OK, @c9r, you got really lucky. Your wife nearly died, and if the placenta hadn’t detached quickly on its own, she very well could have. Her odds of survival would have been much much higher in the hospital.
Guess what, many hospitals DO allow immediate skin-on-skin/breastfeeding as long as the baby is healthy and breathing well. And no, the doctor would not have gone digging around inside the uterus to look for tears, that doesn’t even make sense. The doctor would have examined the placenta visually, to see if it appeared intact. If there appears to be a chunk missing from it, then the doctor checks for retained fragments.
Luckily, your midwife carried pitocin. Many midwives do not, and depending on where you live and what type of degree she holds, it may be illegal for her to administer drugs, since she doesn’t have the training.
I’m just going to remind the thread to remain kind and personable with one another. It’s okay to disagree. It’s not okay to be rude about it or attack other people.
Here’s something important I realized when having my first child.
I had my first child at the age of 35, one year before my health plan would have paid for an amniocentesis. At the time I assumed that the health plan’s basis for setting policy on when to pay for that procedure would have been based on there being “significant risk” of one of the maladies the procedure would detect (where “significant risk” wasn’t formally defined in my mind). However, that is NOT the basis of the policy.
The policy is based on two curves. Both curves have the mother’s age as the horizontal (X) axis. As the vertical (Y) axis, the first curve graphs the chances of having one of the issues detected by the procedure, which is a curve that slowly rises as the mother’s age increases. The second curve’s Y axis graphs the chances of the amnio itself causing a spontaneous abortion, which – if I recall – is pretty much a constant value across the range of ages where it’s at all common to give birth, and so is a fixed horizontal line. The basis of my health plan’s policy on when to pay for an amnio was based on the point where those two curves crossed… in other words, the plan began paying for amnio at the point where the chances of having something like Downs syndrome (along with all the other detectable conditions) began exceeding the chance of the pregnancy being inadvertantly terminated by the amnio procedure itself.
If you think about this, it can be cast as a “reasonable” policy, sort of neutral in its ethics. What I find NOT ok is how little this is explained to parents. Because people shouldn’t rely on the idea that the health industry is looking out for them, shouldn’t believe that if the policy won’t pay for an amnio, then there’s no reason to want one. Specifically: the more a given parent leans toward the view that they – for whatever personal reasons – would find it a hardship to bring a Downs syndrome child into the world, they should choose to pay for an amnio sooner than their plan necessarily would. Conversely, the more a given parent leans to the view that they’d keep a child even if it had Downs syndrome, the more they should age past the point of the amnio being paid for before choosing to have the procedure done.
And that’s a very good point. People can have different values and risk assessments. Some people wouldn’t terminate for birth defects no matter what, some people might, depending on the likely severity. An amniocentesis carries some risk to the child, so the choice of whether or not to do the test should rest with the family, however, the doctor should explain the advantages and disadvantages. Other people’s choices are not my business, but I strongly believe everyone needs access to the best possible information on which to base them.
Yes, after thinking a lot about this whole divide between the medical wisdom and the midwifery/home birth wisdom, I’ve come to see the issue as this:
There is indeed a medical event happening during birth, and every family of course cares that their child be healthy. And this is all the hospitals care about.
However, these is another thing happening too - a spiritual event. There is a family being born - it’s a father and mother, or two moms, or two dads and a surrogate, or a family that already has kids - adding a new member or two or three to the team. It’s beautiful and amazing to become a mother, whether for the first time or the 10th… And it really sucks to go through it in a hospital with nurses and doctors who act as if the mother is just a normal part of their daily routine instead of a person going through something extraordinary in her life.
Despite all the window dressing that hospitals have recently added of making the rooms more homey and offering hot tubs and such, most of them really miss the point that women and families are seeking something holy and caring that acknowledges this special experience as also important.
Some people feel that attending to their emotional and spiritual needs will positively impact the medical event. I believe this as well. I also think that there are times when the medical event just overrides despite the best hopes and intentions, and it is then that a hospital is very valuable.
I really wish that instead of fighting on these medical points there could simply be a discussion of the spiritual and emotional aspects of birth and how to make a family feel that these important needs are also met.
Most midwives are nurse midwives these days. To become a nurse midwife, you must have worked for ten years as a labor and delivery nurse before starting the training.
In the USA physicians are trained to believe that their opinions matter more than yours. They truly do believe this (perhaps it is necessary to their trade)
Yes this is a broad generalization, and I would not agree with the conclusion that they will feel no guilt over “manipulating” the patient. BUT it is true that the very training of doctors, at least in North America, does encourage them to dismiss the concerns of non-doctors. Anyone who has had a doctor in their family, will have seen how the interactions with other doctors changes when there is another “doctor” (although not one at all involved in the details of the case, or even a specialist in the field) present, advocating for the patient.
Ideally in medicine you choose to go with a doctor with whom you feel a rapport. My family doctor (who was to supervise at my delivery) was a smart and sensitive lady whom I trusted. The problem with deliveries, however (and this can apply to midwives as well, although they go to greater lengths to prevent it) is that there is no guarantee that the person you want will be able to assist. Deliveries are not always on time and even the devoted doctor/midwife who is willing to be on call 24/7 may be in no state to assist (like if, for example, s/he was just up 20 hours assisting another birth). Usually there is a team and you can be relatively sure of getting one of the people, but it is a lot harder to develop relationships with all the people that might be the one to assist.
I was lucky to find an awesome doctor who was very honest and forthcoming about the hows and whys of pregnancy care. More often than not her explanations included the fact that there aren’t real good studies on most topics because no one wants to touch pregnancy-it’s too risky-but we have found that when we do xyz we get this outcome vs. abc and this outcome. The truth is, scientifically, a lot of it is a guessing game and most of our knowledge about pregnancy is based on experience.
I think this article is spot on, we have to look at the little evidence we have and weigh the risks and what we are comfortable with. I’m all for home births for others (my sister was born at home), but I wanted a hospital because I am a plan for the worst case scenario kind of person. I do notice that most people who look at the evidence tend to go more natural with things and I include myself in that observation. However, I would like to reassure those of you who think doctors and hospitals are unfeeling that there are good ones out there.
The hospital I delivered at has midwives and doctors and treats them as interchangeably good. They also have a lot of the natural childbirth choices (such as placing the baby on mom for breastfeeding immediately and rooming in) as their defaults. Even better, at intake they ask you a bunch of questions about what you want for your birth and put it right into your medical chart. My practice had doctors and a midwife and when my doctor asked me about my birth preferences, she suggested I might want to request one of the midwives while at the hospital as she feels they have more knowledge and experience with helping women through natural childbirth (she was more than happy to attend my birth either way).
I ended up with Cholestasis which has the risk of stillbirth as a possible outcome, so my natural childbirth was thrown out the window. There is little to no research on Cholestasis but doctors have determined anecdotally that the still births occur in the last 3 weeks of pregnancy and so if they deliver 3 weeks early they can avoid the risk. They have no idea what causes any of it or how it works. So, I had an induction with everything I did not want-ivs, pitocin, constant monitoring, eventual epidural bc pitocin is hell. Although I HATED being constantly monitored and being hooked up to everything, given the situation I decided the risk of the unknown was worth the unpleasantness of not being able to move during childbirth. The hospital was rather insistent on all of the precautions (and rightfully so!), but they did let me attempt natural childbirth, they did not try to rush my induction or start a countdown clock to c-section, and they let me have the midwife. My little guy was stuck for a half hour but they didn’t rush to c-section then, instead the midwife used positioning to get him out and although he was a little blue from being stuck they still put him on me immediately (he was making noise, just not crying) and suctioned him on my stomach before taking him away to give him some oxygen and then brought him back to me to breastfeed once he let out a good cry and pinked up.
Short story is even with complications, the hospital was still considerate of my feelings and desires. When it comes to the evidence, we need to be careful not to assume that all hospitals and doctors are going to ignore your wishes. Take the time to see what is in your area, what your personal options are and then decide bc the generalization that all hospitals are bad is just as terrible as others saying home births are dangerous. Also, I bypassed the hospital 5 minutes from my house to go to the better one 30 minutes away.
And the same people might choose different options if circumstances change.
I’ll never forget running into another parent I knew en route to my doctor’s appointment to discuss the negative medical findings from an amniocentesis. I had a very high-maintenance kid in nursery school…if I had to cope with a severely damaged baby who might be in the NICU for months, and had a 99+% likelihood of dying within the first year, how would that affect the child who was already here on the planet needing my attention? Unfortunately, this parent was Catholic and insisted that I would have to figure out how to manage juggling both children because that was the only right choice to make.
Up until that point, I had been a pro-choice, but not a choice I would make, kind of person. Had it been my first baby, no question I would have handled whatever came my way. In fact, I didn’t do any prenatal testing with my first baby, for just that reason. But I was now responsible for a child whose life would be seriously impacted by the situation, and so my decision would have to put her needs first.
Fortunately, the medical concerns turned out to be not as serious as they seemed so I didn’t have to make such a difficult choice. But I think this is a perfect example of how even people who know what they would do in the situation would make a different choice if one or more of the variables changed.
I was fortunate to have been able to have one of my children through a midwife practice within a hospital. The admitting and laboring protocols were entirely separate, but we were in a part of the hospital so if something went catastrophically wrong there was no transportation needed to get to an O.R.
Wow that’s so great! I had mine at a birthing center near a hospital and near a firestation where they had special arrangements to transport to the hospital ASAP. However, due to the legal issues going on with midwifery, even these politically involved midwives had to shut down.
Absolutely! I was staunchly against a self-chosen c-section, but when I found out I would need to be induced 3 weeks early I did begin to consider it because I figured a days long induction of pain and tiredness that doesn’t take and leads to a c-section anyway would be worse than the loss of attempting a vaginal birth.
Luckily, my doctor cares more about me than schedules and explained that if we go into the induction expecting it to take time and letting it get started slowly, then we have every reason to expect it to be successful. She said the problems that lead to inductions becoming c-sections are because the doctor or patient is unwilling to give it time. Sometimes it is the doctor wanting to get home for dinner and sometimes it is the patient who gets into the moment and gets anxiety about it not progressing which causes it not to progress and other stresses that can lead to a need for a c-section. Incidentally for some patients she would have mentioned c-section as an option bc she knew their temperament might not weather the days long induction, but for me she never brought it up. It was me, the anti c-section girl who did. Go figure.
That’s exactly how my NP explained it to me. Fortunately, the Harmony test and the NT tests are also excellent predictors of chromosomal abnormalities such as Downs. I’m pregnant with my first at 35 and they initially told me my risk of Downs was 1 in 250 and the risk of losing the baby due to an amnio was about the same. Based on the NT, my risk is much lower than 1 in 250 at this point and my insurance just approved the Harmony as well since I’m “advanced maternal age.” My insurance definitely would have covered the amnio or CVS too based solely on my age.
There is a lot of well-meaning judginess that goes around when it comes to pregnancy and child-rearing questions. I can’t speak for women, but I wonder if there would be better outcomes overall if there was less pressure on women to make the “right” decision?
Am I misunderstanding you, or are you trying to bring in completely unrelated topics in and put them in my mouth? Because that’s what it seems like to me; you want to misrepresent my ideas so that you can dismiss my opinions.
I agree that there is a lot of judgement and pressure and really a lot of it is misguided. However, I think that with kids we can’t just say do what you want b/c what parents do does greatly effect their children. I hate when I hear people tell parents to just follow their instincts, what they feel is right for their children is what is right, because instincts aren’t always right. We now have a lot of research on child development and know what parenting styles benefit kids the most. Yes, we need to give parents a break and not expect them to be perfect, but we also need to educate parents on child development and make sure they have appropriate information before we tell them to do what they think is best. As it stands, parents are getting much more help and information about pregnancy and making better and more informed choices as a result. I’d like to see parenting head in that direction. Most people go to childbirth classes, but few go to parenting classes and generally there is a stigma associated with it.
To add to Maggie’s book list, Brain Rules for Babies has a lot of great info for parenting and does cite sources.
I think Petronius is referring to you stating you have scientific evidence for what your partner should have done while the doctor was saying do what I say or your baby will be hurt. Petronius is assuming your evidence is not as good as the doctor’s, which I think is wrong to assume. The best thing to do in these situations (if time is not a factor) is to seek a second opinion. The key is to being open to the opinion if they agree with the doctor. Doctors are not always right, but neither are patients. What happened to you guys sucks. Patients should feel free to question their doctors and should never feel bullied into a course of action. That being said, patients should be open to what their doctors say too. Some patients do stupid things like one lady my nurse at the antenatal testing unit told me about. She had the same thing as me, and she went to all of her monitoring appointments and her baby wasn’t doing well. She then refused to deliver early, even though the risk was random still-birth that the doctors admittedly had no idea how to prevent other than deliver early. Nurse wasn’t sure what happened to her as they only do testing there and aren’t involved with deliveries.
Ah, I get it. The assumption that anyone who disagrees with a wearer of the white coat is misinformed, most likely due to reading popular literature. Thanks!
I actually have more training and education than the typical physician, and in that specific case (where we were talking about my family history) vastly more knowledge and expertise than the people I was arguing with. And my argument was proven entirely correct, by the way - everything happened exactly as I predicted it would if labor was chemically induced, except for the part where the hospital staff hurriedly did an amniotomy while I was temporarily out of the room, and the fact that it lasted 30 hours before they finally gave up and did the C-section.
@Petronius, you know what they call the guy who graduated at the bottom of his class in medical school? Doctor. It’s not reasonable to assume all physicians are wiser than the common man, although we should hope that many of them are.
I’ll happily agree to all that. However. We need also to remember how incredibly difficult it can be for the medical profession, as a group, to accept ideas that challenge existing doctrines - a preponderance of evidence is rarely sufficient, as shown by the widespread rejection of the work of Semmelweis (despite his results being independently confirmable) and the more recent H. pylori discovery (despite Marshall actually infecting himself as evidence).
It’s true research science does inform medicine… eventually… but medical science is not medical practice nor vice versa. Whenever I find a physician who will seriously consider real world data that challenges his or her medical liturgy I treasure that doctor! Find them and send them your medical business, I say. My kids’ pediatrician is one.
Thanks for the response, @CCProf. The midwife did immediately inspect the placenta to look for missing tissue. I acknowledge that things might have turned out quite differently had the placenta not been in tact. And I appreciate you clarifying what the hospital procedures might have been like
Having watched my father die of cancer, and after watching my Mother-in-Law whither away to cancer while my Wife and I cared for her (she died 1 year and 1 week before my daughter was born, and yes she was treated), my Wife and I made a conscious decision to make choices based on how we want to live, rather than by how we might die. If my Wife had bled out during childbirth, it would have been the worst thing that ever happened to me. And I no doubt would have forever questioned the avoidability of it. But it was our decision; we made it together. And we were informed.
The pregnancy was the most relaxed and wonderful time we had ever experienced. I know several people who were constantly stressed, and frankly terrified, while pregnant. The trick of course is to strike the right balance between living the way that makes you happy, and not dying too soon.
I have never feigned to do everything possible to stay alive, only what’s reasonable by my own definition. And in the gap between what’s possible and what’s reasonable lies risk, and also happiness.
A key part of the “training” with our Midwife was discussing when and how to transfer to a hospital. Our strategy was always one of appropriate escalation. We were lucky to have a Midwife with 35 years experience successfully making difficult calls. The care was excellent. The experience was happy. And the outcome was good. If it had gone badly, we would have been at the hospital in 10 minutes. That might have been too late, or it might not have. I’m thankful that we had a choice between a good midwife and a good hospital. I hope to continue to have the option of both, and the hegemony of neither.
