Thursday, November 8, 2007

Is hospital birth traumatic?

I've read a bunch of stuff comparing home birth to hospital birth lately and I've been thinking about it a lot. The thing is, giving birth at home is higher risk. This is undeniable. Fetal mortality or injury happens more frequently. The data is there.

But at the same time... We have babies who are born who are GROTESQUELY deformed, who normally would not live through birth, and for good reason. Obstetrics often interferes with natural processes, and while it is the mother's choice if she wants to go to such extremes for an infant who will die soon anyway, or need massive surgery, or something, in this country the law says we have to save every child we can at birth. Home birth probably can be called more "natural" birth because deformed babies who shouldn't survive are less likely to.

And there is truth in the "traumatic" nature of hospital births-- many, many doctors are pricks who treat all their patients like idiots, and many OBs will severely disrespect the mother by, say, assuming she'll change her mind, or inducing labor when they shouldn't, or manhandling her. Should all efforts be made to save the baby? Yes. But there are a lot of processes that are done in hospitals frequently not because of the health of the mom or the baby, but because of convenience.

Episiotomies are a classic example. Most women don't need episiotomies. They might tear, but tearing will heal, and there are non-invasive methods to prevent tearing. Episiotomies should only be done if the vagina can't naturally stretch for some reason (like the birth is very, very fast), the baby is actually impeded from exiting, there is fetal distress (like his heart rate stops) and they need to resuscitate, or in some cases, if there's a breech birth (as in the picture at right, a footling breech). Many OBs do episiotomies to speed things along when they aren't needed, and what's worse, many of them used to sew up the vulva tighter than was needed, calling it a "Daddy stitch." I don't know how common that is today, though. Unnecessary episiotomies are a danger (of infection, of painful healing) that needn't be taken.

Many people describe "birth trauma" as originating from being touched or entered without direct consent. This one kind of bugs me, because how hard is is before the labor really gets going to say, "I may need to touch you in this way for this reason, in this way for this reason, in this way for THIS reason..." and then do a quick warning before actually touching? There was a story on the Navelgazing Midwife's blog about a woman who had a doctor put her hand up her vagina and into her uterus, without any sort of pain killer, with no more warning than "Brace yourself, sweetie, this is gonna hurt." Would it be so hard to say, "I need to do thus-and-such or you will have complications, and I have to put my hand up there, and would you like a shot? But I have to do it soon."

I mean, yes, there are times when things are happening too fast to really ask for permission every time you touch between the woman's legs, but not always. The least a doctor can do is not offer an epidural more than once until the woman asks for one (it's not just about doing it "naturally"-- I know, for example, that I will want to wait until I feel it is unbearable before I get an epidural simply because I don't like any meds that I don't really, really need), and neither allow the nurses to say disrespectful or manipulative things nor say them themselves.

They should really have a better code for OBs, more specific than the Hippocratic. There's a lot of things they do that they shouldn't or should do a little differently. Actually, gynecologists and ER docs in general need a better code for handling female reproductive systems, especially for rape tests, which if they are not done properly can feel very invasive. I can't remember where I was reading this (Feministing?), but someone was talking about a doctor who brought students in to see the pattern of bruising on her thighs after she was raped, despite never clarifying with her that that was okay, and tried to take pictures for the jury if she decided to go to trial. I was reading that and thinking, uh, why couldn't they cover her genitals with a cloth or something, and just take pictures of her thighs? It would still show the evidence without making her feel violated.

My feeling on home birth is it's okay as long as one accepts the higher risks, and those risks are made clear. I also think that direct-entry midwives (who require only on-the-job training and maybe a few classes) should have much stricter regulations and certification as such. And hospital birth should be done in a more delicate, caring manner. Women at that time are flooded with hormones, they need to have people who understand their emotional needs. And no doctor should ever treat a woman with less respect, consideration and care because she was a home birth transfer to the hospital after a complication.

And one more thing-- unless the baby is going to be put up for adoption or is in the NICU, the mother should get to hold the baby either right after the birth or the second she (the mother) wakes up. I'm of the opinion that it should be quickly wipe down, towel off, check for immediate problems and hand to the mother, or the father if the mother is under anesthesia at the time. That sort of thing rarely causes problems and means the world to parents.

Men's docs probably have similar problems with making men feel violated, like in proctology, but it comes up less often and I want to be an OB/gyn, so naturally I'm focusing on that issue.

To find out more, here's what I've been reading:

Navelgazing Midwife is a natural birth and home birth advocate and works as a midwife/birth coach.
The Homebirth Debate Blog exposes some of the dangers of home birth and the problems that come from home birth advocacy. Caution-- the writer is very anti-home birth. However, she cites real articles and studies so you can read those.

17 comments:

Debby S, CLC said...

I understand your thought that homebirth is more dangerous. I used to think the same thing. Trouble was, science didn't back me up. When I found out the truth, it was a real amazing day for me. There all several places you can find this info, but the one thing that really got my attention back when I found this out, was that every study done by the gov't found homebirth to be safer unless they added in births in taxi cabs and such. The safety factor was huge, but it was there.

It sounds like you think things through a good bit. I'd encourage you to really look into this more. What you find may surprise you as much as it did me.

P.S., Washing off a baby's hands before s/he nurses can interfere with baby-led breastfeeding.

Debby S, CLC said...

Well, I made several typos. I'm sorry.

It should be "There are several places...." and "The safety factor wasn't huge...."

Radical Midwife said...

I would highly suggest that you read "Gentle Birth, Gentle Mothering" by Dr. Sarah Buckley. http://www.sarahjbuckley.com/ She is a GP doctor in Australia. If you can't find her book anywhere, at least browse some of her articles on her website.

Basiorana said...

debby s, clc: Every study I've read, including government ones, cites home birth as more dangerous once you factor in transfers to the hospital. If you don't include those, yes, it is less dangerous (because the rest of the time, births are normal). Both sides tend to skew the statistics, though, I've noticed. The trouble with natural birth is that there is no denying that since people started giving birth in hospitals both mother and baby mortality rates went WAY down.

I do plan on doing a lot more research before I go into medicine.

radical midwife: That looks like an interesting book, thank you. I will definitely check it out as soon as I have money for it.

kymmy said...

Very interesting. I hope you do more research because you sound like you would make a smart dr if you keep up your research and glean information from several sources.

I just recently had my forth child at home (UC). It was a personal decision and as far as I was concerned the safest way for me to birth after having 3 at hospital. For some it sounds risky but I think for someone like me the risks were less. I didn't tear! THe birth was just amazing and so very different to what I had experienced at hospital.

Anonymous said...

I see this is a very old post, but I had to point out that mortality rates did not go down upon birth being taken over by doctors and performed in hospitals - it actually went up. It only went down upon 1) the adoption of germ theory (psst- doctors finally submitting to washing their filthy hands in between autopsies and vaginal exams), 2) the invention of sulfa drugs (aka simple antibiotics to treat infections that may occur despite best practices), and 3) better living conditions for all (including, but not limited to, clean, running water, electricity and refrigeration, better nutrition, better prenatal care, and the abandonment of the "art" of corsetry). It is arguable that the maternal and neonatal mortality rates would have dropped *even more* if doctors and hospitals had never taken over birth in the first place. Just FYI - you seemed open to different points of view :)

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