if that OB had just waited for the cord to stop pulsating, it wouldn't of been needed.

Sorry to rant there. I'm a little frustrated with my job right now, but I am very happy to be starting grad school this Spring!

Normal birth is out there, but it is rarely seen in the hospital setting.

Sandwitch883RN · Nov 5, 2010

IMO...which may not be worth much..lol...There is such a fear of legal action if there is an adverse outcome, that physicians do as much intervention as possible to CYA. The prevalent mindset now is to do as much "preventative" intervention as possible to avoid being at fault later. The thing is, all the intervention that is done is what creates the problems that occur. Yes, I know things can happen anyway but we sure don't minimize the chance of it happening by doing so much unneccesary stuff!

yelnikmcwawa · Nov 7, 2010

Don't wanna hijack your thread because I'm not a CNM, but when I was pregnant, I just "knew" that if I stepped foot in a hospital I would not get the kind of birth I wanted. Healthy women are not necesarily at risk of having a birth go awry, it's the interventions implimented in the hospital setting that make births go from "normal" to problematic. I switched from an OB to a CNM at week 21 gestation and ended up having a phenomenal, short, supportive, and complication free birth in a birth center.

I didn't want to set foot in a hospital because I figured that sick people go there to have their health complications treated. I wanted to welcome my son into the world, not "fix" my laboring body. It is my opinion that the hospitals create the vast majority of birthing problems. Yes, medical care is nescessary for some women and babies, and thank goodness it's there when needed. But just like it's hard to lose weight if you keep the house stocked with cakes and cookies...it's hard to have a problem free labor when there's so much equipment around that's designed to treat problems. JMTC

:dncgbby:

ruralnurs · Nov 7, 2010

I was an RN at a very small hospital that did not do high risk OB, so the two docs that did OB really tried to keep things as low risk as possible. They DID NOT do elective inductions and God forbid an elective C-section. I seldom saw internal monitoring and the docs loved for us to have the woman out of bed moving and they both would deliver in any position the woman wanted. I loved OB and considered CNM but for various reasons chose a different APN role. I still visit this board however.

I see so much complaint about (not necessarily in this thread) doctors and nurses taking natural birth away from mothers. This is true in many instances but we need to call it the way it is too. Many women do NOT want a natural birth. I have cared for so many woman that want an epidural at 8 months, they do NOT want to feel pain or discomfort, they want the baby to be born on its due date or even a pre selected date, they want the whole family in for the show, do not want to breast feed in the first hour because they need to go out and smoke, don't want to do to CB classes, don't want to have suggestions or instructions by nurses that really want to help, once they get the epidural don't want to even move as much as possible to prevent a c-sec,etc. I remember begging women to try the ball, try walking, try the shower, etc. I have been with the docs when they are arguing with a mom that just because her due date was 3 days ago does not mean the doc needs to induce right now.

I taught the CB classes, they were FREE they got several nice gifts to include a nice car seat, we fed them and did everthing we could but they wanted the gifts then came up with an excuse to leave as soon as possible.

My daughter's best friend from HS is 22 and now Pg with first baby. I offered to give her videos, talk to her, etc. She said her doc is trying to talk her into CB classes but she does not think she needs them, after all she believes in pain control so will get an epidural.

So yes, the medical providers have taken natural birht away due to fear of lawsuits and convienence and power and control and whatever, but part of this is woman that want a medicalized birth.

Just my thoughts........

yelnikmcwawa · Nov 7, 2010

Ruralnrse, you make many valid points. And yes, there are many women out there who do not have any interest in knowing what it feels like to give birth. However, I cannot even tell you how many women I have known that have been dumbfounded after hearing about my birth. They told me that they didn't even know there were other birthing options out there besides the typical legs in stirrrups, epidural turned on. And an added bonus...many of the women I share my birth story with seem intrigued about exploring their other options.

I think that those of us in the healthcare field need to remember that people not in healthcare may not feel comfortable seeking out healthcare options on their own, but are more than open to exploring them once presented. Our society does a HORRIBLE job of explaining birth options to pregnant women, and perhaps if more women knew that other options existed, they may be more interested in trying them out.

ruralnurs · Nov 7, 2010

yelnikmcwawa,

Thanks for your response. I just don't know if I buy it. I agree that all women should be given all options to them, but in my limited experience I just see our nation has become a people that want things easy and fast and with minimal work involved. I have given birth to 6 children, 5 with no pain meds all natural births and the 6th via emergency c-section (that I do believe was warranted). Having babies is hard work, anyone that has had a baby knows that. Our society has, for the most part, shied away from the tradition of working hard for things.

My other specialty is mental health. One of the best evidenced based care therapies shown by research for anxiety and depression is Cognitive Behavioral Therapy. It is very effective for anxiety but what do most people in our nation want? They want Xanax or maybe Zoloft (or other SSRI). People choose to have bariatric surgery rather than do the work needed to lose weight. Take sleeping pills rather than practice strict sleep hygiene. Formula feed because they can easier give the baby to someone else (not all women formula feed for this reason I know). I am sure we can all think of things where we as a society has chosen the easier/faster way to attain what we want. I know that a c-section is not easier than a lady partsl natural birth (it was easily the worst thing that ever happened to me in my entire life). But women that have never had either can't fathom that getting some nice drugs and having other people do the work of cutting your baby out is harder than pushing your baby into the world on your own. They see that a scheduled c-section in convenient and won't be as painful (ya, bull%#@*).

I know this is a rant but with the internet and movies like "the Business of Being Born" I have a hard time believing that most women that want to be actively and autonomously involved in their pregnancy and birth don't know what is available. Yes in my neck of the woods here there are little to no options for birth environment (tiny hospital, bigger hosp 80 miles away or homebirth with or without a birth attendant) and women may not know they can have a voice. Except when I was an RN at the tiny hospital I made it my mission to educate them, to give them a voice and a choice. I told them in the first few minutes of my CB class or when I first took over their care as their nurse that this was their birth and they get to decide most things. I was a fanatic and even my fellow nurses thought I was over the top with trying to keep things as natural as possible. Seldom did I ever see a woman choose not to have interventions.

Sometimes it may be lack of knowledge but I think it is the way our society is going. I hate to see it and I hope that my 3 daughters all have the births they want, but what I wanted and what they may want may be different.

I think we need to preserve natural and intervention free birth for women that want it. But rather than blaming the medical profession for women that want an intervention-laden birth, we need to recognize it for what it is.

A choice.