Friday, September 08, 2006

Deep introspection

The story many of us in the "natural" birth arena tell ourselves is that there is a whole-family, mother-friendly, optimal way of managing pregnancy, labor and delivery. This is not just an alternative to mainstream birth views. It is the profoundly right view. It favors less intervention over more, mothers as partners in their care, the body -- not calendars or clocks -- as accurate timekeeper for an optimal delivery.

And our agenda in following this paradigm is the mother's and baby's well being.

"Our" view is in opposition to the mainstream, medical model that views pregnancy and birth as crises -- and lawsuits -- waiting to happen. It is comfortable subjugating a body's natural timeline and processes to procedures that, however undelicately or insensitively, produce a live baby at the end.

When a family believes in the natural birth paradigm and all it represents, then is betrayed by that model, what does that say about it? In the end, the family whose baby dies in utero at 41 weeks gestation sees the medical model and its promise to extract a live baby at whatever point the family wants, and says, "Of course." They feel foolish to have trusted their caregiver, their baby, their instincts, her body.

Can we blame that family for saying that next time they will induce labor at 38 weeks? It seems impossible to expect them to do otherwise. Fool me once, shame on you; fool me twice, shame on me.

Help me, friends. Tell me again why it is that let families gamble with their babies for a shot at an empowering birth. Isn't a live birth ultimately most important?

I have said before that natural birth is the closest thing to a religion that I have. But I look at mainstream religions and see they offer something my religion doesn't: an ability to explain and comfort in the face of this kind of loss. If my religion can't withstand a fundamental challenge, perhaps the other sect -- the hospital-trained one -- really has all the answers.

It certainly has two new converts.

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Blogger clara said...

That is such a tough one, I`m glad you wrote about it. I can only add that nature itself is so unbelievably imperfect. Plenty of animals lose their babies during birth, some are even eaten by their fathers.
As a mom who lost a baby to severe shoulder dystocia in a natural birth with no lithotomy position & no drugs, I can relate to your clients who feel utterly let down right now. I also had to go the medical route for my next 2 and it can still be empowering,especially when parents feel that they "own" their decisions. The natural way still works most of the time, but a mother`s instincts may equally pull her to what gives her the most peace of mind and there is nothing wrong with that.

9:22 AM  
Blogger WinterWheat said...

Profound post.

I wanted to go the natural childbirth route but gestational diabetes at week 8 and the need to manage Graves' Disease persuaded me to stay with an OB, though I still had a doula.

I am all for the demedicalization of women's health, especially in the birthing and breastfeeding arenas, but in my case the desire to take full command of (and therefore full responsibility for) at least one aspect of it was emotionally devastating. I couldn't make enough milk for my daughter and really believed all my BFing books that implied that the ONLY reason is that I wasn't committed enough. As I posted on my blog, I only found out recently that excessive thyroid hormone (I was hyperthyroid for 3 mos. following the birth) depresses oxytocin. Ahhh--so THAT'S why she could only get an ounce out of me in 1/2 hour of nursing. I'm still pumping and feeding DD, who's almost 7 months, but she went on a nursing strike at 11 weeks because she could never enough at one time. To make a long story short, I was EXTREMELY hard on myself, in part because I am a scholarly critic of commercialism and didn't want to support the Nestle corporation by ever touching a DROP of formula. But if it weren't for commercial formula, my kid would have been one of the ones who, back in the old days, simply starved (or ate whatever I could give her that didn't seem poisonous).

The medical route can fail us and the natural route can fail us. And both can empower and reassure us. Why do we have to be 100% medical or 100% natural?

12:25 PM  
Anonymous Lindsay said...

It's very sad, heartbreaking, that this family lost their baby.

It is one case, one situation. An anecdote. I know it doesn't feel that way to that family.

Please remember to look at the big picture and recognize that medicalized birth and c-sections are more dangerous for mother and child. Just ask the New York Times this week.

12:31 PM  
Blogger Tara said...

What a hard situation, full of questions that are so difficult (or impossible) to answer. Intellectually I want to say that there is no way to know if a medicalized pregnancy would have saved that baby--maybe baby would not have survived an induction at 38 weeks and then the parents would be full of guilt that they induced and angry that they followed the doctor's advice. We all know that the medical model makes many promises it can't keep, and that doctors lose babies too... birth is sometimes coupled with loss, and there is no way for anyone to promise otherwise. Every birth, every breath, every day is a gamble. All we can do is make the choices that put the odds on our sides as much as possible. I think natural birth does that.

But emotionally, I can understand that they are full of grief and doubt and that they would do anything to not lose another baby. Sometimes all of the evidence and research in the world cannot convince our hearts. Hopefully time will help them heal and become more gentle on themselves and the choices they made. Sending peaceful thoughts to you all.

2:30 PM  
Blogger Bekah said...

I cannot separate my faith from my life. I find that the Catholic worldview really does explain these things in a way which, maybe not comforting immediately to the suffering family, at least offers a reasonable explanation.

We believe that God created perfection. We believe that due to man's choice, sin and error came upon the world. But, because God's creation wasn't fully destroyed, life proceeds normally and well most of the time, naturally. Because life is no longer perfect, though, sometimes things happen as a result of the fallen state of the world, leading to suffering.

The difficult question to answer is why did God allow this innocent one to die? It does seem cruel, especially to those most affected. But, I believe every life and death, no matter how long or short, has a purpose. In the initial aftermath, it is often difficult to discover what that purpose may be, but when the pain subsides a little, I am sure that each and every person touched by this young life will be changed. That potential for change will reveal the meaning and purpose in this young soul's life.

The loss of a child is always a tragedy. I am praying for this family and for you that you will be comforted through this ordeal, and reunited with this life in the hereafter.

3:33 PM  
Blogger Sarahthedoula said...

I'm so sorry that you are hurting right now. Surround yourself with the people and things you love. Allow yourself to be cared for. Keep asking hard questions. I don't have answers for you, but I am listening as you ask the questions, and holding you in my thoughts and prayers.


9:37 PM  
Anonymous rg said...

Natural birth is supposed to give all of us natural birth believers the best chance at a holistic, empowering experience when we are lucky enough to have a healthy normal birth. Losing a baby at 41 weeks is the farthest point from normal. Does the medical faith have better ways of identifying the abnormal births? Does it have a better record of predicting bad outcomes? Only some of the time. It's all done on faith. Faith you could learn something, do something, fix something. The science is imperfect, too.

There may be medical birth believers who would have every woman induced or operated on at 40 weeks on the dot striving to prevent this awful, abnormal outcome; that course of action has bad outcomes of its own, sends other families screaming for the opposite experience. Keep striving for the balance of our faith in natural childbirth and appropriate, life-saving medical care. That's the best we can do, even when it's not good enough.

12:42 AM  
Anonymous Anonymous said...

This idea requires the assumption that the medical model of care guarantees a healthy outcome. When we are reminded of the cases where iatrogenic intervention has caused a poor outcome (uterine rupture that is the result of the use of cytotec for induction for example)the issue becomes even more complex because we acknowledge that each strategy carries its own unique type of 'risk'.

I am so sorry for this families loss, I cannot begin to imagine what any of you are feeling. Very, very sorry.

10:53 AM  
Blogger fpmama said...

I can appreciate how you (and the family you cared for) feels when something like that happens. From their point of view, if they'd just had an induction at 40 weeks, the baby would be alive in their arms today, and they would never understand the depths of grief parents who lose a child feel.
I had a similar crisis of faith in natural childbirth after a friend invited me to her homebirth - a healthy woman, expecting her 2nd baby, the first having been also born at home. She finally started to labor at 41 wks 4 days. A few minutes after I arrived, the midwife listened to heart tones and found they were very low. We packed her up and drove to my hospital, where I quickly called my OB backup, and put in an internal monitor while I waited for him. The hearttones slowly struggled back up to around 100, and he felt she was close enough to delivering her baby that we should proceed vaginally. A few minutes later, her white, still son was born into my hands with no heartbeat. After 5 minutes of chest compressions and bagged respirations, his heart started to beat slowly. We eventually intubated him and transferred him to a NICU. Next month he will turn 2 years old. He has never smiled at his mother, cannot sit or roll, and is fed by g-tube. Somehow, this glowingly healthy woman who'd received excellent midwifery care, and prompt attention when there was a problem, had a placental abruption for no apparent reason, and her beautiful, longer-for son was permanently brain damaged by the lack of oxygen.
After that birth, while grieving with that family, and working through the issues around it together, for a while the mother and I felt strongly that who cares about a birth feeling good to the mother? Why go after a nice birth and end up with a dead or permanently injured baby? Why hadn't she just transferred care to the hospital at 40 weeks and had an induction? Why hadn't we just done a cesarean when we arrived at the hospital?
Over time, and with a little distance from the acute grief and shock of this situation, I have regained much of my faith in birth, and in promoting natural birth and low-intervention care. See, it's not just an obvious matter of choosing between an empowering birth or a live, healthy baby. All the actual evidence we have backs treating pregnancy and childbirth as the natural life process it is, and encouraging women to be in control and empowered also promotes the baby's best chance.
What that doesn't take away, is that people are not statistics. Occasionally terrible things happen to people who have made the best decisions - and sometimes we never find out the reason why. Of course no one would ever carry to 41 weeks if they knew their baby would die, but the problem is, you can't always predict where lightening will strike. Once you've been struck, though, it is only natural to react by taking every lightening precaution ever heard of the next time you venture outside. And no surprise if despite all the available evidence, you choose to take additional precautions that have only anecdotes behind them, because no one could stand being struck twice.
The trick, for those of us who care for birthing families, is to remember that such lightening strikes are rare and will never be preventable by a blanket promotion of extreme interventions. I once had a stillbirth in my practice at 36 wks 2 days - should I induce all women then at 36 wks? We can only do the best we can, and all the evidence backs our style of care.
A big hug to you doulicia, I know this is such a painful time, and adding in the soul-shaking of doubting your whole belief system makes it so much harder. The friend I mentioned above is 34 weeks now, planning to birth with me in hospital next month, and working with her through this pregnancy has been both terrifying and healing as we have walked the line between doing everything we can to have a healthy baby and not giving up the beautiful birth she'd like for this beloved baby. I'll let you know how it goes!

11:06 PM  
Blogger I am a Milliner's Dream, a woman of many "hats"... said...

Powerful thoughts and well said.

I've often said I don't like the term "natural" childbirth. I feel as if, in and of itself, childbirth is "natural." It's being interceded with--necessary or not--is unnatural.

I think we can only do what we know. I don't think this family drank the Kool-aid, so to speak, and are cursed to a new belief. I think, and hope, in the healing that they will. once again, be ABLE to trust their gut. If their instinct then is to induce at 38 weeks, I believe they should--and will.

My concern now is that they feel no guilt over doing THIS time what their gut and instincts told them to do. Being able to trust anything or anyone again will be the challenge.


3:30 AM  
Blogger doulicia said...

Thank you all for your thoughts and support. In my heart I still believe that normal birth -- birth with parents involved in decisions, birth that recognizes the body as wise -- is the way to go.

But I don't know if I could tell that to this family. And that throws me for a loop.

I like the things I believe in also to be quanifiably "right." What many of you have helped me remember is that the kind of birth I believe in DOES have numbers to support its validity. It does not jeopardize women and their babies. This is hard to believe when an exception to the rule comes along.

And I also appreciate those of you who reminded me that it does not have to be a dichotomy: medical/clinical birth can be empowering and woman-centered. The important thing is informed consent and parental peace of mind.

A homebirth midwife once told me that women will end up birthing (or birthing best) where they feel safest. A woman who plans for a homebirth, but in her heart believes homebirth is unsafe, will likely end up delivering in the hospital. And vice versa!

I need to work within families' own circumstances and senses of safety. Provided they are fully informed.

Again, thank you all for sharing your thoughts and stories. They are all very helpful to me.

10:49 AM  
Anonymous mama o' matrices said...

I would vote for a balance. Americans are used to customer service, even where medical issues are concerned. We want our birth control to be idiot proof, our pain to vanish immediately, and so on. Similarly with babies, we want things to be as we choose - but it just doesn't work that way.
A method of care that balances the medical reality against the family's wishes offers the best chance of a live birth. A method of care that prioritizes the baby over the family's wishes can nearly guarantee it.

Me, I'd line up the stats and talk folks through it. Let them choose.

10:27 PM  
Anonymous Anonymous said...

Remember also, hospital managed births also result in dead babies.

6:12 PM  
Anonymous Bethany Dykman said...

As a doula, I found this post particularly introspective for myself as it's a situation I haven't yet faced. I appreciate your willingness to question what is "right". If our belief in natural birth becomes nothing more than dogma, we have lost. It is examination and renewed faith in what childbirth is and can be that brings the power into empowered childbirth. So thanks for sharing.

And a note to winterwheat who shared her dilemma on making milk and buying overlooked what really happened in the old days...not starvation, but wet-nursing. We've lost the wisdom in sharing our milk.

3:41 PM  
Blogger emjaybee said...

I know this is an old post, I hope you don't mind if I answer. As others have said, there is no satisfactory "why" when a baby dies or is hurt. And it happens in hospitals, all the time. It might have happened during an induction, too. There is no proof (from what you posted) that her homebirth caused this baby's injury. The baby might have been hurt no matter how many skilled medical professionals were present.

There is no answer to these situations. But we have to hold on to doing the best we can, the way we know has the best outcomes for the most mothers and babies.

If you were an OB who lost a woman or baby to complications from an intervention or c/ would feel the opposite kind of guilt, perhaps, for meddling in a natural process and creating more risks for her.

All birth has risks, partly because our knowledge of birth is still so very limited. That's the legacy of sexism, as women's health has been given short shrift in medicine for decades. Perhaps if our knowledge were more advanced, this mama's risks would have been ID'd sooner and this outcome avoided. But that's not something you or she can help.

9:53 PM  

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