Saturday, February 12, 2011

Brutality in the delivery room (Orig Post Date: 3/10/10)

Hello uLocal members and Local Voices fans. This being my first post, I really wanted to ease you all into my style, but it seems that the greater forces out there had other plans. Eventually you will get to see the post I was originally going to put up, but right now I have something I need to get off my chest.

 A woman’s options for the birth of her child in Des Moines are appalling. Activist groups are making strides for more rights for midwives and for reasons that, quite frankly, make me sick to my stomach, they are running into more opposition than the pro same sex marriage folks. Unfortunately, you don’t hear about the opposition because birthing options are not as news worthy as Gay and Lesbian marriages, and birthing options don’t make for good campaign speech fodder. Unless you are directly related to the issue either as the expectant mother, a care provider, or the spouse or family member of the expectant mother, you are most likely unaware of the current climate. It is very hard to get any support or coverage for birthing rights and options for women.

You, as the patient and expectant mother, are just expected to blindly trust your obstetrician. To believe that he or she will make the best decisions for you and your baby, go to the hospital like a good little patient, lay on your back, let them bully you and tell you that you’re doing something wrong and that’s why X part of labor isn’t going according to the textbooks, and that now a Cesarean Section is the right thing to do. That the C-section is saving you and your baby, and you should be grateful to your doctor because they are rescuing you from this horrible situation.

Are there cases where a C-section is necessary? Sure. Are there cases where a C-section is done and it is absolutely unnecessary; when the mother simply needed time to work through the stall in her labor? You better believe it!

Anyone who doesn’t believe that there are doctors out there that are only in it for the money are just lying to themselves. A local midwife told me about a conversation she had with an ob/gyn shortly after moving to the area. He flat out told her that he wasn’t in it for the joy of catching babies, or to help women have the best possible birth experience, he was in it for the money. He didn’t care about what the mother wanted, or what was in her best interest not just for that pregnancy and delivery, but for any future pregnancies and deliveries she would experience.

All it takes is one bad experience and that can damage a woman in ways that she may not even realize. Whether it’s a rough exam during labor that causes a stall that leads to a C-section, or an unnecessary C-section that leads to complications post-partum or with a subsequent pregnancy, labor and delivery. Any one of those things can scar a woman either physically or emotionally, and she may never be able to overcome that injury. There is a palpable hostility in the labor and delivery wing, and it becomes more pronounced in direct proportion to the level of assertion and education the woman has and exercises in regard to her right to have the kind of labor and birth experience she wants, rather than submitting to what the doctor and nurses feel is best.

If a woman has already had one C-section, her options are that much more limited. The medical community in Des Moines does not look fondly on VBAC (Vaginal Birth After Cesarean). There is only one hospital in town that even allows a woman to try for a VBAC, and because of the monitoring that they require she is stuck in a bed on her back. She is not allowed the freedom of movement necessary for birth to progress, and is unfortunately moving towards another C-section. At this time, a woman’s best bet for a successful VBAC is to get on with the midwives at the University of Iowa hospital in Iowa City, and hope that one of the local Des Moines midwives can assist with her prenatal care so she doesn’t have to drive two hours each way to her appointments. It of course helps if that woman was a previous patient of a Des Moines midwife, but I don’t think it’s a deal breaker if she wasn’t. Thankfully the University midwives are all too aware of the sad state of birthing options in Des Moines, and are willing to work with women and their Des Moines based care providers.

Being the capital city, I would think that Des Moines, with its three large metro hospitals or West Des Moines with its two brand new hospitals, would be better equipped to monitor a mother trying for VBAC in a way that she could actually have a chance of being successful. Perhaps it’s not a lack of ability, but a lack of desire to want to help a woman in that situation. A successful VBAC will not make as much money for the hospital, and requires the doctor to be available throughout the woman’s entire labor so he can “deliver” the baby when it’s time. If a woman is denied a VBAC, then a C-section is scheduled when it’s convenient for the doctor, and there is additional revenue for the hospital because a surgical delivery costs on average $2000 more than a vaginal birth (patient cost after basic insurance).

For all the people out there that say, “What’s the big deal? It’s just a C-section.” Let me remind you that it is not “just” a C-section, it is major abdominal surgery, and it’s not a small incision either. It is at least five inches long, and the surgeon typically uses approximately twenty staples to hold the incision closed.

Not only are they cutting through the abdominal wall (your core muscles), but they are also cutting open an organ that is primarily muscle and has stretched to five times its normal size. That’s a lot of scar tissue that has to stretch again for any subsequent pregnancies which, in turn, are limited in number and further complicated, as well as classified as high risk, simply because of that first C-section.

If you have ever had a scar in a place where it stretches or bends even a little, you know how uncomfortable and even painful that can be. Now imagine that pain and discomfort as a constant for nine months.

Yeah, doesn’t sound like a lot of fun does it?

So if it could be avoided by not forcing a C-section on a woman because there’s someplace the doctor needs to be in an hour, it’s Christmas Eve, or Thanksgiving day and she has stalled at seven centimeters, don’t you think it would be worth it to let her work through it?

You can’t become an obstetrician and expect to have banker’s hours or a banker’s income. That’s not the way nature works.

You want banker’s hours, and to be where the money is, be a banker not a baby catcher.

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