Monday, January 18, 2010

A Sign on a Door

“Because the Physicians at Aspen Women’s Center care about the quality of their patient’s deliveries and are very concerned about the welfare and health of your unborn child, we will not participate in a “Birth Contract”, a Doula Assisted, or Bradley Method delivery. For those patients who are interested in such methods, please notify the nurse so we may arrange transfer of your care.”

A photo of this sign has been posted on the internet and has created a stir in the pro-natural birth community. Wow! So here is a hospital being completely upfront with their beliefs: natural childbirth is less safe, laboring moms and dads do not have the right to make their own choices during the birth process regarding the safety of their babies, and they can not bring into the process any outside professionals who do believe in the safety of natural birth. As a doula I am both shocked and glad they are being this straight forward. Many hospitals and medical professionals share these same beliefs but they are not so open about it. The women in Aspen who take a tour of this facility before they make a choice about where to birth their babies can decide for themselves if the philosophy of birth expressed here is a good match for them. Luckily I was able to find one other hospital in the Provo Utah area where the Aspen Women’s Center is located so women do have a choice.

At the root of this sign are two men, Dr. Robert Bradley and Dr. Fernand Lamaze but to understand why a sign like this would end up hanging on a door in a maternity ward it is helpful to look at a little history. Perhaps one of the worst times for birthing women in this country occurred during the era when doctors stopped going to their patients and medicine became more centralized. Driven by the discovery of germs to be feared and a culture that was turning away from individualization and toward efficiency, hospital protocols turned birth from a family event into the business of birth. Culturally women were trained to acquiesce to male authority figures and so they passively allowed the process of birthing babies to be taken over, fathers were excluded, rigid hospital routines were followed and male doctors dominated the scene.

Then the Sixties arrived and with it the women’s movement, hippies and the protest era. Into this powerful mix walked Dr. Bradley and Dr. Lamaze to spearhead the “natural” birth movement here and abroad. Although their “methods” differed they both believed two things; the sensations of birth can be handled without pain medication and a husband’s help is vitally important to the process. Through their books and training of out of hospital birth educators they changed maternity care in this country by creating consumers, moms and dads, who demanded changes. Fathers went from being completely excluded and made to sit anxiously waiting in a separate room to being required to be an active participant at their child’s birth. Women showed doctors it was possible to experience labor without being rescued by pain medication; birthing in up right positions became possible and labor beds which convert into a variety of positions were adopted. Babies who weren’t drugged in labor could latch-on and nurse immediately after birth and did not need bottles and formula; La Leche League and the breastfeeding movement began. Now hospitals have lactation consultants on staff. Women who had not received medications and/or surgery could immediately begin to care for their infants and rooming-in became the norm; only infants who need special care go to our local nurseries now so they look like ghost towns. None of these changes were begun from within the system they came about through consumer demand on the system, although all along the way nurses, certified nurse midwives and a few doctors listened to their clients and ultimately were the ones to bring about change within the system.

Here are some of the changes I have seen in San Luis Obispo in the twenty years since I became a doula. When I was pregnant with my son there were two hospitals to choose from in San Luis; General Hospital which was known for being more pro-natural birth and Sierra Vista which had just gone through a dramatic physical renovation to create less “hospitally” looking rooms where a mom could stay throughout her time in the hospital. You had two choices of care providers who supported a natural birth, Dr. Lickness or the Certified Nurse Midwives working for Dr. Johnson and Dr. Richards. Kathleen Huggins had published her “Nursing Mother’s Companion” and begun the Breastfeeding Warm Line which dramatically increased our county’s breastfeeding rate. Did you want to try to birth vaginally after a cesarean? Talk to Dr. Clutter; eventually all the doctors in town would “allow” a woman to try for a V-BAC. At General Hospital the nurses worked hard to achieve the World Health Organizations “Baby Friendly” status and later with the help of the nurse midwives, Linda Seeley, Midday Johnson, and Lisa Winnick, and Dr. Spalding they began doing water births. At French hospital the nurses have worked with the anesthesiologists to find a level of medication which will give adequate pain control and leave the mom able to be more of an active participant during pushing. Sierra Vista increased the level of care they could provide seriously ill newborns so moms and babies can stay together in the county instead of being flown to bigger hospitals. Many beliefs about standard safety procedures have changed too, such as, when I had my son I was continuously on the baby heart monitor but now even the American College Of Obstetricians and Gynecologists agree that fifteen minutes out of every hour is adequate for picking up a baby who’s in trouble. Doulas became more common in the county and I personally felt more accepted as part of an over all team working to achieve the most positive births possible for my clients. Each of these changes and many others started small, one doctor saying yes or nurse saying I’ve never seen that done before but if it’s what you want. . .

None of these changes happened without push back from the established system. The stakes are high. The business of birth is big money. The fear of litigation is all too real. My birth class clients have had doctors throw their birth plans across the room. I sat in a doctor’s office and heard him tell my doula client that “natural” birth was all very well but it wasn’t optimal. Both our hospitals currently refuse to “allow” women to birth in water. Now because of space issues dads aren’t always able to stay with moms and babies after their births at our hospitals. I listened to a birth professional tell a group of women that Bradley classes teach women not to trust their care provider but I believe it is a birth educator’s responsibility to teach women to trust themselves and to trust birth and it is the care provider’s responsibility to foster a trusting relationship with their client. Sierra Vista asks doulas to sign a paper agreeing to do little else than bring ice chips and hold a woman’s hand. These days many women don’t want to actually feel birth, our society is too accustomed to medicating our pain away. Add to that our culture’s obsession with scheduling our lives and we get inductions and planned cesareans. Meanwhile our hospitals’ cesarean section rates are climbing as is our premature birth rate as too many babies are being “scheduled” to be born too early.

So this sign on a hospital’s maternity ward door doesn’t surprise me but it does sadden me to see that the things women and their partners, nurses, doctors and midwives have worked so hard to achieve in moving birth in our country toward a more humane, family centered experience grounded in the belief that women are created with the power in them to birth their babies is being eroded.

Jennifer Stover
Labor of Love Childbirth Preparation & Doula Services

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