Saturday, July 20, 2013

Birthing choices

I wanted to write up a post about our birthing choices, since this is such a hot topic in the mommy blogosphere. (And after this, I think I won’t post about babies until I actually have one, unless you count knitting.) First off, I’d like to share a post with a great title, The Lazy Birthing Manifesto – because sometimes, having too many choices isn’t a good thing. I do believe in educating oneself about all the options, though, as well as their risks and benefits, and to figure out how this jives with one’s values and feelings. On that topic, here are two awesome posts, one about a woman’s choice to give birth in a hospital setting and another about a woman’s choice to give birth at home, both of which I can understand. It’s interesting to note, however, that in North America, more and more women choose midwives over obstetricians, including in hospital settings. Sometimes it’s to avoid what they consider an unnecessary C-section (like in this case of a breech baby delivered safely in a home setting), and other times it’s to get more humane care (just read some of My OB said what? and you’ll see what I mean).

For various reasons, mostly having to do with being extra cautious, the Engineer and I both agree that the hospital is the best place for me to give birth. We do not have a Baby-Friendly-certified hospital in San Antonio, unfortunately, but we are lucky enough to have a good hospital near where we live. It was built several years ago and isn’t used to full capacity yet, so health care there is more one-on-one than in many places. All the rooms are private, which is a definite plus (along with the fact that the patient controls the lighting and thermostat in her room). Obviously, it’s not perfect: the rate of C-sections for first-time mothers is close to 40% (and is much higher for subsequent births, despite the latest studies on VBACs), although our OB’s rates are lower. Patients can’t eat or drink during labor, there are no birthing pools or hot tubs in which to labor, they don’t supply birthing balls, and as in most hospitals, medical intervention is encouraged even when not necessary. That being said, there are squat bars available for labor, there’s an anesthesiologist at all times so that you don’t have to wait too long for an epidural if you want one, they do have a policy of having the baby rooming in with the mother at all times unless he/she needs to be in the NICU down the hall, they support skin-to-skin contact after birth as well as breastfeeding (and have a lactation consultant on the premises 20 hours a week), and they minimize interventions in the hour following birth to let the parents bond with their baby. Plus, they do have pretty secure facilities, so there’s little risk of having too many unwanted spectators (seriously, some of the comments on this articleare pretty horrific). So even though I’m a little apprehensive about certain aspects, overall, I’d have to say I’m relatively satisfied with this hospital.

I did find out recently that, for certain medical reasons, I am not likely to be induced and quite a bit more likely than average to have a C-section instead of a vaginal birth, which does not thrill me. At all. However, while I am somewhat of a control-freak by nature and I was hoping for a natural childbirth experience, I understand and accept that I can’t control the birth; I just read all I could to set things up in my favor and I’ll make the best of my circumstances when the time comes. (Again, it’s not that I’m against C-sections at large, but I do think they tend to be overused these days. They are of course literally life-saving procedures in some situations, and even some elective C-sections are perfectly justified, as I’ve come to realize. I wouldn’t say that about a woman who, months in advance, schedules the date of her elective C-section before her due date just because it fits her schedule better. But then there’s a big grey area: you might be in a situation where your practitioner says he really doesn’t want you to go over 41 weeks because of the increased risks in your particular case, or he might say that it’s fine to go up to 42 weeks with proper monitoring, and you have to make up your mind based on the level of risk in your specific situation.)

On a side note, the Engineer found this page with a chart showing the probability of delivery resulting from spontaneous labor on every day of the pregnancy after 35 weeks. There’s an obvious peak at 40 weeks exactly, which was to be expected, but it’s interesting to note that there are also smaller peaks at 39 weeks and 41 weeks exactly – we’re theorizing that this is due to a psychosomatic effect. My odds of giving birth on the exact day I’d like are apparently 2.8% (although, now that I’ve made it this far into the pregnancy without signs of labor, I’m assuming that everything being at 0% before today for me means that all other probabilities after today increase accordingly).

Two more links that I like: this awesome video of a water birth, for those of you who’ve never seen one; and this video of labor pains simulated on a man (the post is in French, but the video is in English). There have been more recent simulations that I’ve seen circulating, but this one is the first I saw, so it’s the one I’m sharing. I’m not against epidurals per se, of course, I’m just opposed to having them done so routinely. That being said, I understand that other people have different opinions. When the Engineer and I took our birthing classes, the instructor presented slides with all the pros and cons of epidurals, which reaffirmed in my mind that the ideal choice for me would be to give birth without one, but prompted another couple to ask why they weren’t standard, because all the cons seemed perfectly acceptable to them. So, to each their own.

I’m also aware that the American health care system isn’t necessarily set up in my best interest post-partum. For example, in France, perineal re-education is standard, but here they often just tell you to do some Kegels and send you on your way. I mean, here’s the one time when I would actually want Republicans in my vagina (NSFW) – what a missed opportunity!

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